Engagement, experience, and satisfaction with peer-delivered whole health coaching for veterans with PTSD: A mixed methods process evaluation.

Abstract

To describe the process of peer delivered Whole Health Coaching, a primary care based intervention in which peers provide patients with individualized support to set and work toward wellness goals. Fifteen primary care Veterans with PTSD participated in peer delivered Whole Health Coaching during a multiple baseline design study. This is a planned mixed methods concurrent equal status analysis of the process of peer delivered Whole Health Coaching including patient engagement, patient experience, fidelity to the coaching and peer roles, and patient satisfaction. Data sources were feedback interviews, electronic medical record reviews, self report assessments, and observer fidelity ratings of session recordings. Qualitative data were used to expand the interpretation of quantitative descriptive data. A rapid assessment approach was used for qualitative analysis. Retention in peer delivered Whole Health Coaching was 11 of 15 participants, and factors facilitating engagement were peers as providers and flexibility in scheduling/modality of sessions. Peers demonstrated high fidelity to coaching skills, Whole Health Coaching phases and stages, and the peer role. Participants expressed high satisfaction and perceived peer delivered Whole Health Coaching as helpful with making progress on individualized wellness goals. Results build on the literature describing the expansion of peer services into primary care and implementation of interventions such as wellness coaching. This initial small study suggests that peers can deliver high quality wellness coaching, and this description of the process can guide the integration of peers doing wellness coaching in similar clinical settings and for future research trials. Impact StatementPeer providers can deliver high quality wellness coaching to Veterans with PTSD in a manner that is satisfactory to those Veterans. These findings can help inform integration of peers in settings where wellness coaching is performed.

Peer Workers in Co-production and Co-creation in Mental Health and Substance Use Services: A Scoping Review

“…Some studies also applied qualitative-oriented methods, such as interviews (Beehler et al, 2014 ; Muralidharan et al, 2020 ; Wusinich et al, 2020 ) and a case study (Harris et al, 2020 ). Clinical trials typically measured peer workers’ fidelity in delivering specific tasks (Fortuna et al, 2018 ; Johnson et al, 2021 ; Kern et al, 2013 ; McCarthy et al, 2019 ) or compared patients’ symptoms and functioning before and after peer workers (co)-delivered services (Cheng & Yen, 2021 ).…”

“…While these clinical trials and RCT studies have been criticized for their lack of attention to core peer work principles when measuring outcomes (King & Simmons, 2018 ), some of them explicitly reported that the pre-defined activities reflected a peer support perspective (Johnson et al, 2021 ; McCarthy et al, 2019 ; Shaw et al, 2021 ; Simpson et al, 2014 ; Thomas & Salzer, 2018 ; Wusinisch et al, 2020 ). Some also included measurements of fidelity to peer support principles before conducting RCTs (Green et al, 2013 ; Kidd et al, 2021 ).…”

Peer specialist-led interventions in primary care at the Veterans Health Administration: An integrative review.

“…The 13 included articles, published between 2014 and 2022, were based on 11 unique studies; two articles (Johnson, Possemato, Martens, et al, 2022;Resnik et al, 2017) conducted secondary analyses of data that were used in two other articles included in our review (Johnson, Possemato, Khan, et al, 2022;Yoon et al, 2017). Regarding intervention targets, two studies targeted mental health symptoms and stress broadly, one study targeted health/well-being broadly, two studies targeted health/treatment engagement for homeless veterans specifically, one study targeted mental health treatment initiation, two studies targeted depression and/or anxiety, one study targeted posttraumatic stress disorder (PTSD), one study targeted alcohol use, and one study targeted both alcohol use and "Having a peer helped me better navigate the VA system" Sixty-five percent of the subsample and 83% of the full sample benefited from a peer mentor.…”

“…See Table 4 for further details on qualitative themes extracted from these articles. Regarding common themes that emerged from feedback from veterans, many emphasized the significance/helpfulness of working with a peer with shared lived experiences, which enhanced rapport and trust (Blonigen et al, 2021(Blonigen et al, , 2022(Blonigen et al, , 2023Johnson, Possemato, Khan, et al, 2022). Another theme was the importance of personalizing an intervention to individual veteran goals/symptoms (Johnson, Possemato, Khan, et al, 2022;Resnik et al, 2017).…”

“…Regarding common themes that emerged from feedback from veterans, many emphasized the significance/helpfulness of working with a peer with shared lived experiences, which enhanced rapport and trust (Blonigen et al, 2021(Blonigen et al, , 2022(Blonigen et al, , 2023Johnson, Possemato, Khan, et al, 2022). Another theme was the importance of personalizing an intervention to individual veteran goals/symptoms (Johnson, Possemato, Khan, et al, 2022;Resnik et al, 2017). Many veterans reported that peers were helpful in providing accountability (Blonigen et al, 2021(Blonigen et al, , 2023Possemato et al, 2019;Seal et al, 2021), motivation and encouragement (Blonigen et al, 2023;Johnson, Possemato, Khan, et al, 2022;Seal et al, 2021), emotional support (Blonigen et al, 2022;Johnson, Possemato, Khan, et al, 2022;Possemato et al, 2019;Resnik et al, 2017;Seal et al, 2021), resources (Blonigen et al, 2022;Johnson, Possemato, Khan, et al, 2022;Seal et al, 2021), and assistance with navigating the VA and other health care systems (Blonigen et al, 2022;Johnson, Possemato, Khan, et al, 2022;Resnik et al, 2017).…”