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Factors Associated with Changes in Knowledge and Attitude towards Public Health Concepts among Chiropractic College Students Enrolled in a Community Health Class
Abstract
This survey was conducted to identify factors that may be associated with changes in knowledge and attitudes towards basic health promotion and public health concepts among chiropractic students enrolled in a course in community health.
Anonymous surveys were conducted of students before and after a second-year chiropractic college course in community health. Results were analyzed using percentages and Chi Square statistics as appropriate.
Students' knowledge of health promotion and public health concepts improved significantly by the end of the course. Students' attitudes towards these also improved, although to a lesser degree. Students indicated that they had a favorable impression of the importance of utilizing health promotion in practice and working with other public health professionals. However, vaccinations were still looked upon unfavorably by half of the students by the end of the course. Pre-class, a positive attitude towards public health concepts was associated with being female, older, Latino, having children, having a poorer perceived health status, conservative politically and religious. These differences tended to lessen by the end of the course.
A course in community health was successful in adding to students' knowledge and positive attitudes towards health promotion and public health. However, additional educational strategies are needed to ensure changes in future practice behavior, particularly in the area of vaccinations.
... 33 Two studies found that a course introducing chiropractic students to health promotion and public health changed their attitudes toward public health and increased their perception of its relevance to chiropractic practice. 37,38 ...
... 78 Curricula for teaching public health concepts to CIH providers, such as chiropractors, have been developed 79,80 and evaluated. 37,38 The need for more comprehensive basic public health education for all CIH trainees has been discussed in prior literature. Madigan and colleagues argued that existing curricula were not widely applied in chiropractic colleges because they were too extensive, were too prescriptive, and lacked sufficient stakeholder input in their development. ...
Complementary and integrative health (CIH) providers, such as chiropractors and naturopathic doctors, have been an underutilized public health asset in the response to the COVID-19 pandemic. This report seeks to inform how they can be better integrated into future responses to public health emergencies.
The authors convened an expert panel of ten CIH and public health practitioners and researchers for a daylong discussion of how the CIH workforce could be better mobilized during future crises. In this report, the authors summarize the key barriers identified in the discussion and make recommendations on how they can be overcome.
... Sebuah studi menemukan bahwa jenis kelamin perempuan cenderung memiliki sikap yang lebih baik terhadap pentingknya kesehatan publik sehingga perubahan sikap dan pengetahuan akan dilihat lebih signifikan pada partisipan perempuan. 10 Pada studi ini tidak diungkapkan data demografis dari partisipan penyiluhan, akan tetapi peserta di dominasi oleh ibu-ibu dari Desa Trojan, sehingga hal ini mungkin menjadi salah satu faktor yang mendukung adanya perubahan nilau pengetahuan setelah materi penyuluhan disampaikan. Selain itu, dikatakan bahwa partisipan yang sydah meiliki anak cenderung memiliki sikap yang lebih baik terhadap konsep kesehatan masyarakat sehingga pemberian penyuluhan memberikan efek yang lebih besar pada kelompok tersebut. ...
... Selain itu, dikatakan bahwa partisipan yang sydah meiliki anak cenderung memiliki sikap yang lebih baik terhadap konsep kesehatan masyarakat sehingga pemberian penyuluhan memberikan efek yang lebih besar pada kelompok tersebut. 10 Sebuah studi yang dilakukan di China yang menilai efek dari penyulihan mengenai infeksi menular menunjukkan bahwa terdapat perbedaan skor pengetahuan yang signifikan sebelum dan sesudah pemberian mayteri penyuluhan yaitu dari 40,03% menjadi 72,23% (p<0,001). Peserta perempuan memiliki skor peningkatan yang secara signifikan lebih tinggi dibandingkan partisipan lainnya (p<0,001). ...
