Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach.
Adapting Coordinated Anxiety Learning and Management for Veterans Affairs Community-Based Outpatient Clinics: Iterative Approach.
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DOI：
10.2196/10277
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发表时间：
2018-08-22
影响因子：
5.2
通讯作者：
Cucciare MA
中科院分区：
文献类型：
--
作者：
Abraham TH;Marchant-Miros K;McCarther MB;Craske MG;Curran GM;Kearney LK;Greene C;Lindsay JA;Cucciare MA
美国退伍军人事务部(VA)的一项国家优先事项是在所有退伍军人事务部的医疗机构中增加循证心理疗法(EBP)的可用性和可及性。然而，许多退伍军人，特别是那些使用偏远的退伍军人管理局门诊的退伍军人，仍然没有得到亟需的循证治疗。在退伍军人事务部社区门诊诊所(CBOC)将临床培训转化为常规实践时，需要制定战略支持精神卫生服务提供者。协调焦虑学习管理(Calm)计划是一个计算机交付的程序，支持门诊环境中的提供者向包括创伤后应激障碍在内的抑郁症和焦虑症患者提供认知行为治疗(CBT)。我们研究的目标是：(1)通过关键利益相关者焦点小组的反馈，使现有的基于计算机的计划适用于农村退伍军人社区组织；(2)开发适应计划的原型；(3)确定适应计划的可接受性和可行性。心理健康利益相关者包括实施循证计划的退伍军人管理局负责人(n=4)、CBT中的退伍军人专家(n=4)、退伍军人社区心理健康提供者(n=8)，以及被诊断为精神健康状况的退伍军人(n=8)，这些退伍军人使用CAMPE计划接受治疗并在退伍军人社区接受治疗。使用包括3波焦点小组讨论的迭代方法来开发经修改的CAMPE原型。在每一波焦点小组讨论之后，使用模板分析将利益相关者的建议和反馈快速传达给设计团队。最初的计划首先经过了数据收集、设计修改和产品开发的过程。接下来，开发了一个原型。最后，通过现场演示对重新设计的方案进行了可接受性和可行性测试。主要利益相关者建议对最初的Calm计划进行修改，该计划通过纳入以退伍军人为中心的内容来改变其模块的外观。这些修改可能不会影响最初的CAME计划的完整性，但改变了它的内容，以更好地反映农村退伍军人的人口特征和经历。利益相关者团体的反馈表明，这些变化将有助于退伍军人管理局患者对计划内容的认同，潜在地提高他们的治疗参与度。发展模式对于从利益相关者那里收集可行的建议以适应基于计算机的计划是有效的，它可以导致开发出可接受和可行的计算机提供的干预措施。研究结果对开发针对更广泛的行为变化的基于计算机的程序和加强对EBP的参与具有一定的意义。
A national priority at the US Department of Veterans Affairs (VA) is to increase the availability and accessibility of evidence-based psychotherapies (EBPs) across all VA medical facilities. Yet many veterans, particularly those who use remote outpatient VA clinics, still do not receive much needed evidence-based treatment. Strategies are needed for supporting mental health providers at rural VA community-based outpatient clinics (CBOCs) as they translate their clinical training to routine practice. The Coordinated Anxiety Learning Management (CALM) program is a computer-delivered program that supports the delivery of cognitive behavioral therapy (CBT) by providers in outpatient settings to patients with depression and anxiety, including posttraumatic stress disorder. The objectives of our study were to (1) adapt an existing computer-based program to rural VA CBOCs through feedback from key stakeholder focus groups; (2) develop a prototype of the adapted program; and (3) determine the adapted program’s acceptability and feasibility. Mental health stakeholders included VA leaders (n=4) in the implementation of EBPs, VA experts (n=4) in CBT, VA CBOC mental health providers (n=8), and veterans (n=8) diagnosed with a mental health condition treated using the CALM program and receiving treatment in a VA CBOC. An iterative approach comprising 3 waves of focus group discussions was used to develop a modified prototype of CALM. Following each wave of focus group discussions, template analysis was used to rapidly communicate stakeholder recommendations and feedback to the design team. The original program was first adapted through a process of data collection, design modification, and product development. Next, a prototype was developed. Finally, the redesigned program was tested for acceptability and feasibility through a live demonstration. Key stakeholders suggested modifications to the original CALM program that altered its modules’ appearance by incorporating veteran-centric content. These modifications likely have no impact on the integrity of the original CALM program, but have altered its content to reflect better the demographic characteristics and experiences of rural veterans. Feedback from stakeholder groups indicates that changes will help VA patients identify with the program content, potentially enhancing their treatment engagement. The development model was effective for economically gathering actionable recommendations from stakeholders to adapt a computer-based program, and it can result in the development of an acceptable and feasible computer-delivered intervention. Results have implications for developing computer-based programs targeting behavior change more broadly and enhancing engagement in EBP.
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