Naturopathy in Australia: Where are we now? Where are we heading?

Barriers and Facilitators to the Inclusion of Naturopaths in Interprofessional Health Care Teams: A Scoping Review

Objective: The growing population of individuals with chronic pain presents a challenge to a globally overburdened health care workforce. Naturopaths are trained as primary health care providers who manage patients with chronic pain and, yet, are often overlooked in health care teams. This scoping review aims to identify barriers and facilitators affecting naturopathic inclusion into interprofessional health care teams managing patients with chronic pain. Methods: This study protocol was registered a priori through Open Science (https://doi.org/10.17605/OSF.IO/2G3JT). A search was conducted using databases AMED, CINAHL, MEDLINE, SCOPUS, Web of Science, APA PsycInfo, and Health Business Elite. Search limits included English language from 2012 to 2023. Included publications were from academic and gray literature. Search terms used included the following: "Naturopath*" OR "Integrative medicine" AND "Health care system*" OR "Health system*" OR "Models of health care" OR "Professional autonomy" OR "Professional regulation" OR "Professional govern*" OR "Interprofessional practice (IPP)" OR "Multidisciplinary communication." The scoping review utilized Covidence software and was analyzed using thematic analysis. Themes were identified following Arksey and O'Malley's (2005) framework to inform a narrative approach. Results: Five themes emerged that relate to the inclusion of naturopaths in health care teams as follows: (1) perceptions of naturopathy, (2) practice standards, (3) legitimacy, (4) resources, and (5) shifting power dynamics and cooperation. Conclusions: Barriers for naturopathic inclusion into health care teams are influenced by perceptions of naturopathy, naturopathic education standards, regulations, research, and patient equity and access. Facilitators for inclusion include the growing shift toward person-centered care, greater interprofessional education, and shared assets, including colocation.

Evidence implementation in naturopathy: A cross-sectional study of Australian naturopaths

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.

Professional identity research in the health professions-a scoping review

Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.

International prevalence of consultation with a naturopathic practitioner: a systematic review and meta-analysis

OBJECTIVES

Naturopathy is a traditional medicine system informed by codified philosophies and principles, and an emphasis on non-pharmacologic therapeutic interventions. While naturopathy is practised by approximately 75 000-100 000 000 naturopathic practitioners in at least 98 countries, little is known about the international prevalence of history of consultation with a naturopathic practitioner. This study reports a systematic review and meta-analysis of studies describing the global prevalence of history of consultation with a naturopathic practitioner by the general population.

SETTING

The included literature was identified through a systematic search of eight databases between September and October 2019, as well as the grey literature.

PARTICIPANTS

Studies were included if they reported the prevalence rate of consultations with a naturopathic practitioner by the general population.

INTERVENTIONS

Survey items needed to report consultations with a naturopathic practitioner as defined in the country where data was collected, and not combine naturopathic consultations with other health services or only report consulations for illness populations.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary measures used for the analysis was consultations in the previous 12 months. Other prevalence timeframes were reported as secondary measures.

METHODS

Meta-analysis of prevalence data was conducted using random effects models based on individual countries and WHO world regions.

RESULTS

The literature search identified eight manuscripts summarising 14 studies reporting prevalence for inclusion in the review. All included studies had a low risk of bias. Meta-analysis of the included studies by world region found the 12-month prevalence of history of naturopathy consultations ranged from 1% in the Region of the Americas to 6% in the European and Western Pacific Regions.

CONCLUSIONS

There are up to sixfold differences in the prevalence of naturopathy consults over 12 months between and within world regions, which may be driven by a range of policy, legislative and social factors.

PROSPERO REGISTRATION NUMBER

CRD42020145529.

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice

BACKGROUND

The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation.

METHODS

Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach.

RESULTS

A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively.

CONCLUSIONS

Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

An examination of technologies in complementary medicine education and practice: The perceptions and experiences of naturopathy students, faculty and educational leaders

OBJECTIVES

Little is known about the education of future CM practitioners. The objective is to explore the perceptions and experiences of students, faculty and professional leaders toward technologies in complementary medicine education and practice.

DESIGN AND SETTING

Qualitative focus groups and one-on-one semi-structured interviews were conducted in CM educational organizations and institutions in North America (United States / Canada) and Australia involving seven focus groups (29 naturopathic students), and 30 one-on-one interviews (faculty, educational and professional leaders of the naturopathic profession).

RESULTS

Data analysis identified five issues reported. These related to perceptions of; the shortfalls of CM classroom technology, the value of technology within CM clinical practice, learning technologies in the classroom, addressing equity concerns as a consequence of learning technology use, and the need to develop technology literacy skills amongst students and faculty.

