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Leach MJ, Veziari Y. Evidence implementation in naturopathy: A cross-sectional study of Australian naturopaths. Complement Ther Clin Pract 2023; 52:101777. [PMID: 37385012 DOI: 10.1016/j.ctcp.2023.101777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE: Evidence implementation refers to the application of appropriate enabling strategies to improve clinician engagement with the best available evidence. To date, little attention has been paid to evidence implementation in disciplines such as naturopathy. This study addresses this knowledge gap by examining the determinants of evidence implementation in Australian naturopathic practice. MATERIALS AND METHODS This cross-sectional study was open to all Australian naturopaths who had internet access and were fluent in the English language. Participants were invited to complete the 84-item Evidence-Based practice Attitude and utilization Survey (EBASE) online between March and July 2020. RESULTS The survey was completed in full by 174 naturopaths (87.4% female; 31.6% aged 40-59 years). While participant attitudes were predominantly favourable of evidence implementation, engagement in evidence implementation activities was reported at a low to moderate level. Factors impacting participant engagement in such activities included a lack of clinical evidence in naturopathy, lack of time, and a moderate to moderately-high level of self-reported skill in evidence implementation. Enablers of evidence implementation were access to the internet, free online databases, full-text journal articles, and online education materials. CONCLUSION This study has provided valuable insights into the level of, and factors impacting evidence implementation among Australian naturopaths. Attitude did not pose a major barrier to evidence implementation; rather, the barriers were largely structural and cognitive. This suggests that the obstacles to evidence implementation in naturopathy are most likely surmountable with the right means and concerted effort.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Military Road, Lismore, NSW, 2480, Australia.
| | - Yasamin Veziari
- National Centre for Naturopathic Medicine, Southern Cross University, Military Road, Lismore, NSW, 2480, Australia.
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Steel A, Schloss J, Leach M, Adams J. The naturopathic profession in Australia: A secondary analysis of the Practitioner Research and Collaboration Initiative (PRACI). Complement Ther Clin Pract 2020; 40:101220. [PMID: 32891294 DOI: 10.1016/j.ctcp.2020.101220] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION This study provides the most detailed empirical examination of the naturopathic profession and naturopathic practice in Australia. METHODS Naturopaths from the Practitioner Research And Collaboration Initiative (PRACI) were invited to participate in an online workforce survey. RESULTS The baseline survey was completed by 281 naturopaths and 155 (55.2%) completed the second survey. Respondents were predominantly female (86.7%), with a mean age of 45.5 years (SD 10.4). A diverse range of clinical interest topics were disclosed; most frequent were digestive (84.0%) and women's (79.4%) health. Diet/nutrition (91.1%), sleep (90.2%), stress management (85.3%) and physical activity/fitness (79.4%) were commonly discussed during consultation. CONCLUSION Although respondents reported a varied scope of practice, there was a notable emphasis on lifestyle prescriptions. Given lifestyle diseases are the leading cause of death in Australia, a more in-depth examination of the preparedness of the naturopathy workforce to integrate into community-based health care teams is now warranted.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia, 2006.
| | - Janet Schloss
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia, 2006; Endeavour College of Natural Health, Brisbane, Australia, 4006.
| | - Matthew Leach
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia, 2006; National Centre for Naturopathic Medicine, Southern Cross University, Lismore, Australia.
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia, 2006.
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Casteleijn D, Steel A, Bowman D, Lauche R, Wardle J. A naturalistic study of herbal medicine for self-reported depression and/or anxiety a protocol. Integr Med Res 2019; 8:123-128. [PMID: 31193603 PMCID: PMC6536771 DOI: 10.1016/j.imr.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Mental health conditions including anxiety and depression account for around 8% of the global disease burden. Anxiety and depression often coexist and impose a high individual and social burden. Patients with mental and behavioural conditions may be at increased risk of co-morbidities and are often high health-care utilisers. Herbal medicine is estimated to be used by up to 80% of the worlds population, and by 22% of Australian women seeking care for depression. The holistic and tailored treatment approach offered by practitioners of herbal medicine is difficult to capture in randomised controlled trials and as such there is a paucity of research demonstrating the outcomes of real-life practice. This project aims to address this gap with a whole practice, observational model. METHODS/DESIGN The study will employ a naturalistic observational design. Two-hundred patient participants will be recruited to be treated by 15 clinician participants from different naturopathic clinics. The observed changes in anxiety and depression symptoms of patients will be documented across three consultations using validated patient-reported outcome measures (SF-36, DASS-21, GHQ-28 and POMS-2). CONCLUSION Clinical studies investigating the efficacy of individualised herbal medicine treatment as prescribed by a naturopath are rare. Our study attempts to fill this gap with a longitudinal observation of individualised care as practiced by naturopaths in Australia; to offer valuable insights into the effectiveness of individualised herbal medicine practice and provide contextualisation of data currently focused on individual herbal medicines in specific conditions.Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12616000010493.
