Veteran Engagement Implementation Strategies to Prevent Rural Veteran Suicide

防止农村退伍军人自杀的退伍军人参与实施策略

• 批准号: 10535422
• 负责人: Eva Woodward
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10535422
• 关键词: Address; Adoption; Ambulatory Care Facilities; Area; Award; Caregivers; Clinic; Clinical; Clinics and Hospitals; Communities; Competence; Consumer Participation; Data; Development; Ensure; Evaluation; Family; Family Caregiver; Feedback; Feeling suicidal; Future; General Population; Goals; Health behavior outcomes; Healthcare; Healthcare Systems; Human Resources; Impact evaluation; Infrastructure; Intervention; Interview; K-Series Research Career Programs; Knowledge; Low income; Manuals; Mental Depression; Methodology; Methods; Monitor; Outcome; Patients; Policies; Population; Process; Provider; Psychologist; Reduce health disparities; Reporting; Research; Research Methodology; Research Personnel; Risk; Rural; Rural Population; Safety; Scientist; Severities; Site; Standardization; Suicide; Suicide prevention; Techniques; Testing; Time; Training; United States Department of Veterans Affairs; Update; Variant; Veterans; Voice; Vulnerable Populations; Work; acceptability and feasibility; base; behavioral health; career; clinical practice; community based participatory research; design; effective intervention; effective therapy; effectiveness implementation study; evidence base; experience; follow-up; group intervention; health care disparity; health care quality; health care service; health disparity; health equity; implementation facilitation; implementation intervention; implementation outcomes; implementation process; implementation research; implementation science; implementation strategy; implementation study; improved; improved outcome; innovation; meetings; member; novel; prevent; process evaluation; programs; racial minority; research study; skills; suicidal behavior; suicidal risk; uptake

Background. As a psychologist with strong beginner implementation science competencies, Dr. Woodward’s goal is to become an independent investigator and advanced implementation scientist to improve health equity in VA by engaging vulnerable Veterans in implementing healthcare services. In this CDA, she will acquire skills to identify, manualize, pilot, and rigorously evaluate effective methods to engage vulnerable Veterans (those who experience health disparities) throughout the implementation process. Health care disparities persist in VA. In community-based participatory research (CBPR), engaging consumers in research helps vulnerable populations improve health behaviors and outcomes. Thus, implementation researchers could also engage consumers in selecting and tailoring implementation strategies. Implementation strategies are techniques to enhance uptake of an intervention (e.g., quality monitoring, sustainability planning). There is little consumer involvement in this process likely because no formal guidance exists. Dr. Woodward will manualize methods to engage vulnerable Veteran consumers (including families, caregivers, community members) in selecting and tailoring implementation strategies. This manual (called Consumer Voice) will provide concrete guidance on what, when, where, how, and why an implementer might engage consumers in implementing or redesigning healthcare services. Dr. Woodward will pilot this manual in the context of implementing Safety Planning Intervention (SPI) for suicide prevention, focused on rural Veterans, a population particularly vulnerable to suicide. Suicide is VA’s top clinical priority. SPI is an effective intervention that reduces suicidal ideation and behaviors. Dr. Woodward needs training in CBPR, mixed methods in implementation research, and implementation strategy design. Significance/Impact. By adding Veterans’ voices throughout the implementation process, VA can increase access to and quality of healthcare for vulnerable Veterans and improve health equity. Dr. Woodward’s training will ensure her expertise in implementation science and health disparities to meet VA’s needs. Innovation. Consumer Voice is timely given critical needs for innovative implementation science to reduce health disparities and VA’s increasing emphasis on Veteran engagement. Consumer Voice is novel as the first manual to guide a process for consumer engagement throughout implementation; [although it will be piloted on SPI, it will be generalizable to other vulnerable groups and interventions.] Specific Aims. 1) Identify and manualize methods to engage consumers in selecting and tailoring implementation strategies (Consumer Voice). 2) Use Consumer Voice and pilot its acceptability, feasibility, and preliminary effect on implementation and Veteran outcomes. 3) Evaluate SPI sustainment [as a metric of Consumer Voice’s impact.] Methodology. In Aim 1, Dr. Woodward will use a CBPR approach to develop Consumer Voice. During the Aim 2 pilot, Dr. Woodward will implement SPI in two community-based outpatient clinics serving rural Veterans. The comparison site will receive Implementation Facilitation (IF) and the implementation site will receive IF+Consumer Voice. Dr. Woodward will use mixed methods to assess feasibility and acceptability of Consumer Voice. Dr. Woodward will use a pilot hybrid implementation- effectiveness Type 3 design and compare IF to IF+Consumer Voice on: 1) implementation (reach, adoption, fidelity); and 2) Veteran outcomes (depression severity, suicidal ideation, suicidal behavior). In Aim 3, Dr. Woodward will use mixed methods to re-evaluate Aim 2 outcomes at 12-month follow up to assess SPI sustainment. Dr. Woodward will also gather qualitative data from stakeholders to understand what hinders or promotes SPI sustainment and [compare the degree to which consumers were involved in each site’s Sustainability Action Plan]. Next Steps/Implementation. Dr. Woodward will conduct a full evaluation of Consumer Voice on implementation outcomes and suicide disparities between urban and rural Veterans. Full dissemination will include VA cyberseminars and meetings with policy and program partners.

