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"If You Really Want to Be Successful, You Need to Be Engaged": Virtual Whole Health Groups Can Change Veteran Views On Health and Well-BeingVeterans’ Perspectives highlights research conducted by HSR and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research. In the March - April 2025 Issue:
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Introduction
"As a Veteran you need to take part, take charge. I guess the way I look at it is be engaged. Just like work or a project. If you really want to be successful, you need to be engaged . . . It is up to ME; it is MY health." -a Veteran participant in TCMLH
VA is transforming into a Whole Health system of care. Rather than islands of medical care focused on disease management, a Whole Health system is comprised of teams of professionals who build lasting partnerships with Veterans and develop personalized health plans based on an individual Veterans’ values, needs, and goals. One challenge in achieving this transformation is that Veterans’ experiences in the military command system, and in conventional patient-clinician relationships, may make the Whole Health model difficult to understand and engage with. To address this challenge, VA has designed the Whole Health Pathway – a series of one-on-one and group-based offerings that introduce Veterans to the basics of Whole Health. This includes Taking Charge of My Life and Health (TCMLH), a peer-led group program for introducing Veterans to Whole Health concepts. Ideally, by the time a Veteran has completed TCMLH sessions, they will have developed self-care skills, acquired knowledge they can use to pursue well-being, and gained confidence to take a more active role in their healthcare. In 2020-2021, a team of researchers from VA’s Center for Evaluating Patient-Centered Care (EPCC) – an initiative sponsored by VA QUERI and the Office of Patient-Centered Care & Cultural Transformation (OPCC&CT) - conducted an evaluation of TCMLH. In January 2022, they published the lessons learned by staff members who implemented the TCMLH program.1 In August 2022, the same team reported what they had learned from Veteran participants in the groups. The EvaluationBetween Summer 2020 and Fall 2021 – the height of the COVID-19 pandemic, after VA facilities had transitioned to virtual delivery of healthcare and well-being services – the EPCC team evaluated TCMLH in a series of semi-structured, in-depth telephone interviews with 15 Veterans who had completed a virtual course of the program. FindingsThe team identified five main themes among the Veterans’ accounts of TCMLH:
- I live really close. It's not a commute down here, it's a parking thing and, honestly, you go up there and you park, and it takes forever. It's a big campus at the VA. - I think it made us… more relaxed. …if you're sitting in a conference room or… at a VA hospital trying to do the same thing it feels more closed in . . . Some Veterans did note the virtual format made it more difficult to form connections with other participants: - I think there are so many physical cues that I know I give, and… that I've seen… in groups where people are fidgeting, or you can tell when they're either anxious or scared or nervous, and I think a lot of that gets lost in the video. - … if you're gonna do an hour-long session, add 10 minutes or 30 minutes, so that there is a little bit of social interaction in front of and behind the session.
-That's the common theme there is to be really good to yourself, and that has been an eye-opener for me because… I've spent… more time in my life beating myself up than I have been being good to myself and finally it's taken hold . . .” -… by the end of the class people were talking about, ‘Hey, I wanna lose weight, I wanna…stop smoking, I wanna start going for walks. I wanna start meditating more. I wanna start seeing my kid, my grandkids more.’ Whatever it was it seemed like people were more… in tune with themselves… Some participants referred specifically to elements of the TCMLH curriculum, including VA’s Circle of Health, as helping to shift their perspectives: - …your health and wellness goes well beyond just… your body. You know, it's your relationships, it's the things you eat, it's your diet, it's your mental attitude and capability and things of that nature. …I think it's all very important and… people need to understand how it's connected. Several interviewees noted the value of setting Specific, Measurable, Action-oriented, Realistic and Timed (SMART) goals as featured in the Veteran’s Personal Health Plan, a tool used in the Whole Health system of care to document Veterans’ personal health and well-being goals: - …it makes you sit back and [think] where do you wanna go and how do you wanna get there, and you take smaller steps rather than bigger steps and you take those smaller steps and you break it down even more. …So that everything is not so overwhelming for you.
