A pilot trial of health coaching to improve functioning and reduce suicide risk among reintegrating Veterans

Portland Va Medical Center, Portland OR

Investigators

Abstract

Background: Veterans’ suicide risk is highest during the first year after military service separation. This heightened suicide risk has been associated with difficulties reintegrating into civilian life. Deficiencies in role functioning (knowing who you are and where you are heading in life) is one of the most commonly reported challenges during reintegration. Role functioning is critical for optimal functioning in adult life roles (e.g., employment) and it is predictive of suicidal ideation and attempts. However, there are no evidence-based interventions that address role functioning to reduce suicide risk and improve functioning in adult life roles. Significance: The importance of reaching Veterans proximal to service separation outside of traditional clinic settings is clear; Veterans’ risk for suicide is highest within the first year of service separation and Veterans are not well-connected to VA care or other services during this time period. Health coaching is a non-clinical health behavior change modality that is designed to improve role functioning and can be delivered virtually (via telephone/video). Although health coaching has been embraced by the Veterans Health Administration (VHA), no rigorous, fully powered trials have examined the effectiveness of health coaching. Virtually-delivered health coaching may be an easily scalable, low-cost approach to reach reintegrating Veterans outside of clinic settings to reduce suicide risk and improve functioning in adult life roles. Innovation: No studies have examined the use of health coaching among reintegrating Veterans outside of the clinic setting. This study’s strategic use of virtually-delivered health coaching builds on VHA’s investment in this non-clinical modality that has the potential to reduce suicide risk during a high-risk transition period. Specific Aims: This pilot study will 1) Examine the feasibility of study procedures and acceptability of the health coaching intervention among reintegrating Veterans; 2) Evaluate measures of mediators and outcomes for suitability in a future confirmatory efficacy trial; and 3) Determine barriers and facilitators of implementation of health coaching among reintegrating Veterans. Methodology: We will enroll a national sample of 94 Veterans within three months of military service separation and follow them for 9 months, capturing their first year of separation. Participants will be randomized to health coaching + enhanced usual care (EUC) or EUC only. The intervention group will receive up to 12 health coaching sessions over the phone or via video (per participant preference). All participants will receive a booklet about VA benefits and services, organized by functional domains, as an enhancement to “usual care.” Participants will complete self-report assessments at baseline, mid-intervention (month 2), post- intervention (month 4), and follow-up (month 9). Approximately 30 participants will complete qualitative interviews on their experiences with health coaching and intervention coaches will complete exit interviews on their experiences delivering coaching. VHA administrative data will be used to ascertain VHA care utilization. We will use study log data, a satisfaction measure, and qualitative interviews to examine feasibility of the study methods and acceptability of the intervention, including potential harms. Evaluation of measures for inclusion in a future efficacy trial will involve characterizing typical variation, descriptive analyses of within-person change across time, and adjusted estimates of treatment effect sizes with 95% confidence intervals. To inform barriers and facilitators to implementing virtually-delivered health coaching we will analyze Veteran qualitative interviews and coach exit interviews using a primarily descriptive thematic analysis approach. Next steps: Data gathered in this study will inform design of a subsequent efficacy trial of virtually-delivered health coaching among reintegrating Veterans and future implementation strategies. This line of research will inform the strategic use of virtually-delivered health coaching as a population-based rehabilitation approach to reduce suicide risk and improve functioning in life roles among reintegrating Veterans.