背景。作为一名具有强大的初学者实施科学能力的心理学家，伍德沃德博士的 目标是成为一名独立研究者和高级实施科学家，以改善健康公平 在弗吉尼亚州，让弱势退伍军人参与实施医疗保健服务。在此 CDA 中，她将获得技能 确定、手动化、试点和严格评估有效方法来吸引弱势退伍军人（那些 在整个实施过程中经历健康差异的人）。医疗保健差距依然存在 弗吉尼亚州。在基于社区的参与式研究 (CBPR) 中，让消费者参与研究有助于弱势群体 人群改善健康行为和结果。因此，实施研究人员也可以参与 消费者选择和定制实施策略。实施策略是技术 加强干预措施的采用（例如质量监测、可持续性规划）。消费者很少 参与这一过程可能是因为不存在正式指导。伍德沃德博士将采用手动方法 让弱势退伍军人消费者（包括家庭、护理人员、社区成员）参与选择和 制定实施策略。本手册（称为消费者之声）将提供具体指导 实施者可以让消费者参与实施或重新设计的内容、时间、地点、方式和原因 医疗保健服务。伍德沃德博士将在实施安全规划的背景下试用本手册 预防自杀的干预措施 (SPI)，重点关注农村退伍军人，这是一个特别容易遭受自杀伤害的人群 自杀。自杀是 VA 的首要临床优先事项。 SPI 是一种有效的干预措施，可以减少自杀意念 行为。 Woodward 博士需要 CBPR 培训、实施研究混合方法以及 实施策略设计。意义/影响。通过在整个过程中加入退伍军人的声音 实施过程中，退伍军人事务部可以增加弱势退伍军人和老年人获得医疗保健的机会和质量 改善健康公平。伍德沃德博士的培训将确保她在实施科学和健康方面的专业知识 满足 VA 需求的差异。创新。鉴于对创新的关键需求，消费者之声是及时的 实施科学以减少健康差距，退伍军人事务部越来越重视退伍军人的参与。 消费者之声作为第一本指导消费者参与整个过程的手册是新颖的 执行; [虽然它将在 SPI 上进行试点，但它将推广到其他弱势群体和 干预措施。] 具体目标。 1) 确定并手动制定吸引消费者选择和使用的方法 定制实施策略（消费者的声音）。 2) 使用消费者声音并测试其可接受性， 可行性，以及对实施和退伍军人成果的初步影响。 3) 评估 SPI 维持[作为 消费者声音影响力的衡量标准。]方法论。在目标 1 中，伍德沃德博士将使用 CBPR 方法来 开发消费者声音。在 Aim 2 试点期间，Woodward 博士将在两个社区实施 SPI 为农村退伍军人提供服务的门诊诊所。比较站点将获得实施促进 (IF) 和 实施现场将收到IF+Consumer Voice。伍德沃德博士将使用混合方法来评估 消费者声音的可行性和可接受性。伍德沃德博士将使用试点混合实施 - 有效性 类型 3 设计并将 IF 与 IF+Consumer 进行比较 声音：1) 实施（覆盖范围、采用、 保真度）； 2) 退伍军人结果（抑郁严重程度、自杀意念、自杀行为）。在目标 3 中，Dr. 伍德沃德将在 12 个月的随访中使用混合方法重新评估目标 2 的结果，以评估 SPI 维持。伍德沃德博士还将从利益相关者那里收集定性数据，以了解是什么阻碍或 促进 SPI 维持并[比较消费者参与每个网站的程度 可持续发展行动计划]。后续步骤/实施。伍德沃德博士将对 消费者对实施结果和城乡退伍军人之间自杀差异的声音。满的 传播将包括 VA 网络研讨会以及与政策和计划合作伙伴的会议。