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

"Diluting Its Value as a Word by Applying It to Everything": A Qualitative Study Exploring Perspectives and Practices of Mindfulness Practitioners

Objective

The aim of this research was to explore the perspective, language, description, and practices of practitioners who identify as using mindfulness techniques for a range of health and clinical conditions.

Methods

This study was guided by a qualitative descriptive methodology. Mindfulness practitioners from a variety of backgrounds that included medical, allied health, complementary and alternative medicine, and traditional Buddhism from across Australia were invited to share their perspectives. Semi-structured interviews were conducted via Zoom, telephone, and face-to-face which were audio-recorded and transcribed verbatim. The transcripts were thematically analysed.

Results

Sixteen mindfulness practitioners from Australia self-nominated to participate in this study. Overall, the interviews revealed similarities, differences and even disagreements between participants from the different modalities regarding mindfulness. Participants from similar disciplines also reported differing perspectives and nuanced opinions. Differences appeared to stem from both participant background, training, and the overall aims of their practice.

Conclusion

This research highlights the complexities of what constitutes mindfulness. This study has highlighted, across a broad cohort, that for mindfulness practitioners, their beliefs, aims, and practices are varied and influenced by a range of factors including their ideological perspectives. While the diversity and broad application of mindfulness may be one of its strengths, it may also be its weakness as its value may be diluted due to plurality of understanding and multiplicity in use. This requires careful and considered actions from mindfulness stakeholders.

Association between Paediatric Complementary and Alternative Medicine Use and Parental Health Literacy, Child Health, and Socio-Economic Variables: A Prospective Study

Complementary and Alternative Medicines (CAMs) constitute products and practices not considered allopathic medicine. CAM use is high in children, but little is known about factors that may influence parents using CAM with their child. This study aimed to determine the variables associated with CAM use in children with a prospective study among children and their parents attending a tertiary care hospital in New Zealand (NZ). Outcomes included current CAM use, parental opinions on CAM, parental health literacy and child well-being. This study was completed by 130 parents (85% female), and the mean child age was 6.7 years. CAM use was reported for 59 (45%) children, the most common being oral supplements and body manipulation. Children were more likely to use CAM if their parent had higher health literacy (p = 0.001), and if they had previously attended the emergency department within 12 months (p = 0.03). There was no association between child well-being and CAM use. Parental opinion of using CAM only if a doctor recommended it was associated with CAM use for their child (p = 0.01). Only 40% of parents disclosed their child's CAM use to the medical team. This study highlights that parental health literacy influences the use of CAM for children in NZ, providing insight for translational research to improve CAM safety and disclosure rates in NZ.

The engagement of psychology with complementary medicine: A critical integrative review

Amidst the global rise in complementary medicine (CM) use for mental health, a substantial number of clients consulting a psychologist also utilise at least one form of CM. Yet, how psychologists should engage with CM in their clinical practice (e.g., how to respond to a client disclosing CM use or enquiries regarding CM products or services for mental health) remains contested and unclear. In response, a systematic integrative review was conducted to examine empirical literature reporting on one or more aspects of the relationship between psychology (incorporating clinical practice, professional associations and academia) and CM, and how that relationship may relate to or inform psychologists' engagement with CM in their clinical practice. Twenty-seven peer-reviewed articles met the specific inclusion criteria and quality appraisal was employed. Analysis shows a substantial number of psychologists are engaging with, or are interested in engaging with, CM in their clinical practice. Analysis identified a dissonance between psychologists' engagement with CM in clinical practice and the limited engagement of the broader discipline of psychology with CM. Further research is required to understand these differing types of engagement with a view to helping inform relevant policy and practice guidelines, and ultimately assist psychologists in navigating CM in their clinical practice.

The step in time study: A feasibility study of a mobile app for measuring walking ability after massage treatment in patients with osteoarthritis

Background

Massage therapy is a popular intervention for those suffering osteoarthritis, however, there is a paucity of evidence to support its effectiveness in osteoarthritis. A simple measure that could potentially assess the benefits of massage treatment is walking speed which is a predictor of mobility and survival length, particularly in ageing populations. The primary aim of the study was to assess the feasibility of using a phone app to measure walking ability in people with osteoarthritis.

Methods

This feasibility study used a prospective, observational design to collect data from massage practitioners and their clients over a 5-week period. Feasibility outcomes included practitioner and client recruitment and protocol compliance. The app MapMyWalk was used to record average speed for each walk. Pre-study surveys and post-study focus groups were conducted. Clients received massage therapy in a massage clinic and were instructed to walk in their own local community for 10 min every other day. Focus group data were analysed thematically. Qualitative data from clients’ pain and mobility diaries were reported descriptively. Average walking speeds were graphed for each participant in relation to massage treatments.

Results

Fifty-three practitioners expressed interest in the study, 13 completed the training, with 11 successfully recruiting 26 clients, 22 of whom completed the study. 90% of practitioners collected all required data. A strong motivation for participating practitioners was to contribute to evidence for massage therapy. Client compliance with using the app was high, but low for completing pain and mobility diaries. Average speed remained unchanged for 15 (68%) clients and decreased for seven (32%). Maximum speed increased for 11 (50%) clients, decreased for nine (41%) and remained unchanged for two (9%). However, data retrieved from the app were unreliable for walking speed.

Conclusions

This study demonstrated that it is feasible to recruit massage practitioners and their clients for a study involving mobile/wearable technology to measure changes in walking speed following massage therapy. The results support the development of a larger randomised clinical trial using purpose-built mobile/wearable technology to measure the medium and long-term effects of massage therapy on people with osteoarthritis.

Enablers and barriers to evidence implementation in complementary medicine: A systematic review

Background

Despite the push for complementary medicine (CM) practitioners to engage in evidence implementation, and arguments in support of evidence-based practice (EBP), uptake of EBP amongst most CM professions remains low. This review aimed to synthesise the evidence examining the barriers and enablers to evidence implementation in CM.

Methods

Any primary study examining enablers and barriers to evidence implementation in CM were eligible for inclusion. Eight databases and search engines were searched for eligible studies. Reference lists of included studies were screened, and authors of included studies were contacted to identify current or unpublished studies that met the inclusion criteria.

Results

Thirty-nine published and unpublished studies were included in this review. The seven published qualitative studies and 25 published quantitative studies were rated as moderate to high quality. Fifty-two distinct barriers and 62 discrete enablers were identified. Reported barriers were predominantly structural (e.g. limited availability of time and clinical evidence) and cognitive (e.g. skills deficits), with relatively fewer studies reporting cultural (e.g. lack of industry support) or attitudinal barriers (e.g. lack of interest in, or relevance to CM). Enablers of evidence implementation largely focussed on improving access to bibliographic databases and evidence reviews, supporting skills acquisition, and cultivating leadership and interprofessional/interagency collaboration.

Conclusion

The findings of this review highlight the diverse barriers and enablers to evidence implementation in CM that span multiple dimensions. The interplay between these various factors highlights the complexity of evidence implementation, and the need for a targeted multistakeholder, multidimensional solution to optimise evidence-based practice in CM.

Evidence implementation among complementary medicine practitioners: a meta-summary

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.