JMIR Publications

ABSTRACT

Background:

There are 8.8 million American Veterans over the age of 65. Older Veterans often have complex health conditions increasing their risk for social isolation and loneliness, disability, adverse health events (e.g., hospitalization and death), mental illness, and heavy healthcare utilization. This population also exhibits low levels of physical function and daily physical activity, which are factors that can negatively influence health. Importantly, these are modifiable risk factors that are amenable to physical therapy intervention. We used a working model based on the dynamic biopsychosocial framework and social cognitive theory to both conceptualize the multifactorial needs of older Veterans with multiple health conditions and to develop a novel, four-component telehealth program to address their complex needs.

Objective:

The purpose of this qualitative program evaluation was to describe Veterans’ experiences of a multicomponent telehealth program and identify opportunities for quality and process improvement. We conducted qualitative interviews with telehealth program participants to 1) collect their feedback on this novel program; 2) explore their experience of program components; and 3) document perceived outcomes and the impact on their daily life, relationships, and quality of life.

Methods:

As part of a multiple methods program evaluation, individual, semi-structured interviews were conducted with key informants who completed ≥ 8 weeks of a 12-week multicomponent telehealth program for Veterans aged 60 years and older with at least 3 medical comorbidities. Interviews were audio recorded and transcribed. Data were analyzed using a directed content analysis approach; Dedoose software was used to assist with data analysis.

Results:

Twenty-one individuals enrolled in the program, of whom 15 (71.4%) met inclusion criteria for interviews, and all 15 completed one-hour interviews. Six main conceptual domains were identified: technology, social networks, therapeutic relationship, patient attributes, access, and feasibility. Themes emerged from each domain and serve to detail unique experiences of the telehealth program. Key informants also provided feedback related to different components of the program leading to adaptions for the biobehavioral intervention, group sessions (transition from individual to group sessions and group session dynamics), and technology supports.

Conclusions:

Findings from this program evaluation supported ongoing quality and process improvements, in preparation to rigorously test the intervention in a larger population through a randomized control trial. Findings may be adapted for the development of similar programs in different contexts. Further research is needed to develop a deeper understanding of how program components influence social health and longer-term behavior change.