Pre-Implementation Strategies to Adapt and Implement a Veteran Peer Coaching Intervention to Improve Mental Health Treatment Engagement Among Rural Veterans
Pre-Implementation Strategies to Adapt and Implement a Veteran Peer Coaching Intervention to Improve Mental Health Treatment Engagement Among Rural Veterans
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DOI：
10.1111/jrh.12201
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发表时间：
2016-09-01
影响因子：
4.9
通讯作者：
Seal, Karen H.
中科院分区：
文献类型：
--
作者：
Koenig, Christopher J.;Abraham, Traci;Seal, Karen H.
目的：电话激励辅导已被证明可以增加城市退伍军人心理健康治疗的开始。然而，没有研究测试过资深同行提供的电话激励辅导，以促进心理健康治疗的启动和参与。本研究描述了实施前的策略与8退伍军人事务部（VA）在美国西部和中南部社区为基础的门诊适应和实施多地点务实的随机对照试验的电话同侪激励教练的农村退伍军人。方法：我们使用了两种实施前策略，形成性评价（FE）研究和循证质量改进（EBQI）会议，使干预措施适应利益相关者的需求和文化背景。FE数据是定性的，半结构化的采访与农村退伍军人和VA诊所的工作人员。结果进行了快速分析，并提交给利益相关者在EBQI会议，以优化干预implementation.Findings：FE研究结果表明，VA诊所提供者感到不堪重负退伍军人的心理健康需求，并承认有限的心理健康服务在VA诊所。农村退伍军人的采访表明，地理，后勤和文化障碍，VA心理健康治疗的启动和自我保健，以科普心理健康症状的偏好。EBQI会议导致了几个干预适应，包括退伍军人研究招募，同行退伍军人教练培训，并扩大了精神卫生保健结果的定义。随着退伍军人事务部采取行动培养社区伙伴关系，以个性化和扩大农村退伍军人的护理机会，与参与的利益攸关方，如这里所述的实施前过程，可以帮助指导其他研究人员和临床医生实现积极主动和以退伍军人为中心的医疗保健服务。
Purpose: Telephone motivational coaching has been shown to increase urban veteran mental health treatment initiation. However, no studies have tested telephone motivational coaching delivered by veteran peers to facilitate mental health treatment initiation and engagement. This study describes pre-implementation strategies with 8 Veterans Affairs (VA) community-based outpatient clinics in the West and Mid-South United States to adapt and implement a multisite pragmatic randomized controlled trial of telephone peer motivational coaching for rural veterans.Methods: We used 2 pre-implementation strategies, Formative Evaluation (FE) research and Evidence-Based Quality Improvement (EBQI) meetings to adapt the intervention to stakeholders' needs and cultural contexts. FE data were qualitative, semi-structured interviews with rural veterans and VA clinic staff. Results were rapidly analyzed and presented to stakeholders during EBQI meetings to optimize the intervention implementation.Findings: FE research results showed that VA clinic providers felt overwhelmed by veterans' mental health needs and acknowledged limited mental health services at VA clinics. Rural veteran interviews indicated geographical, logistical, and cultural barriers to VA mental health treatment initiation and a preference for self-care to cope with mental health symptoms. EBQI meetings resulted in several intervention adaptations, including veteran study recruitment, peer veteran coach training, and an expanded definition of mental health care outcomes.Conclusions: As the VA moves to cultivate community partnerships in order to personalize and expand access to care for rural veterans, pre-implementation processes with engaged stakeholders, such as those described here, can help guide other researchers and clinicians to achieve proactive and veteran-centered health care services.