Pilot Testing a Virtual Mindfulness-Based Intervention Aimed at Improving Reintegrating Veterans' Health Outcomes

背景：重新融入社区是后9/11退伍军人过渡的关键时期。困难 与退役相关的问题都有很好的记录，其中包括社会挑战 结构的隔离和损失。抑郁症在9/11事件后重新融入社会的退伍军人中很常见，并可能进一步 使这些重新融入社会的挑战复杂化。尽管9/11事件后退伍军人的需求得到了很好的记录， 尽管有大量资源，但退伍军人继续报告说，支助不足，没有使用可用的服务。AS 因此，发展能够有效解决退伍军人心理健康问题的重返社会服务至关重要 需要使用增加老兵参与可能性的方法。 重要意义：退伍军人事务部(VA)已承诺解决与过渡相关的问题 9/11后退伍军人群体面临的挑战，特别是支持他们心理健康护理的方案 需要。心理健康也是一个优先研究领域。退伍军人事务部的2022-2028年战略计划包括一项战略 确保退伍军人管理局计划和倡议支持全人并解决心理健康和其他问题的目标 影响退伍军人福祉的挑战，包括军队向文职人员的过渡。重新连接到 平民生活使用改善正念(回收)干预的活动解决了优先事项和 解决9/11事件后重新融入社会的退伍军人心理健康问题的战略。我们还将吸引退伍军人的 参加虚拟干预的经验，以扩大对如何最好地设计和 使用虚拟组件实施干预，这为另一个高度优先的研究领域提供了信息。 创新和影响：回收引入了各种基于正念的简短练习(平均为10 会议纪要)，与教育和小组讨论等其他要素相结合，这些要素的重点是 关于退伍军人重新融入社区的各个方面(例如，睡眠、人际关系)。回收会议继续扩大 传统练习项目(身体扫描、瑜伽)包括其他正念练习(内在资源、 恢复性冥想)对参与者的整体功能产生了积极影响，并可以 缓解焦虑、压力和抑郁。各种简单的回收实践使退伍军人能够轻松地 将这些实践整合到他们的日常生活中，并探索几种类型的实践，以找到最适合他们的 他们的需求。这种方法增加了持续参与的可能性，因此也增加了持续受益的可能性。 此外，回收的虚拟交付是基于之前的研究，该研究表明虚拟提供可能 通过正念干预提高退伍军人的参与度。 具体目标：本项目的具体目标是(1)进行随机对照试点研究，以评估 回收干预的可行性；(2)进行定性访谈，评估回收的可接受性； (3)细化和准备回收干预措施，以便进行更广泛的测试。 方法：在目标1中，我们将进行一项双臂随机对照试验研究，以评估以下方面 可行性(例如，招募、随机化、保留在干预和控制部门)。在目标2中，我们 将使用定性访谈从目标1回收的有目的抽样的子组中获得意见 参与者(N=16)评估可接受性。我们将使用快速定性调查进行分析。在AIM 3、我们将使用AIMS 1和AIMS 2的结果反复改进回收方案和测试程序。 我们将与HSR&D CHIC研究顾问小组和运营部门的退伍军人小组进行磋商 合作伙伴(例如，以患者为中心的护理和文化转型办公室)。 下一步/实施：拟议试点项目的结果将直接告知并提供关键试点 卫生服务研究与开发(HSR&D)调查员发起研究(IIR)功绩的数据 批准申请。未来的IIR将以完全随机的方式评估回收的有效性 对照试验，同时规划实施。

Background: Community reintegration is a critical period of transition for post-9/11 Veterans. Difficulties associated with the transition out of military service are well documented and include challenges such as social isolation and loss of structure. Depression is common among reintegrating post-9/11 Veterans and can further complicate these reintegration challenges. Despite the well-documented needs of post-9/11 Veterans and numerous resources, Veterans continue to report inadequate support and are not using available services. As such, it is critical to develop reintegration services that can effectively address Veterans' mental health care needs using approaches that increase the likelihood of Veteran engagement. Significance: The Veterans Affairs (VA) Administration has committed to addressing the transition-related challenges of the post-9/11 Veteran cohort, particularly programming to support their mental health care needs. Mental health is also a priority research area. The VA's 2022-2028 Strategic Plan includes a strategic goal that ensures VA programs and initiatives support the whole person and address mental health and other challenges affecting Veterans' well-being, including the military-to-civilian transition. The REconnecting to Civilian Life using Activities that Improve Mindfulness (RECLAIM) intervention addresses the priority and strategy of addressing reintegrating post-9/11 Veterans' mental health. We will also elicit Veterans' experiences in participating in a virtual intervention to expand the understanding of how best to design and implement interventions with virtual components, which informs another high priority research area. Innovation and impact: RECLAIM introduces a variety of brief mindfulness-based practices (averaging 10 minutes), which are integrated with additional components, such as education and group discussion, that focus on aspects of Veterans' community reintegration (e.g., sleep, relationships). RECLAIM sessions expand on traditional practice offerings (body scan, yoga) to include other mindfulness practices (inner resource, restorative meditations) that have demonstrated positive impacts on participants' overall functioning and can mitigate anxiety, stress, and depression. The variety of brief practices in RECLAIM allows Veterans to easily integrate these practices into their daily lives and explore several types of practices to find what best meets their needs. This approach increases the likelihood of continued engagement and, therefore, continued benefit. Additionally, virtual delivery of RECLAIM is based on previous research suggesting that virtual offerings may enhance Veterans' engagement with mindfulness-based interventions. Specific aims: The specific aims of this project are (1) conduct a randomized controlled pilot study to assess feasibility of the RECLAIM intervention; (2) conduct qualitative interviews to assess acceptability of RECLAIM; and (3) refine and prepare the RECLAIM intervention for broader testing. Methodology: In Aim 1, we will conduct a two-arm randomized controlled pilot study to assess aspects of feasibility (e.g., recruitment, randomization, retention in both the intervention and control arms). In Aim 2, we will use qualitative interviews to elicit input from a purposefully sampled subgroup of Aim 1 RECLAIM participants (N=16) to assess acceptability. We will use rapid qualitative inquiry to conduct the analysis. In Aim 3, we will use the findings from Aims 1 and 2 to iteratively refine the RECLAIM protocol and testing procedures. We will consult with a panel of Veterans from the HSR&D CHIC Research Advisory Panel and operational partners (e.g., Office of Patient Centered Care and Cultural Transformation). Next steps/implementation: Findings from the proposed pilot project will directly inform and provide key pilot data for a Health Services Research and Development (HSR&D) Investigator Initiated Research (IIR) Merit grant application. The future IIR will assess the effectiveness of RECLAIM in a fully powered randomized controlled trial while simultaneously planning for implementation.