Pilot Testing a Virtual Mindfulness-Based Intervention Aimed at Improving Reintegrating Veterans' Health Outcomes

试点测试基于虚拟正念的干预措施，旨在改善退伍军人重返社会的健康结果

• 批准号: 10749770
• 负责人: Sarah Shue
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749770
• 关键词: Address; Affect; Anxiety; Applications Grants; Area; Award; Collaborations; Community Healthcare; Consult; Control Groups; Data; Diagnosis; Education; Ensure; Family; Feedback; Funding; Future; Goals; Health; Health Services Research; Healthcare Systems; Intervention; Interview; Investigator-Initiated Research; Life; Manuals; Meditation; Mental Depression; Mental Health; Mental Health Services; Methodology; Methods; Military Personnel; Modality; Outcome; Outcome Assessment; Participant; Patient-Centered Care; Patients; Personal Satisfaction; Persons; Pilot Projects; Procedures; Process; Protocols documentation; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Priority; Resources; Sampling; Scanning; Services; Sleep; Social isolation; Social support; Strategic Planning; Stress; Structure; Subgroup; Suggestion; Testing; United States Department of Veterans Affairs; Update; Veterans; Veterans Health Administration; Work; Yoga; acceptability and feasibility; arm; care delivery; cohort; community reintegration; cost; critical period; depressive symptoms; design; effectiveness evaluation; experience; feasibility testing; hybrid type 1 trial; improved; innovation; interest; internalized stigma; intervention refinement; military service; mindfulness; mindfulness intervention; mindfulness meditation; pilot test; post 9/11; programs; psychoeducation; psychoeducational; psychosocial; psychosocial adjustment; psychosocial stressors; randomized controlled design; randomized trial; recruit; research and development; treatment arm; virtual; virtual delivery; virtual intervention; whole health

Background: Community reintegration is a critical period of transition for post-9/11 Veterans. Difficulties associated with the transition out of military service are well documented and include challenges such as social isolation and loss of structure. Depression is common among reintegrating post-9/11 Veterans and can further complicate these reintegration challenges. Despite the well-documented needs of post-9/11 Veterans and numerous resources, Veterans continue to report inadequate support and are not using available services. As such, it is critical to develop reintegration services that can effectively address Veterans' mental health care needs using approaches that increase the likelihood of Veteran engagement. Significance: The Veterans Affairs (VA) Administration has committed to addressing the transition-related challenges of the post-9/11 Veteran cohort, particularly programming to support their mental health care needs. Mental health is also a priority research area. The VA's 2022-2028 Strategic Plan includes a strategic goal that ensures VA programs and initiatives support the whole person and address mental health and other challenges affecting Veterans' well-being, including the military-to-civilian transition. The REconnecting to Civilian Life using Activities that Improve Mindfulness (RECLAIM) intervention addresses the priority and strategy of addressing reintegrating post-9/11 Veterans' mental health. We will also elicit Veterans' experiences in participating in a virtual intervention to expand the understanding of how best to design and implement interventions with virtual components, which informs another high priority research area. Innovation and impact: RECLAIM introduces a variety of brief mindfulness-based practices (averaging 10 minutes), which are integrated with additional components, such as education and group discussion, that focus on aspects of Veterans' community reintegration (e.g., sleep, relationships). RECLAIM sessions expand on traditional practice offerings (body scan, yoga) to include other mindfulness practices (inner resource, restorative meditations) that have demonstrated positive impacts on participants' overall functioning and can mitigate anxiety, stress, and depression. The variety of brief practices in RECLAIM allows Veterans to easily integrate these practices into their daily lives and explore several types of practices to find what best meets their needs. This approach increases the likelihood of continued engagement and, therefore, continued benefit. Additionally, virtual delivery of RECLAIM is based on previous research suggesting that virtual offerings may enhance Veterans' engagement with mindfulness-based interventions. Specific aims: The specific aims of this project are (1) conduct a randomized controlled pilot study to assess feasibility of the RECLAIM intervention; (2) conduct qualitative interviews to assess acceptability of RECLAIM; and (3) refine and prepare the RECLAIM intervention for broader testing. Methodology: In Aim 1, we will conduct a two-arm randomized controlled pilot study to assess aspects of feasibility (e.g., recruitment, randomization, retention in both the intervention and control arms). In Aim 2, we will use qualitative interviews to elicit input from a purposefully sampled subgroup of Aim 1 RECLAIM participants (N=16) to assess acceptability. We will use rapid qualitative inquiry to conduct the analysis. In Aim 3, we will use the findings from Aims 1 and 2 to iteratively refine the RECLAIM protocol and testing procedures. We will consult with a panel of Veterans from the HSR&D CHIC Research Advisory Panel and operational partners (e.g., Office of Patient Centered Care and Cultural Transformation). Next steps/implementation: Findings from the proposed pilot project will directly inform and provide key pilot data for a Health Services Research and Development (HSR&D) Investigator Initiated Research (IIR) Merit grant application. The future IIR will assess the effectiveness of RECLAIM in a fully powered randomized controlled trial while simultaneously planning for implementation.

