Relationship between Future Orientation and Pain Severity in Fibromyalgia Patients: Self-Compassion as a Coping Mechanism.

The present study examined the relationship between future orientation and fibromyalgia-related pain severity in a sample of 287 adults with fibromyalgia. Specifically, authors examined dimensions of self-compassion (for example, self-kindness, isolation, mindfulness) as possible mechanisms through which future orientation might be associated with pain severity. Results of conducting a multiple mediator test with 10,000 bootstraps indicated that the significant negative association between future orientation and pain severity was mediated through one specific self-compassion dimension, namely, isolation. The article concludes with a discussion of the implications of the present findings for working with fibromyalgia patients, specifically the potential value of social workers working with fibromyalgia patients to build future orientation as a resilience factor to combat pain severity. Also discussed is the value of working with patients to develop a sustainable social support system that can disrupt experiences of social isolation and disconnectedness from others, and which appear to contribute to greater pain severity.

A dual continuum model of the reasons for use of complementary health approaches among overweight and obese adults: findings from the 2012 NHIS.

BACKGROUND: Obese and overweight individuals have greater illness and disease burden, but previous findings from the 2002 National Health Interview Survey (NHIS) suggest that they are no more likely to use complementary health approaches (CHA) than those of normal weight. The current study investigates the relationship between weight status and CHA use, and among CHA users, examines differences in reasons for use by weight status. We propose and test a Dual Continuum Model of Motivations for Use of CHA to examine differences in reasons for use by weight status. METHOD: Participants were drawn from the 2012 NHIS, a nationally representative sample of civilian, non-institutionalized US adults (N = 34,525). Weight status was operationalized by body mass index. CHA use was measured in the past year and was categorized into alternative providers, products, and practices. Among CHA users (N = 9307) factors associated with use were categorized as health enhancing or health reactive. RESULTS: Logistic regression showed overweight and obese individuals were less likely to use alternative providers, products, and practices than normal weight. Multinomial logit regression showed some support that overweight and obese adults were less likely than normal weight persons to use CHA for health-enhancing reasons, and more likely to use for health reactive reasons. CONCLUSIONS: Despite greater health burden, overweight and obese adults are underutilizing CHA, including modalities that can be helpful for health management. The Dual Continuum Model of CHA Motivations shows promise for explicating the diversity of reasons for CHA use among adults at risk for health problems.

Use and Disclosure of Complementary Health Approaches in US Adults With Cardiovascular Disease.

Evidence indicates that use of Complementary Health Approaches (CHAs) is common in patients with cardiovascular disease (CVD) and has benefits and risks. Yet, disclosure of CHA use to physicians is not uniformly high. The present study aimed to assess the prevalence and patterns of CHA use and disclosure in patients with CVD in a nationally representative US sample. Use of specific CHA modalities and the predictors and reasons for nondisclosure were examined. In the 2012 National Health Interview Survey, a nationally representative sample of adults aged 18+ was used, and 12,364 patients who reported being diagnosed with CVD were analyzed using weighted bivariate and logistic regression. Analyses revealed that 34.75% of patients with CVD had used CHA in the previous year. Women, those with higher education and income, who had functional limitations, greater mental distress, and healthier lifestyles were significantly more likely to use CHA. Nonvitamin, nonmineral supplements was the most prevalent CHA used (19.22%). Rates of nondisclosure were highest among younger and better educated CHA users. In patients with CVD who did not disclose CHA use to their physician (33.67%), 45.51% said the reason was because physician did not ask; 8.75% said the reason was because they were not using CHA at the time. In conclusion, over 1/3 of patients with CVD used CHA in the previous year, and nonvitamin, nonmineral supplements were the most commonly used modality. The findings underscore the importance of provider-initiated communication about CHA use in patients with CVD to minimize the potentially harmful consequences of nondisclosure.

Prevalence and predictors of complementary and alternative medicine use among people with coronary heart disease or at risk for this in the sixth Tromsø study: a comparative analysis using protection motivation theory.

