2017 HSR&D/QUERI National Conference

1070 — ActiVets: A Clinical Innovation to Improve Physical Health Among Rural Veterans with PTSD

Lead/Presenter: Tisha Deen, COIN - North Little Rock
All Authors: Deen TL (Central Arkansas Veterans Healthcare System North Little Rock COIN) Abraham TH (Central Arkansas Veterans Healthcare System North Little Rock COIN) Roca JV (Central Arkansas Veterans Healthcare System) Harris K (Central Arkansas Veterans Healthcare System) Rabalais AE (Central Arkansas Healthcare System)

Rural Veterans have a higher disease burden than urban Veterans. Furthermore, Veterans with PTSD report more barriers to engaging in healthy behaviors (e.g., exercise, smoking cessation, substance use) than Veterans without mental illness. This data suggests that rural Veterans with PTSD may require additional support to improve health. ActiVets is a clinical demonstration project funded by the VHA Office of Rural Health to create an innovative approach to decreasing this disparity.

ActiVets was developed by a team of experts in PTSD and behavioral health in the PTSD clinic at the Central Arkansas Veterans Healthcare System. It combines elements of two evidence-based approaches: mindfulness and value-based decision-making from Acceptance and Commitment Therapy (ACT) and strategies to set and reach goals from self-regulation theory. The unique approach targets the specific barrier of avoidance to engaging in health behaviors in Veterans with PTSD. ActiVets consists of two 90-minute groups and six optional monthly maintenance groups The intervention was condensed to increase access for rural Veterans. Data were collected at the first session and after 4-6 months.

A total of 180 Veterans with PTSD participated from FY14 to FY16. Most participants were men (87%); rural (75%) rural and minority (64%). Baseline (n = 180) health status was fair or poor and most were sedentary and overweight at baseline. At follow-up (n = 93), 75% of participants walked 10 minutes daily and 82% ate leafy vegetables at least once per week. Additional follow-up data (n = 48) revealed 44% lost at least 5 pounds and 23% lost 10 pounds or more. Each monthly optional meeting was attended by 15-25 Veterans (120/180 attending at least one). Qualitatively, most Veterans reported using the ACTiVets approach to implement health behaviors (e.g., exercising 3-4 days per week, gardening, eating small meals).

Preliminary findings suggest that ACTiVets is accepted by rural Veterans with PTSD and may be useful to improve health outcomes for these Veterans. Future research is needed to fully understand the impact of the ACTiVets intervention.

Dissemination of this project and results can inform innovations aimed at improving health behaviors by targeting the specific needs of the Veterans.