Background: Tuberculosis (TB) is one of the infectious diseases that still need attention, especially in developing countries where the prevalence is still high. Health promotion is a step that can be done to prepare citizens in terms of their abilities and knowledge regarding TB disease. This study aims to see changes in people's knowledge after health promotion about TB in the village of Trojan, Klungkung, Bali.Methods: A cross-sectional descriptive study has been conducted to assesses the knowledge responses before and after delivery of material on TB. Health promotion was carried out on April 2nd 2018 in Banjar Desa Trojan Klungkung. Before giving the material 3 questions were given to 3 participants randomly, then after giving the material for 30 minutes, 3 questions were given to 9 random communities. Data were analyzed using SPSS version 17 for WindowsResults: A total pre-test score was 44.4% while the post-test score was 88.9% where there was an increase of 44.5% after the material was given. In addition, all of the respondents showed a perfect post-test score (100,0%) both in the questions related to the symptoms of TB as well as the route of transmission for TB, respectively,Conclusion: This study shows that there is an increase in knowledge after the provision of health promotion through post-test evaluation. Latar Belakang: Tuberkulosis (TB) merupakan salah satu penyakit menular yang masih perlu diperhatikan terutama di negara berkembang dimana prevalensinya masih tinggi. Penyuluhan merupakan suatu langkah yang dapat dilakukan untuk mempersiapkan warga dalam hal kemampuan dan pengetahuan mengenai penyakit TB. Studi ini bertujuan untuk melihat perubahan pengetahuan warga setelah dilakukan penyuluhan mengenai TB di Desa Trojan, Klungkung, Bali.Metode: Sebuah studi potong lintang deskriptif telah dilakukan untuk menilai respon pengetahuan sebelum dan sesudah penyampaian materi penyuluhan mengenai TB. Penyuluhan dilakukan pada tanggal 2 April 2018 di banjar Desa Trojan Kelungkung. Sebelum pemberian materi diberikan 3 buah pertanyaan kepada 3 peserta secara acak, kemudian setelah pemberian materi selama 30 menit, diberikan 3 buah pertanyaan kepada 9 masayarakat acak. Data dianalisis menggunakan SPSS versi 17 untuk Windows.Hasil: Total nilai pre-test adalah 44,4% sedangkan nilai post-test adalah 88,9% dimana terjadi peningkatan sebesar 44,5% setelah pemberian materi. Di samping itu, seluruh responden menunjukkan hasil nilai post-test sempurna (100,0%) baik pada pertanyaan yang berhubungan dengan gejala TB maupun jalur transmisi TB, secara berturut-turut.Kesimpulan: Studi ini menunjukkan bahwa terdapat peningkatan pengetahuan setelah pemberian penyuluhan melalui evaluasi post-test.
... Students, faculty, and staff at 1 chiropractic college campus (92% response) strongly support the notion that chiropractors have a responsibility to role model healthy behaviors and to educate their patients regarding healthy behaviors. 11 Other research efforts include guidelines and improvements in geriatrics, 12,13 pediatrics, 14 wellness concepts, 15 community health, 16 public health education, 17 preventive health services counseling at chiropractic colleges, 14 community-based health promotion, 18 injury prevention, 19 and use of Network Spinal Analysis for improving health behaviors. 20 A nutrition and youth soccer intervention was a recent example of chiropractic practicebased community-wide health promotion in Mississippi. ...
... I incorporate those fitness objectives into recommendations I make to my patients.a) strongly agree b) agree c) neither agree nor disagree d) disagree e) strongly disagree f) don't know/not sure16. Regarding access to quality health services, objectives include increasing the proportion of persons 18 years and over who asked or were given advice by their health care provider in the past 12 months regarding physical activity or exercise, diet and nutrition. ...
The purpose of this study was to determine the familiarity with and stated advocacy of Healthy People 2010 objectives by member doctors of the Mississippi Chiropractic Association.
Peer experts established face validity of a questionnaire regarding the Leading Health Indicators. This survey was distributed to 157 Mississippi Chiropractic Association members in 2009 during a conference and a follow-up by postal mail.
Most doctors of chiropractic in the sample (n = 68, or 43% response) consider themselves wellness-oriented health care providers. Forty-two percent had read, 29% had not read, and another 29% were unsure whether they had read the Healthy People 2010 national objectives. Almost half (44%) strongly or somewhat agreed that their office practice reflects support for the Healthy People 2010 objective. In contrast, 27% disagree and 29% were unsure if their practice reflects the Healthy People 2010 objectives. There were differences between support and practice behaviors for some of the objectives. Chiropractors who have read the objectives tend to be more supportive of the national goals. Doctors of chiropractic in this sample are supportive of most Leading Health Indicators, and the majority reports that they incorporate these public health goals into their practices.
Familiarity with reading the Health People objectives seems to be related to reported practice behaviors. There is a need to improve the percentage of practicing doctors of chiropractic who are familiar with Healthy People objectives. Future health education initiatives may assist doctors of chiropractic in further incorporating public health objectives into their practice behaviors and improving quality health care.
... Although no research has attempted to change attitudes towards LE itself, studies that have provided participants with information to change their attitudes towards other topics have had some success. For example, when chiropractic undergraduate students participated in a community health class lasting one semester, they exhibited more favorable attitudes towards public health concepts, such as collaboration between chiropractors and public health agencies, compared to before the course (Rose & Ayad, 2008). Additionally, although Rose and Ayad's chiropractic study established that knowledge and attitudes are linked, it is a fairly loose connection since although favorable attitudes did increase, it was not to the extent that their knowledge did. ...
