Patient-centered Strategies to Engage Veterans in Behavioral Health Services

以患者为中心的策略让退伍军人参与行为健康服务

• 批准号: 10197988
• 负责人: Jessica Yelena Breland
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-10-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197988
• 关键词: Address; American; Behavioral; Belief; Body Weight decreased; Caring; Cessation of life; Chronic; Clinic; Collaborations; Country; Data; Databases; Diabetes Mellitus; Disease; Doctor of Philosophy; Ensure; Evaluation; Gender; Goals; Grant; Health; Health Promotion; Health Services; Health behavior; Healthcare; Interview; Literature; Mentors; Mentorship; Methods; Modeling; Motivation; Nurses; Obesity; Outcome; Overweight; Patients; Persons; Physical Function; Population; Primary Health Care; Procedures; Protocols documentation; Quality of life; Randomized Controlled Trials; Research Personnel; Risk; Schedule; Scientific Advances and Accomplishments; Special Population; Speed; Substance Use Disorder; Testing; Text; Time; Training; Veterans; Veterans Health Administration; Visit; Weight; Weight Gain; Weight maintenance regimen; Woman; Women' s Health; Women' s Health Services; Work; Writing; administrative database; behavioral health; cost; design; disorder prevention; experience; health belief; hybrid type 1 trial; implementation science; implementation strategy; implementation tool; improved; innovation; men; motivational enhancement therapy; neglect; novel; patient oriented; physical conditioning; population health; preference; programs; recruit; satisfaction; self help; theories; tool; tool development; treatment arm; treatment program; weight loss intervention

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.”

这个CDA将提供杰西卡Y。布里兰博士的培训和经验，成为一个 独立的VA卫生服务研究人员专注于实施以患者为中心的战略， 行为健康服务的退伍军人。为了实现这一目标，她将与她的导师和顾问合作 开发和评估以患者为中心的，激励性的自助工具，以增加体重的参与度 通过三个步骤处理损失：1 ) 确定患者和组织的体重减轻预测因素 治疗参与; 2）开发一种激励性的自助工具，让退伍军人参与减肥 3）对自助工具进行试点测试。 近80%的退伍军人（以及约70%的其他美国人）超重/肥胖，增加了他们的风险 昂贵且使人衰弱的慢性病的治疗。鉴于减肥治疗可以减少糖尿病和其他疾病， 条件下，增加减肥治疗的参与（任何和持续的参与）可以延长 数百万条生命不幸的是，VA有一个减肥治疗实施差距：VA提供治疗， 94%的超重/肥胖退伍军人，但只有10%使用它们。此外，虽然动机性面试 提高参与度，临床医生使用它的时间有限。一个激励性的自助工具可以增加 不需要临床医生的时间的减肥治疗参与。 为了开发该工具，Breland博士提出了一种混合方法，提供了三个重要的 创新：人口健康方向，动机访谈的自助应用，以及小说 使用实施科学和健康信念理论进行评估的理论基础， 行为。在目标1.1中，她将确定VA行为减肥治疗，包括但不限于 动起来！(VA的主要减肥治疗），通过对临床医生和国家领导人的采访。 结果将确定目标1.2分析和治疗的因变量，以纳入自助工具 (Aim 2.3）。在目标1.2中，她将确定患者和组织参与度的预测因素， 目标1.1中确定的损失治疗，按性别进行分层分析，并使用现有的妇女健康 评价倡议主数据库。结果将提供关于减肥治疗的人群水平数据 参与，以及一些关于参与除MOVE！之外的VA治疗的第一批数据。结果将 还确定与参与度差相关的人群和组织因素，以进一步了解 通过与临床医生（目标2.1）和退伍军人（2.2）的访谈，开发工具内容并定义 执行战略。在目标2.3中，她将使用先前目标的结果来调整现有的激励措施 访谈协议转化为一个互动的，激励性的，自助工具，使用文本和视频，以提高 参与减肥治疗。最后，她将通过招募VA Palo Alto小学来试点测试该工具 护理临床医生和患者（目标3）。结果将评估方法的可行性，以测试该工具在一个 随后的混合1型试验，包括临床医生和退伍军人对该工具的满意度， 使用和收集/分析结果的程序的必要变更：减肥治疗 参与，减肥，生活质量和身体功能。 与这些目标相关的培训利用了她的导师和顾问在以下方面的专业知识： 数据库分析（Frayne，Maguen，Phibbs）; 2）实施科学（Asch，Goldstein）; 3）行为学 健康（Timko，Maguen）; 4）业务伙伴关系（所有导师）;和赠款写作（所有导师）。的 与包括国家健康促进中心在内的业务伙伴开展了工作， 疾病预防和妇女健康服务，以确保它促进科学文献，同时 与他们的目标保持一致。这项工作也符合弗吉尼亚州的卓越蓝图，强调“高质量， 以退伍军人为中心的护理”和推进“退伍军人和国家的医疗保健创新”。

项目成果

Rapid conversion to virtual obesity care in COVID-19: Impact on patient care, interdisciplinary collaboration, and training.

• DOI: 10.1002/osp4.550
• 发表时间: 2022-03
• 期刊: Obesity science & practice
• 影响因子: 2.2
• 作者: Lohnberg JA;Salcido L;Frayne S;Mahtani N;Bates C;Hauser ME;Breland JY
• 通讯作者: Breland JY

Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives.

• DOI: 10.2196/29916
• 发表时间: 2021-12-08
• 期刊: JMIR formative research
• 影响因子: 2.2
• 作者: Breland JY;Agha K;Mohankumar R
• 通讯作者: Mohankumar R

National Veterans Health Administration MOVE! Weight Management Program Participation During the COVID-19 Pandemic.

• DOI: 10.5888/pcd19.210303
• 发表时间: 2022-03-10
• 期刊: Preventing chronic disease
• 影响因子: 5.5
• 作者: Gray KE;Hoerster KD;Spohr SA;Breland JY;Raffa SD
• 通讯作者: Raffa SD

Common Sense Models of Obesity: a Qualitative Investigation of Illness Representations.

肥胖常识模型：疾病表征的定性调查。

• DOI: 10.1007/s12529-022-10082-w
• 发表时间: 2023
• 期刊: International journal of behavioral medicine
• 影响因子: 2.7
• 作者: Breland,JessicaY;Dawson,DariusB;Puran,Deloras;Mohankumar,Rakshitha;Maguen,Shira;Timko,Christine;Frayne,SusanM;Nevedal,AndreaL
• 通讯作者: Nevedal,AndreaL

Correlates of health care use among White and minority men and women with diabetes: An NHANES study.

患有糖尿病的白人和少数族裔男性和女性医疗保健使用的相关性：一项 NHANES 研究。

• DOI: 10.1016/j.diabres.2019.03.001
• 发表时间: 2019
• 期刊: Diabetes research and clinical practice
• 影响因子: 5.1
• 作者: Wong,JessieJ;Hood,KoreyK;Breland,JessicaY
• 通讯作者: Breland,JessicaY