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Solomonian L, Blesoff J, Garofalo L, Lucas S, Picardo A, Garber A, Wilson M, Leach M. Naturopathic Management of Acute Pediatric Respiratory Infections: A Modified Delphi Study. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:181-195. [PMID: 36827416 DOI: 10.1089/jicm.2022.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Objective: Both the United Nations and the World Health Organization have identified antimicrobial resistance as a significant threat to global health. The Centers for Disease Control and Prevention identified five pediatric respiratory conditions as requiring particular scrutiny in terms of antibiotic stewardship. This study sought to identify strategies used by experienced naturopathic practitioners to treat acute respiratory infections in children. The authors theorize that naturopathic strategies safely fill the gap between watchful waiting and antibiotic prescription, thus reducing the use of antibiotics. Methods: Naturopathic practitioners in Canada, the United States, and Australia with a minimum of 5 years of experience in clinical naturopathic care of children were recruited for a modified Delphi study. A 14-person panel of practitioners was selected to complete a series of four iterative surveys assessing agreement to statements in five domains of knowledge/attitudes, assessment/diagnosis, management, monitoring, and education. Items were deemed to have reached consensus if they reached a predetermined threshold of 70% agreement, or failed to reach a threshold of 40% agreement. Items between these boundaries were modified and retested until either consensus was reached or the four surveys had been completed. Results: Results yielded a large degree of agreement on core naturopathic approaches to the management of acute pediatric respiratory infections, especially lifestyle strategies, including adequate rest and dietary recommendations. The use of vitamins C and D was strongly supported, as were herbs, particularly echinacea and elderberry. Some hydrotherapy and topical applications specific to the individual focus on infection also reached consensus. Results suggested that most respondents, even if they have the authority to prescribe antibiotics, rarely deem it necessary to do so. Conclusion: Findings of this study provide (1) clarity on the role of naturopathic doctors in the management of pediatric health concerns and the stewardship of antibiotics; and (2) initial guidance to less experienced naturopathic practitioners. The findings also identify key priorities for research into the safety and effectiveness of naturopathic interventions to reduce the unnecessary prescribing of antibiotics.
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Affiliation(s)
| | - Jamine Blesoff
- National University of Health Sciences, Lombard, IL, USA
| | | | - Sandra Lucas
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Andrea Picardo
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Anna Garber
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Mariah Wilson
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia
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Leach MJ, Veziari Y. Enablers and Barriers to Evidence Implementation in Complementary Medicine: A Systematic Review. Integr Med Res 2022; 11:100899. [DOI: 10.1016/j.imr.2022.100899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022] Open
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Vosoughi MN, Zamanzadeh V, Valizadeh L, Ghahramanian A, Lotfi M, Bagheriyeh F, Pourmollamirza A. An introduction to the TPSN model: a comprehensive approach to reducing the theory-practice gap in nursing. BMC Nurs 2022; 21:261. [PMID: 36131277 PMCID: PMC9494876 DOI: 10.1186/s12912-022-01030-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background There are still concerns about the effectiveness of clinical education models which are done with the aim of reducing the theoretical-practical gap in nursing. In this article, we intend to describe an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. The basis of this work is the full-time presence of nursing teacher in the clinical settings and the development of their role to improve the education of students and nurses and the quality of nursing services. Methods This was a participatory action research. This action research was implemented in four steps of problem identification, planning, action and reflection. Interviews, focus groups and observation were used for the qualitative part. Clinical Learning Environment Inventory (CLEI), Job Satisfaction in Nursing Instrument questionnaires and Patient Satisfaction with Nursing Care Quality Questionnaire were completed before and after the study. Qualitative content analysis, paired and independent t test were used for data analysis. Results The academic-practice integration Model of TPSN is a dynamic and interactive model for accountability in nursing Discipline. Unlike the medical education model that includes patients, students, and physicians as the three points of a triangle, this model, which is shaped like a large triangle, places the person in need of care and treatment (patient, client, family, or society) in the center of the triangle, aiming to focus on the healthcare receiver. The model consists of three components (Mentoring component, Preceptorship component, and integrated clinical education component). Each of the components of this model alone will not be able to eliminate the ultimate goal of bridging the theory-practice gap. Conclusions A new and innovative model was proposed to reduce the theory-practice gap in the present study. This model increases the collaboration between educational institutions and healthcare settings compared with the previous models. The TPSN model helps students, nurses, and nursing instructors integrate theoretical knowledge with clinical practice and act as professional nurses.
