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2023 HSR&D/QUERI National Conference Abstract

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1195 — Tailoring a Cardiovascular Disease Risk Reduction Program for Women Veterans: The Example of TEAM-WOVEN

Lead/Presenter: Julie Schexnayder,  COIN - Durham
All Authors: Schexnayder JK (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System; University of Alabama at Birmingham), Lewinski A (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System; Duke University) Shapiro A (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System) Lanford T (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System) White-Clark C (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System) Zullig LL (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System; Duke University) Gierisch JM (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System; Duke University) Bosworth HB (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System; Duke University) Goldstein KM (Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System; Duke University)

Objectives:
Cardiovascular disease (CVD) is the leading cause of death among women. To maximize CVD prevention efforts for women Veterans, specific attention is needed to increase CVD risk awareness among women and their providers, to facilitate routine assessment of women-specific CVD risk factors, and to strengthen primary care teams’ abilities to manage under-recognized CVD risk factors in women. One approach to enhancing CVD risk assessment and management for women is through tailoring existing, evidence-based CVD prevention programs. We present an example of gender-tailoring the Veterans Affairs (VA) Team-supported, EHR-leveraged, Active Management (TEAM) hypertension program to enhance the acceptability of CVD risk reduction for women.

Methods:
TEAM is an evidence-based population health management program designed to improve hypertension control; it has been implemented in 16 VA sites. In the last year, we recruited 50% women Veteran participants and implemented program enhancements for gender-specific CVD risk assessment and education. Our tailoring process included: 1) review of the evidence on women-specific CVD risk assessment and programmatic gender tailoring; 2) qualitative interviews with women Veteran participants and TEAM-WOVEN clinic staff capturing their experiences interacting with the program, soliciting gender-based adaptation suggestions, and assessing feasibility and acceptability; 3) support and active monitoring of site-level tailoring of program materials, and 4) monitoring of blood pressure values for all Veteran participants. Results of these activities guided modifications to TEAM materials in line with current evidence on women-specific CVD risk factors. Modified materials underwent review by our study team, TEAM-WOVEN clinic staff, and a women Veteran engagement group prior to implementation.

Results:
Based on our literature review, we considered potential gender-differences in preferences for intervention modality, gender composition of TEAM-WOVEN population health managers, educational content on CVD risk, and social support. In-depth, semi-structured interviews were collected with 18 women Veterans and 11 TEAM-WOVEN clinic staff in the last two years. Qualitative findings suggested that the TEAM-WOVEN intervention modality was acceptable, and that women Veterans appreciated having their clinic teams check in on them periodically to alert them to opportunities to improve their health. The gender of TEAM-WOVEN clinic staff did not emerge as a point of discussion in interviews; currently, all population health managers are women. TEAM clinic staff were supportive of proposed women-specific enhancements to TEAM materials. To date, TEAM-WOVEN tailoring has resulted in the 1) addition of gender and sex-specific risk enhancing factors for CVD in Population health manager’s scripts for CVD risk assessment; 2), guidance on CVD risk awareness counseling specific to women, and 3) adoption and customization of women-focused health education materials.

Implications:
Women-specific risk factors for CVD are often underrecognized by women Veterans and their providers. TEAM exhibited several features that may have increased its acceptability to women Veterans, and we identified multiple opportunities to enhance content on women-specific CVD risk. Our approach may be useful for enhancing other VA risk reduction programs with gender-specific tailoring needs.

Impacts:
Gender-tailoring of an existing VA CVD risk reduction program was well received by clinicians and women Veterans and may accelerate more equitable CVD prevention.