Whole Health coaching to rural Veterans through telehealth: Advantages, gaps, and opportunities.

Background: The Veterans Health Administration (VHA) is one of the largest providers of telehealth in the United States and continues to lead the way in transforming healthcare services. VHA has been implementing its Whole Health (WH) initiative since 2018, a proactive practice empowering patients to take charge of their health and well-being. A key facilitator of the WH initiative is the WH coach who partners with Veterans to achieve their health-related goals. A gap exists in the literature regarding the understanding of WH coaches' use of telehealth to engage rural-residing Veterans. COVID-19 unexpectedly interrupted in-person VHA delivery of care, including WH coaching which primarily relied on in-person delivery and focused less on telehealth. During the pandemic, WH coaches had to adapt and integrate different modalities to engage their Veteran patients. We examined WH coaches' approaches to extending coaching to rural Veterans via technology, emphasizing the advantages of telehealth, existing gaps in telehealth delivery, and opportunities for telehealth as a coaching modality. Methods: This project was implemented as part of a larger mixed methods evaluation regarding WH coaching for rural Veterans; this manuscript presents the findings from the qualitative data from the larger study. The qualitative dataset is comprised of data collected using three different qualitative methods: four focus groups (n = 11; 3-4 participants per group), in-depth individual interviews (n = 9), and open-ended responses from a national web-based survey (n = 140). Focus group, in-depth interview, and open-ended survey data were collected sequentially and separately analyzed following each wave of data collection. Findings from the three analyses were then collaboratively merged, compared, reorganized, and refined by the evaluation team to create final themes. Results: Three final themes that emerged from the merged data were: (1) Advantages of Telehealth; (2) Telehealth Gaps for Rural Veterans, and (3) Strategies for Bridging Telehealth Gaps. Themes explicate telehealth advantages, gaps, and opportunities for rural Veteran WH coaching. Conclusion: Findings highlight that video telehealth alone is not sufficient for meeting the needs of rural Veterans. Digital technologies hold promise for equalizing health access gaps; however, both human factors and broadband infrastructure constraints continue to require WH coaches to use a mix of modalities in working with rural Veterans. To overcome challenges and bridge gaps, WH coaches should be ready to adopt a blended approach that integrates virtual, in-person, and lower-tech options.

Occupational Therapists' Experiences in Conducting Home Assessments and Modifications: Virtual Versus In-person Home Visits...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

To investigate occupational therapists' experiences with home assessments and modifications in VHA, while comparing virtual to in-person home visits. A preliminary qualitative study using semi-structured individual interviews. Department of Veterans Affairs (VA) Home Based Primary Care (HBPC). Purposefully selected occupational therapists implementing home assessments and modifications for rural Veterans (N=3). Not applicable. Semi-structured individual interview via Microsoft Teams. Home visits to conduct home assessments and modifications for rural Veterans were standards of care delivery. However, travel restrictions and social distance during the COVID-19 pandemic required a shift toward virtual care. Our preliminary results show that the VA Video Connect (VVC) application allows occupational therapists to provide instant feedback and training to Veterans when new equipment is installed in the Veteran's home, without the need to drive long-distance. However, the VVC does not allow occupational therapists to measure physical features of the home, such as door threshold height and hallway width. Participants also reported difficulty evaluating Veterans' functioning, such as balance, strength, and gait pattern. Thus, the VVC improves access to the services but requires additional assistance from caregivers compared to in-home assessments. Initial home assessments are recommended to be conducted during home visits, but follow-up visits can be conducted via telehealth depending on Veterans' and caregivers' ability to utilize telehealth devices and perform self-assessments. The study team has no conflicts of interest to report.

