Developing a Peer Support Protocol for Improving Veterans’ Engagement to Computer-Delivered Cognitive Behavioural Therapy

Ray, John M.; Kemp, Lakiesha; Hubbard, Amanda; Cucciare, Michael A.

doi:10.1017/s1352465816000539

Cited by 15 publications

(12 citation statements)

References 50 publications

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“…PSSs are individuals who use their own experiences with mental illness, substance use, or behavioral health concerns and treatment to serve as models for instilling hope, engaging patients in treatment, and helping patients access resources (Chinman, Salzer, & O’Brien-Mazza, 2012; Myrick & del Vecchio, 2016). Thus, PSSs are a potential resource to increase app use in primary care, by providing technical support and accountability to use them (Ray, Kemp, Hubbard, & Cucciare, 2017).…”

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confidence: 99%

Use and perceptions of mobile apps for patients among VA primary care mental and behavioral health providers.

Miller¹,

Kuhn²,

Yu³

et al. 2019

Professional Psychology: Research and Practice

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Mobile apps for mental health concerns are a convenient, potentially effective way for primary care patients to access resources and self-management tools. Providers' perceptions of such apps are critical to their adoption and integration into practice. This study evaluated use and perceptions of apps among Veterans Affairs Primary Care Mental Health Integration (PCMHI) providers, and identified the chal-This article was published Online First April 15, 2019. KATHERINE E. MILLER received her PhD in clinical psychology from the University of Tulsa. She is currently a research postdoctoral fellow at the Mental Illness Research, Education, and Clinical Center at the Cpl. Michael J Crescenz VA Medical Center. Her areas of professional interest include the prevention and treatment of chronic sleep disturbances, specifically related to recovery from traumatic events, and the use of innovative technologies.

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confidence: 99%

Use and perceptions of mobile apps for patients among VA primary care mental and behavioral health providers.

Miller¹,

Kuhn²,

Yu³

et al. 2019

Professional Psychology: Research and Practice

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“…The weekly phone sessions with peer specialists were scheduled for 15–30 min and were initiated by the peers. The key components of these sessions entailed peers (1) inquiring about use of the app, (2) providing suggestions on how app content could be applied to participants’ lives to reach their drinking goal, (3) offering technical support to navigate the app and understand its functionality, and (4) encouraging ongoing utilization of the app and suggesting action plans tailored to their needs (Ray et al, 2017). Phone sessions were provided by three peers employed by VHA, all of whom had lived experience with alcohol use problems and were in recovery.…”

Section: Methodsmentioning

confidence: 99%

Using peers to increase veterans’ engagement in a smartphone application for unhealthy alcohol use: A pilot study of acceptability and utility.

Blonigen¹,

Harris²,

Kuhn³

et al. 2021

Psychology of Addictive Behaviors

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Mobile apps can only increase access to alcohol treatment if patients actively engage with them. Peers may be able to facilitate such engagement by providing supportive accountability and instruction and encouragement for app use. We developed a protocol for peers to support engagement in the Stand Down app for unhealthy alcohol use in veterans and tested the acceptability and utility of the protocol. Thirty-one veteran primary care patients who screened positive for unhealthy alcohol use and were not currently in addiction treatment were given access to Stand Down for four weeks and concurrently received weekly phone support from a Department of Veterans Affairs peer specialist to facilitate engagement with the app. App usage was extracted daily, and pre/post treatment assessments measured changes in drinking patterns, via the Timeline Followback interview, and satisfaction with care, via quantitative and qualitative approaches. A priori benchmarks for acceptability were surpassed: time spent in the app (M = 93.89 min, SD = 92.1), days of app use (M = 14.05, SD = 8.0), and number of daily interviews completed for tracking progress toward a drinking goal (M = 12.64, SD = 9.7). Global satisfaction, per the Client Satisfaction Questionnaire, was high (M = 26.4 out of 32, SD = 4.5). Pre to post, total standard drinks in the prior 30 days (MPre = 142.7, MPost = 85.6), Drinks Per Drinking Day (MPre = 5.4, MPost = 4.0), and Percent Heavy Drinking Days (MPre = 35.3%, MPost = 20.1%) decreased significantly (ps < .05). Findings indicate that Peer-Supported Stand Down is highly acceptable to veteran primary care patients and may help reduce drinking in this population. A larger controlled trial of this intervention is warranted.

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“…Such providers would be veterans who are currently in recovery from addiction and have been trained to serve other veterans who are actively struggling with these issues. By encouraging utilization of the app and monitoring Veterans' progress toward their recovery goals, a peer provider can provide supportive accountability to patients who use Step Away, thus increasing the reach and sustainability of this app with the veteran population [25]. Therefore, the samples for this study were veteran patients who screened positive for hazardous drinking during a VHA primary care visit and peer providers who serve veterans with addiction.…”

Section: This Studymentioning

confidence: 99%

From “Step Away” to “Stand Down”: Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans

Blonigen

Harris

Kuhn

et al. 2020

JMIR Mhealth Uhealth

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Background US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population. Objective The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population. Methods Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity. Results Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (Stand Down: Think Before You Drink) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population. Conclusions The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking.

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Developing a Peer Support Protocol for Improving Veterans’ Engagement to Computer-Delivered Cognitive Behavioural Therapy

Abstract: The findings extend the literature on online, patient-facing mental health protocols by identifying emotional support and 'real life' skills application as Veteran-preferred components of a peer-support protocol designed to enhance use of and engagement in cCBT for depression and anxiety.

Cited by 15 publications

References 50 publications

Use and perceptions of mobile apps for patients among VA primary care mental and behavioral health providers.

Use and perceptions of mobile apps for patients among VA primary care mental and behavioral health providers.

Using peers to increase veterans’ engagement in a smartphone application for unhealthy alcohol use: A pilot study of acceptability and utility.

From “Step Away” to “Stand Down”: Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans

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