Veteran Engagement in Health Services Research: a Conceptual Model

Strategies for engaging patients in co-design of an intervention

OBJECTIVE

We provide practical guidance about using co-design methods to collaborate with patients to create patient-facing interventions, which others can use when undertaking similar projects.

METHODS

This is a narrative review synthesizing co-design principles and published literature with our experience working alongside five Veteran patients of the U.S. Department of Veterans Affairs in New England to co-design a portfolio of patient-facing materials to improve patient-centered care coordination. Our process took 12 weeks (April - June 2022) and was conducted entirely via video conference.

RESULTS

Co-design is a participatory research method. Its principles include sharing power over the research process and products, agency for all participants, embracing a plurality of forms of knowledge, and mutual and reciprocal benefit. We describe three stages of the co-design process (preparatory work; design and development; feedback and closure), strategies and techniques we used at each stage, challenges we faced, and considerations for addressing them.

CONCLUSION

Co-designing patient-facing interventions blends different forms of knowledge to produce practical, contextually specific interventions with ownership by the people who will use them.

PRACTICE IMPLICATIONS

Co-design is a feasible methodology for most health services research teams whose goal is to intensify patient engagement in research.

The COVID-19 pandemic’s influence on employment outcomes of veterans enrolled in VA healthcare vocational rehabilitation

BACKGROUND: Employment has been shown to be the fourth most commonly reported need for veterans and their families, and unemployment rates have ranged from 1–69% dependent on the mental health diagnosis. Complications from the COVID-19 pandemic have had a significant impact on psychological functioning, and social isolation has led to increased psychiatric symptoms. Vocational rehabilitation is an intervention provided to Veterans in an attempt to remove barriers to employment while also increasing involvement in gainful work activity. OBJECTIVE: The purpose of the current study was to examine the impact that COVID-19 has had on employment rates at discharge for veterans with mental health disorders participating in a VHA vocational rehabilitation program. METHODS: An outcome-based, summative program evaluation design was used to assess the quality of Veterans served (2016-2021) at a vocational rehabilitation program served at a medical center located in VISN 12 of the U.S. Department of Veteran Affairs. RESULTS: Findings showed that veterans with Bipolar and Psychosis were less likely to discharge with employment (not considering COVID-19). CONCLUSION: No significant meaningful differences existed in employment rates when comparing pre/post March 2020 (official start of COVID-19 pandemic) for veterans with psychiatric diagnoses.

Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations

ABSTRACT

In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination.

Process evaluation of the Invictus Pathways Program

INTRODUCTION

UniSA's Invictus Pathways Program (IPP), a service program, was originally developed to assist veterans to train for and participate in the Invictus Games. More recently, the scope of the IPP has widened to support and improve wellbeing and facilitate post traumatic growth and recovery among participants who are living with physical and mental health injuries and conditions. This paper describes the components of the IPP and reports its process evaluation.

METHODS

Underpinned by a pragmatic approach, data related to participant and student involvement in the IPP, the number of participant training sessions, session attendance, program activities and events, and program fidelity were compiled from process documentation that had been collected between 2017 and 2020, inclusive. Following ethics approval, semi-structured interviews were conducted with participants of the IPP, members of their family support network, and university staff to understand the operations of the IPP and satisfaction with the program.

FINDINGS

There was high fidelity for the student-led exercise training aspects of IPP; however, data collection relevant to participants' psychological outcomes, and non-training IPP events and activities did not always occur as intended. Between 2017 and 2020, 53 veterans had participated in or were still participating in the IPP, and 63 allied health students had completed placements as student trainers. Fifty-three individual training sessions were delivered in 2017, increasing to 1,024 in 2020. Seventy-one interviews were completed with key IPP stakeholders. The qualitative analysis identified four higher order themes: Implementation and fidelity of the IPP, Satisfaction with the IPP, Areas of the IPP requiring improvement and suggestions for change, and Sustainability of the IPP. Satisfaction was generally high for the IPP, although there were factors that negatively impacted the experience for some participants and their family support network. Suggestions for improvement to program components and delivery aspects were made during the interviews, and the precariousness of IPP funding and sustainability was raised as an ongoing concern.

CONCLUSION

This process evaluation has demonstrated that the physical activity training components of the IPP were delivered with high levels of fidelity, and that satisfaction with the IPP is mostly high, although there are areas that could be improved. There is a need for a more structured approach to the ongoing evaluation of the IPP. This includes ensuring that program staff have a shared understanding of the purpose of evaluation activities and that these activities occur as intended. Beyond this is the need to secure funding to support the sustainability of the IPP, so that it can continue to contribute to the wellbeing of veterans living with physical and mental health conditions, and their families.

