Continuum Model of Determinants Across Socioecologically Nested Health Care Partners: Patient, Clinician, and Administrator Perspectives on Complementary and Integrative Health Care for Nonpharmacological Pain Management.

Purpose: This work explores perceptions across a state with both rural and urban populations in an ecologically informed mapping of health care partners to gain a panoramic view of potential barriers and facilitators to using complementary and integrative healthcare (CIH) for nonpharmacological pain management (NPM). Materials and methods: Semi-structured interviews (N = 48) were conducted with a regionally representative recruitment in six stakeholder groups: chronic pain patients (n = 15), CIH providers (n = 12), clinicians (primary/specialty care providers, nurse practitioners, n = 8), health care administrators (n = 6), and health insurance representatives (n = 7). A six-phase approach using collaborative and iterative thematic analysis was employed. Results: Findings suggest that themes of determinants exist on a continuum from barrier to facilitator, rather than in isolation. Continuums emerged in four categories of themes: Financial, Logistic, Relational, and Experiential. Major barriers were access, insurance, biases, and education, and major facilitators were partnership, education, and awareness. Ecological nesting of stakeholder major themes showed that perceptions by patients emphasized Financial and Experiential categories; providers emphasized Financial, Logistical, and Relational; administrators emphasized Relational and Experiential; and insurance representatives emphasized Relational. Conclusion: The continuum model enables use of person-centered scaling of barriers to facilitators in four categories to communicate their own personal context. Socioecological mapping reveals potential differences in perceptions of health care partners. Future work includes systematic review of the literature within the categories and development of a tool to identify person-centered barriers, needs, and facilitators to utilization of CIH for NPM.