The Role and Influence of Traditional and Scientific Knowledge in Naturopathic Education: A Qualitative Study

Co-Design of an Evidence-Based Practice Continuing Education Course for Canadian Naturopathic Doctors

Objectives: Evidence-based practice (EBP) is a clinical decision-making process combining the best available scientific evidence with clinician expertise and patient preference. While EBP has been associated with a range of benefits, it is recognized that EBP is used suboptimally by a range of health professionals, including naturopathic doctors (NDs). Canadian NDs have expressed a high level of interest in opportunities to improve their EBP skills; however, barriers exist, including those that apply broadly to health professionals, and those that are unique to the naturopathic profession. The objective of the present project was to co-design an EBP continuing education (CE) course tailored to the needs and preferences of Canadian NDs. Design: These needs were solicited through the use of focus groups. Groups were stratified based on participants' use of evidence at baseline. The focus groups asked NDs about their definition of EBP, and their interest in an EBP course, including preferred content, and method of delivery. The focus group discussions were transcribed, and thematic analysis was completed. Subjects: Twenty-two Canadian NDs participated. Results: Participants reported a high level of understanding of EBP, a high level of interest in participating in an EBP course and provided actionable recommendations about course content and delivery. Some of the themes that emerged were consistent across the groups while others differed by stratification. Conclusions: The findings of this project will inform the development and evaluation of a future CE course.

Patient-shared knowledge and information in clinical decision-making: an international survey of the perspectives and experiences of naturopathic practitioners

INTRODUCTION

Most knowledge translation models pay relatively little attention to patient-held knowledge and are largely based on the premise that researchers and clinicians hold all valuable knowledge, and patients are passive recipients of such knowledge. Counter to this clinician- and researcher-centred lens is a growing interest and awareness of patients as experts in their health. While naturopathic medicine is described and experienced as a patient-centred system of traditional medicine, the position of patient-held knowledge is unclear particularly when considered alongside their use of other more objective forms of knowledge such as research evidence.

METHODS

This international online cross-sectional survey aimed to explore naturopathic practitioners' perceptions of the value and contribution of patient-shared knowledge and information within the context of naturopathic clinical consultations.

RESULTS

The survey was completed by 453 naturopathic practitioners (response rate: 74.3%). Approximately two-thirds (68.2%) of respondents reported using information shared by the patient. Most rated 'information provided by the patient' as either 'extremely important' (60.7%) or 'very important' (31.4%) to patients. Highest levels of trust were reported for information provided by the patient ('completely': 9.9%; 'a lot': 53.6%). Most practitioners indicated they trusted knowledge and information derived from the patient's personal health history 'completely' (n = 79; 21.8%) or 'a lot' (n = 226; 62.4%) from the patient's perspective of living with a health condition ('completely' [n = 63, 17.4%]; 'a lot' [n = 224, 61.9%]). Patients were the highest ranked stakeholder group (mean: 1.5) perceived to influence NP use of patient experience of living with a health condition to inform clinical decision-making.

CONCLUSION

Researchers and policy makers are increasingly focused on the value of the 'expert patient' in clinical decision-making, yet health professionals' report challenges and, in some cases, resistance to meaningfully engaging with patient-shared knowledge in practice. However, our study has found patient-shared knowledge - inclusive of patient experience of their health condition - is among the knowledge used and trusted by naturopathic practitioners to inform their clinical decision-making. This study both offers insights into the knowledge translation behaviours of an under-researched health profession and provides a novel contribution to the wider aim of adopting patient-shared knowledge into clinical care more generally.