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Affiliation(s)
- Maryam Namadi Vosoughi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leila Valizadeh
- Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Lotfi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzaneh Bagheriyeh
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
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Leach MJ, Foley H. Evidence implementation among complementary medicine practitioners: a meta-summary. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:499-511. [PMID: 35998915 DOI: 10.1515/jcim-2022-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To explore the factors impacting evidence implementation in complementary medicine (CM) practice. CONTENT MEDLINE and CINAHL were systematically searched for cross-sectional studies examining evidence implementation among CM practitioners. Qualitative data from eligible studies were collated and analysed using a meta-summary approach. Data were coded according to the five domains of the Consolidated Framework for Implementation Research (CFIR), and translated into barriers and enablers. SUMMARY Qualitative data were available for 614 participants (from 16 disciplines) across 14 studies. Coding identified 34 themes, with most themes aligning with the Inner Setting (11 themes) and Characteristics of the Intervention (10 themes) domains of the CFIR. The most commonly referenced barriers to evidence implementation were: 'Lack of supportive resources' (Effect size [ES]=33.3%), 'Research misalignment with profession and practice' (ES=14.5%) and 'Lack of access to knowledge and information' (ES=10.5%). The most common enablers were: 'Recognition of a need for change' (ES=8.2%) and 'Perceived adaptability of EBP to the profession' (ES=7.8%). OUTLOOK This research offers new insights into the challenges and opportunities to implementing evidence-based practices in the field of CM. The findings underline the complexity of the phenomenon, and the need for a nuanced, multi-faceted and multi-stakeholder approach to improving evidence implementation in CM.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW, Australia
| | - Hope Foley
- National Centre for Naturopathic Medicine, Southern Cross University, East Lismore, NSW, Australia
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Veziari Y, Kumar S, Leach MJ. An exploration of barriers and enablers to the conduct and application of research among complementary and alternative medicine stakeholders in Australia and New Zealand: A qualitative descriptive study. PLoS One 2022; 17:e0264221. [PMID: 35180276 PMCID: PMC8856519 DOI: 10.1371/journal.pone.0264221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/06/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Most studies examining complementary and alternative medicine (CAM) stakeholder engagement with evidence-based practice have relied on quantitative research methods, which often fail to capture the nuances of this phenomena. Using qualitative methods, this study aimed to explore the experiences of CAM stakeholders regarding the barriers and enablers to the conduct and application of research. METHODS This research was guided by a qualitative descriptive framework. CAM practitioners and researchers of multiple CAM disciplines from across Australia and New Zealand were invited to share their personal perspectives of the study phenomena. Semi-structured interviews were conducted via Zoom, which were audio-recorded and transcribed verbatim. Rigour strategies were applied to ensure the credibility of results. The transcript was analysed using thematic analysis. RESULTS CAM stakeholders identified an array of barriers and enablers to the conduct and application of research within their disciplines. The barriers and enablers that emerged were found to be inter-connected with two similar constructs: capacity and culture. Captured within the construct of capacity were five themes-lack of resources, inadequate governance/leadership, lack of competency, bias directed from outside and within CAM, and lack of time for research. Within the construct of culture were two themes-intrinsic perceptions in CAM, and lack of communication within and outside CAM. CONCLUSIONS Promoting evidence-based practice and engaging with research in CAM continues to face challenges. This study, for the first time, has highlighted the multitude of interlinked barriers that confront CAM stakeholders when engaging with research. These findings highlight the need for a concerted and targeted approach to tackle these challenges.
