TY - JOUR
T1 - Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 QUERI
T2 - study protocol for a cluster-randomized hybrid type 3 effectiveness-implementation trial
AU - the EMPOWER QUERI Team
AU - Hamilton, Alison B.
AU - Finley, Erin P.
AU - Bean-Mayberry, Bevanne
AU - Lang, Ariel
AU - Haskell, Sally G.
AU - Moin, Tannaz
AU - Farmer, Melissa M.
N1 - Funding Information:
EMPOWER 2.0 was funded by the VA Quality Enhancement Research Initiative (QUERI; grant number 20-028).
Funding Information:
Dr. Hamilton is supported by a VA HSR&D Research Career Scientist Award (RCS 21-135). Dr. Moin also receives support from the NIH/NIDDK (R01DK124503, R01DK127733, and R18DK122372), NIH/NIDDK/ Centers for Disease Control and Prevention (U18DP006535), the Patient-Centered Outcomes Research Institute (PCORI; SDM-2018C2-13543), the Department of Veterans Affairs (CSP NODES, CSP#2002), and UCLA/UCOP.
Funding Information:
All views expressed are those of the authors and do not represent the views of the US Government or the Department of Veterans Affairs. The authors would like to thank the EMPOWER QUERI 2.0 team, the VA Women’s Health Research Network (SDR 10-012), the participating Veteran Integrated Service Networks, and the women Veterans who inspire this work. Dr. Hamilton is supported by a VA HSR&D Research Career Scientist Award (RCS 21-135). Dr. Moin also receives support from the NIH/NIDDK (R01DK124503, R01DK127733, and R18DK122372), NIH/NIDDK/ Centers for Disease Control and Prevention (U18DP006535), the Patient-Centered Outcomes Research Institute (PCORI; SDM-2018C2-13543), the Department of Veterans Affairs (CSP NODES, CSP#2002), and UCLA/UCOP.
Publisher Copyright:
© 2023, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Women Veterans are the fastest-growing segment of Veterans Health Administration (VA) users. The VA has invested heavily in delivering care for women Veterans that is effective, comprehensive, and gender-tailored. However, gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and the rate of perinatal depression among women Veterans is higher than that among civilian women. Challenges such as distance, rurality, negative perception of VA, discrimination (e.g., toward sexual and/or gender minority individuals), and harassment on VA grounds can further impede women’s regular use of VA care. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 builds on work to date by expanding access to evidence-based, telehealth preventive and mental health services for women Veterans with high-priority health conditions in rural and urban-isolation areas. Methods: EMPOWER 2.0 will evaluate two implementation strategies, Replicating Effective Practices (REP) and Evidence-Based Quality Improvement (EBQI), in supporting the implementation and sustainment of three evidence-based interventions (Virtual Diabetes Prevention Program; Telephone Lifestyle Coaching Program; and Reach Out, Stay Strong Essentials) focused on preventive and mental health care for women Veterans. We will conduct a mixed-methods implementation evaluation using a cluster-randomized hybrid type 3 effectiveness-implementation trial design to compare the effectiveness of REP and EBQI on improved access to and rates of engagement in telehealth preventive lifestyle and mental health services. Other outcomes of interest include (a) VA performance metrics for telehealth care delivery and related clinical outcomes; (b) progression along the Stages of Implementation Completion; (c) adaptation, sensemaking, and experiences of implementation among multilevel stakeholders; and (d) cost and return on investment. We will also generate implementation playbooks for program partners to support scale-up and spread of these and future evidence-based women’s health programs and policies. Discussion: EMPOWER 2.0 provides a model for mixed-methods hybrid type 3 effectiveness-implementation trial design incorporating evaluation of performance metrics, implementation progress, stakeholder experience, and cost and return on investment, with the ultimate goal of improving access to evidence-based preventive and mental telehealth services for women Veterans with high-priority health conditions. Trial registration: ClinicalTrials.gov, NCT05050266 . Registered on 20 September 2021.
AB - Background: Women Veterans are the fastest-growing segment of Veterans Health Administration (VA) users. The VA has invested heavily in delivering care for women Veterans that is effective, comprehensive, and gender-tailored. However, gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and the rate of perinatal depression among women Veterans is higher than that among civilian women. Challenges such as distance, rurality, negative perception of VA, discrimination (e.g., toward sexual and/or gender minority individuals), and harassment on VA grounds can further impede women’s regular use of VA care. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 builds on work to date by expanding access to evidence-based, telehealth preventive and mental health services for women Veterans with high-priority health conditions in rural and urban-isolation areas. Methods: EMPOWER 2.0 will evaluate two implementation strategies, Replicating Effective Practices (REP) and Evidence-Based Quality Improvement (EBQI), in supporting the implementation and sustainment of three evidence-based interventions (Virtual Diabetes Prevention Program; Telephone Lifestyle Coaching Program; and Reach Out, Stay Strong Essentials) focused on preventive and mental health care for women Veterans. We will conduct a mixed-methods implementation evaluation using a cluster-randomized hybrid type 3 effectiveness-implementation trial design to compare the effectiveness of REP and EBQI on improved access to and rates of engagement in telehealth preventive lifestyle and mental health services. Other outcomes of interest include (a) VA performance metrics for telehealth care delivery and related clinical outcomes; (b) progression along the Stages of Implementation Completion; (c) adaptation, sensemaking, and experiences of implementation among multilevel stakeholders; and (d) cost and return on investment. We will also generate implementation playbooks for program partners to support scale-up and spread of these and future evidence-based women’s health programs and policies. Discussion: EMPOWER 2.0 provides a model for mixed-methods hybrid type 3 effectiveness-implementation trial design incorporating evaluation of performance metrics, implementation progress, stakeholder experience, and cost and return on investment, with the ultimate goal of improving access to evidence-based preventive and mental telehealth services for women Veterans with high-priority health conditions. Trial registration: ClinicalTrials.gov, NCT05050266 . Registered on 20 September 2021.
KW - Diabetes Prevention Program
KW - Evaluation
KW - Evidence-based quality improvement
KW - Hybrid effectiveness-implementation trial
KW - Implementation strategies
KW - Mixed methods
KW - Reach Out, Stay Strong Essentials
KW - Replicating effective programs
KW - Stages of Implementation Completion
KW - Telephone Lifestyle Coaching
UR - http://www.scopus.com/inward/record.url?scp=85165603531&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85165603531&partnerID=8YFLogxK
U2 - 10.1186/s43058-022-00389-w
DO - 10.1186/s43058-022-00389-w
M3 - Article
C2 - 36890587
AN - SCOPUS:85165603531
SN - 2662-2211
VL - 4
JO - Implementation Science Communications
JF - Implementation Science Communications
IS - 1
M1 - 23
ER -