A Clinician-Facilitated Intervention to Integrate a Mobile Health App in Mental Health Care to Improve the Social Support of Veterans with PTSD

Background: Veterans with PTSD often have substantial interpersonal problems and low perceived social support from family, partners, and peers. Interpersonal problems result in poor social reintegration and functioning, which is associated with greater suicidal ideation and behavior. There is a critical need to provide accessible treatments to Veterans with PTSD to reduce their social isolation by increasing their social support. We created ACTsocial, a mobile app that provides Veterans with PTSD with motivational enhancement, psychoeducation, and skills to improve their social support, thereby reducing their social isolation. We propose to assess implementation constructs within the development process for an ACTsocial provider support guide and then examine the acceptability, feasibility, and preliminary efficacy outcomes of integrating ACTsocial into mental health care for Veterans with PTSD in a pilot trial. Significance: Low social support is a key factor related to poor physical and mental health and increased mortality risk for Veterans with PTSD, including from suicide. An approach with great potential to increase social connectedness for Veterans with PTSD involves digital treatments, like ACTsocial. Adding support from providers, including licensed and unlicensed providers, such as contact and monitoring, can increase use of digital interventions like ACTsocial. This project will provide critical information on how to best integrate a provider-supported ACTsocial app in mental health care. Innovation & Impact: This study is innovative in several respects: 1) ACTsocial applies a promising evidence- based treatment approach to the problem of poor social functioning and increased risk of suicide among Veterans with PTSD; 2) ACTsocial will fill a substantial gap in accessible services that tackles social isolation due to PTSD; and 3) there is an important need to understand how to best implement the ACTsocial app in mental health care to increase Veteran engagement and provider support with the ACTsocial app. Specific Aims: The primary objectives of the proposed project are to: Aim 1. Develop a provider support guide for the integration of the ACTsocial app in mental health settings by completing interviews with mental health providers (n=12), including psychologists and social workers (n=6) and peer support specialists (n=6), as well as Veterans (n=12) guided by the Consolidated Framework for Implementation Research framework to determine existing barriers and facilitators to integrating the ACTsocial app into mental health care. Aim 2. Examine the feasibility, acceptability, and preliminary efficacy outcomes of ACTsocial integrated into mental health care among Veterans with PTSD (n=20) and mental health providers (n=4) in a pilot open trial using both qualitative and quantitative methods. Aim 3: Prepare a final version of the ACTsocial provider support guide and app for a future Hybrid Type 2 Effectiveness-Implementation trial. Methodology: For Aim 1, we will develop the content for ACTsocial provider support guide using interview data from mental health providers (psychologists, social workers, peer specialists) and Veterans. For Aim 2, we will conduct a pilot trial of ACTsocial to gain information on acceptability and feasibility of integrating the ACTsocial app in mental health care, and preliminary efficacy outcomes of the ACTsocial app using a mixed methods approach. For Aim 3, we will use feasibility, acceptability, and efficacy data from the pilot trial to make final revisions to the ACTsocial provider support guide and ACTsocial app. Next Steps/Implementation: This pilot study will inform a future Hybrid Trial Type 2 Effectiveness- Implementation trial to study the ACTsocial app integrated into mental health care. This research will lead to future implementation and dissemination strategies to accelerate the benefits of ACTsocial to patient care. Project Number: 1I21HX003985-01A1 | Fiscal Year: 2025 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: Megan Kelly | Institution: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL, BEDFORD, MA | Activity Code: I21 | Study Section: HSR-4 Mental and Behavioral Health[HSR4] View on NIH RePORTER: https://reporter.nih.gov/project-details/11109156