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Affiliation(s)
- Yasamin Veziari
- UniSA Allied Health & Human Performance, University of South Australia, North Terrace, Adelaide, South Australia, Australia
| | - Saravana Kumar
- UniSA Allied Health & Human Performance, University of South Australia, North Terrace, Adelaide, South Australia, Australia
| | - Matthew J. Leach
- Southern Cross University, National Centre for Naturopathic Medicine, East Lismore, New South Wales, Australia
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Leach MJ. Implementation science in New Zealand naturopathic practice: a cross-sectional study. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:781-790. [PMID: 35092655 DOI: 10.1515/jcim-2021-0508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Understanding and addressing the barriers to evidence-based practice (EBP) falls within the realm of implementation science. To date, disciplines such as naturopathy have paid little attention to implementation science, meaning the obstacles to delivering best practice care have largely been ignored. This study addresses this knowledge gap by examining the determinants of evidence implementation in New Zealand naturopathic practice. METHODS This cross-sectional study was open to all New Zealand 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 February and July 2020. RESULTS The survey was completed in full by 104 naturopaths (86% female; 55% aged 40-59 years). While attitudes toward EBP were generally favourable, engagement in EBP activities was reported at a moderate-low level. Factors potentially contributing to the modest uptake of EBP were the moderate level of self-reported EBP-related skill, lack of clinical evidence in naturopathy and lack of time. Enablers of EBP uptake that were supported by the majority of participants were access to the Internet, online databases, EBP education materials, and full-text journal articles. CONCLUSIONS This study has provided much-needed insight into the level of EBP engagement among New Zealand naturopaths, as well as the various factors impacting evidence implementation. Attitude did not pose a major barrier to evidence implementation; rather, the barriers were largely structural, cognitive and cultural. This suggests that the barriers to EBP uptake in naturopathy are not unsurmountable.
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Affiliation(s)
- Matthew J Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Military Road, Lismore, NSW 2480, Australia
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Ng JY, Hilal A, Maini I. What traditional, complementary, and integrative medicine recommendations exist across osteoporosis clinical practice guidelines? A systematic review and quality assessment. Integr Med Res 2021; 11:100803. [PMID: 34840950 PMCID: PMC8605333 DOI: 10.1016/j.imr.2021.100803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/07/2021] [Accepted: 10/13/2021] [Indexed: 12/18/2022] Open
Abstract
Background Traditional, complementary and integrative medicine (TCIM) is sought by more than 50% of patients with osteoporosis. Despite this, many healthcare providers lack the knowledge to adequately counsel patients on safe and effective TCIM use. The purpose of this study was to determine the quantity and quality of TCIM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of osteoporosis. Methods MEDLINE, EMBASE and CINAHL databases, in addition to the Guidelines International Network, and the National Center for Complementary and Integrative Health website were searched from 2009–2020. CPGs making TCIM recommendations for the treatment/management of osteoporosis were assessed with the AGREE II instrument. Results Of 536 unique search results, 27 osteoporosis CPGs made mention of TCIM therapies. From highest to lowest, scaled domain percentages of all eligible CPGs averaged to 92.59% for scope and purpose, 88.79% for clarity in presentation, 55.04% for stakeholder involvement, 47.84% for editorial independence, 46.53% for rigor of development, and 36.96% for applicability. Of the 27 CPGs assessed, 4 CPGs were recommended as is by both appraisers, while 23 CPGs were recommended with modifications. Conclusions Recommendations pertaining to calcium and vitamin D supplementation and exercise were favorably recommended across nearly all CPGs. In the case of other TCIM interventions, recommendations varied greatly, which may present challenges for CPGs target users due to a lack of consistency. Given the varying quality of osteoporosis CPGs found, those requiring improvement may benefit from their guideline development panel utilizing the AGREE II instrument to inform future updates.
