Table 3.

CS-PTSD coach barriers as identified by the qualitative analyses

Barrier theme	CFIR construct	Initial plan for resolving the barrier
Stakeholders
1. Strong leadership support and clinic champions are needed	Leadership engagement	Elicit strong local primary care and mental health leadership. Find a champion for each primary care clinic.
2. The technology gap experienced by a minority of providers and patients must be addressed	Complexity	The study team will train PC-MHI clinicians to be comfortable with the technology and/or select tech-savvy PC-MHI clinicians. In marketing the study, the CS piece will be emphasized in that even patients who are wary of technology can do this with the help of the clinician. This treatment will not be for everyone, but offered as a novel alternative to traditional treatment.
3. PCPs need education about how to talk to their patients about PTSD and PTSD treatment	Knowledge and beliefs about the intervention	The training will be done immediately before initiating the protocol and will involve education on the effectiveness of PTSD treatments and scripts on how to talk to patients about seeing the PC-MHI clinician.
4. Clinicians will need education about the app and why we are doing the study.	Knowledge and beliefs about the intervention	Clear up any misconceptions about PTSD Coach (e.g., this replaces traditional PTSD treatment). Provide strong rationale for why brief primary care based treatments for PTSD are needed.
5. Primary care clinic staff will need to be open to do new things.	Implementation climate	Need to select PC-MHI clinicians who are willing to do something new. When this is not possible, we need to try to motivate PC-MHI clinicians and provide them with a high level of support. Clinicians reluctant to adopt CS-PTSD Coach may be more motivated if they see their colleagues have early successes.
Veterans—none reported
Clinicians
1. The manual did not provide enough instruction on collaborative goal setting	Patient engagement	The manual was revised to include explicit instructions for collaborative goal setting including wording to describe the goal setting process and adding explicitly stated goals for each session for clinicians to tailor to individual patients.
2. The homework assignments were complicated	Complexity of the intervention	The homework assignments included in the manual were simplified so that the revised draft emphasizes only the components of the homework that clinicians perceived as most important.
3. The manual lacked guidance on how to help more complex patients	Patient engagement	Clarification and recommendations were added to the manual regarding how to handle difficult case situations including ambivalent patients, unengaged patients, and patients with significant life stressors.
4. Telephone sessions were difficult but this modality was important to patients	Patient needs and resources	Common difficulties with the telephone modality (e.g., cannot look at the patient’s device together to see the app) were identified in the manual and tips were added to facilitate telephone sessions despite barriers.
5. Parts of the manual were complicated and difficult to read	Complexity	The manual language was simplified and the formatting was streamlined to improve readability and usability.