Existing research extension has yielded varying results about whether the public’s attitudes towards life extension are positive or negative. Such differences could be accounted for by factors such as general attitudes towards developments in science and technology and exposure to fiction (such as books or movies) which generally portray life extension in an unfavorable light. This study revealed that, at least among 16 to 17 year-old High School Juniors, there was a correlation between a favorable orientation towards scientific and technological developments and positive attitudes towards life extension. Additionally, participants who had witnessed representation of life extension in fiction were less likely to hold positive attitudes towards it. The specification of the physical state in which people would live an extended lifespan in was also found to be significant in forming attitudes towards life extension. The main positive arguments about life extension were cited to be having more time, being able to be with loved ones longer, and it being beneficial towards society and humanity. However, the most significant negative arguments were that overpopulation would become a severe issue, outliving loved ones would be distressing, and abuse of power. In an attempt to change attitudes towards life extension from negative to positive, a 15-minute presentation about either the social and personal, ethical, or scientific aspect was generally ineffective in doing so. However, out of the favorable change that did occur, the presentation on the scientific feasibility of life extension was found to be the most effective.
... Education can play an important role in prompting positive change in behaviour (60,61). Increases in knowledge and awareness have been found to lead to changes in attitudes (62). Education of health care providers on specific health issues is therefore expected to help increase their knowledge and awareness and, ultimately, promote a positive change in behaviours. ...
Background
Seasonal influenza vaccination (SIV) rates remain suboptimal in many populations, even in those with universal SIV.
Objective
To summarize the evidence on interventions on health care providers (physicians/nurses/pharmacists) to increase SIV rates.
Methods
We systematically searched/selected full-text English publications from January 2000 to July 2019 (PROSPERO-CRD42019147199). Our outcome was the difference in SIV rates between patients in intervention and non-intervention groups. We calculated pooled difference using an inverse variance, random-effects model.
Results
We included 39 studies from 8370 retrieved citations. Compared with no intervention, team-based training/education of physicians significantly increased SIV rates in adult patients: 20.1% [7.5–32.7%; I2 = 0%; two randomized controlled trials (RCTs)] and 13.4% [8.6–18.1%; I2 = 0%; two non-randomized intervention studies (NRS)]. A smaller increase was observed in paediatric patients: 7% (0.1–14%; I2 = 0%; two NRS), and in adult patients with team-based training/education of physicians and nurses together: 0.9% (0.2–1.5%; I2 = 30.6%; four NRS). One-off provision of guidelines/information to physicians, and to both physicians and nurses, increased SIV rates in adult patients: 23.8% (15.7–31.8%; I2 = 45.8%; three NRS) and paediatric patients: 24% (8.1–39.9%; I2 = 0%; two NRS), respectively. Use of reminders (prompts) by physicians and nurses slightly increased SIV rates in paediatric patients: 2.3% (0.5–4.2%; I2 = 0%; two RCTs). A larger increase was observed in adult patients: 18.5% (14.8–22.1%; I2 = 0%; two NRS). Evidence from both RCTs and NRS showed significant increases in SIV rates with varied combinations of interventions.
Conclusions
Limited evidence suggests various forms of physicians’ and nurses’ education and use of reminders may be effective for increasing SIV rates among patients.
... 4,5,7 However, DCs and chiropractic students alike demonstrate a limited awareness of the public health concerns faced by patients. [8][9][10] While chiropractic accrediting bodies specify public health competencies 11 , the impact of didactic coursework on students' attitudes toward and engagement in public health work is not well understood 12 . ...
Purpose:
To describe chiropractic students' perceptions of their future role in public health following an international service-learning experience.
Methods:
Four, 60-minute focus groups were held with 17 upper-level students from 1 U.S. chiropractic college after a mentored clinical experience in 4 international settings. Two investigators analyzed the transcribed focus group interviews.
Results:
We identified 3 themes where chiropractic students emphasized the public health contributions of chiropractors, usually through one-on-one interactions with patients. The primary theme was the prevention and treatment of spine and musculoskeletal conditions through chiropractic care. Next, chiropractors might improve patients' access to health services through screenings, referrals, and monitoring acute and chronic conditions. Lastly, patient education could help patients manage spinal health and make lifestyle modifications.
Conclusion:
Incorporating service learning strategies within chiropractic curriculum may increase student awareness and participation in public health activities.
... After completion of the public health course, the younger, healthier students also demonstrated significant and more substantial positive changes in their attitudes about public health. Chiropractors and chiropractic users have historically been perceived as having "antivaccination" tendencies; however, evidence is accruing of changes over time in the personal and professional attitudes of chiropractors toward vaccination, [24][25][26][27][28][29][30] and more research should be directed toward better understanding vaccination attitudes and behaviors of all health care providers, 30 their patients, and the general public. More research is needed as well to better understand the challenges and implications of changing recommendations for preventive vaccinations, especially because the most recent CDC guidelines for seasonal influenza recommend that all US adults should be considered "high priority" for receiving vaccination. ...