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Affiliation(s)
- Jeremy Y Ng
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Centre for Learning and Discovery, McMaster University, Hamilton, Ontario, Canada
| | - Arwa Hilal
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Centre for Learning and Discovery, McMaster University, Hamilton, Ontario, Canada
| | - Ishana Maini
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Centre for Learning and Discovery, McMaster University, Hamilton, Ontario, Canada
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Wong CHL, Tse JVH, Nilsen P, Ho L, Wu IXY, Chung VCH. Barriers and facilitators to promoting evidence uptake in Chinese medicine: a qualitative study in Hong Kong. BMC Complement Med Ther 2021; 21:200. [PMID: 34266433 PMCID: PMC8280573 DOI: 10.1186/s12906-021-03372-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/30/2021] [Indexed: 01/01/2023] Open
Abstract
Background In response to the World Health Organization’s recommendation, policy makers have been adopting evidence-based healthcare approach to promote the development of traditional, complementary and integrative medicine (TCIM) into Hong Kong’s health system. Disseminating synopses of clinical evidence from systematic reviews or randomized trials is regarded as a potentially effective strategy to promote evidence uptake. The study aimed to identify barriers and facilitators to implementing this strategy among Hong Kong Chinese medicine practitioners (CMPs). Methods Twenty-five CMPs aged under 45 years and trained in Hong Kong after reunification with China in 1997 were interviewed individually. Four clinical evidence synopses of randomized trials and systematic reviews on Chinese medicine interventions were presented, and CMPs were asked to comment on their applicability in routine practice. The Consolidated Framework for Implementation Research (CFIR) was applied to guide interview and analysis. Results The barriers included: i) CMPs’ perceived difficulties in applying complex evidence in decision-making and ii) inadequate training and limited consultation time. The facilitators were i) availability of publicly accessible and user-friendly synopses, ii) formation of community of evidence-based practice among CMPs with input from key opinion leaders, iii) opportunity for interprofessional collaborations with conventional healthcare providers, and iv) patients’ demand for evidence-based clinical advice. Besides, i) CMPs’ knowledge and beliefs in evidence-based healthcare approach, ii) presentations of evidence-based information in the synopses, and iii) clinical decision making as influenced by quality of evidence reported acted as both barriers and facilitators. Conclusions This CFIR-based qualitative study investigated how the World Health Organization recommendation of promoting evidence use in routine practice was perceived by CMPs trained in Hong Kong after reunification with China in 1997. Key barriers and facilitators to applying evidence were identified. Such results will inform tailoring of implementation strategies for promoting evidence uptake, in the context of a well-developed health system dominated by conventional medicine. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03372-5.
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Affiliation(s)
- Charlene Hoi Lam Wong
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
| | - Jeffrey Van Ho Tse
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Building 511-001, Entrance 76, plan 13, Campus US, 58183, Linköping, Sweden
| | - Leonard Ho
- School of Chinese Medicine, Chung Chi College, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Irene Xin Yin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Rm 527 5/F, 238 Shangmayuanling Alley, Kaifu District, Changsha, China.
| | - Vincent Chi Ho Chung
- Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, Hong Kong
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Veziari Y, Kumar S, Leach M. Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review. BMC Complement Med Ther 2021; 21:201. [PMID: 34266441 PMCID: PMC8281683 DOI: 10.1186/s12906-021-03371-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM. METHODS The scoping review was undertaken using the Arksey and O'Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data. RESULTS Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers. CONCLUSIONS While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.
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Affiliation(s)
- Yasamin Veziari
- UniSA Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Saravana Kumar
- UniSA Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, Military Road, East Lismore, NSW 2480 Australia
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Veziari Y, Kumar S, Leach M. Barriers to the conduct and application of research among complementary and alternative medicine professions in Australia and New Zealand: A cross-sectional survey. Complement Ther Med 2021; 60:102752. [PMID: 34126172 DOI: 10.1016/j.ctim.2021.102752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Despite the growing international popularity and use of complementary and alternative medicine (CAM), the uptake of evidence-based practice (EBP) in CAM has been slow. This cross-sectional survey aimed to further our understanding of the factors impacting EBP uptake in CAM. METHODS The 32-item oBSTACLES instrument was administered online using the SurveyMonkey™platform. The survey evaluated barriers to both the conduct and application of research among CAM practitioners and researchers, from multiple CAM disciplines across Australia and New Zealand. Participants were recruited via practice-based research networks, professional associations, CAM educational institutions, CAM research centres, pertinent product manufacturers and social media platforms. Data were analysed using descriptive statistics. RESULTS Six hundred and eighty-two CAM stakeholders responded to the survey. Barrier items were divided into two interlinked constructs, "capacity" and "culture". Capacity related to issues regarding access, competency, bias, incentives, and time, whereas culture related to values and complex systems. Under capacity, the greatest proportion of participants (>70 %) agreed that access was a barrier to the conduct and application of research, including lack of funding, institutional support, research training and collaborations. In terms of culture, the majority of participants (>60 %) agreed that values were a barrier to research conduct and application, including limited undergraduate research opportunities and diverse views of evidence. CONCLUSION Findings from this research suggest a multitude of barriers negatively impact the conduct and application of research in CAM. Insights gained from this research will be instrumental in developing actionable strategies aimed at mitigating the impact of these barriers to improve research engagement in CAM.
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Affiliation(s)
- Yasamin Veziari
- University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Saravana Kumar
- University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Matthew Leach
- Southern Cross University, Military Road, East Lismore, NSW, 2480, Australia.
