The goal of HSR&D's Center for Health Information and Communication (CHIC
) in Indianapolis, IN, is to improve Veterans' healthcare through innovative research on health information, technology, and communication
Veterans frequently face a sense of disconnectedness in their social lives (i.e., loneliness, social isolation) and personal lives (i.e., self-connectedness, lack of purpose or goals when they leave the military), which may be exacerbated during the COVID-19 pandemic. This lack of connectedness – both social and self – has been established as a risk factor for suicidal behaviors. Further, the rate of suicide among post-9/11 Veterans (ages 18-34) remains the highest of all Veteran cohorts, increasing by 76% from 2005 through 2017. Working to reduce the rate of suicide among post-9/11 Veterans, a holistic community-based health promotion program was designed to facilitate social and self-connectedness. Led by researchers at HSR&D’s Center for Health Information and Communication (CHIC), the purpose of this study was to elicit Veteran and stakeholder feedback to prepare the program for piloting and implementation.
REconnecting to Civilian Life using Activities that Incorporate Mindfulness
In alignment with VA’s recommendation to strengthen protective factors in preventing suicidal behaviors, a collaborative team within VA developed a holistic health promotion program known as RECLAIM (REconnecting to Civilian Life using Activities that Incorporate Mindfulness). RECLAIM focuses on a broad range of factors impacting Veterans’ health and addresses the whole person (e.g., emotional, physical, spiritual, social wellness) to facilitate overall connectedness and to reduce the risk of suicidal behaviors among post-9/11 Veterans. As RECLAIM was being prepared for piloting, it was important that post-9/11 Veterans, who may be future participants in the program, and Veteran stakeholders, who would have the ability to recommend or refer Veterans to the program, were involved in its design. Thus, investigators in this study conducted focus groups and interviews with post-9/11 Veterans (n=14) and Veteran stakeholders (n=27) regarding their initial perceptions of the RECLAIM program and considerations for future implementation.
About the Veteran Participants
The average age of Veteran participants was 39 years. Most participants had served in the Army (71%) and had seen combat (79%). Many Veterans indicated they were employed (64%), several were retired (29%), and a few were unable to work due to disability (21%). All Veterans in this study were receiving VA healthcare at the time of their participation.
Initial feedback from participants in this study indicate that RECLAIM is an acceptable and Veteran-centric program. Analysis of the feedback revealed three main themes:
- Enhancing program recruitment and retention;
- Perceived ability of a health promotion program to provide more holistic, Veteran-centered care; and
- Using health promotion programs to help Veterans establish structure in their daily lives.
Specific comments from Veterans, by theme, include the following.
Focus group participants frequently discussed how to get Veterans interested in a health promotion program, what would be necessary for buy-in, and how to keep Veterans engaged in program activities, even after the program concludes.
If you could have a [Veteran] that [others] respected and could sit down with everybody, all of the guys that are getting out or whatever and you talk about these things and be like look, y’all are about to get out. The transition is difficult. Like if you have a respected [Veteran] talk about this…the [Veterans] would listen. –Veteran
Participants with previous experience practicing mindfulness techniques suggested being clear on the level of difficulty involved in learning the proposed activities.
These things are not very easy either, right? They are something that require discipline and daily practice. It took me some time to accept that in order to live a normal life again or anything resembling that, that it was going to take effort, constant effort every single day to get from where I was to where I wanted to be. –Veteran
Participants also suggested reaching out to individuals before they exit the military to establish a sense of familiarity with RECLAIM prior to transitioning back into civilian life.
… Before people get out of [the military] introducing them to some of these things and programs that are paired up. [Letting them know that] the VA has something that’s similar so that when they get out, it looks and feels like home to them. Because the military was home. – Veteran
Perceived ability of a health promotion program to provide more holistic, Veteran-centered care
Participants expressed how the RECLAIM program centered around wellness and how it might encourage Veterans to pursue healthcare outside of illness. One Veteran participant described RECLAIM as “more like wellness than healthcare” because it moves beyond the typical medical model (i.e., specific disease or symptoms) and considered the whole person.
If your body is not doing well, then your mind doesn’t do well. And a lot of doctors, they’ll just throw some meds at mental health to try to make you feel better and they don’t take into consideration the exercise, the eating, the environment that you’re in, or the social aspects. – Veteran
Like it’s just the world that we live in, how busy we are, and how much we put on our plates that we…. It’s very easy to be unmindful, which makes us feel more disconnected. –Veteran
Participants indicated that the space for conducting the program “feels less clinical” than a hospital setting and would provide a “quiet space” for Veterans to focus on things like meditation and breathing.
I mean, I love my country but flags and military logos and the president and all that, I mean it’s not going to feel like a relaxing environment to me, you know? …If you really want me to relax, that’s probably not the best way. – Veteran
Using health promotion programs to help Veterans establish structure in their daily lives
Veterans discuss how they had grown accustomed to the structure of the military. Participants also agreed that providing structure would be especially beneficial for younger Veterans who entered the service prior to acquiring a sense of independence.
I’m out and I’ve never done anything else. I don’t know how to be an adult. Because the military told me what to wear, when to be there. They provided me a nice check…gave me clothes, food, and everything. So for me to get out, I have to do it all by myself, everything. – Veteran
[The military] is a high stress job. But then even when you get out it’s different because now, you’re [experiencing] a very different stress. The stress they’re used to is military stress. That is something you can handle because you’re going to do it every day. – Veteran
This feedback will be used to improve future implementation of the RECLAIM program. In addition, future research might incorporate the aspects of RECLAIM that participants indicated were appealing into other programs for post-9/11 Veterans. In addition, study findings highlight barriers and facilitators to program implementation, along with strategies for recruiting and retaining participants. These are barriers and facilitators that future work should consider and proactively address to increase Veterans’ ability to successfully engage with Veteran-directed programs and interventions.
Shue S, Brosmer J, and Matthias M. Reducing Veterans’ risk for suicidal behaviors: A qualitative study to inform development of the RECLAIM health promotion program. BMC Health Services Research. August 1, 2020;20(1):707.
HSR&D is currently conducting studies on suicide prevention in areas that include but are not limited to: Impact of COVID-19 and Social Distancing on Mental Health and Suicide Risks in Veterans; Enhancing Social Connectedness among Veterans at High Risk for Suicide through Community Engagement; Veteran Engagement Implementation Strategies to Prevent Rural Veteran Suicide; and Advancing Suicide Prevention for Female Veterans. For more information, visit HSR&D’s Suicide research page.