Development and Cross-Sectional Evaluation of a Text Message Protocol to Support Mental Health Well-being

Impact Statement The VA created a text message tool, called "Coping During COVID," that sends text messages to support self-care during the pandemic. Of the 651 veterans who completed a survey, 90% reported that the messages were useful. Veterans wrote that the text messages helped them pay more attention to their mental well-being, learn how to better care of themselves, practice healthy coping, and feel more positive and connected. Coping with stressors related to the coronavirus disease (COVID) pandemic has caused major mental health challenges. Text message interventions are identified as helpful for promoting health behavior self-management. Drawing from cognitive-behavioral theory (CBT), U.S. Veterans Health Administration staff developed a 20-week automated text messaging protocol called "Coping During COVID" to support veterans' self-care during the pandemic. This project evaluated attitudes about and perceived helpfulness of the protocol among 651 veterans. A cross-sectional evaluation quantitatively assessed COVID-related stressors as well as reported use, acceptability, attitudes, and perceived helpfulness of the protocol via a self-administered online questionnaire. Open-ended questions assessed perceived helpfulness/unhelpfulness of the protocol. Of the 651 veterans (22% of those enrolled in the protocol) who responded to the survey, 73.1% were male and 88.5% were 50 years or over. Ninety percent found the protocol messages helpful and about half endorsed various additional benefits, including feeling better, being more educated about coping behaviors, and being better able to focus on positive thoughts. Qualitative feedback was overwhelmingly positive. For example, veterans stated that the protocol "was like having a personal coach giving hints and tips to cope with the boredom every day," that it "gave me reminders of skills I was not using. It helped me focus on the positives," and brought relief from "many hopeless and sad thoughts horizontal ellipsis the messages from Annie have been a Godsend to me." Overall results suggested that the Coping During COVID text messaging protocol successfully supported the majority of respondents' self-care efforts during the COVID pandemic.