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Naturopaths are consulted by 6.2% of the Australian adult population, which is comparable to the rates of consultations with acupuncturists (7.9%) and osteopaths (5.4%)1. The Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance2 (‘the Natural Therapies Review’) found there is evidence to suggest whole-system naturopathic practice is effective in improving patient health for a range of chronic health conditions. However, the Natural Therapies Review noted the unregulated nature of the workforce made it difficult to apply in the Australian context, particularly as most of the identified research was conducted in North America. Yet, Australian naturopathic education is comparable in both length and breadth to North American courses. The Australian naturopathic profession has been calling for registration for many years3 and every government report in the last 20 years examining the need for registration of naturopathy has recommended this should occur4. Despite the continued exclusion of naturopaths from the prevailing Australian regulatory mode, the profession has grown in size, strength and professional status at a national and international level. For example, the regulatory model developed by the naturopathic profession in lieu of government registration5 is held up as a best-practice model for self-regulation that could be adopted by other unregistered health professions. Alongside this, Australian naturopathic education is recognised by the international peak body — the World Naturopathic Federation (WNF) — as aligning with the highest tier of professional qualification internationally6 and Australian naturopathic researchers attract more government research funding than other registered complementary medicine professions. Even so, since the Natural Therapies Review in 2013 the evidence for whole-system naturopathic practice has continued to increase: Whereas the Natural Therapies Review found only one systematic review for naturopathy containing 6 RCTs with 692 patients, a more recent review has identified 31 RCTs comprising 9,798 patients, which provide evidence for an increased number of chronic conditions improved by naturopathic care7.
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Australian Journal of Herbal and Naturopathic Medicine 2019 31(1)
9© NHAA 2019
Article
An evidence-based overview of naturopathic
practice in Australia
Executive summary
Naturopaths are consulted by 6.2% of the Australian
adult population, which is comparable to the rates of
consultations with acupuncturists (7.9%) and osteopaths
(5.4%)1.
The Review of the Australian Government Rebate on
Natural Therapies for Private Health Insurance2 (‘the
Natural Therapies Review’) found there is evidence to
suggest whole-system naturopathic practice is effective
in improving patient health for a range of chronic health
conditions. However, the Natural Therapies Review noted
the unregulated nature of the workforce made it difcult
to apply in the Australian context, particularly as most of
the identied research was conducted in North America.
Yet, Australian naturopathic education is comparable in
both length and breadth to North American courses.
The Australian naturopathic profession has been calling
for registration for many years3 and every government
report in the last 20 years examining the need for
registration of naturopathy has recommended this should
occur4. Despite the continued exclusion of naturopaths
from the prevailing Australian regulatory mode, the
profession has grown in size, strength and professional
status at a national and international level. For example,
the regulatory model developed by the naturopathic
profession in lieu of government registration5 is held up
as a best-practice model for self-regulation that could
be adopted by other unregistered health professions.
Alongside this, Australian naturopathic education is
recognised by the international peak body — the World
Naturopathic Federation (WNF) — as aligning with the
highest tier of professional qualication internationally6
and Australian naturopathic researchers attract more
government research funding than other registered
complementary medicine professions.
Even so, since the Natural Therapies Review in 2013
the evidence for whole-system naturopathic practice
has continued to increase: Whereas the Natural
Therapies Review found only one systematic review
for naturopathy containing 6 RCTs with 692 patients, a
more recent review has identied 31 RCTs comprising
9,798 patients, which provide evidence for an increased
number of chronic conditions improved by naturopathic
care7.
Jon Wardle1, Amie Steel1,2, David Casteleijn1,3 and Diana Bowman1,3
1 Discipline of Public Health, Faculty of Health, University of Technology of Sydney, NSW, Australia
2 Australian Register of Naturopaths and Herbalists (ARONAH)
PO Box 711, Fortitude Valley, Qld 4006
3 Naturopaths and Herbalists Association of Australia (NHAA) PO Box 696, Ashfield NSW 1800 Australia
doi.org/10.33235/ajhnm.31.1.9-13
Role of naturopathy in the Australian
health system
Approximately 6.2% of Australians have consulted with
a naturopath in the previous 12 months1 and 75% of these
users have a chronic illness8. Furthermore, approximately
1 in 10 Australians with chronic diseases such as sleep
disorders (13.6%), type 1 and 2 diabetes (11.9%), mental
health disorders (9.0%) and asthma (8.7%) consult with a
naturopath (Table 1)9. Based on unpublished data collected
through the Practitioner Research and Collaboration
Initiative (PRACI) a world-rst, practice-based
research network for complementary medicine
professions including naturopathy10 — Australian
naturopaths also report frequently treating patients
with diagnosed illness of national importance such as
insomnia, depression/anxiety, menstrual disorders, and
arthritis (among others). Half of naturopathic patients
visit their naturopath for most of their health issues and
59.6% use their naturopath as their primary provider,
with 22.2% as their sole primary care provider and
37.1% as the primary provider in conjunction with other
health providers (for example, GPs) used in a secondary
capacity11.
