Reaching Veterans Most in Need: Evaluating Engagement in a National Telephone Lifestyle Coaching Program for Veterans

Background: Participating in a comprehensive lifestyle intervention can reduce the risk of cardiovascular disease—the leading cause of death among Veterans. Objective: We assessed whether a national, virtual lifestyle change program (Telephone Lifestyle Coaching, TLC) promoted equal access to care across vulnerable Veteran subgroups (women, racial/ethnic minorities, rural Veterans). Design: We conducted a retrospective evaluation of reach (referrals) and engagement (enrollment) during TLC’s implementation at 44 Veterans Health Administration (VA) sites (March 2019—September 2023). We used bivariate analyses to compare referred vs. non-referred and enrolled vs. not enrolled Veterans, and multivariate logistic regression—among all Veterans and stratified by sex—to assess factors associated with referral and enrollment. Participants: All TLC-eligible Veterans at the 44 implementation sites (N = 2,333,586). Main Measures: We evaluated factors associated with referrals and enrollment in terms of sex, race, ethnicity, and urban/rural residence, controlling for age, prior VA lifestyle program participation, mental health diagnoses, trauma, and cardiovascular health in regression analyses adjusting for clustering by site. Key Results: TLC referral was associated with being female, prior lifestyle program participation, and diagnoses of depression, PTSD, military sexual trauma, overweight/obesity, and cardiovascular risk. Among men, the odds of referral were higher among Black/other race Veterans compared to White Veterans. Enrollment was associated with being female, prior lifestyle program participation, and overweight/obesity diagnosis. Among females, Hispanic/Latino ethnicity increased odds of enrollment while among males, rural residence increased odds of enrollment. Conclusion: TLC demonstrated success in reach and engagement across a diverse Veteran population. Rurality and mental health conditions were not a barrier to TLC program referral, while prior participation in a VA lifestyle change intervention may facilitate subsequent engagement in lifestyle change programs. Providing a virtual option for lifestyle-focused counseling programs is essential for addressing persistent disparities in Veterans’ cardiovascular health outcomes.