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Table 1 Free list items within their dimensions of the cultural domain

From: Veteran-centered barriers to VA mental healthcare services use

Dimension 1 Dimension 2 Dimension 3 Dimension 4 Dimension 5
Worry and concern about what others think Financial, personal, and physical obstacles Confidence in the VA healthcare system Navigating VA benefits and healthcare services Privacy, security, and abuse of services
Racism (31)a Homelessness (14) No follow-up from doctors or counselors (28) Lack of knowledge and understanding (43) Fearing of losing security clearance (45)
Stigma (32) Health, injury, sickness (26) Problems with scheduling appointments (13) Concerns about getting mental healthcare (4) Fear of using video teleconferencing (example: V-tel) (9)
Judgment (30) Having other priorities (example: life getting in the way) (12) Too few providers and staff (15) Paperwork is daunting (example: VA referral forms are hard to fill out) (33) Losing rights fought for (39)
Perception of mental healthcare (20) Not having steady employment (36) Lack of available treatment (16) Outreach about VA healthcare (3) Veterans abusing system (29)
Civilians not understanding what veterans have gone through (11) Legal issues (1) No follow-up from VA (40) Problems with getting service connected disability (23)  
“Suck it up” mentality (6) Finances (example: not having enough money) (37) Appointments are hard to get (10) Mental health not asked about in primary care (5)  
Friends, family, doctor thinking you’re “crazy” (38) Childcare (44) Clinics respond slowly to Veterans in crisis (25) Knowledge of where to go and who to contact for mental health services (18)  
Trust (41) Cost of travel (46) Providers changing jobs or leaving (35) Knowledge of what kinds of mental health treatments are available (27)  
Worry about what others think (24) Travel distance (19) Waiting for appointments (34)   
Weakness (example: feeling like a failure or weak) (42) Transportation problems (7)    
Anxiety (22)     
Alcohol and drug use (8)     
  1. aNumbers beside each phrase represent items consolidated from the free list exercise and presented to veterans during the pile-sort activity. These numbers were used for the Multi-Dimensional Scaling and Cluster Analysis