Two recent studies that examined National Health Interview Survey data reported divergent findings regarding the propensity of adult chiropractic users to receive seasonal influenza immunization. Although one study found a statistically significant negative association between chiropractic use and influenza vaccination, another found that chiropractic users were significantly more likely to be vaccinated. The purpose of this study is to extend previous works by delving more deeply into recent data to identify adult chiropractic users at high risk and high priority for vaccination against influenza and pneumococcal disease.
We used data from the 2007 National Health Interview Survey in an attempt to replicate previous methodologies and further examine vaccination among adult chiropractic users (age ≥18 years) who, according to the Center for Disease Control and Prevention guidelines, should receive influenza and/or pneumococcal vaccination. We used complex survey design methods to make national estimates and used logistic regression to determine if having used chiropractic care predicted vaccination.
We found major methodological differences between the prior studies. In our analyses, we found that chiropractic users were significantly less likely than nonusers to have received the pneumococcal vaccine, and we found no significant difference between chiropractic users and nonusers relative to having received the seasonal flu vaccine.
Methodological differences in previous studies that investigated the association between chiropractic care and adult vaccination likely explain divergent findings reported in the literature. Future studies should consider these differences.
... A few published studies have investigated Latino views on the HPV vaccine; however, most have focused on acceptance, not distribution. Latinos tend to have high acceptance of vaccines against STIs in general (Blair, 2008) and are more likely to want their children vaccinated against infectious diseases than Whites and Asians (Rose and Ayad, 2008). Studies conducted within the United States found that Latino parents were more likely to say they would vaccinate their daughters before the age of 13 than non-Latino parents (Constantine, et al., 2006). ...
This research project examined the views of Latina mothers living in Durham, North Carolina on four major ethical dilemmas surrounding HPV vaccine distribution: mandating the vaccine for school entry, vaccinating males as well as females, allowing adolescent access to the vaccine without parental permission and requiring the vaccine for new female immigrants to the United States. Forty-five self-identified Latina mothers living in Durham, NC participated in six focus groups conducted in Spanish between September – October 2009. Latina mothers showed high acceptance of the vaccine in general, but voiced low desire to vaccinate their own daughters. Participants also favored conservative approaches to its distribution. Mothers opposed a school mandate, believing parental and individual autonomy should be respected, but were in favor of vaccinating males to protect them from HPV and related diseases. Participants also believed parental consent should be required for adolescent vaccination, because parents have a right and responsibility to be involved in the decision. Lastly, Latina mothers disagreed with the immigrant requirement, calling it a form of discrimination and racism. Cultural factors did influence some of participants’ views; however, the majority of opinions expressed were similar to those encountered in the literature for other groups. The HPV vaccine has the potential to reduce cervical cancer incidence among Latinos; however, mothers must be better informed about the vaccine, which could increase their desire to vaccinate their own daughters. The vaccine’s affordability within the Latino community must also be considered. PPS Honors Thesis
... To promote public health training in the chiropractic colleges, a model course was developed to provide a common public health curriculum in the chiropractic colleges 85 Follow-up evaluations on public health educational programs were published for at least 5 different campuses. 22,[86][87][88][89] Topics related to special populations have also become more visible in the chiropractic literature. These include family violence, immunization, and smoking cessation efforts in education. ...
This article provides an overview of primary chiropractic issues as they relate to public health. This collaborative summary documents the chiropractic profession's current involvement in public health, reflects on past barriers that may have prevented full participation within the public health movement, and summarizes the relationship of current chiropractic and public health topics. Topics discussed include how the chiropractic profession participates in preventive health services, health promotion, immunization, geriatrics, health care in a military environment, and interdisciplinary care.
This study evaluated the effectiveness of a 7-h educational intervention in enhancing Hong Kong nursing students’ knowledge and attitudes regarding sexuality in older adults. Its content encompassed perspectives of love, theory of sexuality, and topics on sexual health. A total of 169 first-year Hong Kong nursing students participated in the intervention program. The intervention significantly enhanced nursing students’ knowledge [F (1, 218) = 257.10, p < .001] and positive attitudes [F (1, 218) = 54.17, p < .001]. Sexuality educators may adapt the program of the intervention for the purpose of caring older patients with different sexual health concerns.
The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries in children? What ways can doctors of chiropractic stay updated on evidence-based information about vaccines and immunization throughout the lifespan? Can smoking cessation be a prevention strategy for back pain? Does chiropractic have relevance within the VA Health Care System for chronic pain and comorbid disorders? How can chiropractic use cognitive behavioral therapy to address chronic low back pain as a public health problem? What opportunities exist for doctors of chiropractic to more effectively serve the aging population? What is the role of ethics and the contribution of the chiropractic profession to public health? What public health roles can chiropractic interns perform for underserved communities in a collaborative environment? Can the chiropractic profession contribute to community health? What opportunities do doctors of chiropractic have to be involved in health care reform in the areas of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?
