JMIR Publications

ABSTRACT

Spinal cord injury (SCI) is a debilitating injury that results in chronic paralysis, impaired functioning and drastically altered quality of life (QOL). The Department of Veteran Affairs (VA) is the single largest spinal cord injury (SCI) comprehensive healthcare provider in the nation serving approximately 450 newly injured veterans and active duty service members annually. In addition to requiring specialized clinical healthcare, SCI often results in physical limitations which heighten the role caregivers in SCI healthcare management. Accessing SCI specialty care may be further challenged with development of complexities evident in chronic SCI, the effects of aging, transportation costs, or the distance to the VA hospital or outpatient services, therefore, methods to facilitate improved access are crucial. The “Triangle of Healthy Caregiving for SCI Veterans” is a patient-centered intervention which incorporates SCI Veterans’ caregivers into the VA SCI healthcare team (HCT) and extends into the homes of SCI Veterans using real-time clinical video teleconferencing (CVT). CVT facilitate video-clinic visits, which include clinical evaluations, therapy (physical/occupational), or supportive services (e.g., social work). SCI Veterans’ propensity to multiple secondary complications makes a healthy partnership crucial for the success of keeping better health and functional outcomes as well as quality of life. The goal of the current study is to qualitatively assess the acceptability and utilization of the “Triangle of Healthy Caregiving for SCI Veterans” intervention with SCI Veterans, caregivers, and healthcare teams to modify, improve, and refine the “Triangle of Healthy Caregiving for SCI Veterans” intervention. The direct or indirect impact of the “Triangle of Healthy Caregiving for SCI Veterans” intervention has not yet been determined. The proposed project will qualitatively assess SCI Veterans’, their caregivers’ and VA healthcare team’s perspectives and experiences in the “Triangle of Healthy Caregiving for SCI Veterans” to determine the benefits, challenges and outcomes for everyone involved in the intervention. This three phase qualitative study will collect data using in-depth interviews, observations, semi-structured interviews and focus groups. First, in-depth interviews with Telehealth Coordinators to systematically document the administrative procedures involved in the enrollment of SCI Veterans’ into the CVT system. Next, structured observation of the CVT enrollment process and logistics of home installation of the CVT system will be conducted. Semi-structured interviews will be conducted to assess specific elements of the “Triangle of Healthy Caregiving for SCI Veterans” program, perceived utility and effectiveness, as well as general impressions of the impact of the intervention on the SCI Veterans health and functioning outcomes; caregiver burden and daily caregiver burden. Finally, the research team will conduct one focus group to evaluate the ways in which the “Triangle of Healthy Caregiving for SCI Veterans” is useful in healthcare delivery to SCI veterans and support services to SCI caregivers. This study is relevant because VA medical benefits can significantly enhance the lives of service members who suffer from catastrophic medical conditions during and post active duty. Promoting health through the least invasive means encourages higher satisfaction, can increase participation in preventive care, reduce secondary complications, and reduce cost of medical care.