Personal Health Record-Facilitated Diabetes Self-Management Among Rural Veterans

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Anticipated Impacts on Veterans Health Care: The proposed project offers a potential solution to strengthening Veterans' self-management of chronic disease conditions through intervention to an easily accessible, self-management tool, the VA's PHR - My HealtheVet that fosters the knowledge and skill-building aspects of diabetes self-management. The proposed approach creates flexible and accessible strategies for increasing knowledge, developing self-monitoring skills, building self-efficacy and enhancing patient empowerment. Thus, active orientation to the use of MHV as a skill-building tool will foster adoption of proper self-monitoring behaviors. The proposed project serves to yield a more patient-oriented process in access to and quality of care, and disease management. Furthermore, this project will provide early evidence to increase adoption and use of MHV in disadvantaged Veteran groups. Background: Veterans bear a disproportionate burden of diagnosed diabetes at a 24% prevalence compared to 8.3% nationally. Patient-level factors account for >95% of patient care and health management. Poor patient knowledge/information and participation are two key factors responsible for the most prevalent disparities in the VA healthcare system for which patient activation and adherence interventions may help to reduce disparities in care, but patients have a low rate of engagement in self-care behaviors. Healthcare systems have established personal health records (PHRs), such as My HealtheVet (MHV), that enable patients to access their own health records, obtain health information, and communicate with providers about their disease conditions. This study proposes to activate patients and improve patient diabetes-related behaviors through development of an adapted brief MHV-driven patient activation and self-care intervention that enhances DSM skills (e.g., physical activity, diet, medication adherence, and self-monitoring) in high-risk, rural Veterans. Objectives: The objectives of this study are to: (a) Adapt a brief My HealtheVet (MHV) intervention to enhance its appropriateness for Veterans with diabetes increase patient activation and DSM skills; (b) test feasibility and preliminary effectiveness of the adapted brief MHV intervention on DSM skills in rural Veterans; and (c) evaluate Veterans' experience with the adapted brief MHV intervention and identify perceived barriers, facilitators, and enablers of its use, and assess the potential for wider dissemination. Methods: To achieve these objectives, we will develop an adapted brief MHV intervention that targets DSM skills. Training for features of My HealtheVet (setting goals, entering/tracking data, researching health-related information, secure messaging) will first be developed. We will obtain a nonrandomized sample of at least 20 rural Veterans, age 45+ years, with diabetes and either hypertension or hyperlipidemia from community- based outpatient clinics in the Charleston VA catchment area. The intervention will involve an initial in-person session with the rest of intervention sessions delivered remotely. In addition, weekly reminders (or booster messages) will be sent to each participant through the MHV secure messaging. All participants will undergo assessments at baseline and at 6 weeks follow-up. For those who agree, semi-structured telephone interviews will be conducted with study participants to evaluate Veterans' experience with learning and navigating MHV through the intervention and to assess feasibility, ease of use, and refinement for potential dissemination to a broader audience. Primary outcomes, frequency of and satisfaction with MHV use, and secondary outcomes, change in DSM skills and clinical indicators, will be assessed in all participants at baseline and at 6 weeks follow-up. Quantitative analysis will involve rate of adoption and mixed effects models. The primary qualitative analysis will involve cognitive interviewing and discourse analysis of semi-structured interviews.