Chronic Tinnitus among Veterans with and without TBI: Service Needs and Interests

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 DESCRIPTION (provided by applicant): Project Background/Rationale: Tinnitus is common among Veterans, particularly those with a history of traumatic brain injury (TBI), and can result in substantial cognitive, emotional, or slep disorders. Over 1.1 million VA-enrolled Veterans were service-connected for tinnitus in 2013. Tinnitus is a life-long condition for which there is no "cure." However, our team has developed Progressive Tinnitus Management (PTM), a program designed to be delivered in-person or by telephone to teach Veterans (with and without TBI) methods for managing tinnitus symptoms. In randomized, controlled trials, clinic-based and telephone- based PTM led to clinically-significant reductions in tinnitus-related distress and dysfunction. Therefore, translation of evidence-based PTM into routine clinical practice is an imperative next-step. We are conducting research to understand barriers to PTM uptake across VA sites. Preliminary findings have shown that: 1) sites with comprehensive TBI services may be more prepared to implement PTM; but that, 2) all sites lack data supporting the need for, and interest in, PTM among Veterans with tinnitus. Project Aims: This project will address this gap by examining the epidemiology of clinically-significant tinnitus among Veterans in the VA system of care. Specifically, our aims are to: 1) Identify the proportion of Veterans with tinnitus in need of clinical services; 2) Examine Veterans' interests in PTM, either clinic- or telephone-based; and 3) Evaluate differences in Veterans' needs and interests by their TBI history. Project Methods: This two-year project will utilize a sequential mixed-methods study design. In Phase 1, we will conduct a survey of 1,200 randomly sampled Veterans identified with tinnitus and stratified by TBI history. Surveys will be mailed using a modified Dillman approach and will collect information on Veterans' tinnitus symptoms, severity, and dysfunction; interests in and perceptions of PTM; and overall health and functioning. In Phase 2, semi-structured telephone interviews will be conducted with a portion of survey respondents, purposively sampled based on response patterns to survey questions. Interviews will address Veterans' tinnitus symptoms and dysfunction; experiences with tinnitus-related healthcare; and interests in and perceived barriers to receiving PTM. Survey and interview data will be triangulated with VA administrative data to fully understand Veterans' needs for, and interests in, PTM services. Anticipated Impact: Tinnitus is an increasingly significant problem for Veterans, particularly those with a history of TBI. PTM is highly effective at reducing tinnitus-related dysfunction, but VA leaders and clinicians are in need of empirical data to support its implementation. Results of our research will directly address this need by generating contextualized (quantitative and qualitative) data on the number of Veterans in need of PTM services, their interests in receiving these services, and the personal experiences, attitudes, and beliefs that drive their expressed needs and interests.