The Effects of Suicide Exposure on Mental Health Outcomes Among Post-9/11 Veterans: Protocol for an Explanatory, Sequential, Mixed Methods Study

BACKGROUND

The toll associated with suicide goes well beyond the individual who died. This study focuses on a risk factor for veteran suicide that has received little previous empirical attention-exposure to the suicide death of another person.

OBJECTIVE

The study's primary objective is to describe the mental health outcomes associated with suicide exposure among veterans who served on active duty after September 2001 ("post-9/11"). The secondary objective is to elucidate why some veterans develop persistent problems following suicide exposure, whereas others do not.

METHODS

This is an explanatory, sequential, mixed methods study of a nationally representative sample of post-9/11 veterans enrolled in Department of Veterans Affairs (VA) health care. Our sampling strategy was designed for adequate representation of female and American Indian and Alaska Native veterans to allow for examination of associations between suicide exposure and outcomes within these groups. Primary outcomes comprise mental health problems associated with trauma and loss (posttraumatic stress disorder and prolonged grief disorder) and suicide precursors (suicidal ideation, attempts, and planning). Data collection will be implemented in 3 waves. During wave 1, we will field a brief survey to a national probability sample to assess exposure history (suicide, other sudden death, or neither) and exposure characteristics (eg, closeness with the decedent) among 11,400 respondents. In wave 2, we will include 39.47% (4500/11,400) of the wave-1 respondents, stratified by exposure history (suicide, other sudden death, or neither), to assess health outcomes and other variables of interest. During wave 3, we will conduct interviews with a purposive subsample of 32 respondents exposed to suicide who differ in mental health outcomes. We will supplement the survey and interview data with VA administrative data identifying diagnoses, reported suicide attempts, and health care use.

RESULTS

The study began on July 1, 2022, and will end on June 30, 2026. This is the only national, population-based study of suicide exposure in veterans and the first one designed to study differences based on sex and race. Comparing those exposed to suicide with those exposed to sudden death for reasons other than suicide (eg, combat) and those unexposed to any sudden death may allow for the identification of the common and unique contribution of suicide exposure to outcomes and help seeking.

CONCLUSIONS

Integrating survey, qualitative, and VA administrative data to address significant knowledge gaps regarding the effects of suicide exposure in a national sample will lay the foundation for interventions to address the needs of individuals affected by a suicide death, including female and American Indian and Alaska Native veterans.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51324.

Towards a framework for patient-centred care coordination: a scoping review protocol

INTRODUCTION

Patient-centred care and care coordination are each key priority areas for delivering high quality healthcare. However, the intersection between these two concepts is poorly characterised. We theorise that greater advancements in healthcare quality could be realised when care is organised in a way that aligns with patients' preferences, needs and values across every level of the healthcare system. There is currently no published review that describes the intersection of patient-centred care and care coordination. We will undertake a scoping review that will be foundational to the development of a conceptual framework for patient-centred care coordination that integrates and synthesises the overlap between these two concepts and describe how it manifests across levels of the healthcare system.

METHODS AND ANALYSIS

A multidisciplinary team of reviewers will conduct a scoping review of published and grey literature to identify and synthesise key concepts at the intersection of patient-centred care and care coordination, following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidance for scoping reviews. Databases we will use in our search include PubMed, CINAHL, Embase, Social Sciences Abstracts, Nursing and Allied Health Premium, Health and Medical Collection, and PsycINFO. Articles will be included that are English-language; published during or after 2001; describe a theory, conceptual model, theoretical framework or definition that addresses both patient-centred care and care coordination. Articles will be excluded if they do not address the intersection of patient-centred care and care coordination; discuss a patient-centred medical home without discussion on patient-centred care concepts; or discuss a paediatric, inpatient or palliative care setting. A data extraction template will facilitate qualitative thematic analysis and findings will be synthesised into a conceptual framework.

ETHICS AND DISSEMINATION

This work does not require ethics approval. A preliminary framework will be presented to a group of patient stakeholders for refinement before dissemination through a peer-reviewed journal and conference presentations.

Engaging veterans in the research process: a practical guide

Aims: Provide guidance for engaging military veterans in various research teams to help overcome veterans' lack of trust in research. Methods: We draw from our combined experience to present four case studies of veteran research on sensitive topics to illustrate successful engagement with veterans. Results: For each case example, we describe veterans' contributions at different phases of research. We then share practical guidance for realizing benefits and overcoming challenges of engaging veterans in research at each phase. In our experience, successful engagement has built trust by aligning research with participants' own experience as veterans. Conclusion: Investigators wishing to engage veterans in research may benefit from the lessons presented through these case studies.