背景：重新融入社区是 9/11 事件后退伍军人的关键过渡时期。困难 与退伍相关的问题有据可查，其中包括社会等挑战 结构的隔离和损失。抑郁症在 9/11 事件后重新融入社会的退伍军人中很常见，并且可能进一步加剧 使这些重返社会挑战变得更加复杂。尽管 9/11 事件后退伍军人的需求有据可查， 尽管资源众多，退伍军人仍然报告支持不足，并且没有使用可用的服务。作为 因此，开发能够有效解决退伍军人心理健康问题的重返社会服务至关重要 需要使用增加退伍军人参与可能性的方法。 意义：退伍军人事务部 (VA) 管理局已致力于解决与过渡相关的问题 9/11 后退伍军人群体面临的挑战，特别是支持他们心理健康护理的规划 需要。心理健康也是一个优先研究领域。 VA 的 2022-2028 年战略计划包括战略 确保 VA 计划和举措支持整个人并解决心理健康和其他问题的目标 影响退伍军人福祉的挑战，包括军民过渡。重新连接到 使用提高正念活动（RECLAIM）干预的平民生活解决了优先事项和 解决 9/11 后退伍军人重返社会心理健康问题的战略。我们还将征集退伍军人的 参与虚拟干预的经验，以扩大对如何最好地设计和 利用虚拟组件实施干预措施，这为另一个高度优先的研究领域提供了信息。 创新和影响：RECLAIM 引入了各种简短的基于正念的实践（平均 10 分钟），这些内容与其他内容相结合，例如教育和小组讨论，重点关注 关于退伍军人重新融入社区的各个方面（例如睡眠、人际关系）。 RECLAIM 会话扩展为 传统练习（身体扫描、瑜伽）包括其他正念练习（内在资源、 恢复性冥想）已证明对参与者的整体功能有积极影响，并且可以 减轻焦虑、压力和抑郁。 RECLAIM 中的各种简短练习使退伍军人能够轻松地 将这些实践融入到他们的日常生活中，并探索几种类型的实践，以找到最适合的实践 他们的需求。这种方法增加了持续参与的可能性，从而持续受益。 此外，RECLAIM 的虚拟交付基于之前的研究，表明虚拟产品可能会 提高退伍军人对基于正念的干预措施的参与。 具体目标：该项目的具体目标是（1）进行随机对照试点研究以评估 RECLAIM 干预的可行性； (2) 进行定性访谈以评估 RECLAIM 的可接受性； (3) 完善和准备 RECLAIM 干预措施以进行更广泛的测试。 方法：在目标 1 中，我们将进行一项双组随机对照试点研究，以评估以下方面： 可行性（例如，招募、随机化、干预组和对照组的保留）。在目标 2 中，我们 将使用定性访谈从目标 1 回收的专门抽样小组中获取意见 参与者（N = 16）评估可接受性。我们将使用快速定性调查来进行分析。瞄准 3、我们将使用目标 1 和 2 的发现来迭代完善 RECLAIM 协议和测试程序。 我们将咨询 HSR&D CHIC 研究咨询小组和运营部门的退伍军人小组的意见 合作伙伴（例如，以患者为中心的护理和文化转型办公室）。 后续步骤/实施：拟议试点项目的调查结果将直接告知并提供关键试点 卫生服务研究与开发 (HSR&D) 研究者发起研究 (IIR) 优点的数据 拨款申请。未来的 IIR 将在全动力随机试验中评估 RECLAIM 的有效性 控制试验，同时规划实施。