Chiropractic care is among the more commonly used Complementary and Alternative Medical (CAM) therapies. Spinal co-morbidities include many of the most common causes of premature death and disability. Health promotion and disease prevention have been used in the profession and taught in educational settings but not yet fully embraced in usual practice. This manuscript reviews areas in which health promotion has been emphasized in chiropractic education along with instances in which health behavior theories (HBTs) have been applied. Chiropractic clinical and educational programs should consider application of HBTs to move clinicians and interns forward regarding better advising roles with patients related to prevention and health promotion.
The purposes of this project were to develop consensus definitions for a set of best practices that doctors of chiropractic may use for promoting health and wellness and preventing disease and to describe the appropriate components and procedures for these practices.
A multidisciplinary steering committee of 10 health care professionals developed seed statements based on their clinical experience and relevant literature. A Delphi consensus process was conducted from January to July 2011, following the RAND methodology. Consensus was reached when at least 80% of the panelists were in agreement. There were 44 Delphi panelists (36 doctors of chiropractic, 6 doctors of philosophy, 1 doctor of naturopathy, 1 registered nurse).
The statements developed defined the terms and practices for chiropractic care to promote health and wellness and prevent disease.
This document describes the procedures and features of wellness care that represent a reasonable approach to wellness care and disease prevention in chiropractic clinical practice. This living document provides a general framework for an evidence-based approach to chiropractic wellness care.
Scientifically rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published. The objective of this study is to compare care seekers of doctors of chiropractic (DCs) and general practitioners (GPs) in the United States and Canada on a comprehensive set of sociodemographic, quality of life, and health-related variables.
Data are from the Joint Canada/U.S. Survey of Health (JCUSH), 2002-03, a random sample of adults in Canada (N = 3505) and the U.S. (N = 5183). Respondents were categorized according to their pattern of health-care use in the past year. Distributions, percentages, and estimates (adjusted odds ratios) weighted to reflect the complex survey design were produced.
Nearly 80% of respondents sought care from GPs; 12% sought DC care. Compared with GP only patients, DC patients in both countries tend to be under 65 and white, with arthritis and disabling back or neck pain. U.S. DC patients are more likely than GP only patients to be obese and to lack a regular doctor; Canadian DC patients are more likely than GP only patients to be college educated, to have higher incomes, and dissatisfied with MD care. Compared with seekers of both GP and DC care, DC only patients in both countries have fewer chronic conditions, take fewer drugs, and have no regular doctor. U.S. DC only patients are more likely than GP+DC patients to be uninsured and dissatisfied with health care; Canadian DC only patients are more likely than GP+DC patients to be under 45, male, less educated, smokers, and not obese, without disabling back or neck pain, on fewer drugs, and lacking a regular doctor.
Chiropractic and GP patients are dissimilar in both Canada and the U.S., with key differences between countries and between DC patients who do and do not seek care from GPs. Such variation has broad and potentially far-reaching health policy and research implications.
The chiropractic profession has long considered itself to be a preventive science. Recently the Council on Chiropractic Education (CCE) has defined a set of standards that must be implemented at all US chiropractic colleges as of January of 2007. These are specific to wellness measures and health promoting efforts that should be performed by chiropractors. This will mandate traditional health promotion and prevention methods be taught to students at accredited colleges and to practicing chiropractors.
To present the idea of performing traditional health promotion and wellness-concepts in chiropractic practice as a call to action for clinicians and generate discussion on the topic.
This manuscript discusses relevant topics of health promotion and prevention for chiropractors and other practicing clinicians that should be made priorities with patients in order to enhance both patient health and community and population health.
All practicing chiropractors, as well as other clinicians should take these new standards from the CCE as a call to action to begin helping patients address the removable causes of morbidity, disability and premature mortality where they exist, in addition to treating their painful spinal conditions.
Many chiropractors treat patients with spinal adjustments based on the theory that correction of vertebral subluxations will restore and maintain health. This paper explores the controversy surrounding the practice of chiropractic and discusses some of the dangers associated with inappropriate use of spinal manipulation. Treatment of infants and children by subluxation-based chiropractors who do not endorse such medically accepted procedures as immunization or use of antibiotics is especially a cause for alarm. Explaining the scientifically rejected chiropractic subluxation therapy and describing some of the questionable treatment methods based on this theory, a veteran chiropractic reformer concludes that if the chiropractic profession fails to abandon the false premise upon which it is based, it will remain controversial and some aspects of chiropractic treatment will continue to be a threat to public health.
