Wellness Self-Management
Condition: Mental Illness; Chronic Medical Illness
MeSH terms: Mental Disorders
Study type: Interventional

Summary: 
      Veterans with schizophrenia, other serious mental illnesses (SMI), and Post Traumatic Stress
      Disorder (PTSD) are at elevated risk for co-occurring chronic medical conditions resulting in
      increased risk of disability, high health care spending, reduced quality of life and early
      mortality. Physical wellness is increasingly recognized as a key component of the VA's
      commitment to developing recovery-oriented and Veteran-centered mental health treatment.
      There is also growing recognition of the value of interventions that promote and improve
      patient self-management of chronic medical conditions. Building on the established efficacy
      of consumer facilitated medical illness self-management programming used in the general
      population and two recent adaptations for use with SMI adults in the public health sector
      (including the investigators' own evaluation of an intervention called Living Well), the
      investigators propose to complete a randomized controlled effectiveness trial of the Living
      Well intervention and simultaneously conduct a well specified process evaluation to optimize
      knowledge accrual regarding important factors that may improve future adoption,
      implementation and sustainability of the Living Well intervention in the VA system of care.
    

Detailed description: 
      Background:

      Veterans with schizophrenia, other serious mental illnesses (SMI), and Post Traumatic Stress
      Disorder (PTSD) are at elevated risk for co-occurring chronic medical conditions resulting in
      increased risk of disability, high health care spending, reduced quality of life and early
      mortality. Physical wellness is increasingly recognized as a key component of the VA's
      commitment to developing recovery-oriented and Veteran-centered mental health treatment.
      There is also growing recognition of the value of interventions that promote and improve
      patient self-management of chronic medical conditions. Building on the established efficacy
      of consumer facilitated medical illness self-management programming used in the general
      population and two recent adaptations for use with SMI adults in the public health sector
      (including the investigators' own evaluation of an intervention called Living Well), the
      investigators propose to complete a randomized controlled effectiveness trial of the Living
      Well intervention and simultaneously conduct a well specified process evaluation to optimize
      knowledge accrual regarding important factors that may improve future adoption,
      implementation and sustainability of the Living Well intervention in the VA system of care.

      Aims:

      Primary AIM 1: Complete a randomized controlled effectiveness trial of the Living Well
      intervention with 242 Veterans with mental illness and at least one co-occurring chronic
      medical condition and evaluate the intervention's effects on functional and service related
      outcomes. The investigators hypothesize that those randomized to the Living Well intervention
      will, in comparison to those randomized to a medical illness education and support group,
      demonstrate improved general health functioning including physical and emotional functioning
      as well as reduced rates of medical emergency room visits for management of a chronic medical
      condition. The investigators will also evaluate intervention effects on more proximal
      attitudinal and behavioral outcomes and assess how these factors mediate improvement in the
      functional and services related outcomes.

      Primary AIM 2: Complete a well specified process evaluation based on the RE-AIM evaluation
      framework to better understand contextual factors that can improve the Reach, Effectiveness,
      Adoption, Implementation and Maintenance which together determine the potential public health
      impact of the Living Well intervention.

      Methods:

      A mix of temporally overlapping quantitative and qualitative methods will be used to maximize
      integration and synthesis of data streams across the two aims to optimize knowledge accrual.

      Impact:

      Despite the growing recognition that self-management strategies hold enormous promise for
      improving quality and outcomes of care for chronic medical illnesses, and the fact that
      self-management is gaining prominence as a mental health recovery oriented treatment focus,
      there are currently no evidence-based peer facilitated medical illness self-management
      interventions available for dissemination within the VA mental health system. The proposed
      study is designed to both generate evidence supporting the effectiveness of a peer
      co-facilitated intervention and to help speed throughput to public health impact by
      collecting important contextual information about factors that may improve future
      dissemination and implementation efforts.
    

Intervention name(s): Living Well; Medical Illness Education & Support Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This study will involve a clinical trial of Living Well (LW), a 12-session, peer co-led, group intervention designed to help veterans with co-occurring Serious Mental Illnesses and Chronic Medical Conditions learn techniques for better health management and ways to live a healthier lifestyle. Key topics that will be discussed are medication side effects, how symptoms of mental illness may affect veterans' ability to manage their medical conditions, effects of substance use on medical and mental health functioning, learning ways to eat healthier and exercise, and how to communicate more effectively with care providers. There will be 3 booster sessions after the 12 sessions, once a month for 3 months.; The comparison condition will be a general Medical Illness Education and Support (MIES) group that will discuss common challenges experienced by those living with a wide range of chronic illnesses and behavioral and lifestyle management techniques that may help veterans to better handle chronic medical conditions that also meets for 12 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Health Services Research
Keywords: self-management