title: Pre-Implementation Strategies to Adapt and Implement a Veteran Peer Coaching Intervention to Improve Mental Health Treatment Engagement Among Rural Veterans.
abstract: Telephone motivational coaching has been shown to increase urban veteran mental health treatment initiation. However, no studies have tested telephone motivational coaching delivered by veteran peers to facilitate mental health treatment initiation and engagement. This study describes pre-implementation strategies with 8 Veterans Affairs (VA) community-based outpatient clinics in the West and Mid-South United States to adapt and implement a multisite pragmatic randomized controlled trial of telephone peer motivational coaching for rural veterans.
  
  
  
  We used 2 pre-implementation strategies, Formative Evaluation (FE) research and Evidence-Based Quality Improvement (EBQI) meetings to adapt the intervention to stakeholders' needs and cultural contexts. FE data were qualitative, semi-structured interviews with rural veterans and VA clinic staff. Results were rapidly analyzed and presented to stakeholders during EBQI meetings to optimize the intervention implementation.
  
  
  
  FE research results showed that VA clinic providers felt overwhelmed by veterans' mental health needs and acknowledged limited mental health services at VA clinics. Rural veteran interviews indicated geographical, logistical, and cultural barriers to VA mental health treatment initiation and a preference for self-care to cope with mental health symptoms. EBQI meetings resulted in several intervention adaptations, including veteran study recruitment, peer veteran coach training, and an expanded definition of mental health care outcomes.
  
  
  
  As the VA moves to cultivate community partnerships in order to personalize and expand access to care for rural veterans, pre-implementation processes with engaged stakeholders, such as those described here, can help guide other researchers and clinicians to achieve proactive and veteran-centered health care services.
authors: San Francisco Veterans Affairs Health Care System, San Francisco, California. cjkoenig@sfsu.edu.|Department of Communication Studies, San Francisco State University, San Francisco, California. cjkoenig@sfsu.edu.
authors: Christopher J
authors: CJ
authors: Koenig
authors: Center for Mental Healthcare & Outcomes Research, Health Services Research and Development, Little Rock, Arkansas.|Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Traci
authors: T
authors: Abraham
authors: San Francisco Veterans Affairs Health Care System, San Francisco, California.
authors: Kara A
authors: KA
authors: Zamora
authors: San Francisco Veterans Affairs Health Care System, San Francisco, California.
authors: Coleen
authors: C
authors: Hill
authors: Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.|South Central Mental Illness Research Education Clinical Center (MIRECC), Little Rock, Arkansas.|General Internal Medicine & Geriatrics, Tulane University School of Medicine, New Orleans, Louisiana.
authors: P Adam
authors: PA
authors: Kelly
authors: Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.|South Central Mental Illness Research Education Clinical Center (MIRECC), Little Rock, Arkansas.|Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.
authors: Madeline
authors: M
authors: Uddo
authors: Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.|Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.
authors: Michelle
authors: M
authors: Hamilton
authors: Center for Mental Healthcare & Outcomes Research, Health Services Research and Development, Little Rock, Arkansas.|Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Jeffrey M
authors: JM
authors: Pyne
authors: San Francisco Veterans Affairs Health Care System, San Francisco, California.|Department of General Internal Medicine, University of California-San Francisco, San Francisco, California.|Department of Psychiatry, University of California-San Francisco, San Francisco, California.
authors: Karen H
authors: KH
authors: Seal
mesh_terms: D015444:Exercise / Q000523:psychology; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D000071252:Mentoring / Q000379:methods; D010342:Patient Acceptance of Health Care; D010379:Peer Group; D036301:Qualitative Research; D012424:Rural Population; D000073278:Self-Management; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology*; D000078329:Workforce
keywords: health services research; mental health initiation and engagement; pre-implementation research; qualitative research methods; rural veterans