Preparing for the sequel: A formative evaluation of a mutual-aid support group for Veterans living with chronic pain

Abstract Information: In 2022, our team of four developed, implemented, and evaluated a mutual aid group facilitated by Veterans living with chronic pain for Veterans living with chronic pain. The group, “Vet-to-Vet,” was funded by the Office of Rural Health and was implemented in a single Veterans Health Administration (VHA) healthcare system. The multi-method evaluation was designed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data sources included a recruitment tracker, structured surveys at baseline and 6-month follow-up, semi-structured interviews at 6-month follow-up, and a log to track adaptations to the program. Of the 16 Veterans who enrolled in Vet-to-Vet, 88% completed the initial session, and 56% attended at least half of the sessions at 6-months. While there were no significant differences from baseline to 6-month follow-up for quantitative outcomes, qualitative interviews revealed that participants experienced a strong sense of camaraderie, satisfaction with the program, and other outcomes that were not captured quantitatively such as a heightened ability to advocate for medical care. Adaptations to the proposed program were intended to improve implementation, and there were no consistent barriers identified. We present the processes, findings, and recommendations from an evaluation of a Veteran-led mutual aid group for Veterans living with chronic pain. This abstract addresses the AEA guiding principle of Systematic Inquiry and competency of Professional Practice within a small team, and the question of how to tell the story of a program when evaluation outcomes are inconclusive.

Relevance Statement:

Background: Chronic pain is common among US Veterans, and barriers to in-person treatment and self-management resources can be especially challenging for rural Veterans. We developed and implemented a virtual group intervention to provide mutual aid for rural Veterans with chronic pain.

Methods: We conducted an observational study of a weekly virtual group intervention for rural Veterans with chronic pain. All sessions were facilitated by trained peers. The intervention began in April 2022 with a 9-week curriculum on values clarification and goal setting, and the second phase (weeks 10-24) consisting of weekly mutual aid meetings. The intervention and evaluation were funded by the VA Office for Rural Health. The multi-method evaluation was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Data collection activities included tracking recruitment, enrollment, and retention, structured surveys at baseline and 6-month follow-up, and semi-structured interviews at 6-month follow-up. Structured surveys included measures of pain severity, loneliness, and global impression of change. Semi-structured interviews focused on the Veterans’ experience and suggestions for program improvement. Interviews were audio-recorded, transcribed, and analyzed. There was also a log of adaptations that the evaluator and implementation team used to document changes to the program.

Results: Reach: We outreached 46 Veterans, and 16 Veterans enrolled in the group intervention (12 participants, 4 facilitators). This group was 75% male, 50% White, 87.5% rural. Participants reported an average pain duration of 22 years and baseline pain severity of 6.2/10. Fourteen individuals (88%) completed the initial session, and 56% attended more than half of sessions at 6-month follow-up. Effectiveness: There were no significant differences from baseline to 6-month follow-up for pain severity or loneliness. At 6-month follow-up, 42% reported global improvement, and 25% reported global worsening of pain symptoms. Themes from semi-structured interviews included a sense of camaraderie; participants appreciated holding space with others who were living with chronic pain. Most participants preferred the mutual aid phase to the structured curriculum, and many described learning from the other Veterans. As one participant shared: “Going to these groups made me realize that I can get this care. I have to get this. I have to make people listen to me. And I've just stayed on that on that process, I'm not giving up. I'm gonna seek care. I'm gonna get help. “ Implementation: Most of the adaptations enhanced the implementation but some looked ahead to maintenance. Several adaptations were initiated by the group facilitators and members (e.g., a storytelling component). Barriers for Veteran participation were varied and included their personal schedules, discomfort with meditation or open sharing, and their ongoing chronic pain.

Conclusions: A virtual group mutual aid intervention was feasible and acceptable for rural Veterans with chronic pain but did not demonstrate improved quantitative outcomes in its initial cohort. Despite this negative finding, the qualitative interviews suggest that the Veterans found participation valuable. As the intervention expands to new sites, this evaluation will inform adaptations to improve the acceptability of the group, including enhancing the storytelling component in the mutual aid phase.