Related Experiment Video
Updated: Feb 28, 2026

Simultaneous Application of Transcranial Direct Current Stimulation during Virtual Reality Exposure
Published on: January 18, 2021
Reaching Veterans Most in Need: Evaluating Engagement in a National Telephone Lifestyle Coaching Program for Veterans
Kimberly Clair1, Bevanne Bean-Mayberry2,3, Catherine Chanfreau2
1Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. k.clair@ucla.edu.
Background:
Participating in a comprehensive lifestyle intervention can reduce the risk of cardiovascular disease-the leading cause of death among Veterans.
Objective:
We assessed whether a national, virtual lifestyle change program (Telephone Lifestyle Coaching, TLC) promoted equal access to care across vulnerable Veteran subgroups (women, racial/ethnic minorities, rural Veterans).
Design:
We conducted a retrospective evaluation of reach (referrals) and engagement (enrollment) during TLC's implementation at 44 Veterans Health Administration (VA) sites (March 2019-September 2023). We used bivariate analyses to compare referred vs. non-referred and enrolled vs. not enrolled Veterans, and multivariate logistic regression-among all Veterans and stratified by sex-to assess factors associated with referral and enrollment.
Participants:
All TLC-eligible Veterans at the 44 implementation sites (N = 2,333,586).
Main Measures:
We evaluated factors associated with referrals and enrollment in terms of sex, race, ethnicity, and urban/rural residence, controlling for age, prior VA lifestyle program participation, mental health diagnoses, trauma, and cardiovascular health in regression analyses adjusting for clustering by site.
Key Results:
TLC referral was associated with being female, prior lifestyle program participation, and diagnoses of depression, PTSD, military sexual trauma, overweight/obesity, and cardiovascular risk. Among men, the odds of referral were higher among Black/other race Veterans compared to White Veterans. Enrollment was associated with being female, prior lifestyle program participation, and overweight/obesity diagnosis. Among females, Hispanic/Latino ethnicity increased odds of enrollment while among males, rural residence increased odds of enrollment.
Conclusion:
TLC demonstrated success in reach and engagement across a diverse Veteran population. Rurality and mental health conditions were not a barrier to TLC program referral, while prior participation in a VA lifestyle change intervention may facilitate subsequent engagement in lifestyle change programs. Providing a virtual option for lifestyle-focused counseling programs is essential for addressing persistent disparities in Veterans' cardiovascular health outcomes.
Related Concept Videos
Cognitive Dissonance
Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...
Self-Evaluation Maintenance Model
Nursing Evaluation
Post-traumatic Stress Disorder
Symptoms and Behavioral Manifestations
A spectrum of distressing symptoms characterizes PTSD. Recurrent flashbacks, where individuals involuntarily relive traumatic events,...
Self-Evaluation: Self-Enhancement and Self-Verification

