How Engaged Research Improved A Diabetes Self-Management Tool for MyHealtheVet

HSR&D’s monthly publication Veterans’ Perspectives highlights research conducted by HSR&D and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the March 2020 Issue:

• Introduction: This issue focuses on how engaging Veterans in research is improving online, diabetes self-management.
• The Use of My HealtheVet to Improve Diabetes Self-Management: A study led by Dr. Stephanie Shimada works to increase the effective use of online patient portals for Veterans with chronic illness.
• Adding Veterans to the Research Team: We hear from Dr. Shimada and Air Force Veteran, Richard Duffey, about how input from Veterans improves self-management interventions.
• Making Connections by Working Together: The beneficial personal connections that can form between researchers and Veterans.

Introduction

VA understands the value of Veteran engagement in research and how expanding space for varying ideas and experiences can make a difference in the quality and relevance of research studies. In keeping with that spirit, researchers at HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR) formed the Veteran Consultant Network.

Through word of mouth and active recruitment efforts, investigators identify Veterans interested in learning more about VA research and participating as consultants on research teams. Veteran consultants are provided with a formal introduction to CHOIR’s work and the responsibilities they may have as a research team member. Their specific interests or motivations also are identified so that CHOIR can help connect them to research projects or teams that are aligned with their values and experience.

While the initial idea for the VCN was formed in 2015, it took several years of planning for the network to be ready to introduce Veterans as consultants to CHOIR research teams. The formal launch of the VCN in 2018 coincided with one CHOIR researcher’s need for Veteran input at a critical stage of the project. This issue of Veterans’ Perspectives highlights how the engagement of Veterans on a research team improved the quality and relevance of an intervention designed to improve diabetes self-management. This is important because diabetes is more prevalent among Veterans than the general population (25% vs. 9%), and is associated with multiple chronic conditions, including cardiovascular disease and stroke (Liu, et al., 2017).

The Use of My HealtheVet to Improve Diabetes Self-Management

CHOIR investigator, Stephanie Shimada, PhD, focuses on the use of technology to expand access to care and to improve self-care among Veterans with chronic diseases. Her current research targets the use of My HealtheVet to improve diabetes self-management. Currently, more than three million Veterans have registered for the VA Patient Portal on My HealtheVet. Dr. Shimada’s HSR&D-funded study has three primary aims, to:

• Understand the extent to which Veterans with diabetes that use the My HealtheVet patient portal have better health outcomes than those who do not;
• Identify how Veterans with diabetes use the patient portal to support self-care and disease management; and to
• Collaboratively develop a pilot intervention with Veterans that tests the use of My HealtheVet to support management of diabetes and comorbid conditions.

Study findings will inform efforts to increase the effective use of patient portals and enhance healthcare processes and outcomes for Veterans with complex, chronic illnesses.

Adding Veterans to the Research Team

Dr. Shimada’s research team was looking for several Veterans to join their team to participate in the development of the intervention to support diabetes self-management when CHOIR’s Veteran Consultant Network was launched. Through the VCN, Dr. Shimada engaged three Veterans with diabetes who were interested in My HealtheVet, but who had had limited exposure to its functionality. These Veterans were invited to work regularly with the team throughout the intervention development process – to share their ideas and opinions about what was being developed. 

“We wanted to make sure that the training we developed was relevant to what Veterans living with diabetes would find helpful. And because the training [included] a potentially complicated technology like My HealtheVet - to people who haven’t used it before - we wanted to make sure that we were going to provide a training that was easy to understand from a Veteran perspective.”  —Dr. Stephanie Shimada, project lead

How Veteran’s Life Experience Impacts Diabetes Management Intervention

Mr. Richard Duffey, an Air Force Veteran, learned about CHOIR’s Veteran Consultant Network one day when he was at the Bedford VA Medical Center. Following an initial call and participation in a brief orientation, he expressed interest in Dr. Shimada’s study. He and two other Veterans joined the team to work on the development of the intervention. He was a perfect fit as he was actively working on managing his own diabetes and other related complex conditions. Like many individuals who have had challenges managing their diabetes, Mr. Duffey faced challenges with his vision. This experience ended up being critically important as the research team worked together to design the intervention. 

“He struggled with looking at a lot of the materials. So he helped us think about… how do we use color to make it easier?  Or, did we make the font large enough?  He suggested that instead of just having a training guide on paper, ‘Sometimes I just get tired reading. So what about you create some videos that patients could watch?’ So you know, we took his advice and we created some videos. He gave us feedback on those materials, and if it weren’t for the fact that he had these vision issues I think [we wouldn’t have] had that on our radar as a major concern. He brought that perspective.”  —Dr. Shimada

Mr. Duffey also brought in colorful flyers from programs he was involved in that he found engaging and easy to read to serve as models for organizing the information in the training guide. He provided important feedback on all the materials, helping to make sure they were both accessible and relevant to Veterans. Equally important, he shared a lot of his personal experiences during team meetings with trying to coordinate care both within VA and between VA and care in the community. His openness to sharing these experiences allowed the team to brainstorm ways in which My HealtheVet may be able to help support some of the care coordination struggles that he and others encounter.

“It was the way they let me throw my stuff out and explore and listen to me… That was part of a thing that I felt like because I was looking at it differently than they were looking at it. I felt like I was really making a difference 'cuz I felt like they don’t see it this way.”  —Richard Duffey, Air Force Veteran and VCN member

Making Connections by Working Together

In addition to the improvements that Mr. Duffey’s input brought to the quality and relevance of the intervention, the research team also experienced an impact on a personal level.

“It wasn’t just that [sharing his ideas and experiences], it was like the personal connection that we formed. He was very thoughtful that he connected all these different things he’s doing with our project, and he made the effort to bring these things with him. So we really appreciated that.”  —Dr. Shimada

As health services researchers, day-to-day interactions with the Veterans whose lives they hope to improve through their research can be limited. Including Veterans on research teams provides not only an opportunity to see things through a different perspective, but also to cultivate a personal connection to the work. This can help research teams stay mission-focused and create a deeper understanding of those they serve. And for Veterans, it provides an important opportunity to continue their own learning while also making a difference in the lives of other Veterans.

“All these different people with all these little specialties and expertise and different parts making something come together… And I got to see some of the things that I had brought up get implemented and put in. So it’s like, I felt like I played a part.” —Richard Duffey

This exposure to new perspectives inspires CHOIR investigators to continue creating opportunities to engage Veterans as partners in their research.

HSR&D has conducted – and continues to conduct – studies on My HealtheVet and its impact on VA healthcare for Veterans, including the impact of My HealtheVet on healthcare use and costs; co-managed care for Veterans; patient-aligned care team (PACT) members; Veterans infected with HIV; and secure messaging for medication reconciliation, to name a few.

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