Table 4.

Provider open-response feedback on barriers of CBT-N use (n = 27).

CFIR Domain	n (%)	Response Example
Innovation
Complexity	5 (19%)	“Some veterans struggle with the workload outside of sessions.”
Relative Advantage	1 (4%)	“I would say 25% of patients have a really good response to the treatment with significant reduction in nightmares. The other 75% either a) don’t complete, b) are too activated by the therapy, or c) it doesn’t work.”
Inner Setting
Compatibility	2 (7%)	“It’s been a bit difficult implementing CBT-N in a residential settings given that it’s in a hospital setting, bed is not comfortable.”
Relative Priority	2 (7%)	“We don’t take as many cases for CBT-N and encouraged to do more trauma-focused treatments (i.e., CPT, PE, EMDR).”
Resources	9 (33%)	“The only thing stopping me from offering it more frequently is the demands on scheduling”; “It is hard for me to offer the treatment as much of as quickly as I would like because of caseload issues”;“I can do 60-minute appts but do not have support for a 90 minute. It is hard to get all the content in 60 minutes.”
Executing Treatment	5 (19%)	“Need a co-facilitator for the amount of work. It is hard to get a large group of referrals to do the group and then we have dropout or scheduling issues”
Individual
Patient Opportunity or Need	10 (37%)	“Veteran work schedules”; “Some patients are not proficient with technology, making it difficult to get sleep data efficiently.”
Patient Motivation	6 (22%)	“Patient avoidance of writing nightmares”; “While engaging in shared decision making, veterans pick CBT-N the least often.”

Note. CFIR = Consolidated Framework for Implementation Research.