Abstract
BACKGROUND: Initiation rates of trauma-focused evidence-based psychotherapy (TF-EBP) for posttraumatic stress disorder (PTSD) remain low despite large-scale dissemination efforts in the US Department of Veterans Affairs (VA). Through semistructured qualitative interviews, this study examined veterans' recommendations for process improvement in engaging in TF-EBP and mental health care. METHODS: A qualitative analysis was conducted as part of a larger mixed-methods study. Thirty veterans who recently initiated TF-EBP were recruited to complete a semistructured qualitative interview about their experience. Rapid qualitative analysis procedures were used to analyze all interview content and identify themes focused on veteran experiences relevant to process improvement in TF-EBP and mental health care. RESULTS: Seven themes were identified: (1) veterans had a poor understanding of VA mental health care; (2) stigma remains a barrier to engaging in mental health treatment; (3) veterans emphasized the importance of therapy fundamentals (eg, rapport, flexibility) throughout their care; (4) shared decision-making was valued when used to select TF-EBP; (5) respect for preferences in treatment selection was associated with a positive outlook on TF-EBP; (6) veterans wanted clinicians to ask about relevant cultural identities early in their assessment/treatment; and (7) acknowledging culture and using culturally relevant examples strengthened TF-EBP engagement. CONCLUSIONS: Veterans identified 3 areas for continued process improvement: (1) providing information about the diverse range of mental health care services at the VA and the implications of this continuum of care; (2) consideration of veteran preferences in treatment decision-making, including the importance of perceived choice; and (3) incorporating cultural assessment and cultural responsiveness into case conceptualization and treatment.