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Henley AK, Collier E, Robertson K, Biard MA, Bruno K, Bush H, Frees E, Krater C, Woolever S, Burns DS, Robb SL. Music Therapist Experiences of a Randomized Controlled Trial as Clinician Researchers. J Music Ther 2020; 57:315-352. [PMID: 32227108 DOI: 10.1093/jmt/thaa005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Music therapy clinicians bring an important perspective to the design and conduct of clinically meaningful studies. Unfortunately, there continue to be roadblocks that hinder clinician involvement in research and the development of successful partnerships between academic researchers and practicing clinicians. To help grow clinician involvement, it is important that research teams share their experiences. As such, the purpose of this qualitative study was to share music therapists' perspectives about their experience of working as a research clinician on a large multisite randomized controlled trial. 10 board-certified music therapists provided written responses to 6 data-generating questions about: (a) reasons for participating, (b) perceived challenges and benefits, (c) experiences of quality assurance monitoring, (d) professional growth, (e) value of research, and (f) advice for clinicians considering research involvement. Using thematic content analysis, we identified primary themes and subthemes for each question (20 themes; 30 subthemes). Qualitative analysis revealed not only common challenges, such as reconciling clinical and research responsibilities, but also benefits, including continued professional growth, greater understanding of research processes, and research participation as a way to advocate and advance the profession. Finally, for clinicians interested in becoming involved in research, therapists noted the importance of having workplace support from a mentor, supervisor, and/or administrator; seeking out available resources; and knowing roles and responsibilities before initiating research involvement. Findings offer important insight and recommendations to support the involvement of clinicians in research and support further exploration of clinician involvement in dissemination efforts to improve translation and uptake of research into practice.
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Affiliation(s)
| | | | | | | | | | | | | | - Caitlin Krater
- Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | | | - Debra S Burns
- School of Engineering and Technology at IUPUI Department of Music and Arts Technology, Indianapolis, IN
| | - Sheri L Robb
- Indiana University School of Nursing, Indianapolis, IN
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Nguyen J, Smith L, Hunter J, Harnett JE. Conventional and Complementary Medicine Health Care Practitioners' Perspectives on Interprofessional Communication: A Qualitative Rapid Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E650. [PMID: 31569742 PMCID: PMC6843134 DOI: 10.3390/medicina55100650] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/15/2019] [Accepted: 09/24/2019] [Indexed: 01/22/2023]
Abstract
Background and Objectives: People have multi-faceted health care needs and consult a diverse range of health care practitioners (HCP) from both the conventional and complementary medicine healthcare sectors. The effective communication between HCP and with patients are obvious requisites to coordinating multidisciplinary care and shared decision making. Further, miscommunication is a leading cause of patient harm and is associated with reduced patient satisfaction, health literacy, treatment compliance and quality of life. In conventional healthcare settings, the differences in professional hierarchy, training, communication styles and culture are recognised communication barriers. Less is known about interprofessional communication (IPC) that includes traditional and complementary medicine (TCM) HCP. This review aims to summarise the experiences and perceptions of conventional and complementary HCP and identify factors that influence IPC. Methods: A qualitative rapid literature review was conducted. Six databases were searched to identify original research and systematic reviews published since 2009 and in English. Excluded were articles reporting original research outside of Australia that did not include TCM-HCP, already cited in a systematic review, or of low quality with a score of less than three on a critical appraisal skills programme (CASP) checklist. A thematic analysis of included studies was used to identify and explore important and recurring themes. Results: From the conducted searches, 18 articles were included, 11 of which reported data on complementary HCP and seven were literature reviews. Four key themes were identified that impact IPC: medical dominance, clarity of HCP roles, a shared vision, and education and training. Conclusion: IPC within and between conventional and complementary HCP is impacted by interrelated factors. A diverse range of initiatives that facilitate interprofessional learning and collaboration are required to facilitate IPC and help overcome medical dominance and interprofessional cultural divides.
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Affiliation(s)
- Janet Nguyen
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Lorraine Smith
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia.
| | - Jennifer Hunter
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Joanna E Harnett
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW 2006, Australia.
