A pilot trial of health coaching to improve functioning and reduce suicide risk among reintegrating Veterans

背景：退伍军人在退伍后的第一年自杀风险最高。这 自杀风险的增加与重新融入平民生活的困难有关。角色上的缺陷 功能(知道你是谁，知道你在生活中的方向)是最常见的报道之一 重新融入社会期间面临的挑战。角色功能对于成人生活角色中的最佳功能至关重要(例如， 就业)，而且它预示着自杀的念头和企图。然而，没有基于证据的 针对角色功能的干预措施，以降低自杀风险并改善成人生活中的角色功能。 意义：在传统诊所之外接近服役分离的退伍军人的重要性 背景是明确的；退伍军人在退役第一年内自杀的风险最高，退伍军人 在这段时间内没有很好地连接到退伍军人管理局护理或其他服务。健康指导是一种非临床的健康 旨在改善角色功能并可通过虚拟方式提供的行为改变模式 电话/视频)。尽管健康指导已经受到退伍军人健康管理局(VHA)的欢迎， 没有一项严格的、动力十足的试验来检验健康教练的有效性。虚拟提供的健康 辅导可能是一种易于扩展、低成本的方法，可以在临床之外帮助重新融入社会的退伍军人 减少自杀风险和改善成人生活角色功能的设置。 创新：还没有研究调查重新融入社会的退伍军人在退伍军人中使用健康指导的情况 诊所环境。这项研究对虚拟提供的健康指导的战略性使用建立在VHA在这方面的投资 在高危过渡期有可能降低自杀风险的非临床方式。 具体目标：这项初步研究将1)审查研究程序的可行性和可接受性 对重新融入社会的退伍军人进行健康指导干预；2)评估调解人和结果的测量 未来验证性疗效试验的适宜性；以及3)确定实施的障碍和促进者 在重新融入社会的退伍军人中进行健康指导。 方法：我们将在服兵役三个月内从全国范围内抽取94名退伍军人作为样本 分开并跟踪他们9个月，捕捉到他们分开的第一年。参与者将是 随机分为健康指导+强化日常护理(EUC)组或仅EUC组。干预组将收到 最多通过电话或视频进行12次健康指导会议(每个参与者的喜好)。所有参与者将 收到按职能领域组织的关于退伍军人福利和服务的小册子，作为对 “照常照看。”参与者将在基线、干预中期(2个月)、干预后 干预(第4个月)和随访(第9个月)。大约30名参与者将完成定性测试 关于他们与健康教练和干预教练的经历的面试将在以下时间完成 他们提供指导的经验。VHA管理数据将用于确定VHA护理利用率。 我们将使用研究日志数据、满意度测量和定性访谈来检验研究的可行性 干预的方法和可接受性，包括潜在的危害。评估纳入《公约》的措施 未来的疗效试验将包括表征典型的变异，对人内变化的描述性分析 跨时间，并以95%的可信区间调整治疗效果大小的估计。通知障碍物 和促进者实施虚拟交付的健康指导，我们将分析老兵的质量 采用主要描述性的主题分析方法进行访谈和教练离职访谈。 下一步：在这项研究中收集的数据将为设计后续的虚拟交付的疗效试验提供参考 重新融入社会的退伍军人的健康辅导和未来的实施策略。这一系列研究将 告知战略性地使用虚拟提供的健康指导作为一种基于人群的康复方法 降低自杀风险，改善重新融入社会的退伍军人在生活中的作用。

Background: Veterans’ suicide risk is highest during the first year after military service separation. This heightened suicide risk has been associated with difficulties reintegrating into civilian life. Deficiencies in role functioning (knowing who you are and where you are heading in life) is one of the most commonly reported challenges during reintegration. Role functioning is critical for optimal functioning in adult life roles (e.g., employment) and it is predictive of suicidal ideation and attempts. However, there are no evidence-based interventions that address role functioning to reduce suicide risk and improve functioning in adult life roles. Significance: The importance of reaching Veterans proximal to service separation outside of traditional clinic settings is clear; Veterans’ risk for suicide is highest within the first year of service separation and Veterans are not well-connected to VA care or other services during this time period. Health coaching is a non-clinical health behavior change modality that is designed to improve role functioning and can be delivered virtually (via telephone/video). Although health coaching has been embraced by the Veterans Health Administration (VHA), no rigorous, fully powered trials have examined the effectiveness of health coaching. Virtually-delivered health coaching may be an easily scalable, low-cost approach to reach reintegrating Veterans outside of clinic settings to reduce suicide risk and improve functioning in adult life roles. Innovation: No studies have examined the use of health coaching among reintegrating Veterans outside of the clinic setting. This study’s strategic use of virtually-delivered health coaching builds on VHA’s investment in this non-clinical modality that has the potential to reduce suicide risk during a high-risk transition period. Specific Aims: This pilot study will 1) Examine the feasibility of study procedures and acceptability of the health coaching intervention among reintegrating Veterans; 2) Evaluate measures of mediators and outcomes for suitability in a future confirmatory efficacy trial; and 3) Determine barriers and facilitators of implementation of health coaching among reintegrating Veterans. Methodology: We will enroll a national sample of 94 Veterans within three months of military service separation and follow them for 9 months, capturing their first year of separation. Participants will be randomized to health coaching + enhanced usual care (EUC) or EUC only. The intervention group will receive up to 12 health coaching sessions over the phone or via video (per participant preference). All participants will receive a booklet about VA benefits and services, organized by functional domains, as an enhancement to “usual care.” Participants will complete self-report assessments at baseline, mid-intervention (month 2), post- intervention (month 4), and follow-up (month 9). Approximately 30 participants will complete qualitative interviews on their experiences with health coaching and intervention coaches will complete exit interviews on their experiences delivering coaching. VHA administrative data will be used to ascertain VHA care utilization. We will use study log data, a satisfaction measure, and qualitative interviews to examine feasibility of the study methods and acceptability of the intervention, including potential harms. Evaluation of measures for inclusion in a future efficacy trial will involve characterizing typical variation, descriptive analyses of within-person change across time, and adjusted estimates of treatment effect sizes with 95% confidence intervals. To inform barriers and facilitators to implementing virtually-delivered health coaching we will analyze Veteran qualitative interviews and coach exit interviews using a primarily descriptive thematic analysis approach. Next steps: Data gathered in this study will inform design of a subsequent efficacy trial of virtually-delivered health coaching among reintegrating Veterans and future implementation strategies. This line of research will inform the strategic use of virtually-delivered health coaching as a population-based rehabilitation approach to reduce suicide risk and improve functioning in life roles among reintegrating Veterans.