BACKGROUND: Engagement in healthy lifestyle behaviors, such as healthy diet and regular physical activity, are known to reduce the risk of developing coronary heart disease (CHD). Complementary and alternative medicine (CAM) is known to be associated with having a healthy lifestyle. The primary aim of this study was to examine the prevalence and predictors of CAM use in CHD patients, and in those without CHD but at risk for developing CHD, using Protection Motivation Theory (PMT) as a guiding conceptual framework. METHOD: Questionnaire data were collected from 12,981 adult participants in the cross-sectional sixth Tromsø Study (2007-8). Eligible for analyses were 11,103 participants who reported whether they had used CAM or not. Of those, 830 participants reported to have or have had CHD (CHD group), 4830 reported to have parents, children or siblings with CHD (no CHD but family risk), while 5443 reported no CHD nor family risk of CHD. We first compared the patterns of CAM use in each group, and then examined the PMT predictors of CAM use. Health vulnerability from the threat appraisal process of PMT was assessed by self-rated health and expectations for future health. Response efficacy from the coping appraisal process of PMT was assessed as preventive health beliefs and health behavior frequency. RESULTS: Use of CAM was most commonly seen in people with no CHD themselves, but family risk of developing CHD (35.8%), compared to people already diagnosed with CHD (30.2%) and people with no CHD nor family risk (32.1%). All four of the PMT factors; self-rated health, expectations for future health, preventive health beliefs, and the health behavior index - were predictors for CAM use in the no CHD but family risk group. CONCLUSION: These findings suggest that people use CAM in response to a perceived risk of developing CHD, and to prevent disease and to maintain health.

Implicit Reasons for Disclosure of the Use of Complementary Health Approaches (CHA): a Consumer Commitment Perspective.

BACKGROUND: Disclosure of the use of complementary health approaches (CHA) is an important yet understudied health behavior with important implications for patient care. Yet research into disclosure of CHA has been atheoretical and neglected the role of health beliefs. PURPOSE: Using a consumer commitment model of CHA use as a guiding conceptual framework, the current study tests the hypotheses that perceived positive CHA outcomes (utilitarian values) and positive CHA beliefs (symbolic values) are associated with disclosure of CHA to conventional care providers in a nationally representative US sample. METHODS: From a sample of 33,594 with CHA use information from the 2012 National Health Interview Survey (NHIS), a subsample of 7348 who used CHA within the past 12 months was analyzed. The 2012 NHIS is a cross-sectional survey of the non-institutionalized US adult population, which includes the most recent nationally representative CHA use data. RESULTS: The 63.2% who disclosed CHA use were older, were less educated, and had visited a health care provider in the past year. Weighted logistic regression analyses controlling for demographic variables revealed that those who disclosed were more likely to report experiencing positive psychological (improved coping and well-being) and physical outcomes (better sleep, improved health) from CHA and hold positive CHA-related beliefs. CONCLUSIONS: CHA users who perceive physical and psychological benefits from CHA use and who hold positive attitudes towards CHA are more likely to disclose their CHA use. Findings support the relevance of a consumer commitment perspective for understanding CHA disclosure and suggest CHA disclosure as an important proactive health behavior that warrants further attention.

Reasons for continuing use of Complementary and Alternative Medicine (CAM) in students: a consumer commitment model.

BACKGROUND: Research on continued CAM use has been largely atheoretical and has not considered the broader range of psychological and behavioral factors that may be involved. The purpose of this study was to test a new conceptual model of commitment to CAM use that implicates utilitarian (trust in CAM) and symbolic (perceived fit with CAM) in psychological and behavioral dimensions of CAM commitment. METHODS: A student sample of CAM consumers, (N = 159) completed a survey about their CAM use, CAM-related values, intentions for future CAM use, CAM word-of-mouth behavior, and perceptions of being an ongoing CAM consumer. RESULTS: Analysis revealed that the utilitarian, symbolic, and CAM commitment variables were significantly related, with r's ranging from .54 to .73. A series hierarchical regression analyses controlling for relevant demographic variables found that the utilitarian and symbolic values uniquely accounted for significant and substantial proportion of the variance in each of the three CAM commitment indicators (R(2) from .37 to .57). CONCLUSIONS: The findings provide preliminary support for the new model that posits that CAM commitment is a multi-dimensional psychological state with behavioral indicators. Further research with large-scale samples and longitudinal designs is warranted to understand the potential value of the new model.

Health-related self-perceptions over time and provider-based Complementary and Alternative Medicine (CAM) use in people with inflammatory bowel disease or arthritis.