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Wong CH, Wu IX, Cheung WK, Ho RS, Leach MJ, Peng W, Zhang Y, Wu JC, Chung VC. Impact of evidence-based healthcare education for Chinese medicine practitioners: A pre-post evaluation. Complement Ther Med 2019; 45:38-44. [DOI: 10.1016/j.ctim.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
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Leach MJ, Sundberg T, Fryer G, Austin P, Thomson OP, Adams J. An investigation of Australian osteopaths' attitudes, skills and utilisation of evidence-based practice: a national cross-sectional survey. BMC Health Serv Res 2019; 19:498. [PMID: 31315615 PMCID: PMC6637614 DOI: 10.1186/s12913-019-4329-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022] Open
Abstract
Background Osteopaths are an integral member of the health care team, playing a pivotal role in the provision of care for patients with musculoskeletal disorders. Osteopaths, like other health care providers, are under increasing pressure to deliver evidence-based health care and to improve patient outcomes. However, the extent to which osteopaths engage in evidence-based practice (EBP), particularly in Australia, is not well understood. This study therefore set out to investigate the attitudes, skills and use of EBP, and perceived barriers and enablers of EBP uptake, among osteopaths practicing in Australia. Methods National cross-sectional survey of Australian registered osteopaths. Eligible participants were invited by email and other digital media recruitment strategies to complete the online Evidence-Based Practice Attitude and Utilisation Survey (EBASE). Results A total of 332 osteopaths completed the survey. The demographic characteristics of respondents were generally consistent with the characteristics of the Australian osteopathy workforce. The respondents were mostly favourable of EBP, with the majority agreeing or strongly agreeing that EBP assists in making decisions about patient care (86.7%) and improves the quality of patient care (75.6%). While most respondents (88.3%) had some training in EBP, most reported a moderate level of perceived skill in EBP. The majority of respondents engaged infrequently (0–5 times) in EBP activities within the last month, and most indicated that a very small or small proportion of their clinical practice was based on clinical research evidence. Leading barriers to the uptake of EBP were lack of time and lack of clinical evidence in osteopathy. Key enablers of EBP uptake were access to the internet and online databases at work, and access to full-text articles and EBP education materials. Conclusions Osteopaths participating in the survey were largely supportive of evidence-based practice, yet engaged infrequently in EBP activities. An important next step in this research is to identify suitable strategies that effectively improve EBP uptake in osteopathy, and perchance, improve patient outcomes.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, Australia.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Tobias Sundberg
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Musculoskeletal and Sports Injury Epidemiology Center (MUSIC), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gary Fryer
- College of Health & Biomedicine, Victoria University, Melbourne, Victoria, Australia.
| | - Philip Austin
- Department of Pain Management, Greenwich Hospital, Sydney, Australia
| | - Oliver P Thomson
- University College of Osteopathy, London, United Kingdom.,Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration (COME), Pescara, Italy
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Sundberg T, Leach MJ, Thomson OP, Austin P, Fryer G, Adams J. Attitudes, skills and use of evidence-based practice among UK osteopaths: a national cross-sectional survey. BMC Musculoskelet Disord 2018; 19:439. [PMID: 30526551 PMCID: PMC6286591 DOI: 10.1186/s12891-018-2354-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/20/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Evidence-based practice (EBP) is a clinical decision-making framework that supports quality improvement in healthcare. While osteopaths are key providers of musculoskeletal healthcare, the extent to which osteopaths engage in EBP is unclear. Thus, the aim of this cross-sectional study was to investigate UK osteopaths' attitudes, skills and use of EBP, and perceived barriers and facilitators of EBP uptake. METHODS UK-registered osteopaths were invited to complete the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) online. RESULTS Of the 5200 registered osteopaths in the UK, 9.9% (517/5200) responded to the invitation, and 7.2% (375/5200) completed the EBASE (< 20% incomplete answers). The demographic characteristics of the survey sample were largely similar to those of the UK osteopathy workforce. The osteopaths reported overall positive attitudes towards EBP, with most agreeing that EBP improves the quality of patient care (69.3%) and is necessary for osteopathy practice (76.5%). The majority reported moderate-level skills in EBP, and most (80.8%) were interested in improving these skills. Participating osteopaths typically engaged in EBP activities 1-5 times over the last month. Barriers to EBP uptake included a lack of time and clinical evidence in osteopathy. Main facilitators of EBP included having access to online databases, internet at work, full-text articles, and EBP education materials. CONCLUSIONS UK osteopaths were generally supportive of evidence-based practice, had moderate-level skills in EBP and engaged in EBP activities infrequently. The development of effective interventions that improve osteopaths' skills and the incorporation of EBP into clinical practice should be the focus of future research.