Keywords:Immunisation;homoeopathy;chiropractic;naturopathy
Throughout this century there have been many efforts to reform the medical curriculum. These efforts have largely been unsuccessful in producing fundamental changes in the training of medical students. The author challenges the traditional notion that changes to medical education are most appropriately made at the level of the curriculum, or the formal educational programs and instruction provided to students. Instead, he proposes that the medical school is best thought of as a "learning environment" and that reform initiatives must be undertaken with an eye to what students learn instead of what they are taught. This alternative framework distinguishes among three interrelated components of medical training: the formal curriculum, the informal curriculum, and the hidden curriculum. The author gives basic definitions of these concepts, and proposes that the hidden curriculum needs particular exploration. To uncover their institution's hidden curricula, he suggests that educators and administrators examine four areas: institutional policies, evaluation activities, resource-allocation decisions, and institutional "slang." He also describes how accreditation standards and processes might be reformed. He concludes with three recommendations for moving beyond curriculum reform to reconstruct the overall learning environment of medical education, including how best to move forward with the Medical School Objectives Project sponsored by the AAMC.
To describe the practice characteristics and pediatric care of chiropractors.
Cross-sectional, descriptive survey.
Chiropractic practices in the Boston, Mass, metropolitan area.
One hundred fifty licensed chiropractors.
Demographics, practice characteristics, and fee structure. Practitioners were also asked about their approach to childhood immunizations and a clinical scenario. Data were analyzed using simple descriptive statistics.
Ninety (60%) chiropractors responded. All were white and 65% were men. Respondents had on average 122 patient visits weekly, of which 13 (11%) were from children and adolescents. Typical visit frequency ranged from 1 to 3 times weekly. Average visit fees were 38 (initial and follow-up) and 49% of the fees were covered by insurance. Seventy percent of the respondents recommended herbs and dietary supplements. For pediatric care, 30% reported actively recommending childhood immunizations; presented with a hypothetical 2-week-old neonate with a fever, 17% would treat the patient themselves rather than immediately refer the patient to a doctor of medicine, doctor of osteopathy, or an emergency facility.
Children and adolescents constitute a substantial number of patients in chiropractics. An estimated 420000 pediatric chiropractic visits were made in the Boston metropolitan area in 1998, costing approximately $14 million. Pediatric chiropractic care is often inconsistent with recommended medical guidelines. National studies are needed to assess the safety, efficacy, and cost of chiropractic care for children.
This report, released by the Division of Health Promotion and Disease Prevention within the Institute of Medicine at the National Academy of Sciences, asserts that behavioral and social interventions such as health promotion and disease prevention offer great promise to reduce disease morbidity and mortality in the United States, but as yet their potential has not been recognized or tapped by the federal government. Two overarching recommendations are the need to address generic social and behavioral determinants of health rather than the clinical causes of disease and death, and the need to intervene at multiple levels of influence including the individual, interpersonal, institutional, community, and policy levels. Seven recommendations for intervention strategies, nine recommendations for research, and three recommendations for funding are offered.
Although the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College (CMCC) endorse vaccination, the prevalence of anti-vaccination attitudes among Canadian chiropractors is unknown. This study describes the prevalence of anti-vaccination attitudes among Canadian chiropractic students.
An 11-item questionnaire about attitudes toward vaccination was distributed to students enrolled at CMCC during the 1999/2000 academic year. The responses for the 11 items were then summed to arrive at a total score ranging from 0 (most negative attitude toward vaccination) to 22 (most positive attitude toward vaccination). Respondents' perceptions of sources of vaccine information were also investigated.
Over 75% of the students (467 of 621) completed the questionnaire. Most students (53.3%) reported that in general they agreed with vaccination. This was especially true among first-year students (60.7%). However, among fourth year students, only 39.5% agreed with vaccination. The proportion of respondents who stated that they were against vaccination in general was 5 (4.5%) of 112 first-year students, 10 (8.3%) of 121 second-year students, 16 (13.9%) of 115 third-year students and 35 (29.4%) of 119 fourth-year students. The mean scores on the questionnaire were progressively lower with each higher year of study at the College. The mean survey scores for each year of study were first year, 15.9 (95% confidence interval [CI] 15.2-16.6); second year, 16.1 (95% CI 15.3-1 7.0); third year, 14.5 (95% CI 13.5-15.4); and fourth year, 12.8 (95% CI 11.7-13.9). The mean scores varied among year of study and were statistically significant using one-way ANOVA (p < 0.0001). Among students who relied primarily on informal sources of vaccine information, such as the chiropractic literature and informal talks at CMCC, anti-vaccination attitudes were more prevalent in later years.
Most CMCC students reported pro-vaccination attitudes, but there appeared to be an increase in anti-vaccination attitudes as students progressed through the CMCC program. This pattern was seen almost exclusively among students who relied primarily on informal sources of vaccine information rather than on core CMCC lectures or prior lectures at university.
To assess attitudes of current chiropractic students, public health faculty, and practitioners toward the topics of clinical preventive and health promotion services.
Survey of samples of students and faculty at 10 US chiropractic colleges and random sample of US chiropractors stratified by zip code region using proportional allocation.
Descriptive statistics were computed for all 3 samples and statistical modeling was used to explore relationships between practitioner characteristics and their responses concerning counseling on health indicators.