OBJECTIVES: To prospectively investigate how health-related self-perceptions are associated with use of provider-based CAM in two chronic inflammatory diseases, arthritis and inflammatory bowel disease (IBD). DESIGN AND SETTING: A prospective online survey was administered to convenience samples of individuals with arthritis or inflammatory bowel disease, and a follow-up survey completed 6 months later. Participants were recruited via online ads, through national organizations, and support groups. MAIN OUTCOME MEASURES: Surveys included measures of demographics, use of provider-delivered CAM, disease-related factors, self-perceptions of having a healthy lifestyle and being able to handle stress, and trait resilience. RESULTS: 325 people (170 with arthritis and 155 with IBD) completed the initial and follow-up surveys. Rates of CAM use were 43.2% and 45.9% for the arthritis and IBD groups, respectively. T-tests revealed significant differences on healthy lifestyle self-perceptions and trait resilience for both illness groups. Differences in self-perceptions about handling stress were only significant in the IBD group. Multivariate logistic regression controlling for demographics and health-related variables revealed that seeing oneself as having a healthy lifestyle predicted CAM use in both illness groups. Being resilient predicted CAM use only in the IBD group, and self-perceptions about handling stress predicted CAM use only in the arthritis group. CONCLUSIONS: This study provides insights into how health-related self-perceptions are prospectively linked to provider-based CAM use in patients with chronic inflammatory disease. This information is important for both health-care practitioners and researchers as it has implications for maximizing the health-promoting aspects of CAM use and understanding CAM adherence.

Agents of change: how do complementary and alternative medicine providers play a role in health behavior change?

BACKGROUND: Recent investigations indicate that complementary and alternative medicine (CAM) use may be conducive to health behavior change. OBJECTIVE: The goal of this study was to investigate how this change occurs. METHODS: Using Social Cognitive Theory and Self-determination Theory as guiding frameworks, we surveyed a convenience sample of 216 CAM consumers abouttheir CAM therapy and iors and conducted focus groups with 36 CAM consumers. RESULTS: Consumers reported encouragement from providers and improved energy resulting from treatments as reasons for making health behavior changes. Multivariate analysis showed that increased odds of self-reported dietary change were significantly associated with increasing body awareness as a result of therapy, endorsing the statement that sustained improvement for their health conditions required self-care, using an acupuncturist, and being 44 years or younger. Comparable results were found for exercise change, except using an acupuncturist was a significant negative predictor and age was not significant. Focus group findings echoed these themes. CONCLUSION: This initial investigation into how CAM providers may play a role in health behavior change suggests that provider support, increased responsibility for one's health, and the CAM treatments themselves contribute to behavior change, although additional research in this area is warranted.

Provider support in complementary and alternative medicine: exploring the role of patient empowerment.

BACKGROUND: The quality of the patient-provider relationship is well-recognized as having a key role in therapeutic outcomes irrespective of treatment effects. Yet there is a lack of scales to assess aspects of complementary and alternative medicine (CAM) provider support. OBJECTIVES: The objectives of this study were to develop and psychometrically evaluate scales to measure patients' perceptions of provider support, patient-centered care, and empowerment as predictors of health outcomes. METHODS: Based on five focus groups with CAM clients, we developed the following three scales: Perceived Provider Support, Patient-Centered Care (PCC), and Empowerment. The scales were cognitively tested with 6 CAM users and then pilot-tested with 216 respondents. Confirmatory factor analyses, item response theory analyses, and Cronbach's alphas were conducted to evaluate their psychometric properties. Bootstrapping techniques and structural equation modeling were used to evaluate Empowerment as a mediator of the relationship of Perceived Provider Support and PCC with symptom relief. RESULTS: All three scales demonstrated high internal consistency with Cronbach's alphas of 0.85 to 0.90 and confirmatory factor analyses supported a one-factor solution for each scale. Controlling for demographics, presenting problem, and main CAM provider used in the past 12 months, each of the scales had a positive and significant relationship with overall symptom relief for the patient's primary presenting problem (p < .01). Bootstrapped Sobel tests were significant (p < .01), supporting the role of empowerment as a mediator of the impact of PCC and provider support on symptom relief. A structural equation model combining PCC and provider support into a single latent variable representing quality of patient-provider interactions and including empowerment as a mediator fit well. CONCLUSIONS: From a holistic perspective, CAM treatment effects can arise in part from sources related to the therapeutic relationship, as well as the philosophy of healing and specific techniques designed to reduce symptoms. This analysis provides conceptual support for this perspective, a means to evaluate aspects of the therapeutic relationship and to measure its impact on outcomes of CAM treatment across conditions and therapies.

