Veterans' Experiences with Complementary and Alternative Medicine: A Phenomenological Qualitative Interpretive Meta-Synthesis

Background/Purpose: Disappointing results in “gold standard” cognitive behavioral exposure-based therapies (Hassija, Jakupcack, & Gray, 2013), coupled with clear consumer interest, prompted the Department of Veterans Affairs Office of Research and Development (2010) to commission a synthesis of available evidence as to the efficacy of complementary and alternative medicine (CAM) approaches, referring to treatments that are not standard to Western medicine (e.g., mind-body, manipulative, body-based, movement-based, and energy therapies). However, no qualitative studies were included, suggesting the need for a qualitative interpretive meta-synthesis (QIMS) to provide a deeper contextual understanding of veterans’ CAM use. The purpose of this phenomenological study was to develop a synergy of the essence of veterans’ experiences with CAM treatments. The intent was to discover what attracts veterans struggling with stress-related symptoms to CAM and how they benefitted from CAM.

Methods: QIMS is designed to synthesize findings from previous qualitative studies. QIMS involves synthesizing the results of multiple qualitative studies on a topic into a new, synergistic understanding and was developed for the social work profession. Data for QIMS were gathered through the use of purposive sampling to select studies relevant to CAM use by veterans for stress-related concerns. Qualitative studies were found using computer databases and reference lists in the English-language literature of social work, medicine, and psychology. From 484 potential studies screened, 11 were selected for analysis, and a total of four qualitative studies on veteran CAM use published between 2002 and 2013 were identified for inclusion. Across the four studies, the total number of male veterans included in the QIMS was 171. The total number of females was nine. Total sample size was 180, ranging in age from 24 to 83. Triangulation of data collection, sources, and analysts was used to increase methodological rigor. Veteran participants’ experiences were utilized to extract themes related to factors determining CAM use by veterans for stress-related conditions.

Results: Five themes emerged across studies: 1) lived experience related to relief from post-traumatic stress and related symptoms, as well as aspects of the CAM experience; 2) sense of personal responsibility for their healthcare which motivated them to research and seek out CAM techniques; 3) spirituality/existentialism related to feeling in touch spiritually, as well as experiencing peace, sense of ease, and connectedness resulting from participation in CAM; 4) proactive healthcare related to veterans’ desire for preventive, natural, holistic healthcare stemming from concerns around medication side-effects and interactions; and 5) negative case themes centering on emotional lability brought on by CAM techniques, difficulty entertaining opposite beliefs, and concerns about CAM affordability.

Conclusions/Implications: CAM techniques enjoyed wide appeal and feasibility with veterans struggling with stress-related symptoms and, thus, are an important complement to traditional social work practice. Veterans did not seek out CAM because they were wholly dissatisfied with conventional care, but because CAM offered elements conventional care did not. Unlike conventional medicine, CAM was appealing because it not only addressed healing the body, but also the mind, heart and spirit—a holistic focus compatible with social work values.