- … I believed in diet for years but I never [paid] attention. But when I was in the group, they… said, ‘Well, if you're trying to lose weight, make a plan’, and, you know, ‘Try to not eat dinner after 6 o'clock, try to eat before that…’ And I was a person that… would eat any time of the day, any time of night. And that change of habit, I get that from the group. - what [TCMLH] taught me was… foods that I could eat that would help me relax. …I do the teas now… for my health and stuff. So, in doing so, I was able to get off of [pain medication] and I was able to get off of [sleep medication] to sleep. - …one of the guys… encouraged me to do a gratitude journal, and I do a journal and I also keep track of my pain and my drinking. All of these things… I'm not denying them [but] assessing and working on [them]. Significantly, several participants also mentioned difficulty acquiring or maintaining healthy habits after TCMLH ended: - the goal-setting for different things…worked pretty well for me and I tried to maintain that afterwards, after the classes, and it was helpful. But it did seem to fall off. - There were some things that I probably should have integrated into my life, but I wound up not… doing them… …like mindful awareness. The idea of being present, that to me is just foreign, you know for some reason.
- I've been associated with military most of my life… so here is an online class with all these people that did understand and you're… with a group of people that know [you] and [that] you have connection with. - I go to the Y with a few friends that was in the group… and now I feel… comfortable with all the other veterans and <this> makes me feel good that I know I'm helping them out and they're helping me out too. A key feature of the groups’ social dynamic was the opportunity to share experience, insight, and support: - it gives you ideas and it gives you, ‘hey, maybe I can shoot for that, too’ or ‘hey, I like that idea’… - it was like Saturday and I knew I had to talk to somebody on Monday to make sure I preplanned my meals, so I would make sure on Sunday that I could, so if they asked me, I wasn't going to lie. So, I made sure that I… did prepare my meals. So, the accountability, just wanting to be included in the group so [they] know that I did my goal… it helped that way. Several interviewees said TCMLH helped them strengthen relationships with family, old acquaintances, and community. A woman participant said the program helped her overcome a wariness of men that had been caused by negative experiences during military service: - …And now, [I'm]… getting into the groups… that have men in there, cause I'm gonna tell you [laughing], I wouldn't have never got into anything like that, you know. And… I would've been so skeptical about talking. But… it's a good thing now. And I can talk to them, and I can joke with the men that are there, you know?
It’s a teamwork effort and it really should be a teamwork between not only the providers at the VA [and] the various physicians people may see… But it’s a team effort as well and you’re 50 percent of it.
Several interviewees changed their approach to healthcare after TCMLH participation. Some explored new services or delivery methods outside of TCMLH: - …[the facilitators] referred me to acupuncture, which I loved. And… I'll probably get into chiropractic, too, as soon as I go to my doctor. -…when I saw the opportunity for a health coach, it reminded me of one-on-one sessions I used to do with a psychologist years ago… I said, ‘No, I'm tired of talk therapy’. … But… this one-on-one with a coach, it's not the same thing …it's still up to you to do the work, they're just standing on the side and giving suggestions and encouraging you to express yourself about things and how you feel… and I like that coaching thing. Other Veterans mentioned that TCMLH changed how they interacted with their established healthcare team members. One began to prepare for visits by writing down questions for the provider. Another interviewee learned how to advocate for themselves: - …it made me a better patient for one thing …I don't get into that resentment area. They're like, ‘Oh well, you need an MRI. Well, we can't do it for six weeks.’ …and I didn't stay satisfied with the first appointment … But not from a place of resentment, more from a place of – the sooner we know what's going on the better my health will be, so… I got in contact with the people that schedule the MRIs… and I said, ‘I'll go anywhere, if you could just find me the soonest one, I appreciate it’, and they did. So, it made it like three weeks instead of six. ImplicationsThe interviews revealed several factors for future TCMLH teams to consider:
Evaluation Publication Anderson E, Dvorin K, Etingen B, et al. ‘It Makes You Sit Back and Think Where You Wanna Go’: Veteran experiences in virtual whole health peer-led groups. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy. October 2022;25(5):2548-2556. The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. |
