CM Baldwin, Southern Arizona VA Health Care System, Tucson; KW Kroesen, Southern Arizona VA Health Care System, Tucson; Kathi Long, Southern Arizona VA Health Care System, Tucson; Maureen Lifton, Southern Arizona VA Health Care System, Tucson; Iris R. Bell, Southern Arizona VA Health Care System, Tucson

Objectives: The reorganization of the VA into managed care/primary care programs, with a focus on consumer satisfaction, patient-centered care, and concern for quality of life outcomes, has created a need for health services-oriented research on complementary and alternative medicine (CAM) use within the VA system. CAM includes such practices as acupuncture, botanical medicines, chiropractic, folk healing, guided imagery, homeopathy, naturopathy, and massage therapy. Several studies have reported the costs and reasons for use of CAM among civilian populations in the United States. However, few studies have addressed these issues relevant to military veterans. We undertook this study to identify factors related to CAM use by military veterans.

Methods: One hundred subjects were recruited to participate in focus groups in this ethnographic study. Sixty-nine military veterans (60 men, mean age 65 years; 9 women, mean age 51 years) were recruited from VISTA mailing lists, as well as flyers posted in Southern Arizona VA Health Care System (SAVAHCS) Primary Care areas. Ethnic distribution of the veterans was 5% African American, 8% Hispanic, and 87% non-Hispanic white. In addition, 31 spouses, friends, or caregivers also participated in the groups. Of the 12 focus groups (5 to 12 participants per group), nine were held at the SAVAHCS, two at Ft. Huachuca, AZ, and one in Yuma, AZ. Trained facilitators encouraged group participants to relate their uses and costs of, experiences with, and reasons for CAM modalities. Groups were tape-recorded after obtaining informed consent. All tapes were transcribed and coded for content using Atlas.ti software for qualitative analysis. Transcribed data were initially coded by category, including the number of passages within the given category (e.g., CAM Supply Sources, such as health food stores and catalogs—21 passages).

Results: A number of salient themes were determined from the passages, including: CAM use in lieu of intolerable side effects from prescription drugs; the belief that natural is better; self care/personal responsibility for health; a relationship between mind and body (right mental attitude can promote healing, while poor mental attitude can contribute to illness); holism (a patient is the interrelationship of body, mind, and spirit); provider-patient relationship; and out-of-pocket expenses for CAM.

Conclusions: Reasons for CAM use among military veterans are multi-modal and similar to those reported by civilian populations. Veterans praised their Tucson VA providers in general, and the Tucson VA in particular. Limitations to conventional care, particularly relevant to chronic pain or other chronic illnesses such as arthritis, were strong motivators for veterans to turn to CAM providers and modalities.

Impact: Our study offers important insights into the trends in consumer preferences as the VA transitions into a consumer-oriented, primary care/managed care system of health delivery. Results of this study can: 1) assist the VA in understanding motivators for CAM use among military veterans; 2) increase VA awareness of and sensitivity to the meaning of CAM practices for ethnic groups, which could lead to improved adherence with conventional care by minority veterans; and 3) provide direction for future CAM clinical trials and outcomes studies on the safety and effectiveness of specific CAM therapies.