Occupational Therapists' Experiences in Conducting Home Assessments and Modifications: Virtual Versus In-person Home Visits

To investigate occupational therapists' experiences with home assessments and modifications in VHA, while comparing virtual to in-person home visits. A preliminary qualitative study using semi-structured individual interviews. Department of Veterans Affairs (VA) Home Based Primary Care (HBPC). Purposefully selected occupational therapists implementing home assessments and modifications for rural Veterans (N=3). Not applicable. Semi-structured individual interview via Microsoft Teams. Home visits to conduct home assessments and modifications for rural Veterans were standards of care delivery. However, travel restrictions and social distance during the COVID-19 pandemic required a shift toward virtual care. Our preliminary results show that the VA Video Connect (VVC) application allows occupational therapists to provide instant feedback and training to Veterans when new equipment is installed in the Veteran's home, without the need to drive long-distance. However, the VVC does not allow occupational therapists to measure physical features of the home, such as door threshold height and hallway width. Participants also reported difficulty evaluating Veterans' functioning, such as balance, strength, and gait pattern. Thus, the VVC improves access to the services but requires additional assistance from caregivers compared to in-home assessments. Initial home assessments are recommended to be conducted during home visits, but follow-up visits can be conducted via telehealth depending on Veterans' and caregivers' ability to utilize telehealth devices and perform self-assessments. The study team has no conflicts of interest to report.

Meeting the Needs of Rural Veterans: A Qualitative Evaluation of Whole Health Coaches' Expanded Services and Support during COVID-19.

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.

Clinical Considerations and Practical Strategies in Implementing Telerehabilitation by Veterans Health Administration Rehabilitation Providers

Date Presented 04/02/2022 There exists a paucity of data-driven guidelines specific to practicalities implementing telerehabilitation. This study explicates gains in practical knowledge for implementing telerehabilitation that were accelerated during the Veterans Health Administration health care systems' rapid shift to telerehabilitation during the COVID-19 pandemic and contributes clinical reasoning considerations, supportive strategies, and practical approaches for engaging veterans in telerehabilitation. Primary Author and Speaker: Consuelo Kreider Additional Authors and Speakers: Mackenzi Slamka Contributing Authors: Jennifer L. Hale-Gallardo, John C. Kramer, Sharon Mburu, Kimberly Findley, Keith J. Myers, Sergio Romero

Providers' Shift to Telerehabilitation at the U.S. Veterans Health Administration During COVID-19: Practical Applications.

Telerehabilitation provides Veteran patients with necessary rehabilitation treatment. It enhances care continuity and reduces travel time for Veterans who face long distances to receive care at a Veterans Health Administration (VHA) medical facility. The onset of the COVID-19 pandemic necessitated a sudden shift to telehealth-including telerehabilitation, where a paucity of data-driven guidelines exist that are specific to the practicalities entailed in telerehabilitation implementation. This paper explicates gains in practical knowledge for implementing telerehabilitation that were accelerated during the rapid shift of VHA healthcare from out-patient rehabilitation services to telerehabilitation during the COVID-19 pandemic. Group and individual interviews with 12 VHA rehabilitation providers were conducted to examine, in-depth, the providers' implementation of telerehabilitation. Thematic analysis yielded nine themes: (i) Willingness to Give Telerehabilitation a Chance: A Key Ingredient; (ii) Creativity and Adaptability: Critical Attributes for Telerehabilitation Providers; (iii) Adapting Assessments; (iv) Adapting Interventions; (v) Role and Workflow Adaptations; (vi) Appraising for Self the Feasibility of the Telerehabilitation Modality; (vii) Availability of Informal, In-Person Support Improves Feasibility of Telerehabilitation; (viii) Shifts in the Expectations by the Patients and by the Provider; and (ix) Benefit and Anticipated Future of Telerehabilitation. This paper contributes an in-depth understanding of clinical reasoning considerations, supportive strategies, and practical approaches for engaging Veterans in telerehabilitation.

Practical Considerations in Qualitative Health Research During the COVID-19 Pandemic.

The COVID-19 pandemic has forced both quantitative and qualitative health researchers to adapt and strategize data collection strategies without causing any harm to the participants or researchers. This has resulted in utilizing various types of strategies such as online surveys and synchronous virtual platforms such as Zoom and Webex. This transition from face-to-face to synchronous online platforms has helped in increasing coverage as well as reaching participants who are otherwise unreachable. While quantitative health researchers seem to have made a seamless transition to synchronous online platforms, qualitative health researchers who rely on studying participants in their "real-world-settings" are facing unique challenges with online data collection strategies. This article critically examines the benefits and challenges of implementing qualitative health research studies via synchronous online platforms and provides several practical considerations that can inform qualitative health researchers. It can also assist Institutional Review Board members in reviewing and implementing qualitative health research study protocols in a manner that preserves the integrity, richness, and iterative nature of qualitative research methodology.