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Health Services Research & Development

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HSR&D In Progress

December 2020

In This Issue: Enhancing Primary Care for Veterans with Chronic Illness
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Implementing Mobile Health in Primary Care to Enhance Access to Mental Healthcare

Feature Article

Takeaway: This pilot project is the next step in evaluating the effectiveness and implementation potential of using Peer Specialists within VA primary care to support mobile health (mHealth) for Veterans with mental health problems who have difficulty accessing mental healthcare. mHealth is an innovative and low-cost means of expanding access to mental healthcare for Veterans, particularly those living in rural settings or who are affected by the ongoing pandemic.

One in four Veterans presenting to VA primary care suffers from mental health conditions, most commonly depression, which can be a chronic mental illness that leads to poor physical health. However, due to barriers such as time constraints on providers, Veterans’ stigma about seeking mental healthcare, and costs associated with traveling to VA for care, most of these Veterans do not receive any treatment for their mental health problems. The effectiveness of mobile applications (apps) and other mHealth tools is emerging, but poor patient engagement and poor sustainability remain the Achilles’ heel of these tools. Peer Specialists (PS) can enhance patients’ engagement with apps that are intended for self-care of mental health problems by helping to orient patients to these apps and by providing technical support and accountability. In combination with the recent expansion of peer specialists into primary care, studies suggest that they may be the ideal workforce and primary care the ideal setting in which to facilitate the implementation of mHealth into routine care in VA and, in turn, improve access to mental healthcare for Veterans.

This ongoing HSR&D study (February 2020 – January 2021) is testing the deployment of Peer Specialists in the implementation of mHealth in VA primary care. The protocol for peer specialist support of mHealth is grounded in the Whole Health model being disseminated in primary care settings VA-wide. In this study, investigators focus on several VA apps for self-management of mental health problems. Specific aims of the study include:

  • Conducting a formative evaluation to identify barriers and facilitators to using peer specialists to support implementation of mHealth in primary care;
  • Evaluating the feasibility, acceptability, and safety of the protocol among Veteran patients and peer specialists.

To accomplish these goals, investigators will interview Peer Specialists and primary care providers from sites participating in a VA national evaluation of Peers in primary care. Further, at two sites that are participating in the national evaluation (Palo Alto and Syracuse), Peer Specialists will use the protocol to introduce several mental health mobile apps to 12 VA primary care patients who screen positive for depression. Four weeks later, patients will be interviewed to assess satisfaction with the mHealth support received from the peer specialists, feedback regarding barriers and facilitators to this process, and changes in psychiatric distress.


Interviews were conducted with 28 key informants (17 Peer Specialists and 11 primary care providers) from 14 sites participating in VA’s national evaluation of Peers in primary care. Barriers to using Peers to support implementation of mHealth in primary care included:

  • Lack of implementation infrastructure and peer training on mobile health,
  • Lack of knowledge of the peer role among primary care staff, and
  • Limited technology literacy among some patients.

Facilitators to using Peers to support mHealth implementation included:

  • Strong support that this role fit Peers’ scope of practice and expertise, and
  • This role aligned well with a holistic approach to care.

Interview respondents also highlighted the value of Peers in this role, emphasizing the general benefits of apps, demonstrating the apps to patients, and following up with patients to increase accountability for app engagement.


By completing this pilot study, investigators will be well positioned to then evaluate the effectiveness and implementation potential of using peer specialists to support mHealth implementation.

Principal Investigator: Daniel Blonigen, PhD, MA, is an investigator with HSR&D’s Center for Innovation to Implementation (Ci2i) and is part of the VA Palo Alto Healthcare System.

Publications: None to report at this time.

View study abstract

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