Abstract:Purpose To examine the impact of a pilot VA Whole Health Coaching program, including whether and how the program helps veterans improve their health and quality of life. Intervention Whole Health Coaching is a structured program to support veterans in making healthy behavior changes to promote holistic well-being. Design This mixed-methods quality-improvement evaluation combined surveys (pre- and post-coaching) with follow-up qualitative interviews. Setting The setting was a large VA healthcare system, encompa… Show more
“…Whole Health Coaching [24][25][26] provided something akin to this point person for many veterans. Among interviewees, one-onone coaching was often crucial to sustained engagement in wellness activities during pandemic-related disruptions.…”
Background Little is known about the COVID-19 pandemic’s impact on US military veterans’ health, wellbeing, and care engagement. Healthcare systems like VA need additional information about the pandemic’s biopsychosocial impacts and how a Whole Health approach may help to address them. Objective To examine how the pandemic has affected veterans’ health, wellbeing, and engagement in the VA Whole Health System of Care. Method We conducted qualitative interviews with 40 veterans at a large multicampus VA healthcare system during the pandemic. Informed by a Whole Health approach, interviews used open-ended questions to holistically explore pandemic impacts on mental and physical health, healthcare access and engagement, social support, coping strategies, and use of VA healthcare and wellness services. Interviews were conducted by telephone, audio-recorded, and analyzed using a matrix-based technique. Interviews were supplemented by an original survey assessing pandemic impacts; descriptive frequencies were calculated to describe and characterize the interviewed sample. Interview Results Nearly, all participating veterans described significant pandemic impacts on their wellbeing, especially loneliness and sorrow stemming from isolation and disruptions to ordinary routines. These emotional impacts—sometimes combined with new constraints on care access and personal mobility—disrupted veterans’ health plans and sometimes deterred engagement in both routine and wellness care. Veterans already struggling with chronic mental and physical health conditions and those who experienced transitions or losses during the pandemic described the most severe impacts on their wellbeing. Virtual VA wellness services, especially health coaching and mind-body wellness groups, were a key source of support and connection for those who engaged in them. Conclusion We discuss the implications of our findings for care systems attempting to implement a Whole Health System of Care, including how they can address postpandemic barriers to engagement in healthcare and wellness programs, and how wellness programs can be leveraged to support those most at risk after the COVID-19 pandemic and in future crises.
“…Whole Health Coaching [24][25][26] provided something akin to this point person for many veterans. Among interviewees, one-onone coaching was often crucial to sustained engagement in wellness activities during pandemic-related disruptions.…”
Background Little is known about the COVID-19 pandemic’s impact on US military veterans’ health, wellbeing, and care engagement. Healthcare systems like VA need additional information about the pandemic’s biopsychosocial impacts and how a Whole Health approach may help to address them. Objective To examine how the pandemic has affected veterans’ health, wellbeing, and engagement in the VA Whole Health System of Care. Method We conducted qualitative interviews with 40 veterans at a large multicampus VA healthcare system during the pandemic. Informed by a Whole Health approach, interviews used open-ended questions to holistically explore pandemic impacts on mental and physical health, healthcare access and engagement, social support, coping strategies, and use of VA healthcare and wellness services. Interviews were conducted by telephone, audio-recorded, and analyzed using a matrix-based technique. Interviews were supplemented by an original survey assessing pandemic impacts; descriptive frequencies were calculated to describe and characterize the interviewed sample. Interview Results Nearly, all participating veterans described significant pandemic impacts on their wellbeing, especially loneliness and sorrow stemming from isolation and disruptions to ordinary routines. These emotional impacts—sometimes combined with new constraints on care access and personal mobility—disrupted veterans’ health plans and sometimes deterred engagement in both routine and wellness care. Veterans already struggling with chronic mental and physical health conditions and those who experienced transitions or losses during the pandemic described the most severe impacts on their wellbeing. Virtual VA wellness services, especially health coaching and mind-body wellness groups, were a key source of support and connection for those who engaged in them. Conclusion We discuss the implications of our findings for care systems attempting to implement a Whole Health System of Care, including how they can address postpandemic barriers to engagement in healthcare and wellness programs, and how wellness programs can be leveraged to support those most at risk after the COVID-19 pandemic and in future crises.
“…And second, establishes a healthy environment including access to self-management resources and support for healthy lifestyles. With the help of these tools and resources, the M2H program leverages evidence-based practices to help enable behavior change, to include motivational interviewing, positive psychology, and appreciative inquiry [ 25 ]. Fig.…”
Background
The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice.
Methods
The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral.
Discussion
Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity.
Trial registration
Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).
“…Health coaches represent one of the most rapidly growing allied health professions in the United States [ 1 , 2 , 3 , 4 , 5 ]. Health coaches partner with clients to identify wellness goals and bolster the knowledge and skills needed to manage chronic conditions [ 2 , 6 , 7 , 8 , 9 , 10 , 11 ]. They achieve this by facilitating “a respectful, peer-like conversation that evokes versus admonishes, refrains from giving advice or lecturing, and leads with empathy, while building rapport and tracking progress” [ 12 ] (p. 5).…”
Section: Introductionmentioning
confidence: 99%
“…In 2018, the United States (US) Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Patient Centered Care and Cultural Transformation began implementing the Whole Health (WH) initiative, an integrative health approach empowering and equipping Veterans to take charge of their health and wellbeing [ 17 , 18 , 19 , 20 ]. WH coaches have been at the front lines of efforts to transform the VHA from a disease-focused healthcare model to one of “creating health” in partnership with patients [ 8 , 21 , 22 ]; as such, they are helping to shift the conversation from “What is the matter with you?” to “What matters to you?” [ 23 , 24 ]. As of 2021, the VHA had trained close to 2000 Whole Health coaches [ 25 ], and by mid-2022, the Whole Health Coaching course had been provided to more than 3215 VHA staff members (personal communication).…”
Section: Introductionmentioning
confidence: 99%
“…The coronavirus (COVID-19) pandemic disrupted the traditional face-to-face delivery of VHA health and wellness programs [ 35 , 36 ]. While there is evidence demonstrating that Veterans in the VHA’s WH program experienced wide ranging biosocial impacts during the pandemic [ 8 ], there is a need for more understanding about how coaches attempted to meet the needs of Veterans residing in rural areas under conditions of COVID-19. The purpose of this study was to explore perspectives of Whole Health (WH) coaches at the Veterans Health Administration (VHA) on meeting the needs of rural Veterans during this time of national crisis.…”
The purpose of this qualitative study was to explore perspectives of Whole Health (WH) coaches at the Veterans Health Administration (VHA) on meeting the needs of rural Veterans during the COVID-19 pandemic. The evaluation design employed a qualitative description approach, employing focus groups and in-depth interviews with a convenience sample of WH coaches across the VHA system. Fourteen coaches who work with rural Veterans participated in either one of three focus groups, individual interviews, or both. The focus group data and in-depth interviews were analyzed separately using thematic analysis, and findings were then merged to compare themes across both datasets. Four primary themes were identified: bridging social risk factors for rural Veterans, leveraging technology to stay connected with Veterans at-a-distance, redirecting Veterans to alternate modes of self-care, and maintaining flexibility in coaching role, during COVID-19. One overarching theme was also identified following a post-hoc analysis driven by interdisciplinary team discussion: increased concerns for Veteran mental health during COVID-19. Coaches reported using a variety of strategies to respond to the wide-ranging needs of rural Veterans during the pandemic. Implications of findings for future research and practice are discussed.
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