Table 4.

Respondents' Descriptions of Facilitators to Promotion of CIH Within the VA

Themes	Sample coded text
Personal level
Champion for CIH	“Absolutely key is a … respected person champion … sort of keeps things moving.”
Staff interest	[Without the support of] “the person on the ground … it would be a much more difficult path for anyone who would try and get things done.”
Strong commitment to use of CIH from clinical providers	“You really have to have the buy-in from the medical providers. They're going to have to be having that discussion with patients.”
Facility level
Supportive management/administration	“Equally essential is the support and buy-in from administration.”
	“We have a great Director. He is really into CAM.”
Staff time dedicated to provision of CIH	“Being able to have some time … often time is a huge barrier.”
Staff hired in other positions but also trained in CIH therapies	“We have just had a doctor, an M.D., who is also an acupuncturist who has been hired.”
Experienced practitioners in CIH	“The yoga program started primarily through the interest of one MD and one psychologist who both had a high interest … both for personal and professional reasons.
Education of VA providers regarding CIH	“I've been working with the PTSD clinic to create a program and a manual so that any of the staff members … can teach them gentle stretches [that] can be incorporated into their treatment plan.”
Multidisciplinary teams	“She and I and a team … submitted and obtained a grant for doing research.”
Permanent coordinator	“Finding someone with the energy to do this if it's not their full time job … it's very, very difficult … everything seems to be consuming your time, so it's a resource problem.”
Staff acceptance of less usual practices	“We are very much respectful and promote all kinds of spiritual practices.”
Acceptance of skeptical staff by staff promoting CIH	“You just have to let staff have their skepticism but also encourage them as far as what might be possible.”
Facility-specific directory of CIH therapies	“We don't have any sort of directory that people could use. The primary care providers … would do well if they knew who to refer to or had … a sense of when they were offering it … how to contact the person … what the parameters are for the referral.”
VA-wide level
Veteran demand	“The vets are super open … in our yoga group…. I hear people wanting to try other things.”
	“Veterans talk to each other and they encourage each other to … indicate their interest in joining the group.”
VA directive to reduce opioid use in veterans	“It wouldn't be another drug that they would have to take.”
	“Our administration is quite well aware they have a lot of chronic pain patients and it is not always necessarily the best thing to treat them with narcotics.”
CIH used in wider community	“It's so backwards in this government system. Private centers are using music therapy and it's like, when is the government going to get with it?”
Realization of effect of CIH upon PTSD	Originally we had a lot of Viet Nam era veterans in that class [for those with PTSD]. We still do, but now we have a lot more of the younger veterans who were in the more recent conflicts.”

CAM, complementary and alternative medicine; PTSD, post-traumatic stress disorder.