Patient-centered Strategies to Engage Veterans in Behavioral Health Services

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This CDA will provide Jessica Y. Breland, PhD with the training and experience to become an independent VA health services researcher focused on implementing patient-centered strategies to engage Veterans in behavioral health services. To achieve this goal, she will work with her mentors and consultants to develop and evaluate a patient-centered, motivational, self-help tool to increase engagement in weight loss treatments through three steps: 1 ) Identify patient and organizational predictors of weight loss treatment engagement; 2) Develop a motivational, self-help tool to engage Veterans in weight loss treatments; and 3) Pilot-test the self-help tool. Almost 80% of Veterans (and ~70% of other Americans) are overweight/obese, increasing their risk of costly and debilitating chronic conditions. Given that weight loss treatments reduce diabetes and other conditions, increasing weight loss treatment engagement (any and sustained engagement) could prolong millions of lives. Unfortunately, VA has a weight loss treatment implementation gap: VA offers treatment to 94% of overweight/obese Veterans, but only 10% use them. Further, while motivational interviewing improves engagement, clinicians have limited time to use it. A motivational, self-help tool could increase weight loss treatment engagement without requiring clinicians' time. To develop the tool, Dr. Breland proposes a mixed-methods approach offering three significant innovations: a population health orientation, a self-help application of motivational interviewing, and a novel theoretical basis for evaluation that uses implementation science and theories of health beliefs and behaviors. In Aim 1.1, she will identify VA behavioral weight loss treatments, including, but not limited to MOVE! (VA's primary weight loss treatment), through interviews with clinicians and national leaders. Results will identify dependent variables for Aim 1.2 analyses and treatments to include in the self-help tool (Aim 2.3). In Aim 1.2, she will identify patient and organizational predictors of engagement in the weight loss treatments identified in Aim 1.1, stratifying analyses by gender and using the existing Women's Health Evaluation Initiative Master Database. Results will offer population-level data on weight loss treatment engagement, and some of the first data on engagement in VA treatments other than MOVE!. Results will also identify populations and organizational factors associated with poor engagement, to further understand through interviews with clinicians (Aim 2.1) and Veterans (2.2) to develop tool content and define implementation strategies. In Aim 2.3, she will use results of prior aims to adapt existing motivational interviewing protocols into an interactive, motivational, self-help tool that uses text and videos to enhance engagement in weight loss treatments. Finally, she will pilot-test the tool by recruiting VA Palo Alto primary care clinicians and patients (Aim 3). Results will assess the feasibility of methods to test the tool in a subsequent Hybrid Type 1 trial, including clinicians' and Veterans' satisfaction with the tool, barriers to its use, and necessary changes to procedures for collecting/analyzing outcomes: weight loss treatment engagement, weight loss, quality of life, and physical functioning. Training related to these aims draws on her mentors' and consultants' expertise in: 1) Administrative Database Analyses (Frayne, Maguen, Phibbs); 2) Implementation Science (Asch, Goldstein); 3) Behavioral Health (Timko, Maguen); 4) Operational Partnerships (all mentors); and Grant Writing (all mentors). The work was developed with operational partners, including the National Center for Health Promotion and Disease Prevention and Women's Health Services, to ensure that it advances the scientific literature, while aligning with their goals. The work alsoaligns with VA's Blueprint for Excellence, emphasizing “high quality, Veteran-centered care” and advancing “healthcare innovation for Veterans and the country.”