Led by Laura Petersen, MD, MPH, FACP, the mission of HSR&D's Center for Innovations in Quality, Effectiveness and Safety (IQuESt) in Houston, TX is to improve health and wellbeing in healthcare delivery through innovation, implementation, and mentorship
Compared to civilians, Veterans are more likely to experience mental illness – 14% of Veterans are diagnosed with depression, 9% are diagnosed with post-traumatic stress disorder (PTSD), and 5% are diagnosed with anxiety. Further, many Veterans experience difficulties transitioning to civilian life. Among Veterans surveyed about their transition to civilian life, 40% reported difficulties in the previous month, many even three years after their last deployment. A potential avenue to improve mental health and well-being is positive psychology, defined as the scientific study of what makes life most worth living. Self-guided positive psychology interventions can be used to decrease symptoms of mental illnesses and to promote overall wellbeing. A self-guided resource that incorporates positive psychology interventions would allow Veterans access to resources in their homes, without having to enroll in a mental health program, wait for appointments, or overcome the stigma of seeking or receiving care at a mental health clinic. In addition, self-guided resources can be provided to Veterans for little or no cost and do not require travel or access to mental health professionals. However, it is important to note that self-guided resources do not replace treatment from a clinician.
Led by Jennifer Bryan, PhD and Ali Asghar-Ali, MD, investigators with HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt) and the South Central Mental Illness Research, Education, and Clinical Center (MIRECC), this project sought to create the “Veterans Wellness Guide” – a self-guided resource comprising goal setting and evidence-based interventions for Veterans, which incorporate self-kindness, gratitude, breathing techniques, and mindfulness. A Veteran Engagement Group reviewed the guide and provided feedback on Veteran-centric content and design. After investigators revised the guide, a subset of the group approved changes. Additional Veterans used it for two weeks and, again, provided feedback.
The Veteran Wellness Guide
Primarily driven by concepts from positive psychology, the “Veterans Wellness Guide” incorporates elements from several areas of psychology to create brief interventions for skill-building for Veterans. The Guide begins with a brief introduction to SMART (Specific, Measurable, Attainable, Relevant, Timely) goal setting, and is then divided into five sections: 1) Understanding Health, 2) Managing Thoughts, 3) Making Every Moment Count, 4) Sleeping Well, and 5) Healthy Eating. Each section is created to stand alone, and Veterans can use as many – or as few sections and activities as they like, in any order. For example, the section titled Understanding Health focuses on helping Veterans interpret what health means to them – and on considering what activities in their lives make them feel healthy or unhealthy. The Making Every Moment Count section contains exercises on improving wellness through quick relaxation (e.g., diaphragmatic breathing, meditation), increasing physical activity, engaging in pleasurable activities (e.g., hobbies, laughter), and spending time outdoors on wellness.
A Veteran Engagement Group, with seven Veteran stakeholders from the Houston area, was included in the focus group that provided input on the Guide. Participants were of varying ages (35 to 52), genders (five women, two men), race and ethnicity (African American, White, White/Hispanic, Pacific Islander/Hispanic), military branch (Navy, Army, Marine and Coast Guard), and service eras (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], and the Gulf War). The Veterans also represented many occupations, including peer support specialists (Veterans with personal experience of mental health treatment who are employed by VA and support other Veterans receiving mental health care), Veteran Service Organization (VSO) workers, and students.
Following the initial feedback and revision of the “Veterans Wellness Guide,” six Veterans (three men and three women) pilot tested the Guide and participated in interviews two weeks later. These Veterans had served in multiple war eras (OEF/OIF, Gulf War, and Vietnam War) and in the Army and Air Force. Five Veterans identified as African American, and one identified as biracial.
Veterans reported the “Veterans Wellness Guide” as being highly useful, were willing to recommend it to other Veterans, and identified a need for it in the Veteran community. The Veteran stakeholders reported that all activities in the Guide could be useful and highlighted some activities they thought would be especially beneficial. For instance, many stakeholders liked the mindfulness activity and the gratitude journal in the Managing Thoughts section. Additionally, a recurring theme was the inclusion of family and friends. Many Veterans spoke of sharing the Guide with their spouse, children, neighbors, or a coworker, and remembering how important others are in their journey of wellness. [See below for additional, more specific feedback from Veterans.]
Veterans, VA clinicians, and leadership helped craft a dissemination plan to reach Veterans whether they receive care through VA or the community. The “Veterans Wellness Guide” was then disseminated via email and social media.
Veterans in the pilot test believed that they had gained new knowledge about wellness after reading the Guide – and that it represented a wide spectrum of wellness. The following quotes are from Veterans who participated in the focus group, pilot test, and who provided comments on the website.
I thought it was full of a lot of good information that I didn’t know, and I thought I knew a lot about wellness.
Could help people who are not very healthy move toward wellness exercise; can encourage people to keep a positive attitude when times are difficult.
Treat the whole person. If someone has a mental health problem, you have to heal the whole person.
Great guide to wellness, practical advice. Thanks!
Partnering with Veterans in the creation of the “Veterans Wellness Guide” has led to a Veteran-centric product tailored to meet the unique wellness needs of Veterans. Both Veterans and leadership encouraged wide dissemination of the Guide. Thus far, it has been disseminated nationally and downloaded more than 3,500 times. The Guide can be downloaded for free here.
With the adoption of the Whole Health approach, VA has been focusing on the physical, emotional, and social wellbeing of Veterans. Investigators have met with national VA leadership for Whole Health, who have listed the “Veterans Wellness Guide” on the Whole Health SharePoint – and have presented the Guide on a national call for Whole Health peer- support specialists.