Improving care for veterans' environmental exposure concerns: applications of the consolidated framework for implementation research in program evaluation.

BACKGROUND: Healthcare systems, like the US Department of Veterans Affairs (VA), need policies and procedures for delivering care to special populations including those with environmental exposure concerns. Despite being common and pervasive, especially among Veterans, environmental exposures are largely overlooked by healthcare providers. To successfully implement care for Veterans with military environmental exposure concerns, an understanding of contextual factors impeding care on the provider (e.g., knowledge and beliefs) and organizational (e.g., leadership's priorities) level is needed. Our goal was to conduct an operational needs assessment of providers to examine provider educational needs regarding Veterans' military environmental exposure concerns. METHODS: In 2020, we surveyed 2,775 VA medical and behavioral health providers. Our cross-sectional assessment was informed by the Consolidated Framework for Implementation Research (CFIR) and assessed barriers and facilitators to the uptake and application of knowledge regarding interdisciplinary care for environmental exposure concerns. The web-based survey was emailed to providers across the United States representing a variety of disciplines and practice settings to reflect the interdisciplinary approach to care for environmental exposures. We used bivariate statistics to investigate the intervention setting, inner setting, and individual characteristics of providers regarding care for environmental exposure concerns. RESULTS: Approximately one-third of VA medical and behavioral health clinicians report low to no knowledge of environmental exposure concerns. We find 88% of medical and 91% of behavioral health providers report they are ready to learn more about environmental exposures. Half of medical and behavioral health providers report they have access to information on environmental exposures and less than half report care for environmental exposures is a priority where they practice. CONCLUSIONS: Our findings suggest interdisciplinary providers' knowledge of and discussion with Veterans about environmental exposures may be influenced by contextual factors at the organizational level. Considering individual-level factors and organizational culture is important to consider when supporting care for environmental exposures. Since this needs assessment, VA established targeted programs to improve care related to military environmental exposures in response to legislation; future exploration of these same variables or contextual factors is warranted.

The common-sense model and mental illness outcomes: A meta-analysis.

Psychotherapists can improve their patients' outcomes during and after therapy by improving patients' self-management. Patients who do not effectively manage their mental illness generally have worse outcomes. Leventhal's Common-Sense Model of Self-Regulation theorizes that patients' perceptions of their illness (illness representations) guide their self-management, influencing health outcomes. The present study quantified the relations between illness representations, self-management and outcomes for mental illnesses. We conducted a meta-analysis and included articles if they reported (1) on adults with mental illnesses and (2) the correlation between mental illness representations and mental illness outcomes. Twenty-five articles were included which represented 28 independent samples. The pattern of correlations among illness representations (identity, consequences, timeline, control, coherence and emotional representations), self-management strategies (attendance, engagement and adherence to treatment) and mental illness outcomes (symptom severity and quality of life) was consistent with analyses from previous studies of mental and physical illnesses. The results found threat-related illness representations mostly had a large relationship with worse mental illness outcomes and self-management. Protective illness representations had a small-to-large relationship with better mental illness outcomes and self-management. The results suggest patients' perceptions of their mental illness may be a critical indicator of their mental illness outcomes, including symptom severity and quality of life. This theory-driven meta-analysis supports calls for the inclusion of illness representations in psychotherapy for mental illness.

Psychotherapies for clients with physical health conditions: A scoping review of demographic reporting.

Recent research has highlighted the importance of investigating the efficacy of psychotherapeutic interventions for individuals with physical health conditions. To date, there is evidence that psychotherapeutic interventions are efficacious for a range of physical health conditions (e.g., cancer, obesity, and diabetes). However, less is known about for whom psychotherapeutic interventions for physical health conditions are effective. One reason for this might be pervasive underreporting of demographic data in research, despite the National Institute of Health's 2016 call to action to include such information. Specifically, studies that fail to report full demographic data of participants may reinforce inequities for historically and societally marginalized groups that are traditionally underrepresented in health research; function to restrict researchers from identifying nondiverse, unrepresentative samples; and limit the capacity for future research to address such limitations. To address this gap, we conducted a scoping review of reported demographic data in randomized clinical trials of psychotherapeutic interventions for cancer, obesity, and diabetes. We aimed to identify the frequency and type of demographic data in reported sample characteristics from 2016 to the present. Findings revealed that, on average, studies reported approximately 5 of the 8 demographic domains of interest (M = 5.1; SD = 1.24; range 3-7)-age, sex assigned at birth, race and ethnicity, sexual orientation, gender identity, marital status, education, mental health status-suggesting that researchers are not reporting demographic data regularly or consistently. The current article discusses the implications of underreporting demographic data for external validity and provides suggestions for future research directions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).