Background: Stroke risk factors overlap with chronic diseases, such as hypertension, diabetes and lifestyle choices that compound cardiovascular risk, such as smoking, diet, and inactivity. We previously validated the Self-management TO Prevent (STOP) Stroke Program at our VA facility to improve Veterans access to preventive care and lifestyle modification/self-care therapies. We found travel distance to be the most significant barrier to dissemination of this intervention. Novel approaches to implementation within community-based settings to reach rural Veterans are needed. Objectives: The overall objective of the proposed pilot project is to determine if a video teleconference delivery model for the STOP Stroke Program (V-STOP) is a feasible strategy to improve access to self-management education and specialty care for rural Veterans.
Specific aims are to: (1) determine system/patient/provider barriers and facilitators to implementing V- STOP (2) describe the effects of V-STOP on access, acceptability, patients' knowledge about stroke risk and self-management behaviors, self-efficacy, and quality of life (QOL), and (3) determine effect sizes and measurement strategies for a future randomized clinical trial. Methods: A formative evaluation of V-STOP outcomes and implementation will be completed using a pilot, open trial design. Focus groups, survey, and pre/post test methods will be utilized to identify factors associated with feasibility and effectiveness of implementation. A sample of (N=30) Veterans with a history of stroke or with multiple stroke risk factors will be recruited from two CBOCs in VISN 16 in a two-phase study. During phase 1, (n = 10) Veterans will be recruited equally from both CBOC sites to participate in V-STOP as currently designed. After completion of the intervention, focus groups will be conducted with V-STOP participants and CBOC clinicians will be surveyed using an investigator developed questionnaire. Direct content analysis will identify system, patient, and provider barriers and facilitators to V-STOP implementation. The V-STOP program will be refined based on this feedback. During phase 2, (n = 20) Veterans will be recruited equally from both sites to participate in the refined V-STOP program. Implementation of the intervention will be determined from program attendance, completion rates, and distance traveled for services. Acceptability will be assessed from satisfaction surveys. Pre/post test measures will be applied to describe the effectiveness of V- STOP on patients' self-management skills, stroke risk knowledge, self-efficacy, and QOL. We will report descriptive statistics on the scores and change in each patient's score from baseline, 12 and 18 weeks. With these data from 20 participants, we may consider using the non- parametric alternative to the paired t-test to determine if the scores at baseline differed significantly from the scores at 12 and 18 weeks. We will also determine measurement strategies and sample sizes for a larger comparative effectiveness trial.
Self-management education has been identified as one key strategy to address the burden of chronic disease to help Veterans manage their health conditions more effectively. Improving access to care via telehealth is a VHA strategic initiative. The use of video teleconference technology at local Community-Based Outpatient Clinics (CBOCs) for patient self-management education and for specialty clinic visits has the potential to enhance access to these types of care services for rural Veterans. If self-management education can be delivered effectively to CBOCs via video teleconferencing, this delivery model has the potential to increase accessibility of specialty programs to all Veterans. If this methodology proves to be a beneficial care delivery method for group self-management educations and specialty clinic care it could be expanded as a model for other risk reduction programs.