CONCLUSION

This is the first study to examine the perceptions of students, faculty and professional leaders toward technologies in CM education and practice within an education setting. CM students exhibited complex attitudes and adoption patterns to technology. CM students were critical of faculty who have perceived low levels of digital literacy. The technology issue that students in our study found most challenging was PowerPoint use in the classroom. There is an urgent need to establish a strategic research agenda and modelling around this important area of health care education in order to ensure a well-educated, effective workforce able to deliver the best outcomes for the patients and communities they serve.

Naturopaths' mobilisation of knowledge and information in clinical practice: an international cross-sectional survey

BACKGROUND

The contemporary evidence-based practice model acknowledges the importance of patient preferences and clinician experience when applying evidence within a clinical setting. Knowledge mobilisation (KM) acknowledges the complexities of knowledge translation by recognising and respecting diversity in types of knowledge and how such diversity can influence health care and health care choices. While there has been considerable discussion on KM in health care, it has received little attention in the field of naturopathy. Despite naturopathy's widespread international use, it is unclear how naturopathic practitioners (NPs) use and share knowledge and information in clinical practice. This study examines the mobilisation of knowledge amongst NPs internationally.

METHODS

Online, international, cross-sectional survey of a self-selected sample of NPs from any country, that were either currently in clinical practice or had been in practice within the previous 12 months. The survey was administered in five languages (English, French, Portuguese, Spanish, German). Descriptive statistics were prepared for all survey items.

RESULTS

The survey was completed by 478 NPs who reported using an average of seven (median = 7, SD = 2.6) information sources to inform patient care. NPs also drew on knowledge gained through patients sharing their perspectives of living with their health condition (Always/Most of the time: 89.3%). They mostly sought knowledge about how a treatment might benefit a patient, as well as knowledge about treatment safety and a better understanding of a patient's health condition. NPs frequently reported sharing knowledge developed through consideration of the patient's unique needs (83.3%), and primarily shared knowledge by producing information for the public (72.6%) and for patients (72.2%).

CONCLUSIONS

Based on these findings, it may be argued that NPs practice knowledge mobilisation; employing multiple forms and sources of knowledge, and mobilising knowledge to - as well as from - others. Due to their active engagement in patient and community education, NPs also may be considered knowledge brokers. In the context of the growing understanding of the complexities of knowledge translation and mobilisation in contemporary health care - and particularly within the context of implementation science - this study provides novel insights into an under-researched element of health services accessed by the community.

The Perspectives of Australian Naturopaths about Providing Health Services for People with Sleep Disorders

Objective: The purpose of the study was to determine and describe the clinical approach Australian naturopaths take in providing care for people with sleep disorders, as it well known that Australians commonly seek care from naturopathic practitioners and no data on naturopathic practices for people with sleep disorders is currently documented.Participants: Naturopaths registered with the Australian PRACI (Practitioner Research and Collaboration Initiative) involved in the clinical management of people with sleep disorders.Methods: Consenting participants were invited to participate in semi-structured phone interviews conducted with the aid of a project-specific interview guide until data saturation was evident. Interview recordings were transcribed verbatim and analyzed thematically.Results: A total of 20 naturopaths across 5 different Australian states were interviewed, 4 themes were identifiable. Thematic interpretation suggests that (1) sleep health consults were common and involved detailed history taking by providers, (2) herbal remedies supported by lifestyle and sleep hygiene behaviors were the most common treatments recommended, and (3) interprofessional communication to medical doctors was seldom reciprocated. Government-funded research and establishing statutory registration of naturopaths were identified as key steps in profiling the professions role and to develop/evaluate integrated patient-centered sleep health care models.Conclusion: Naturopaths engage in the treatment of sleep disorders yet face barriers in executing an integration of such approaches within the current health care system. Research is required to explore how to overcome these barriers and develop integrated patient-centered models of care within tertiary sleep clinics and/or primary care physicians.

Improving pharmacy practice in relation to complementary medicines: a qualitative study evaluating the acceptability and feasibility of a new ethical framework in Australia

BACKGROUND

There is a need for clearer guidance for pharmacists regarding their responsibilities when selling complementary medicines. A recently published ethical framework provides guidance regarding the specific responsibilities that pharmacists need to meet in order to fulfil their professional obligations and make a positive contribution to health outcomes when selling complementary medicines.

OBJECTIVE

Evaluate the acceptability and feasibility of a new ethical framework for the sale of complementary medicines in community pharmacy.

METHODS

Australian community pharmacists were invited to participate in online focus groups and interviews. Participants were recruited via multiple methods, including social media and the professional networks of pharmacy groups. Participants were provided the ethical framework prior to the discussion. Discussions were transcribed verbatim and analysed using thematic analysis.