Personality and consultations with complementary and alternative medicine practitioners: a five-factor model investigation of the degree of use and motives.

OBJECTIVES: As interest in and use of complementary and alternative medicine (CAM) providers continues to grow, it is important to understand which characteristics incline people to experiment with and become frequent consumers of CAM practitioners. The purpose of this study was to examine how personality, as assessed by the five-factor model, was related to the breadth, frequency, and types of provider-based CAM use. Relationships between the personality factors (Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism) and motives for consulting CAM providers were also explored. METHODS: A convenience sample of 184 current CAM clients recruited through the offices of 12 conventional medicine and 17 CAM practitioners completed a survey package including measures of health status, CAM use, personality, and motivations for using CAM. RESULTS: Only Openness and Agreeableness were consistently linked to different dimensions of CAM use, with each associated with consultations with CAM practitioners, and homeopaths and naturopaths in particular. After controlling for sociodemographic and health status variables in the stepwise multiple regressions, Openness was associated with the variety of CAM providers tried, whereas Agreeableness was linked to both the breadth and frequency of CAM consultations. Holistic and proactive health motivations were associated with both personality factors, and Agreeableness was also associated with motives reflecting a desire for shared decision-making. CONCLUSIONS: Findings indicate that individuals who are open and agreeable, as described by the five-factor model of personality, consult CAM practitioners to a greater extent. The motives involved suggest a congruency between CAM and their own perspectives regarding health and patient-provider interactions, which may have implications for understanding treatment adherence and outcomes.

When one door closes, another door opens: physician availability and motivations to consult complementary and alternative medicine providers.

The aim of this study was to examine the attitudes, behaviours, and intentions to consult complementary and alternative medicine (CAM) providers, of health-care consumers living in a region with low physician availability. A survey was completed by a convenience sample of 235 CAM clients and nonconsumers recruited from an underserved urban centre in Canada. Nearly half had experienced difficulties getting an appointment with a physician when needed, and those who had experienced difficulties were more dissatisfied with conventional health care. Most participants (85.1%) indicated that they would consider consulting a CAM provider should they have difficulty getting an appointment with a physician in the future, including nearly 60% of the CAM nonconsumers. Participants who had more experience with CAM, greater perceived control over their symptoms, and were dissatisfied with conventional health care, were more likely to express intentions to use CAM should they experience access difficulties in the future. By situating the motivations for CAM within the context of physician availability our findings highlight the importance of geographical context, or place, for understanding attitudes towards CAM and its utilisation.

Provider-based complementary and alternative medicine use among three chronic illness groups: associations with psychosocial factors and concurrent use of conventional health-care services.

OBJECTIVE: The focus of this study was to examine the patterns of provider-based complementary and alternative medicine (CAM) use across three chronic illness groups, and to identify the socio-demographic, health-related, and psychosocial factors associated with CAM use. DESIGN: Cross-sectional international survey administered on the Internet to individuals with arthritis, inflammatory bowel disease (IBD), and mixed chronic conditions. MAIN OUTCOME MEASURES: Self-reported consultations to CAM providers and to a variety of conventional health-care services made in the previous 6 months. RESULTS: 365 surveys were received from people with arthritis (N=140), IBD (N=110), and other chronic conditions (N=115). Overall 38.1% of respondents had used CAM, with rates ranging from 31.8 to 46.1% across the three illness groups. Backward step-wise logistic regression revealed that being female, having more than high school education, a greater number of comorbid conditions, higher perceived control over health and reward motivations, lower stress and less belief that health is governed by chance, were the best predictors of CAM consultations. CAM clients also used a greater variety of conventional health-care services and made more consultations relative to non-CAM clients. CONCLUSIONS: In this study the socio-demographic and health status factors associated with CAM consultations in three different chronic illness groups were similar to those found in the general population. CAM use in the study population was also related to higher use and a greater variety of use of conventional health-care services, and with stronger beliefs in the controllability of health and an enduring motivation to seek out rewards.

Motivations for consulting complementary and alternative medicine practitioners: a comparison of consumers from 1997-8 and 2005.

