Dr. Held is a clinical psychologist in New York City. Dr. Santos is the associate director, and Dr. Helmer is the director, both at the War-Related Illness and Injury Study Center at the VA New Jersey Health Care System in East Orange. Dr. Helmer is an associate professor, and Ms. Marki is a student, both at Rutgers University-New Jersey Medical School in Newark.
The authors report no actual or potential conflicts of interest with regard to this article.
The opinions expressed herein are those of the authors and do not necessarily reflect those ofFederal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies.
Self-selection and low response rate are limitations in this study. Despite the low response rate, the demographic information of the sample generally resembles the population of veterans at VANJHCS for age, sex, era, health status, and presence of mental health problems.24 Of note, the authors received responses from a wide range of veterans in terms of age, military era, and care setting, including some veterans who do not use the VA. However, data are lacking for nonresponders, and the possibility remains that survey respondents self-selected and were more interested in or experienced with CAM than were nonrespondents. Regardless, many findings, including barriers to CAM and the interaction of pain and self-efficacy, are internally valid and are important to consider even if the sample is not representative of the veteran population.
No studies have focused on veteran use of independent CAM practices as defined for this study. These techniques (eg, meditation, qigong) may promote wellness and relieve common symptoms in veterans. The authors’ results suggest that a broad interest in independent CAM practices among veterans exists. The VA and other health care settings should consider implementing classes in these modalities, especially as their reach may be greater than other CAM modalities requiring one-on-one practitioner-patient interaction. Even with broader availability, patients with chronic pain may require extra attention and context to improve or overcome low health-related self-efficacy, maximizing their likelihood of engaging in CAM. This possibility needs to be explored.
Funding for this research was provided by the Veterans Affairs Office of Patient Centered Care and Cultural Transformation, which was not involved in the study design or production of the manuscript. The authors also acknowledge the work of Anna Rusiewicz, PhD, in developing the STAR Well-Kit that was disseminated during this study.