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2023 HSR&D/QUERI National Conference Abstract

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1093 — Feasibility and Acceptability of a Mailed Intervention to Increase Readiness to Reduce Alcohol/Tobacco Use in Rural Veterans with Chronic Conditions

Lead/Presenter: Jacob Scharer,  VA Center for Integrated Healthcare
All Authors: Gass JC (VA Center for Integrated Healthcare), Scharer JL (VA Center for Integrated Healthcare) Bernstein LI (VA Center for Integrated Healthcare) Maisto SA (Syracuse University, VA Center for Integrated Healthcare) Funderburk JS (VA Center for Integrated Healthcare)

Objectives:
Despite efforts to address smoking and risky drinking within primary care, there is a group of Veterans that do not change after receiving the brief intervention by their primary care provider. This is significant as chronic conditions (e.g., cardiovascular disease or diabetes) are worsened by smoking and risky drinking. Thus, a step-up in care is needed. Brief motivational interventions including normative feedback and tailored health education are efficacious among ambivalent patients. However, dissemination of interventions to rural Veterans is difficult due to reduced access to care and reduced use of the internet. Therefore, we developed a remote, low-resource and low-burden motivational/educational mail-based intervention, Motivational Intervention Designed for Self-management and EducaTion (MINDSET). In the current study, we examined the feasibility, acceptability, and preliminary effectiveness of MINDSET in rural Veterans.

Methods:
996 Veterans with rural addresses diagnosed with a cardiovascular condition, diabetes, and/or a respiratory condition who screened positive for current risky drinking and/or smoking for at least two years received MINDSET in the mail. MINDSET includes an interactive, guided mailing with normative feedback, education about drinking/smoking’s connection with specific health conditions, and a self-assessment rating of readiness to change using a 10-pt readiness ruler. Approximately two weeks after receiving MINDSET, Veterans were contacted for a brief telephone support call. Then, Veterans were asked to complete a telephone interview to obtain information on acceptability, feasibility, and effectiveness (ratings of readiness to change using a 10-pt readiness ruler following MINDSET).

Results:
Of 996 who received MINDSET in the mail, 40.5% (404) engaged in the support call, and 50.7% (205) of those (M age = 66.7(SD = 9.1), 94% male) agreed to complete the interview. 130 reported smoking, 134 reported risky drinking, and 59 reported both. Prior to receiving MINDSET, readiness to change smoking was rated 4.7/10 (SD = 3.2), and readiness to change drinking was 3.0 (SD = 2.9). In the interview, 182 (88.7%) of 205 participants reported that they had read MINDSET materials with 57.5% reporting they were read entirely. Regarding acceptability, 42.0% reported that MINDSET was very or moderately helpful, 38.5% were neutral, and only 19.5% found MINDSET unhelpful. In this sample of ambivalent Veterans, from pre-MINDSET to the interview, their readiness to change smoking and drinking significantly increased (t = 4.0, p = .0001 for smoking, t = 2.2, p = .03 for drinking).

Implications:
In a sample of rural Veterans with chronic medical conditions, who have not responded to standard VA interventions for smoking/risky drinking, 40.5% accepted the full “dose” of MINDSET, an intervention that they had not sought out on their own. Overall, MINDSET is generally acceptable, ~80% of Veterans surveyed were favorable or neutral toward receiving MINDSET. Preliminary analyses also suggested that MINDSET significantly increased non-treatment seeking smokers’ and risky drinkers’ readiness to change.

Impacts:
It is difficult to identify ways to reach out to rural Veterans more effectively. MINDSET is a low-cost, low-burden, wide-reaching intervention that can serve as another intermediate step in care for Veterans with chronic conditions that are not responding to brief advice provided by their primary care providers.