• Bobbi S Snowden, Derek Licina, Kathleen Crowley, Gene Migliaccio, and Sueann Ramsey.
• Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA.
• Mil Med. 2023 Jan 4; 188 (1-2): e359e367e359-e367.

IntroductionOne way the U.S. Department of Defense (DoD) works to achieve national security is through security cooperation, by way of building and enhancing partner nation capacity. This study evaluated a health-related security cooperation training initiative delivered by the DoD to military peacekeepers. The study specifically examined outcomes of change, including the beginning phase of sustainability.Materials And MethodsThe U.S. DoD employed a train-the-trainer model in Ghana, Rwanda, Senegal, and Uganda to support the African Peacekeeping Rapid Response Partnership program. U.S. instructors trained 192 peacekeepers through 11 training iterations between December 2016 and March 2020. A mixed-method explanatory sequential design was used to explore training outcomes. Quantitatively, three hypotheses were tested using nonparametric statistical analysis. Qualitative analysis of documents was used to inform and contextually understand the quantitative results. This study was submitted to the George Washington University Institutional Review Board and was fully approved (NCR202918).ResultsQuantitative and qualitative results indicated improved short-term public health knowledge and upskill among partner nation participants. There was the beginning of a cascade effect of the partner nations' ability to autonomously teach tasks and skills to their military to sustain the initiative. Differences in achieving and maintaining change outcomes were related to student characteristics, the training course, and the partner nation.ConclusionsThis research serves as the first published study to empirically examine health-related security cooperation train-the-trainer initiative change outcomes. This research is an essential building block to empirically evaluate and capture change outcomes from security cooperation capacity building training initiatives. The findings and recommendations inform security cooperation policy and associated investments.© The Association of Military Surgeons of the United States 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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