A total of 582 students, 45 faculty, and 496 practitioners were surveyed; the response rate for practitioners was 27%. Over 80% of practitioners reported providing information to patients on musculoskeletal risk reduction, exercise, diet, stress reduction, and injury prevention. Over 80% also reported obtaining information from patients on physical activity, stress, dietary habits, obesity, medication use, and occupational hazards. Concerning immunization information, a much higher proportion of faculty (91%) and students (80%) than practitioners (62%) felt chiropractors should provide both pro and con information to patients. In general, female, younger, and more recently graduated practitioners appeared to be somewhat more likely to agree that chiropractors should provide counseling and to report providing it. An association was seen between attitudes toward health indicator counseling and respondent education. Practitioners with at least a bachelor's degree were statistically significantly more likely to report providing counseling for physical activity and to agree that chiropractors should provide counseling and to report actually providing counseling within the last month for substance abuse, responsible sexual behavior, mental health, and injury and violence prevention (P <.05).
Our results indicate that a substantial proportion of the US chiropractors and students who completed our survey, as well as a number of key faculty, have a positive attitude toward providing clinical preventive services, particularly those related to physical activity and diet. However, the results also suggest that there may be areas where chiropractic training is not consistently meeting the newly established national guidelines for clinical preventive services.
Concerns have been raised about the beliefs and behaviours of chiropractors related to immunization; however, none have systematically examined the relationships between beliefs and behaviours.
We examine the immunization-related behaviours and beliefs of chiropractors in Alberta, Canada, and explore the relationship of beliefs to immunization-related behaviours with patients.
Data were collected in 2002 from a postal survey of Alberta chiropractors. The questionnaire inquired about six behaviours of interest in the six months prior to survey (gave information about risks/benefits of vaccination; advised patients in favour/against have self/children immunized; counselled on freedom of choice; directed to sources of information on immunization). It included items addressing beliefs and norms related to immunization.
The response rate was 78.2% (503/643). Immunization arose with patients at least monthly for 36.5% of respondents, and at least weekly for 9.2%. One quarter advised patients in favour and 27% against having themselves/their children immunized. A parsimonious model of chiropractor pro/anti-vaccination behaviours included beliefs about the efficacy/safety of vaccination, chiropractic philosophy and individual rights.
Similar proportions of chiropractors advise patients in favour or against immunization. A small minority deals with immunization issues frequently. Behaviours can be understood in the context of beliefs.
Evidence-based medicine (EBM) has grown in popularity and prominence in the world of orthodox medicine since the 1980s. The focus of this article is on the process of developing practice guidelines (one type of EBM) and its effects upon chiropractic, a profession with a "philosophy, science and art" that is constructed upon divergent epistemological and methodological tenets (namely, the idea of "vitalism"). The EBM movement is conceptualized as part of a larger political economy surrounding the health care environment that creates a new set of imperatives for orthodox medicine, and also branches of alternative medicine that are in the process of professionalization. The quantitative, positivist and empiricist assumptions of EBM dictate which approaches to treatment and which clinical procedures are legitimate and perhaps reimbursable under systems of managed care. The ramifications of practice guidelines and its effects upon the intraprofessional segments of the chiropractic profession are also discussed.
Complementary and alternative medicine (CAM) use by US adults increased substantially between 1990 and 1997, yet little is known about more recent trends.
Compare CAM therapy use by US adults in 2002 and 1997.
Comparison of two national surveys of CAM use by US adults: (1) the Alternative Health/Complementary and Alternative Medicine supplement to the 2002 National Health Interview Survey (NHIS, N = 31,044) and (2) a 1997 national survey (N = 2055), each containing questions about 15 common CAM therapies.
Prevalence, sociodemographic correlates, and insurance coverage of CAM use.
The most commonly used CAM modalities in 2002 were herbal therapy (18.6%, representing over 38 million US adults) followed by relaxation techniques (14.2%, representing 29 million US adults) and chiropractic (7.4%, representing 15 million US adults). Among CAM users, 41% used two or more CAM therapies during the prior year. Factors associated with highest rates of CAM use were ages 40-64, female gender, non-black/non-Hispanic race, and annual income of dollar 65,000 or higher. Overall CAM use for the 15 therapies common to both surveys was similar between 1997 and 2002 (36.5%, vs. 35.0%, respectively, each representing about 72 million US adults). The greatest relative increase in CAM use between 1997 and 2002 was seen for herbal medicine (12.1% vs.18.6%, respectively), and yoga (3.7% vs. 5.1%, respectively),while the largest relative decrease occurred for chiropractic (9.9% to 7.4%, respectively).
The prevalence of CAM use has remained stable from 1997 to 2002. Over one in three respondents used CAM in the past year, representing about 72 million US adults.