RESULTS

Seventeen community pharmacists participated in the study (11 in 4 focus groups and 6 in individual interviews). There was good representation among participants in terms of gender, years of practice, pharmacy location and script volume. Participants differed in how proactive they were in relation to selling and providing advice on complementary medicines, how they interpreted evidence in relation to complementary medicines, and how they navigated their practice within the retail environment of community pharmacy. The majority of participants found the framework was acceptable for practice and was feasible for implementation with targeted support. Participants identified two important areas for targeted support in implementing the framework: improved access to evidence-based information resources on complementary medicines and independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff.

CONCLUSION

The ethical framework addresses an important gap in providing specific professional guidance to pharmacists when selling complementary medicines. The results of the study suggest that the framework may be acceptable to community pharmacists and be feasible to implement with targeted support.

Practice-Based Research Networks and Massage Therapy: a Scoping Review

BACKGROUND

Practice-based research networks (PBRNs) are means to connect practitioners with researchers and increase the body of rigorous research. PBRNs have been used in medicine for decades, but efforts to create PBRNs in massage therapy (MT) are limited.

PURPOSE

Examine and describe the amount of and nature of MT-related publications derived from PBRN-supported endeavors.

PUBLICATION SELECTION

Databases: Scopus, CINAHL, PubMed, ClinicalKey, EMBASE, Google Scholar. Keywords: massage, massage therapy, practice-based research network, PBRN. Key items: publication year, operating PBRN, article type, study design, general theme, massage therapist involvement/MT application. Inclusion Criteria: studies conducted through a PBRN using MT/massage therapists as an investigated factor; articles/editorials focused on PBRN-related MT research.

RESULTS

Initial database search resulted in 444 records; 40 articles included in analysis from database search, PBRN website access, and PBRN staff contacts. Publication dates ranged from 2005 to 2019, with nearly all published since 2013. Nine PBRNs published 29 articles based on 20 studies and sub-studies as research papers (n=21) or poster/oral presentation abstracts (n=8), and articles discussing the need for PBRNs in MT (n=8). Most research studies were conducted as surveys (n=21), examining practice characteristics (n=9) and patient perspectives/utilization (n=7). Three articles discussing PBRNs in MT were not connected to any specific PBRN.

CONCLUSION

The PBRN model holds promise to further the field of MT, but implementation needs significant development. Promoting the creation and growth of massage-specific PBRNs should be a focus of professional associations and research institutions to expand the body of scientific evidence supporting MT. While the United States has had the most PBRN-related research efforts, a sustainable implementation model is not evident as highlighted by inactivity from US-based PBRNs after initial productivity. An Australian PBRN may serve as a needed sustainability model for massage-related PBRNs in the US if their productivity trajectory continues.

How do patients integrate complementary medicine with mainstream healthcare? A survey of patients' perspectives

BACKGROUND

Complementary medicines (CM) are widely consumed by Australians. However, CM is not included in policy and planning of patient-centred models of healthcare. This study aimed to explore how patients themselves manage to integrate CM with mainstream healthcare.

METHODS

An online survey was distributed through snowball sampling via professional networks and targeted advertising in social media to Australian consumers of CM. Data were managed in Excel and analysed using descriptive statistics in IBM SPSS v23 and Stata v13.

RESULTS

A total of 379 consumers of CM therapies or products completed the survey. The mean age was 51 years, 83% were female and 34% reported having a chronic disease. CM consumers consulted a wide range of healthcare providers. Almost all (97%) had seen a general medical practitioner (GP) within the past year. Overwhelmingly, participants (95%) reported that they themselves were the primary managers of their own healthcare, either on their own (60%) or in collaboration with a CM practitioner (19%) or GP (16%). Approximately 60% of participants reported that they freely discussed their visits to CM practitioners with their GP. Among those, however, males with chronic disease were less likely to disclose CM practitioner consultations (X²₍₁₎ = 4.1, p =  0.04) and over-the-counter pharmaceutical consumption (X²₍₁₎ = 3.8, p =  0.05) to GPs than males without chronic disease. Small numbers in some subgroup analyses suggested that further, larger studies on patient perspectives should particularly target males with chronic disease. Most respondents (83%) valued free choice of health practitioner as extremely or very important (83%). A sense of practitioner community was extremely or very important to the majority (76%) of participants.

CONCLUSION

CM consumers see themselves as primary managers of their healthcare. They want more communication between healthcare providers, which could support them in the safe integration of their total healthcare options. Healthcare policy and planning should recognise the totality of influences on patient health, including the range of CM practitioners and products used by some healthcare consumers.