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

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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.