The purpose of this study is to implement and evaluate a course on "wellness concepts" for chiropractic students, emphasizing national goals and evidence-based practices for health promotion and prevention.
Teaching methods included traditional lecture discussions and experiential activities, including objectives described in Healthy People 2010. Evaluation included pre- and posttests of students' familiarity with and intention to use key concepts, resources, and practices; item analysis of multiple choice exams; and a qualitative survey.
Increases in students' self-reported familiarity were statistically significant for all but 2 of the 23 key topics assessed. At baseline, students already expressed intention to use most wellness-related practices listed, and showed significant increases for approximately half the practices listed at the posttest. Item analysis found students less able to correctly answer questions requiring analytic thinking than simple memorization. Students were most satisfied with the experiential portions of the course.
Although the course was successful at introducing students to national resources and initiatives related to wellness, health promotion, and prevention, these concepts may be more meaningful if integrated into a teaching clinic that encouraged practical application of course concepts.
To investigate the impact of the dissemination of the model public curriculum at one US chiropractic college on chiropractic interns during their outpatient clinical internship.
A retrospective pilot study was performed to evaluate the frequency of 9 patient clinical preventive health recommendations made by interns during their clinical training. The frequency of recommendations by interns completing their public health coursework after dissemination of the model curriculum was compared with those completing their coursework during the period immediately proceeding dissemination. A standardized data abstraction tool was developed to collect data from clinic charts that established a patient's need for any one of 9 preventive health services.
Of the 408 charts examined (204 from each group), there were only 4 documented instances (1%) of recommendations for any of the 9 preventive health service categories. Two recommendations occurred in the precurriculum change period.
The results of this pilot study indicate that there has been no observable impact on intern behaviors toward educating patients in preventive health services since the dissemination of the model public health curriculum at one of the chiropractic colleges in the United States. The impact of this reform in public health education may have been limited by its minimal focus on clinical preventive services and by a focus on didactic rather than a clinically relevant learning exposure.
This study describes the prevalence and correlates of perceptions of Canadian doctors of chiropractic regarding the adequacy of their undergraduate (UG) and postgraduate (PG) educational preparation to counsel patients about immunization/vaccination and explores their preferences for continuing education (CE) in this area.
A cross-sectional population-based postal survey of Alberta chiropractors was conducted in the summer of 2002.
The response rate was 78.2%. Forty-five percent perceived that their formal UG chiropractic education prepared them adequately to counsel people on immunization compared with 64% who agreed that their self-directed PG education prepared them adequately. College of graduation was significantly associated with perceptions related to UG but not PG education. Those who felt prepared to counsel on immunization by UG education used different immunization information sources than those who felt prepared by PG or both UG and PG education. Use of specific sources and perception of preparedness to counsel on immunization were both associated with antivaccination behaviors. Those who felt prepared by PG or both UG and PG education were more likely to engage in antivaccination behavior than others. Most respondents indicated interest in CE on immunization.
The proportion of doctors of chiropractic who perceive themselves adequately prepared to counsel on immunization varies by type of education considered and is related to vaccination behavior. Many are interested in some form of CE related to immunization/vaccination.
This study evaluated the perceptions of research, frequency of use of research findings in practice, and the level of research skills of chiropractors and massage therapists in Canada. Predictors of application of research findings in clinical practice were also explored.
A survey was mailed to members of the College of Chiropractors of Alberta (n = 833) and the Massage Therapist Association of Alberta (n = 650). Univariate and logistic regression analysis were conducted with SPSS and Stata.
A total of 483 questionnaires were returned (response rate, 32.6%). Chiropractors and massage therapists reported an overall positive perception toward research, acknowledging the importance of research to validate their practice. Although both groups felt comfortable using the library, they had little confidence in their research skills and overall application of research in practice was limited. Significant differences were found between the 2 professional groups, with chiropractors reporting more research skills and evidence-based practice. Primary discipline, frequent referral to peer-reviewed journals, and strong agreement with the statement that "research adds credibility to my discipline" were predictors of research application in practice.
It appears that in Canada neither chiropractors nor massage therapists consistently apply research in practice, which may result from a lack of research education and research skills. The differences between the 2 professional groups may be attributed to the chiropractic profession's relatively more research-focused professional training. Strategies to encourage greater research uptake and evidence-based behavior by practitioners include professional association incentives, such as education credits or practitioner cooperatives that would provide time and support for research.
Chiropractic, health promotion and the potential for synergy
- K Stacey
- D Vindigni
- Stacey
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Public health education in chiropractic: the collaborative development of a model course
- L Killinger
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Reform in Public Health Education in Chiropractic
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Beliefs and behaviours: understanding chiropractors and immunization Attitudes toward vaccination: a survey of Canadian chiropractic students
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A Model Course for Public Health Education in Chiropractic Colleges: A Users Guide Available from: http://www
- E Anderson
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