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Valentine SE, Fuchs C, Carlson M, Elwy AR. Leveraging multistakeholder engagement to develop an implementation blueprint for a brief trauma-focused cognitive behavioral therapy in primary care. Psychol Trauma 2022; 14:914-923. [PMID: 34661421 PMCID: PMC9013722 DOI: 10.1037/tra0001145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The implementation of evidence-based treatments (EBTs) to address posttraumatic stress disorder (PTSD) is a public health priority. Successful EBT implementation requires effective collaboration between multiple stakeholder groups, including hospital leaders, providers, and patients, to build buy-in for this effort. Method: We describe our implementation science approach to meaningful stakeholder engagement, as part of a hybrid type I effectiveness-implementation trial of Skills Training in Affective and Interpersonal Regulation for PTSD treatment in primary care (STAIR-PC) at a large safety net hospital. We used primary care and patient community advisory boards (CABs) to interpret key informant interviews and identify strategies to adapt the intervention to ensure fit with the primary care setting. We documented our stakeholder engagement methodology through comprehensive field notes and minutes from CAB meetings, detailing the focus of meetings, suggestions for intervention and delivery adaptations, decision-making processes, and how disagreements about adaptations between stakeholders were resolved. To support replicability, we specify and operationalize implementation strategies to be used across each implementation phase of the trial. Results: Key strategies involved a) ensuring that research questions are relevant to both patients and clinical providers; b) tailoring interventions that are flexible and adaptable to the needs of the local setting; c) continuous engagement of patients and providers throughout the implementation process; and d) building mutual respect, trust, and credibility between the research team, various provider groups, and patients. Conclusions: Our approach to engaging stakeholders informed an implementation blueprint to guide implementation of EBTs for PTSD in safety net hospital primary care clinics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Sarah E. Valentine
- Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Cara Fuchs
- Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
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Haibach JP, Hoerster KD, Dorflinger L, McAndrew LM, Cassidy DG, Goodrich DE, Bormann JE, Lowery J, Asch SM, Raffa SD, Moin T, Peterson AL, Goldstein MG, Neal-Walden T, Talcott GW, Hunter CL, Knight SJ. Research translation for military and veteran health: research, practice, policy. Transl Behav Med 2021; 11:631-641. [PMID: 32043529 DOI: 10.1093/tbm/ibz195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.
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Affiliation(s)
- Jeffrey P Haibach
- U.S. Department of Veterans Affairs, Washington, DC, USA.,Veteran Consulting and Research Corp., Rochester, NY, USA
| | - Katherine D Hoerster
- Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Lisa M McAndrew
- War Related Illness and Injury Study Center, VA New Jersey Health care System, East Orange, NJ, USA.,Department of Educational and Counseling Psychology, University at Albany, Albany, NY, USA
| | | | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jill E Bormann
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Hahn School of Nursing and Health Science/Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA
| | - Julie Lowery
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Susan D Raffa
- VA National Center for Health Promotion and Disease Prevention, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alan L Peterson
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Michael G Goldstein
- VA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
| | - Tracy Neal-Walden
- Steven A. Cohen Military Family Clinic at Easterseals, Silver Spring, MD, USA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia, Charlottesville, VA, USA
| | - Christopher L Hunter
- Primary Care and Clinical Patient Engagement/Experience, Military Affairs, Clinical Support Division, Defense Health Agency, Falls Church, VA, USA
| | - Sara J Knight
- VA Salt Lake City Health care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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VanDerBrink E, Boshra S, Harden SM, Oursler KK, Winett R, Davy B. Adapting the "Resist Diabetes" Resistance Training Intervention for Veterans. Transl J Am Coll Sports Med 2020; 5:39-50. [PMID: 33447658 PMCID: PMC7802802 DOI: 10.1249/tjx.0000000000000118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The Resist Diabetes trial demonstrated that twice-per-week resistance training reduced prediabetes prevalence and improved strength among older adults with prediabetes. Our objective was to determine initial perceptions of patients and care providers in a Veterans Affairs Medical Center (VAMC) regarding Resist Diabetes (RD), and ultimately, inform adaptations to improve uptake of RD in the Veterans Health Administration. METHODS A mixed-methods approach was utilized. Care providers (n=20) and veterans with prediabetes (n=12) were recruited to gauge perceptions of the RD program and identify barriers and facilitators to the program referral process and program implementation. Care provider perceptions of the acceptability, appropriateness and feasibility were determined using a validated survey. Open-ended questionnaires and interview guides, based upon the Consolidated Framework for Implementation Research, were utilized to determine major and minor themes within the provider and veteran responses. To identify the dissemination potential of RD, the availability of onsite fitness facilities at VAMC facilities nationally (n=159) was assessed. RESULTS Providers rated (scaled 1-5; 1=completely disagree, 5=completely agree) the RD program as appealing (4.8+/-0.1), appropriate (4.8+/-0.0), and feasible (4.6+/-0.2). Providers reported that prediabetes/diabetes is a significant problem in the VAMC, and that different prevention programs will appeal to different types of VAMC patients. Patients (n=12; 58% female; aged 65+/-10yrs; BMI 34+/-6 kg/m2; HbA1c 5.7+/-1.8%) expressed interest in an exercise-focused diabetes prevention program and defined key barriers: travel, transportation, and time constraints. Among the responding national VAMC sites, 85% (97/114) reported having an onsite fitness facility. CONCLUSION Salem VAMC care providers and veteran patients demonstrated positive perceptions of the Resist Diabetes program. Program adaptations are needed to address barriers to patient participation including travel, transportation and time constraints.
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Affiliation(s)
- Emily VanDerBrink
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg VA, 24061, USA
| | - Soheir Boshra
- Primary Care Service, Salem Veterans Affairs Medical Center, Salem VA, 24153, USA
| | - Samantha M. Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg VA, 24061, USA
| | - Krisann K. Oursler
- Geriatrics Extended Care Service, Salem Veterans Affairs Medical Center, Salem VA, 24153, USA,Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, 24016
| | - Richard Winett
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg VA, 24061, USA
| | - Brenda Davy
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg VA, 24061, USA,Corresponding Author: Brenda Davy, PhD, RDN, 221 Wallace Hall, Virginia Tech, Blacksburg, VA 24061,
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