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Affiliation(s)
| | - Amie Steel
- University of Technology Sydney, Sydney, Australia
| | - Diana Bowman
- University of Technology Sydney, Sydney, Australia
| | - Romy Lauche
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Bamberg, Germany
| | - Jon Wardle
- University of Technology Sydney, Sydney, Australia
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Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey. Sci Rep 2018; 8:17325. [PMID: 30470778 PMCID: PMC6251890 DOI: 10.1038/s41598-018-35508-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
In order to describe the prevalence and characteristics of complementary medicine (CM) practice and product use by Australians, we conducted a cross-sectional online survey with Australian adults aged 18 and over. Rates of consultation with CM practitioners, and use of CM products and practices were assessed. The sample (n = 2,019) was broadly representative of the Australian population. Prevalence of any CM use was 63.1%, with 36% consulting a CM practitioner and 52.8% using any CM product or practice. Bodywork therapists were the most commonly consulted CM practitioners (massage therapists 20.7%, chiropractors 12.6%, yoga teachers 8.9%) and homeopaths were the least commonly consulted (3.4%). Almost half of respondents (47.8%) used vitamin/mineral supplements, while relaxation techniques/meditation were the most common practice (15.8%). CM users were more likely to be female, have a chronic disease diagnosis, no private health insurance, a higher education level, and not be looking for work. Prevalence of CM use in Australia has remained consistently high, demonstrating that CM is an established part of contemporary health management practices within the general population. It is critical that health policy makers and health care providers acknowledge CM in their attempts to ensure optimal public health and patient outcomes.
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Poor integrative medicine policy results from ignorance: But is it wilful or inadvertent? ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Leach MJ, Steel A. The potential downstream effects of proposed changes in Australian private health insurance policy: The case for naturopathy. ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ooi SL, McLean L, Pak SC. Naturopathy in Australia: Where are we now? Where are we heading? Complement Ther Clin Pract 2018; 33:27-35. [PMID: 30396623 DOI: 10.1016/j.ctcp.2018.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 12/31/2022]
Abstract
Naturopathy is the general practice of natural therapies. It emphasizes prevention, treatment, and promotion of optimal health through therapeutic modalities which encourage the self-healing process of the body. Formalized in the 19th century by the hydrotherapy and nature cure movement in Austria and Germany, naturopathy was introduced to Australia at the turn of the 20th century. It became popular since the 1970s due to social and cultural change characterized by the post-modern philosophy, as well as government policies highlighting individual responsibility and freedom of choice. Naturopathy is one of the most popular forms of complementary medicine in Australia today with naturopaths received 4.9 million consultations annually. Naturopathic consultations are sought for a variety of conditions and, in some areas, as a form of primary care, especially by middle-aged women who have a higher education level and a higher annual income. The number of Australian naturopaths was estimated to be over 4000 in 2017 and expects to grow to over 4600 by 2022, although this number is likely to be an underestimation. Australian naturopaths, as a predominantly female profession, work mainly in private clinical practice with nutritional medicine, herbal medicine, homeopathy, as well as massage therapies being the most common modalities used. There are also signs of greater integration with community pharmacies and integrative medicine clinics in major cities. The Bachelor's degree programs in Naturopathy has just become the only accredited entry-level qualification since late 2015. Currently, there are only 5 private colleges offering naturopathic education, a far cry from the 40 over in mid-2000. The profession continues to be self-regulated. There is no barrier of entry to practice and unqualified practitioners of naturopathy can potentially do harm to the public. The registration of naturopaths remains unresolved due to fragmented representation under many professional associations, disunity among the profession, and objections by certain health care lobbyists. There is a dearth of research demonstrating efficacy of the whole practice of naturopathy in Australia, which has directed the government's decision to withdraw it from private health insurance coverage from 2019. Moving forward, the whole system research of naturopathy in Australia will be in focus with the recent establishment of a practice-based research network and an international research consortium. With increasing scrutiny from evidence-based medicine, the present and future challenge to Australian naturopaths is centered on the integration of both scientific and traditional evidence to form the foundation of a person-centered, evidence-informed practice.
