A Mobile and Web-Based Self-Directed Complementary and Integrative Health Program for Veterans and Their Partners (Mission Reconnect): Protocol for a Mixed-Methods Randomized Controlled Trial

Haun, Jolie; Ballistrea, Lisa; Melillo, Christine; Standifer, Maisha; Kip, Kevin E.; Paykel, Jacquelyn; Murphy, Jennifer L.; Fletcher, Carol E.; Mitchinson, Allison R.; Kozak, Leila; Taylor, Stephanie L.; Glynn, Shirley M.

doi:10.2196/13666

Cited by 9 publications

(8 citation statements)

References 71 publications

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“…The total possible incentive for study participants was up to US $140. All study work was completed in adherence to oversight regulations and the approved published protocol [ 13 ]. Study methods and results are reported in accordance with CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth; Multimedia Appendix 1 ) [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…The protocol for this RCT has previously been described in detail [ 13 ]. MR is a remotely delivered patient-centered self-care management program to help veterans manage their pain and psychological health with their partners.…”

Section: Methodsmentioning

confidence: 99%

“…In this RCT, MR was delivered using detailed wellness-based activities including a program overview and detailed massage instruction. Participants were instructed to (1) complete each practice at least once during the first 2 weeks; (2) after week 2, do ≥1 massage exchange weekly with their partner; and (3) practice their preferred methods at ≥3 times weekly [ 13 ]. Waitlist control participants were permitted to access MR after the assessment period.…”

Section: Methodsmentioning

confidence: 99%

“…Recent VA research also indicates that partner recruitment for remote-delivered interventions is feasible and that their personal relationship with the veteran is a facilitator of recruitment and retention [ 14 ]. Furthermore, MR may overcome common treatment barriers including aversion to seeking professional health care services and travel distance for patients [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…The mode of delivery of CIH treatments is commonly believed by veterans to take place in a health care provider setting. MR introduces veterans to a CIH intervention that is delivered in the home setting and performed through self-care activities or dyadic activities between a veteran and their partner [ 13 ]. While MR uses self-directed dyadic activities to circumvent barriers associated with seeking in-person treatment and removes barriers associated with transportation, it is unclear whether VHA-wide implementation of MR may be hindered by attrition.…”

Section: Introductionmentioning

confidence: 99%

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Mobile and Web-Based Partnered Intervention to Improve Remote Access to Pain and Posttraumatic Stress Disorder Symptom Management: Recruitment and Attrition in a Randomized Controlled Trial

Haun,

Venkatachalam,

Fowler

et al. 2023

J Med Internet Res

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Background Increasing access to nonpharmacological interventions to manage pain and posttraumatic stress disorder (PTSD) is essential for veterans. Complementary and integrative health (CIH) interventions can help individuals manage symptom burden with enhanced accessibility via remotely delivered health care. Mission Reconnect (MR) is a partnered, self-directed intervention that remotely teaches CIH skills. Objective The purpose of this paper is to describe the recruitment, onboarding phase, and attrition of a fully remote randomized controlled trial (RCT) assessing the efficacy of a self-directed mobile and web-based intervention for veterans with comorbid chronic pain and PTSD and their partners. Methods A total of 364 veteran-partner dyads were recruited to participate in a mixed methods multisite waitlist control RCT. Qualitative attrition interviews were conducted with 10 veterans with chronic pain and PTSD, and their self-elected partners (eg, spouse) who consented but did not begin the program. Results At the point of completing onboarding and being randomized to the 2 treatment arms, of the 364 recruited dyads, 97 (26.6%) failed to complete onboarding activities. Reported reasons for failure to complete onboarding include loss of self-elected partner buy-in (n=8, 8%), difficulties with using remote data collection methods and interventions (n=30, 31%), and adverse health experiences unrelated to study activities (n=23, 24%). Enrolled veterans presented at baseline with significant PTSD symptom burden and moderate-to-severe pain severity, and represented a geographically and demographically diverse population. Attrition interviews (n=10) indicated that misunderstanding MR including the intent of the intervention or mistaking the surveys as the actual intervention was a reason for not completing the MR registration process. Another barrier to MR registration was that interviewees described the mailed study information and registration packets as too confusing and excessive. Competing personal circumstances including health concerns that required attention interfered with MR registration. Common reasons for attrition following successful MR registration included partner withdrawal, adverse health issues, and technological challenges relating to the MR and electronic data collection platform (Qualtrics). Participant recommendations for reducing attrition included switching to digital forms to reduce participant burden and increasing human interaction throughout the registration and baseline data collection processes. Conclusions Challenges, solutions, and lessons learned for study recruitment and intervention delivery inform best practices of delivering remote self-directed CIH interventions when addressing the unique needs of this medically complex population. Successful recruitment and enrollment of veterans with chronic pain and PTSD, and their partners, to remote CIH programs and research studies requires future examination of demographic and symptom-associated access barriers. Accommodating the unique needs of this medically complex population is essential for improving the effectiveness of CIH programs. Disseminating lessons learned and improving access to remotely delivered research studies and CIH programs is paramount in the post–COVID-19 climate. Trial Registration ClinicalTrials.gov NCT03593772; https://clinicaltrials.gov/ct2/show/NCT03593772

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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