Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May-Jun;46(3):137-149.
doi: 10.1097/JHQ.0000000000000419. Epub 2023 Dec 14.

Identifying Barriers and Facilitators to Veterans Affairs Whole Health Integration Using the Updated Consolidated Framework for Implementation Research

Christine C Kimpel, Elizabeth Allen Myer, Anagha Cupples, Joanne Roman Jones, Katie J Seidler, Chelsea K Rick, Rebecca Brown, Caitlin Rawlins, Rachel Hadler, Emily Tsivitse, Mary Ann C Lawlor, Amy Ratcliff, Natalie R Holt, Carol Callaway-Lane, Kyler Godwin, Anthony H Ecker

Identifying Barriers and Facilitators to Veterans Affairs Whole Health Integration Using the Updated Consolidated Framework for Implementation Research

Christine C Kimpel et al. J Healthc Qual. 2024 May-Jun.

Abstract

Background: Veterans Affairs (VA) implemented the Veteran-centered Whole Health System initiative across VA sites with approaches to implementation varying by site.

Purpose: Using the Consolidated Framework for Implementation Research (CFIR), we aimed to synthesize systemic barriers and facilitators to Veteran use with the initiative. Relevance to healthcare quality, systematic comparison of implementation procedures across a national healthcare system provides a comprehensive portrait of strengths and opportunities for improvement.

Methods: Advanced fellows from 11 VA Quality Scholars sites performed the initial data collection, and the final report includes CFIR-organized results from six sites.

Results: Key innovation findings included cost, complexity, offerings, and accessibility. Inner setting barriers and facilitators included relational connections and communication, compatibility, structure and resources, learning centeredness, and information and knowledge access. Finally, results regarding individuals included innovation deliverers, implementation leaders and team, and individual capability, opportunity, and motivation to implement and deliver whole health care.

Discussion and implications: Examination of barriers and facilitators suggest that Whole Health coaches are key components of implementation and help to facilitate communication, relationship building, and knowledge access for Veterans and VA employees. Continuous evaluation and improvement of implementation procedures at each site is also recommended.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.. Data Collection and Analysis Process
This process details the process of each individual site collecting data and subsequently six of the eleven sites synthesizing the data using the updated CFIR domains.
Figure 2.
Figure 2.. Updated CFIR Domains and Constructs Identified in Whole Health System Engagement Analysis
The + symbol indicates facilitators whereas the − symbol represents the barriers under the corresponding construct.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. US Department of Veterans Affairs. Whole Health Library. Updated July 29, 2021. Available at: https://www.va.gov/WHOLEHEALTHLIBRARY/about/index.asp. Accessed December 22, 2022.
    1. National Center for Complimentary and Integrative Health. Complementary, alternative, or integrative health: What’s in a name? Updated April 2021. Available at: https://www.nccih.nih.gov/health/complementary-alternative-or-integrativ.... Accessed January 14, 2023.
    1. US Department of Veterans Affairs. About VHA. Updated August 15, 2022. Available at: https://www.va.gov/health/aboutvha.asp. Accessed May 31, 2023.
    1. Krejci LP, Carter K, Gaudet T. Whole Health: The Vision and Implementation of Personalized, Proactive, Patient-driven Health Care for Veterans. Medical Care. 2014: S5–S8. DOI:10.1097/MLR.0000000000000226 - DOI - PubMed
    1. Bokhour BG, Haun JN, Hyde J, Charns M, Kligler B. Transforming the Veterans Affairs to a Whole Health System of Care: Time for Action and Research. Medical Care. 2020; 58(4): 295–300. DOI: 10.1097/MLR.0000000000001316 - DOI - PubMed

Publication types

MeSH terms