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CDA 15-257 – HSR&D Study

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CDA 15-257
Patient-centered Strategies to Engage Veterans in Behavioral Health Services
Jessica Yelena Breland PhD MS BA
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: October 2016 - September 2021

BACKGROUND/RATIONALE:
Almost 80% of Veterans using the Veterans Health Administration (VHA) are overweight or obese, putting millions at risk for costly and debilitating chronic conditions. Weight loss treatments improve health, but there is an implementation gap: VHA offers weight loss treatments to 94% of overweight/obese Veterans, but only 10% use them. Therefore, improving weight loss treatment engagement could prolong millions of lives. Motivational interviewing can improve treatment engagement (i.e., help patients initiate/maintain treatments), but clinicians have limited time to use it. As a result, there is a need for a motivational, self-help tool that can increase Veterans' weight loss treatment engagement without requiring clinicians' time.

OBJECTIVE(S):
Aim 1: Identify patient and organizational predictors of weight loss treatment engagement.
Aim 2: Develop a motivational, self-help tool to increase weight loss treatment engagement.
Aim 3: Pilot-test a motivational, self-help tool to engage Veterans in weight loss treatments.

METHODS:
Aim 1 used interviews with clinicians and national leaders to identify VHA behavioral weight loss treatments, including, but not limited to MOVE! (VHA's primary weight loss treatment). Next, gender stratified administrative database analyses will be used to identify patient and organizational predictors of Veterans' engagement in those treatments. Aim 2 uses Aim 1 results and interviews with VHA clinicians and patients to develop a motivational, self-help tool to increase women and men Veterans' weight loss treatment engagement. Aim 3 will be a pilot test of the tool to assess the feasibility of methods for a subsequent randomized trial of the tool's effects on weight loss treatment engagement.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The proposed research will help identify Veteran populations most in need of improved weight loss treatment engagement and inform efforts to implement VHA weight management programs. Findings may ultimately lead to increased engagement in effective weight loss treatments that will improve the health of Veterans through weight loss, improved physical health, and improved quality of life. Results may also facilitate understanding of and improvements in engagement and outcomes related to other behavioral health treatments.

PUBLICATIONS:

Journal Articles

  1. Sterling MR, EcheverrĂ­a SE, Commodore-Mensah Y, Breland JY, Nunez-Smith M. Health Equity and Implementation Science in Heart, Lung, Blood, and Sleep-Related Research: Emerging Themes From the 2018 Saunders-Watkins Leadership Workshop. Circulation. Cardiovascular quality and outcomes. 2019 Oct 15; 12(10):e005586.
  2. Breland JY, Wong MS, Frayne SM, Hoggatt KJ, Steers WN, Saechao F, Washington DL. Obesity and Health Care Experiences among Women and Men Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Jun 25; 29 Suppl 1:S32-S38.
  3. Patel ML, Wakayama LN, Bass MB, Breland JY. Motivational interviewing in eHealth and telehealth interventions for weight loss: A systematic review. Preventive medicine. 2019 Sep 1; 126:105738.
  4. Wong JJ, Hood KK, Breland JY. Correlates of health care use among White and minority men and women with diabetes: An NHANES study. Diabetes research and clinical practice. 2019 Apr 1; 150:122-128.
  5. Altman M, Huang TTK, Breland JY. Design Thinking in Health Care. Preventing chronic disease. 2018 Sep 27; 15:E117.
  6. Zulman DM, O'Brien CW, Slightam C, Breland JY, Krauth D, Nevedal AL. Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies. Journal of general internal medicine. 2018 Nov 1; 33(11):1937-1944.
  7. O'Brien CW, Breland JY, Slightam C, Nevedal A, Zulman DM. Engaging high-risk patients in intensive care coordination programs: the engagement through CARInG framework. Translational behavioral medicine. 2018 May 23; 8(3):351-356.
  8. Breland JY, Quintiliani LM, Schneider KL, May CN, Pagoto S. Social Media as a Tool to Increase the Impact of Public Health Research. American journal of public health. 2017 Dec 1; 107(12):1890-1891.
  9. Timko C, Ilgen M, Haverfield M, Shelley A, Breland JY. Polysubstance use by psychiatry inpatients with co-occurring mental health and substance use disorders. Drug and Alcohol Dependence. 2017 Nov 1; 180:319-322.
  10. Breland JY, Donalson R, Nevedal A, Dinh JV, Maguen S. Military experience can influence Women's eating habits. Appetite. 2017 Nov 1; 118:161-167.
  11. McAndrew LM, Martin JL, Friedlander M, Shaffer K, Breland JY, Slotkin S, Leventhal H. The Common Sense of Counseling Psychology: Introducing the Common Sense Model of Self-Regulation. Counselling psychology quarterly. 2017 Aug 1; doi.org/10.1080/09515070.2017.1336076.
  12. Breland JY, Donalson R, Li Y, Hebenstreit CL, Goldstein LA, Maguen S. Military sexual trauma is associated with eating disorders, while combat exposure is not. Psychological trauma : theory, research, practice and policy. 2018 May 1; 10(3):276-281.
  13. Breland JY, Phibbs CS, Hoggatt KJ, Washington DL, Lee J, Haskell S, Uchendu US, Saechao FS, Zephyrin LC, Frayne SM. The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans. Journal of general internal medicine. 2017 Apr 1; 32(Suppl 1):11-17.
  14. Breland JY, Donalson R, Dinh JV, Maguen S. Trauma exposure and disordered eating: A qualitative study. Women & health. 2018 Feb 1; 58(2):160-174.


DRA: Cardiovascular Disease, Diabetes and Related Disorders, Other Conditions
DRE: Prevention, Technology Development and Assessment, Treatment - Preclinical
Keywords: none
MeSH Terms: none

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