Vaccination discourses among chiropractors, naturopaths and homeopaths: A qualitative content analysis of academic literature and Canadian organizational webpages.

Vaccine hesitancy-the reluctance to receive recommended vaccination because of concerns and doubts about vaccines-is recognized as a significant threat to the success of vaccination programs and has been associated with recent major outbreaks of vaccine-preventable diseases. Moreover, the association between complementary and alternative medicine (CAM) use and vaccine hesitancy and/or refusal has been frequently reported in the literature. To date, significant gaps persist in our understanding of contemporary Canadian CAM providers' beliefs regarding vaccination and how socio-professional influences may shape their vaccine-related attitudes and behaviours. To address the latter gap, the current study aims to explore the content of professional guidelines, recommendations and other discourses among CAM providers as they concern vaccination by analyzing both academic, peer-reviewed literature and Canadian organizational webpages prepared by and/or for practicing chiropractors, naturopaths and homeopaths. In the academic literature, we identified a number of complex and diverging views on vaccination that spanned topics of effectiveness; safety; theoretical, empirical, and ethical soundness; political justifiability; and compatibility with CAM philosophy and professional boundaries. However, in its current state the CAM literature cannot be described in broad strokes as being either pro- or anti-vaccination without considering finer areas of disagreement. Compared to the academic literature, which focuses more on the conceptual and evidentiary basis of vaccination, a greater proportion of vaccine-related content on Canadian CAM organizations' webpages seems to be dedicated to offering specific directives and prescriptions to providers. Guidelines and standards of practice address a number of issues, including vaccine administration, counsel, education and marketing. As CAM organizations further evolve in Canada and elsewhere as part of a broader "professionalization" initiative, greater attention will need to be directed at their role in shaping providers' beliefs and practices that both support and undermine vaccine promotion efforts.

Morbidity profile of patients seeking Naturopathy and Yoga treatment in South India: A descriptive study.

Background Yoga and Naturopathy (Y&N) is one of the approved Complementary and Traditional systems of Medicine practiced in India. Unlike other systems, it is a drugless system aimed to optimize and facilitate the inherent ability of the human body to heal itself. There is lack of literature on the type of patients seeking Yoga and Naturopathy treatments in India. This study was designed with an objective to assess the morbidity profile of the in-patients treated in a Naturopathy and Yoga hospital. Methods Descriptive study design based on clinical case records. Six hundred and four cases treated as in-patients between April 2017 and July 2018 was analyzed. Results The average age of the patients was 47.4 (SD ± 16.1) years, with 56% were females and 44% males. About 50 different types of morbidity ranging from general rejuvenation to chronic diseases had been reported. Highest reported diseases were chronic in nature, with higher reporting for multiple system morbidity, followed by Obesity, Diabetes Mellitus, Hypertension, Arthritis, and Back pain. Variations were observed in the morbidities based on age and gender of the patients. The median duration of treatment was 8 days. Conclusions Patients seek Yoga & Naturopathy care mainly for chronic conditions, further observations on treatment outcomes, quality of life, and treatment seeking behavior can be explored for the efficacy and feasibility of Yoga & Naturopathy care in managing chronic diseases.

Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system.

Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.

"Getting the water-carrier to light the lamps": Discrepant role perceptions of traditional, complementary, and alternative medical practitioners in government health facilities in India.

The government of India has, over the past decade, implemented the "integration" of traditional, complementary and alternative medical (TCAM) practitioners, specifically practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-rigpa, and Homoeopathy (collectively known by the acronym AYUSH), in government health services. A range of operational and ethical challenges has manifested during this process of large health system reform. We explored the practices and perceptions of health system actors, in relation to AYUSH providers' roles in government health services in three Indian states - Kerala, Meghalaya, and Delhi. Research methods included 196 in-depth interviews with a range of health policy and system actors and beneficiaries, between February and October 2012, and review of national, state, and district-level policy documents relating to AYUSH integration. The thematic 'framework' approach was applied to analyze data from the interviews, and systematic content analysis performed on policy documents. We found that the roles of AYUSH providers are frequently ambiguously stated and variably interpreted, in relation to various aspects of their practice, such as outpatient care, prescribing rights, emergency duties, obstetric services, night duties, and referrals across systems of medicine. Work sharing is variously interpreted by different health system actors as complementing allopathic practice with AYUSH practice, or allopathic practice, by AYUSH providers to supplement the work of allopathic practitioners. Interactions among AYUSH practitioners and their health system colleagues frequently take place in a context of partial information, preconceived notions, power imbalances, and mistrust. In some notable instances, collegial relationships and apt divisions of responsibilities are observed. Widespread normative ambivalence around the roles of AYUSH providers, complicated by the logistical constraints prevalent in poorly resourced systems, has the potential to undermine the therapeutic practices and motivation of AYUSH providers, as well as the overall efficiency and performance of integrated health services.

