Achieving Whole Health: A Preliminary Study of TCMLH, a Group-Based Program Promoting Self-Care and Empowerment Among Veterans

Abstract

Objective An emerging literature suggests patients with chronic illnesses can benefit from integrated, person-centric approaches to health care, including group-based programs. However, much of the research in this area is disease specific. The objective of this study was to collect preliminary evidence on the efficacy of Taking Charge of My Life and Health (TCMLH), a Whole Health group-based program that emphasizes self-care and empowerment on the overall health and well-being of veterans, a population burdened with high rates of multiple chronic conditions. Method Self-reported outcomes, including standardized survey measures, were collected at pretest, posttest, and 2-month follow-up from 77 participants across 15 groups at four VA sites. Random intercept mixed-model regressions were used to analyze data. Results Results from this initial study showed high satisfaction with the program and facilitators, and high attendance. There were significant pre–post gains in self-care attitudes and behaviors, patient motivation, meaning and purpose, mental health, perceived stress, goal progress, and goal-specific hope. Outcomes were maintained at 2-month follow-up for patient motivation, perceived stress, goal-specific hope, and goal progress. Significant gains were observed in health care empowerment and physical health from pretest to follow-up. Conclusions Preliminary findings support the efficacy of TCMLH, a Whole Health group-based program that emphasizes patient empowerment, self-care practices, and peer support. Future research priorities include a rigorous evaluation with a larger sample size and control group to assess effectiveness.

National Implementation of a Group-Based Program Promoting Patient Engagement and Peer Support in the Veterans Health Administration: A Multi-Methods Evaluation

“…For example, lack of space for group sessions and barriers to participant recruitment and retention may have justified use of telehealth modalities and a reduction in the length of the program. Adaptations to TCMLH were both planned (e.g., changes in duration) and unplanned (e.g., delivery modality using telehealth) and occurred by means of local implementers, with direction from program developers on the core components of TCMLH that should be preserved (e.g., self-assessment using the PHI, mindful awareness, SMART goal setting, and self-care educational topic areas) [ 15 ]. As a result, the local adaptations described were consistent with Stirman et al’s framework [ 44 , 46 ] for classifying “contextual modifications” (e.g., changes to format, setting) without altering content of the intervention.…”

“…The VHA has long recognized the importance of promoting patient engagement through peer support by creating distinct position classifications designated for peer support specialists [ 14 ]. Delivered by a trained facilitator (i.e., volunteers, clinicians, administrative staff from community organizations/VHA), TCMLH leverages this organizational investment in peer support through a structured group program that provides veterans with a social environment promoting accountability in which they can (a) determine what matters most to them by exploring their life’s mission, aspirations, or purpose, (b) identify priorities for their health, and (c) acquire skills that empower them to make positive changes in their health through goal-setting [ 15 ]. Key, evidence-based instructional and interactive content includes a Whole Health self-assessment called the Personal Health Inventory (PHI) [ 16 , 17 ], mindful awareness practices [ 18 ], educational self-care content (e.g., nutrition, movement, stress management, and personal development) [ 19 ], and patient-driven SMART (i.e., Specific, Measurable, Action-oriented, Realistic, Timed) goal setting to promote sustainable lifestyle modifications.…”

“…Veterans that have participated in TCMLH report decreased levels of perceived stress, and experience improvements in patient activation, self-care attitudes/beliefs, health goal progress, and quality of life. Feedback from stakeholders revealed the need for program adaptations to support adoption and reach [ 15 , 20 ]. The original curriculum was designed to be delivered via weekly, in-person sessions over 9 weeks.…”

“…Notably, the shift to telehealth required changes to TCMLH facilitator delivery, more robust technical support, and leveraging standardized telehealth technology in a manner that was amenable to group-based delivery and peer support [ 21 ]. Additional details related to TCMLH are published elsewhere [ 15 , 20 , 22 ].…”

‘It Makes You Sit Back and Think Where You Wanna Go’: Veteran experiences in virtual whole health peer‐led groups

“…Prior work indicates that TCMLH participation may positively impact Veteran outcomes, including quality of life, sense of meaning in life, mental health and stress, as well as engagement in healthcare and progress towards achieving personal health goals. 12 , 13 However, little is known about how Veterans themselves perceive these groups or their impacts. In this paper, we seek to fill this gap by exploring Veterans' perspectives on TCMLH groups.…”