Table 1.

Summary of qualitative feedback from provider interview

RE-AIM domain	Provider qualitative feedback
VTH expands the reach of mental health care for rural Veterans	“It’s a lot to ask somebody to commit to an hour a week for 12 weeks [for mental health treatment]. But if they live 2 h away or more, now you are asking them to commit to taking off an entire day of work a week, and that is just tremendous … so I think access to care is really one of the biggest advantages [of VTH].” Provider 3
Factors influencing the effectiveness of VTH as a mode of treatment delivery, e.g.: Window into the home environment Greater engagement in treatment Patient comfort level with technology Loss of patient affect over VTH Environmental distractions for providers and patients Concern over VTH reinforcing maladaptive behaviors (e.g., avoidance)	“So I remember seeing a Veteran with PTSD … her maintenance man was supposed to come because she was uncomfortable. But that was interesting because … you get to see her like triple lock the door … you are seeing that home environment. In some situations, that can be good.” Provider 2
	“The only time that…we have all just sort of a little bit hesitated would be more on dealing with people with severe anxiety and really wanting to not allow them to continue to avoid leaving the house.… We do the first couple sessions in their home and then teach them to come out and see us in person.…” Provider 3
Positive (+)/negative (−) factors influencing provider VTH adoption, e.g.: Addresses logistical concerns (e.g., treatment room availability) (+) Flexible hours for appointments (+) 1-on-1 VTH training (+) Emergency contact procedures (+) Technical problems (−) Lacking the comfort of knowing the patient is in a clinical setting (−) Licensing and delivering care across state lines (−) Scheduling VTH visits (+/−)	“I mean I had to spend 20 min walking this guy and his wife through logging in and then it did not work … it doesn’t really bother me that much because I would just be flexible and just adapt my session based on that. Other providers like that is like a death no. They are not interested in doing it [i.e. VTH] if stuff like that happens.” Provider 1
	“At the beginning, like maybe some people feel like it’s [i.e. VTH] going to be this huge obstacle and it’s not gonna really be the same … it does not really affect that rapport of that service as much as I would have thought.” Provider 7
VTH implementation benefits from advanced planning (e.g., advanced mailing of treatment worksheets), and providers’ abilities to adapt treatment to the home environment (e.g., sharing of homework exercises) as well as address technological issues during sessions	“A couple of times the technology was a problem, and we had to finish a session on the telephone. … Fortunately, that was people that I already had a pretty good decent relationship with. So it was fine. We just rolled with it. It was just a nuisance.” Provider 6
	“You have to be a little bit more flexible. You have to think a little and you know think ahead a bit more. You know cannot just whip out a handout and show it to them.” Provider 1
Maintenance of VTH is contingent on identifying local clinical champions to promote adoption, and improvements to internet/technology, scheduling procedures, and real-time sharing of information during treatment sessions	“If my providers go and use this new system and you have not figured the glitches out, I am gonna get pushback, and once they push against it, it’ll be really hard to get them back. … But you have to have like an advocate that is a provider that can kind of address those concerns because if there are any frustrations. … it’s going to reinforce the idea that this [i.e. VTH] does not work.” Provider 2