BACKGROUND: Use of complementary and alternative medicine (CAM), and especially CAM practitioners, has continued to rise in recent years. Although several motivators of CAM use have been identified, little is known about how and if the motivations for using CAM have changed over time. The purpose of the current study was to compare the reasons for consulting CAM practitioners in consumers in 1997-8 and eight years later in 2005. METHODS: Surveys were displayed in CAM and conventional medicine offices and clinics in Ontario, Canada in 1997-8 and again in 2005, and self-selected participants returned the surveys by mail. RESULTS: In 1997-8, 141 CAM consumers were identified from the 199 surveys returned, and 185 CAM consumers were identified from the 239 surveys returned in 2005. Five of the six CAM motivations were more likely to be endorsed by the 2005 CAM consumers compared to the 1997-8 CAM consumers (all p's < .0001). In 1997-8 the two top reasons for using CAM were that CAM allowed them to take an active role in their health (51.8%), and because conventional medicine was ineffective for their health problem (41.8%). In 2005, the treatment of the whole person (78.3%) was the top reason for using CAM followed by taking an active role in one's health (76.5%). The 2005 consumers were less educated, had slightly more chronic health complaints, had been using CAM for longer, and were more likely to consult chiropractors, reflexologists, and therapeutic touch practitioners than the 1997-8 consumers. Otherwise, the socio-demographic and health profiles of the two groups of CAM consumers were similar, as was their use of CAM. CONCLUSION: Compared to consumers in 1997-8, consumers in 2005 were more likely to endorse five of the six motivations for consulting CAM practitioners. A shift towards motivations focusing more on the positive aspects of CAM and less on the negative aspects of conventional medicine was also noted for the 2005 consumers. Findings suggest that CAM motivations may shift over time as public knowledge of and experience with CAM also changes.

An investigation of the health beliefs and motivations of complementary medicine clients.

The current study was concerned with factors associated with the use of complementary medicine (CM). The reasons for CM use were examined by dividing complementary medicine clients into two groups based on the frequency and length of their use of complementary therapies, and comparing them with conventional medicine clients as well as to each other. New/infrequent CM clients (n = 70), established CM clients (n = 71), and orthodox medicine clients (n = 58) were distinguished on the basis of health beliefs, socio-demographic, medical, and personality variables. Different patterns of predictors of CM use emerged depending on which client groups were compared. In general, health-aware behaviors and dissatisfaction with conventional medicine were the best predictors of overall and initial/ infrequent CM use, and more frequent health-aware behaviors were associated with continued CM use. Medical need also influenced the choice to use CM, and was the best predictor of committed CM use, with the established CM clients reporting more health problems than the new/infrequent CM group. Overall, income was a significant discriminator, but did not predict initial or continued CM use. Openness to new experience was associated with CM use in general, but was most notable in the decision to initially try or explore using CM. The findings support the utility of the three components (predisposing, enabling, and need factors) of the socio-behavioral model for explaining why some people choose CM. Overall, the results of the current study suggest that CM clients need to be looked at in more sophisticated ways, rather than being treated simply as a homogenous group with similar beliefs, motivations and needs.

Treatment seeking and experience with complementary/alternative medicine: a continuum of choice.

OBJECTIVES: To examine the treatment seeking patterns of conventional medicine (CM) and complementary and alternative medicine (CAM) clients across different health problems, and to investigate whether CAM clients with different levels of experience with CAM use different modes of treatment for their health issues. DESIGN: Three-group cross-sectional, self-administered survey study. SETTINGS AND SUBJECTS: One hundred and ninety-nine (199) self-selected participants sampled from CM and CAM clinics and offices OUTCOME MEASURES: Self-reported physical health problems, treatment seeking for health problems, and type of treatment used for each health problem (CM, CAM, or both) Results: Treatment rates for non-life-threatening health issues were significantly associated with client group membership after controlling for differences in the number of health problems (partial r = 0.35, p < 0.0001), with the more experienced CAM clients reporting the highest treatment rates and the CM clients reporting the lowest rates. The newer CAM clients also differed significantly from the more experienced CAM clients in the modes of treatment used for their health issues (p < 0.0001), with the less experienced CAM clients relying more on CM alone (42.0%) or in conjunction with CAM (38.3%), whereas the experienced CAM clients used more CAM with CM (45.0%), or CAM alone (33.5%) than just CM alone (21.5%), for treating their health issues. CONCLUSIONS: CAM users may treat their health issues at higher rates than nonusers, independent of their greater number of health problems. This treatment rate increase may be associated with greater experience with CAM. CAM clients are not homogeneous in their choices of treatment modalities. Newer CAM users still rely heavily on CM treatments, whereas more experienced CAM users depend less on CM alone and more on CAM for treating their non-life-threatening health issues.