Toward a 'green allopathy'? Naturopathic paradigm and practice in Ontario, Canada

Epistemic tensions have long been evident within naturopathy, a heterodox healthcare occupation licensed across much of North America. Naturopaths less inclined toward bioscientific explanatory and evidentiary norms have long used the trope of the 'green allopath' to critique the practices of their more biomedically- (i.e., 'allopathically') inclined colleagues. Using the 'green allopathy' narrative as a conceptual starting point, this work uses a qualitatively-driven, mixed methods design involving interviews (n = 17) and a census-style survey (n = 366) to characterize the paradigmatic and practice patterns of licensed naturopaths in Ontario, Canada between 2017 and 2019. At odds with many interviewees' accounts, survey results suggest that the occupation's overall epistemic character, aligned with the concept of holism, has not changed much over the last two decades. Nevertheless, findings suggest notable changes in Ontario naturopaths' clinical practice patterns over the same period, including: more frequent use of botanical medicines, nutritional supplements and acupuncture; less frequent use of physical medicine (e.g., massage, hydrotherapy); and, an overall reduction in homeopathic usage. Controlling for other factors, older naturopaths are more likely to rely often on non-biomedical diagnostic modes (p = 0.042), suggesting an emerging shift, in practice, toward a 'green allopathy'. Naturopaths' widespread ongoing engagement with therapeutic modalities whose epistemic premises diverge strongly from conventional biomedicine (e.g., homeopathy, East Asian medicine), appears mediated by the increasing body of related bioscientific evidence, and by gender and age (p-values <0.05). Gender and age also significantly predict naturopaths' alignment with more pharmaceutically-oriented care (p values < 0.05). Though naturopathy's 'green allopathization' appears underway, the demographic predominance of women within the profession may temper this trend in the years ahead.

Attitudes To and Uptake of Repertory Software in Homeopathy Clinical Practice-Results of an International Survey

BACKGROUND

 Despite the substantial size of the maturing complementary medicine (CM) industry, the technologies used by practitioners have received little research attention. In the clinical delivery of homeopathy services, repertory software can be employed to cross-reference client symptoms with numerous databases, making the process of seeking a clinical intervention quicker and more accurate. The purpose of the study is to learn about the quantitative patterns of usage, uptake and attitudes to repertory software amongst professional homeopaths.

METHODS

 An online cross-sectional survey of 15 questions was completed by practicing professional homeopaths between August 2016 and May 2017, using non-probability snowball sampling. Questions gathered demographic information, reflections and attitudes on the use of electronic repertories in clinical homeopathy practice.

RESULTS

 In total, 59% of respondents reported using software regularly in practice and 71% found that it adds clear value in their work. Sixty-eight percent of respondents learned about repertory software during homeopathy training, and 47% were introduced to software when they began clinical practice. Lack of sufficient training is a very important barrier to the use of repertory software, indicating that more robust and accessible software training is needed for practitioners. Many respondents agreed with a statement that repertory software represents good value for money and yet 46% agreed that it is cost prohibitive for most practitioners, signaling a challenge for software companies. Few respondents reported regularly using more than three of the most common repertory features.

CONCLUSION

 This preliminary study presents some potentially significant uptake, usage and attitude markers that stand to shed light on the practice of homeopathy and the place of emerging technologies such as repertory software. Ultimately, more research is needed to help identify and address the challenges, risks and tensions around integration of practice-enhancing technologies in CM educational and clinical settings to best serve the diverse and changing needs of practitioners.

Community education and health promotion activities of naturopathic practitioners: results of an international cross-sectional survey

BACKGROUND

Health promotion and patient education are crucial to improved population health and are also among the core principles that define naturopathy. Yet, the activities of naturopathic practitioners (NPs) with regards to health promotion and community education have not been widely studied.

METHODS

A cross-sectional online survey of an international convenience sample of NPs was conducted through disseminating a 15-item questionnaire prepared in five languages. Correlates of most frequently mentioned NP activities were studied.

RESULTS

The survey was completed by 813 NPs representing all world regions. Almost all participants (98%) reported at least one health promotion activity. Most reported were information sheets and handouts (92.7%) or social and professional network communications (91.8%) and information talks presented to community members (84.9%). The majority of NPs (79.5%) indicated that the 'health issues individuals in NPs' community have said they need help with' were a 'very important' consideration when they designed health promotion activities. NP characteristics associated with the likelihood of engaging in specific health promotion activities varied between activities but include gender, time since first qualification, factors considered to identify need when designing an activity, and stakeholder involvement in activity design.

CONCLUSIONS

Health promotion is a key activity of the global naturopathic profession. There are a wide range of patient education tools utilized by NPs.

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.