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Affiliation(s)
- Tobias Sundberg
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Musculoskeletal and Sports Injury Epidemiology Center (MUSIC), Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matthew J. Leach
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Department of Rural Health, University of South Australia, Adelaide, Australia
| | - Oliver P. Thomson
- University College of Osteopathy, London, UK
- Clinical-based Human Research Department, Centre for Osteopathic Medicine Collaboration (COME), Pescara, Italy
| | - Philip Austin
- Department of Pain Management, Greenwich Hospital, Sydney, Australia
| | - Gary Fryer
- Institute for Health and Sport, Victoria University, Melbourne, Victoria Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
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Canaway R, Leach M, Hunter J. Setting an agenda for strengthening the evidence-base for traditional and complementary medicines: Perspectives from an expert forum in Australia. ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Leach MJ, Canaway R, Hunter J. Evidence based practice in traditional & complementary medicine: An agenda for policy, practice, education and research. Complement Ther Clin Pract 2018; 31:38-46. [PMID: 29705478 DOI: 10.1016/j.ctcp.2018.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/29/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To develop a policy, practice, education and research agenda for evidence-based practice (EBP) in traditional and complementary medicine (T&CM). METHODS The study was a secondary analysis of qualitative data, using the method of roundtable discussion. The sample comprised seventeen experts in EBP and T&CM. The discussion was audio-recorded, and the transcript analysed using thematic analysis. RESULTS Four central themes emerged from the data; understanding evidence and EBP, drivers of change, interpersonal interaction, and moving forward. Captured within these themes were fifteen sub-themes. These themes/sub-themes translated into three broad calls to action: (1) defining terminology, (2) defining the EBP approach, and (3) fostering social movement. These calls to action formed the framework of the agenda. CONCLUSIONS This analysis presents a potential framework for an agenda to improve EBP implementation in T&CM. The fundamental elements of this action plan seek clarification, leadership and unification on the issue of EBP in T&CM.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, SA, 5000, Australia.
| | - Rachel Canaway
- Department of General Practice, The University of Melbourne, 200 Berkeley St, Victoria, 3010, Australia.
| | - Jennifer Hunter
- NICM, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith NSW, 2751, Australia.
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Veziari Y, Leach MJ, Kumar S. Barriers to the conduct and application of research in complementary and alternative medicine: a systematic review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:166. [PMID: 28335766 PMCID: PMC5364631 DOI: 10.1186/s12906-017-1660-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/04/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND The popularity of Complementary and alternative medicine (CAM) has grown considerably over the past few decades. This has been accompanied by increasing public pressure for CAM to be evidence-based. Notwithstanding, the conduct and application of research in CAM faces a number of obstacles. No systematic review has mapped these barriers to date. Therefore, this systematic literature review aimed to explore, identify and map the barriers to the conduct and application of research in CAM. METHODS Systematic searching of MEDLINE, Embase, AMED, CINAHL, The Cochrane library, Google scholar and Google was conducted between February and June 2016 for pertinent publications. Pearling (secondary searching) of retrieved publications was also undertaken. Literature published only in English were included; however, no year limit was placed for searching. Two critical appraisal tools were used to critically appraise descriptive studies and opinion publications. RESULTS A total of 21 eligible publications were included in this review; this comprised of eight primary research articles and thirteen opinion publications. A critical appraisal process found two categories of good quality publications while recognising their limitations in terms of descriptive and opinion publications. The synthesised data from the selected publications about the barriers to the conduct and application of research within CAM were captured within two broad components, namely capacity and culture. Capacity encompassed elements such as access, competency, bias, incentives and time. Encompassed within culture were elements relating to the values and complex system of CAM. CONCLUSIONS Multiple barriers exist for the conduct and application of research in CAM. Given the growing popularity of these therapies, it is essential that the evidence base underpinning CAM also continues to expand. Without overt recognition of these barriers, enabling strategies cannot be applied. By addressing these barriers, CAM professions will be able to develop a critical mass and a well-coordinated research effort to assist the integration of evidence - based practice in CAM.
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Affiliation(s)
- Yasamin Veziari
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Matthew J. Leach
- Department of Rural Health, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
| | - Saravana Kumar
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, SA 5000 Australia
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