National Implementation of a Group-Based Program Promoting Patient Engagement and Peer Support in the Veterans Health Administration: A Multi-Methods Evaluation

Abstract

Evidence-based approaches promoting patient engagement and chronic illness self-management include peer support, shared decision-making, and education. Designed based on these components, Taking Charge of My Life and Health (TCMLH) is a group-based, ‘Whole Person’ care program promoting mental and physical self-care and patient empowerment. Despite evidence of effectiveness, little is known about implementation for TCMLH and similar programs. In this first-of-its-kind, multi-methods evaluation conducted between 2015–2020, we report on implementation strategies and intervention adaptations with a contextual analysis to describe TCMLH translational efforts in Veterans Health Administration (VHA) facilities across the United States. Quantitative and qualitative data were collected via listening sessions with TCMLH facilitators, open-ended survey responses from facilitators, and quarterly reports from clinical implementation sites. We used the Consolidated Framework for Implementation Research (CFIR) to analyze, interpret, and organize qualitative findings, and descriptive statistics to analyze quantitative data. Most TCMLH programs (58%) were adapted from the original format, including changes to the modality, duration, or frequency of sessions. Findings suggest these adaptations occurred in response to barriers including space, staffing constraints, and participant recruitment. Overall, findings highlight practical insights for improving the implementation of TCMLH, including recommendations for additional adaptations and tailored implementation strategies to promote its reach.

“A reinstilled hope that they can change”: Facilitator perspectives on a self-care and health promotion peer group program for veterans

“…Identification of impactful program elements may be applied to solidifying program fidelity criteria especially given the desire for modified formats ( 21 , 33 , 89 ). This study can be applied to planning future research on program outcomes, including development of measures for various types of outcomes that occur during the process of behavior change, including the different types of self-efficacy, social identification, and empowerment, in addition to outcomes in physical and mental health.…”

“…Our multi-component evaluation of TCMLH was part of a larger project to design, implement, and evaluate Whole Health educational and wellness programming throughout the VHA system from 2013 to 2020 (VA777-12-C-002; Rychener, PI). We evaluated the TCMLH program from 2016 to 2018, assessing facilitator trainings ( 21 ), site implementation ( 33 ), and participant outcomes ( 34 , 35 ). Our studies of veteran participant outcomes after attending TCMLH found significant improvements from baseline to program conclusion in outcomes related to patient self-management (patient activation, patient motivation, and self-care behaviors) and health indicators (global mental health, perceived stress, and quality of life) ( 34 , 35 ).…”

“… 2 For further information about the TCMLH program, facilitator training, and program implementation, see our other publications ( 21 , 33 – 35 ). …”

How often does homelessness precede criminal arrest in veterans? Results from the U.S. survey of prison inmates.

“…Understanding these veterans’ obstacles would inform strategies for engaging veterans in health services. For example, peer support services may encourage veterans who perceive internal barriers to seek help (Drake et al, 2022). As such, additional research is warranted to inform efforts to engage veterans in programs to mitigate adverse outcomes of veterans experiencing homelessness and criminal legal involvement.…”

Ready, Set, Go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers’ Diffusion of Innovation Theory

“…CSP has driven the development of multiple new trainings in its 10-year existence, using input from the eld staff. For example, trainings on intimate partner violence, peer support programs, and trainings that address caregiving challenges for speci c diseases have been developed, disseminated, and re ned [17,18]. And yet, even in the VA Health Care System, around 50% of caregivers report they have not received the training they need [19].…”