Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
SPONSOR/MONITOR'S REPORT NUMBER(S)
DISTRIBUTION / AVAILABILITY STATEMENTApproved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES
ABSTRACTThis project assessed the usability and feasibility of a multi-behavioral computerized, tailored intervention (CTI) delivered via the Internet for veterans with Post-Traumatic Stress symptoms. The project adapted and modified a CTI system based on the Transtheoretical Model of Behavior Change (TTM), utilizing methods that are characteristic of product development. Phase 1 focused on the review of current CTI programs on smoking cessation, stress management, and depression prevention with veteran focus groups, and integrating suggestions into a multi-behavioral program for application with veterans. Phase 2 was the adaptation of feedback messages and multimedia components. Usability testing of the modified CTI programs was done in Phase 3 and additional modifications to the behavioral modules were made based on the test results. Phase 4 was a feasibility test of the multi-behavioral CTI system with veterans who screened positive for mild to moderate PTSD (mean PCL-M score=55.6, SD=9.4) and depression (mean PHQ-8 score=12.0, SD=4.0). The CTI intervened at baseline, 1, and 3 months, and targeted smoking, depression, and stress. Participants selected a minimum of 2 behaviors and completed self-guided programs for 1-2 hours per month. Participants (n=57) had a mean age of 40.5 (SD=11.2), 74% were male, 70% White, and 56% married, with 86% reporting at least some college. Significant positive change was observed for behavioral and clinical outcomes. At 3-months, 27% of those who smoked cigarettes at baseline had quit (χ2(1)=23.5, p<.001); 72% of those in preaction stages for stress were practicing effective stress management at criteria (χ2(1)=6.2, p=.013); and 67% of those "at risk" for depression reported they were in the action or maintenance stage of change (χ2(1)=8.8, p=.003). At 3-months, scores for depression (PHQ-8) decreased 17% (mean=9.9, SD=5.8; t(56)=2.5, p=0.15), perceived stress (PSS) decreased 19% (t(56)=3.7, p<.001)), and quality of life (QOLS) increase...