Reaching Veterans Most in Need: Evaluating Engagement in a National Telephone Lifestyle Coaching Program for Veterans.

BACKGROUND

Participating in a comprehensive lifestyle intervention can reduce the risk of cardiovascular disease-the leading cause of death among Veterans.

OBJECTIVE

We assessed whether a national, virtual lifestyle change program (Telephone Lifestyle Coaching, TLC) promoted equal access to care across vulnerable Veteran subgroups (women, racial/ethnic minorities, rural Veterans).

DESIGN

We conducted a retrospective evaluation of reach (referrals) and engagement (enrollment) during TLC's implementation at 44 Veterans Health Administration (VA) sites (March 2019-September 2023). We used bivariate analyses to compare referred vs. non-referred and enrolled vs. not enrolled Veterans, and multivariate logistic regression-among all Veterans and stratified by sex-to assess factors associated with referral and enrollment.

PARTICIPANTS

All TLC-eligible Veterans at the 44 implementation sites (N = 2,333,586).

MAIN MEASURES: We evaluated factors associated with referrals and enrollment in terms of sex, race, ethnicity, and urban/rural residence, controlling for age, prior VA lifestyle program participation, mental health diagnoses, trauma, and cardiovascular health in regression analyses adjusting for clustering by site.

KEY

RESULTS

TLC referral was associated with being female, prior lifestyle program participation, and diagnoses of depression, PTSD, military sexual trauma, overweight/obesity, and cardiovascular risk. Among men, the odds of referral were higher among Black/other race Veterans compared to White Veterans. Enrollment was associated with being female, prior lifestyle program participation, and overweight/obesity diagnosis. Among females, Hispanic/Latino ethnicity increased odds of enrollment while among males, rural residence increased odds of enrollment.

CONCLUSION

TLC demonstrated success in reach and engagement across a diverse Veteran population. Rurality and mental health conditions were not a barrier to TLC program referral, while prior participation in a VA lifestyle change intervention may facilitate subsequent engagement in lifestyle change programs. Providing a virtual option for lifestyle-focused counseling programs is essential for addressing persistent disparities in Veterans' cardiovascular health outcomes.