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Affiliation(s)
- Soo Liang Ooi
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia
| | - Lisa McLean
- School of Health & Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW, 2795, Australia.
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Ooi SL, Smith L, Pak SC. Evidence-informed massage therapy - an Australian practitioner perspective. Complement Ther Clin Pract 2018; 31:325-331. [PMID: 29705477 DOI: 10.1016/j.ctcp.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/08/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022]
Abstract
Massage therapy (MT) is the most popular complementary and alternative medicine therapy used by the Australian public. With the growing emphasis by the Australian health authority on evidence-informed healthcare decision-making, there is an increasing demand for massage therapists to move towards the evidence-informed practice (EIP). With MT research gaining significant attention over the last 30 years, clinical evidence exists to support the efficacies of MT on many health conditions, including chronic low back pain. This growing body of research supports MT to become an evidence-informed therapeutic modality. The evidence utilization process of asking clinical questions, searching for available research evidence, and appraising the evidence critically can be incorporated into the clinical practice of MT. Moreover, integrating practitioners' skills and experience with research evidence enables the best treatment plan to address the clients' needs and stated goals. No dichotomy exists between scientific research and the humanistic client care of MT. A massage therapist can gain greater confidence in practice, improve critical thinking and decision-making skills, and increase career satisfaction through EIP. Despite its high public utilization, massage therapists in Australia remain a low-paying profession dominated by part-time workers who rarely utilize research evidence in practice. Professional associations of massage therapists in Australia need to play a key role in promoting EIP through continuing professional education, providing the access to research information and resources, as well as fostering a culture of EIP.
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Affiliation(s)
- Soo Liang Ooi
- Centre for Complementary & Alternative Medicine, 247909, Singapore
| | - Lauren Smith
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia.
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Hall H, Brosnan C, Cant R, Collins M, Leach M. Nurses' attitudes and behaviour towards patients' use of complementary therapies: A mixed methods study. J Adv Nurs 2018; 74:1649-1658. [PMID: 29493807 DOI: 10.1111/jan.13554] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 01/10/2023]
Abstract
AIM To explore Registered Nurses' attitudes and behaviour towards patients' use of complementary therapies. BACKGROUND Despite high rates of use of complementary therapies by the general population, little is known of how nurses respond to patients' use of these therapies. DESIGN A two-phase sequential exploratory mixed methods design. METHODS Nineteen Registered Nurses working in Australia participated in a semi-structured interview in 2015-2016 and emerging themes informed the development of a quantitative survey instrument administered online nationwide in 2016. FINDINGS Emerging key themes "Promoting safe care"; "Seeking complementary therapies knowledge";" Supporting holistic health care"; and "Integrating complementary therapies in practice" were reflected in survey results. Survey responses (N = 614) revealed >90% agreement that complementary therapies align with a holistic view of health and that patients have the right to use them. Most nurses (77.5%) discussed complementary therapies with patients and 91.8% believed nurses should have some understanding of the area. One-third did not recommend complementary therapies and there was a lack of overall consensus as to whether these therapies should be integrated into nursing practice. Nurses with training in complementary therapies held more positive views than those without. CONCLUSION Nurses were generally supportive of patients' interest in complementary therapies, although their primary concern was safety of the patient. Despite broad acceptance that nurses should have a basic understanding of complementary therapies, there was a lack of consensus about recommendation, integration into nursing practice and referral. Further research should explore how nurses can maintain safe, patient-centred care in the evolving pluralistic healthcare system.
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Affiliation(s)
- Helen Hall
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Frankston, Vic., Australia.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia
| | - Caragh Brosnan
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia.,School of Humanities and Social Science, University of Newcastle, Newcastle, Australia
| | - Robyn Cant
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Frankston, Vic., Australia
| | | | - Matthew Leach
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Sydney, Australia.,Department of Rural Health, University of South Australia, Adelaide, SA, Australia
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Wardle J. The extraordinary complexities in defining complementary medicine. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2018.02.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Establishing an international research collaborative for naturopathy: The International Research Consortium of Naturopathic Academic Clinics (IRCNAC). ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The canary in the coal-mine: The complex relationship between complementary and integrative medicine and evidence-based medicine. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wardle J. Complementary and integrative medicine as middle class medicine: Busting the myth. ADVANCES IN INTEGRATIVE MEDICINE 2017. [DOI: 10.1016/j.aimed.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wardle J. More integrative research is needed: But where will it come from? ADVANCES IN INTEGRATIVE MEDICINE 2016. [DOI: 10.1016/j.aimed.2016.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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