Perspectives of complementary and alternative medicine (CAM) practitioners in the support and treatment of infertility.

BACKGROUND: Infertility patients are increasingly using complementary and alternative medicine (CAM) to supplement or replace conventional fertility treatments. The objective of this study was to determine the roles of CAM practitioners in the support and treatment of infertility. METHODS: Ten semi-structured interviews were conducted in Ottawa, Canada in 2011 with CAM practitioners who specialized in naturopathy, acupuncture, traditional Chinese medicine, hypnotherapy and integrated medicine. RESULTS: CAM practitioners played an active role in both treatment and support of infertility, using a holistic, interdisciplinary and individualized approach. CAM practitioners recognized biological but also environmental and psychosomatic determinants of infertility. Participants were receptive to working with physicians, however little collaboration was described. CONCLUSIONS: Integrated infertility patient care through both collaboration with CAM practitioners and incorporation of CAM's holistic, individualized and interdisciplinary approaches would greatly benefit infertility patients.

The application and value of information sources in clinical practice: an examination of the perspective of naturopaths.

BACKGROUND: The approach of evidence-based medicine (EBM), providing a paradigm to validate information sources and a process for critiquing their value, is an important platform for guiding practice. Researchers have explored the application and value of information sources in clinical practice with regard to a range of health professions; however, naturopathic practice has been overlooked. OBJECTIVES: An exploratory study of naturopaths' perspectives of the application and value of information sources has been undertaken. METHODS: Semi-structured interviews with 12 naturopaths in current clinical practice, concerning the information sources used in clinical practice and their perceptions of these sources. RESULTS: Thematic analysis identified differences in the application of the variety of information sources used, depending upon the perceived validity. Internet databases were viewed as highly valid. Textbooks, formal education and interpersonal interactions were judged based upon a variety of factors, whilst validation of general internet sites and manufacturers information was required prior to use. CONCLUSIONS: The findings of this study will provide preliminary aid to those responsible for supporting naturopaths' information use and access. In particular, it may assist publishers, medical librarians and professional associations in developing strategies to expand the clinically useful information sources available to naturopaths.

Approaches to clinical decision-making: a qualitative study of naturopaths.

The type of information used and its application in clinical practice has generated interest due to its relationship to evidence-based medicine (EBM). However, it is also acknowledged that the principles of EBM place less value on practitioners' experience and intuitive insights when making clinical decisions. Research in this area has been conducted with conventional health professionals, meanwhile complementary and alternative medicine practitioners such as naturopaths have received little attention. In response interviews were undertaken with naturopaths to explore their approach to information-seeking and application in clinical settings. Thematic analysis identified how naturopaths incorporate deductive reasoning alongside intuition and clinical experience to overcome difficulties in applying information to relevant clinical situations. This research provides an understanding of the approach taken by naturopaths to improve the relevance of available data when making clinical decisions and is of significance for health policy and health service delivery in this area.

Self-care practices and the need for influenza vaccination in healthy individuals.

The purpose of this research was to determine whether self-care practices in healthy individuals reduce the need for trivalent influenza vaccination and whether naturopathic influenza prevention reduces rate, duration and severity of influenza, absenteeism from work due to influenza and side-effects, as compared to trivalent influenza vaccination. A survey design was followed using exploratory, descriptive and comparative methods. The method of study was an open-label, two-group, parallel study. The data collection tool was a self-administered questionnaire. A two-group sample was obtained through non-probability, purposeful sampling. Data was analysed by means of descriptive and inferential statistics at the 0.05 level of significance. Results indicated that there was no significant difference between the rates of influenza infection of the naturopathic group as compared with the trivalent vaccination group but there was a marginal reduction in the duration of febrile illness in the former group. The naturopathic group were less likely to visit a medical practitioner in order to resolve the influenza, however, they were as likely as the trivalent vaccinated group to commence a new treatment plan. Neither method of influenza prevention resulted in a significant reduction in absenteeism from work. The trivalent vaccinated group had significantly more side-effects than the naturopathic group.