Table 1: Prevalence of consultations with a naturopath
based on diagnosis with nationally important chronic
diseases
Disorder diagnosis % of population who
visited naturopath
Sleep disorder 13.6
Diabetes (type 1 and 2) 11.9
Mental health disorder 9.0
Asthma 8.7
Respiratory disorder 8.5
Cancer 8.3
Gastrointestinal disorder 7.2
Musculoskeletal disorder 6.6
Osteoarthritis 6.0
Cardiovascular disease 5.8
Any chronic disease diagnosis 7.2
Australian Journal of Herbal and Naturopathic Medicine 2019 31(1)
10 © NHAA 2019
The total rate of naturopathic consultations in the
general population is comparable to other registered
health professions, such as acupuncturists (7.9%) and
osteopaths (5.4%)1 and demonstrates a 5% increase
over 10 years12. Australian naturopaths see an average
of 13 to 14 patients per week and 20 to 21 new patients
per month13, often practising in rural and remote areas
where there are shortages of other health services14.
Australian naturopaths are also relatively integrated into
the Australian health system, with one-quarter (25.8%)
of GPs referring to a naturopath at least a few times per
year15.
This same research also indicates the focus naturopaths
place on factors important to population health and
prevention of chronic illness such as sleep, dietary
habits, substance use, and physical activity (Table 2).
The naturopaths’ self-reported practice behaviours align
with national data collected from patients of naturopaths,
indicating they were prescribed dietary changes (96.3%),
lifestyle changes (mainly exercise) (92.6%) and self-care
techniques (such as stress-reduction and pain-reduction
techniques) (70.4%), many of which directly support the
national Australian guidelines for health promotion and
disease prevention11.
Table 2: Self-reported prescriptions of naturopathic
practitioners in Australia (source: PRACI)
Self-reported practice
behaviours
% of practitioners
prescribing
Lifestyle recommendations 98
Dietary modification 90
Herbal medicine 90
Meditation 88
Exercise prescription 83
Yoga 75
Nutritional supplementation 65
Homoeopathy 36
The naturopathic education and research
landscape
Australian education for naturopaths is considered by the
WNF to be in the top tier of education globally (along with
Canada, India, South Africa and the United States)6. The
professional standard for graduation as a naturopath in
Australia is a four-year bachelor degree program (though
lack of regulation means that untrained practitioners
have historically co-opted the title). A comparison of the
leading Australian four-year program and the leading
accredited Canadian four-year program can be found in
Figure 1. It shows the Australian and Canadian courses
being of comparable breadth, with the Australian courses
containing signicantly more nutrition, herbal medicine
and physical medicine content, while the Canadian
course contains more content on homeopathy and more
student clinic training hours.
The commitment to professionalism in education and
training in the naturopathic community can also be
demonstrated through other initiatives of the Australian
naturopathic profession. The Australian Journal of
Herbal and Naturopathic Medicine (the ofcial journal
of the Naturopaths and Herbalists Association of
Australia — NHAA), for example, is Australia’s highest-
ranked complementary medicine profession journal in
the Scopus database*.
The Australian naturopathic education sector has also
embraced research-led teaching more than any other
complementary medicine (CM) profession. Southern
Cross University developed the rst CM research
higher degree program (in naturopathy) in 1996 and the
Endeavour College of Natural Health (ECNH) developed
Australia’s rst research higher degree program in a
private CM college in 2016, by offering an honours
program in naturopathy. In only two years, graduates
of Endeavour’s honours program have produced 15
publications in international peer-reviewed journals from
their original research projects16.
ECNH also leads research initiatives such as the
International Research Consortium of Naturopathic
Course area Australian
college (ECNH)
Canadian
college
(CCNM)
Biosciences (e.g.
Anatomy, Physiology,
Pathology, Pharmacology)
468 463
Social Science (e.g.
Psychology, Public Health,
Critical Research Skills)
312 260
Naturopathic Theory (e.g.
Naturopathic Principles
and Philosophies)
78 24
Naturopathic Clinic (e.g.
student clinic hours)
624 1280
Homoeopathy 0* 119
Physical Medicine (e.g.
massage, manipulation,
hydrotherapy)
156 48
Electives (e.g. sports
specialisation, community
education, advanced
physical skills)
195 24
Herbal Medicine (e.g.
herbal medicine practice,
integrated pharmacology)
390 147
Nutrition and dietetics
(e.g. clinical nutrition,
dietary planning)
429 182
TOTAL HOURS 2496 2537
Figure 1: Course hours in the leading Australian program
versus the leading Canadian naturopathic program
(note: course hours have been converted into Australian
course hours). Homoeopathy is available as an elective in
Australian courses.
Article
Australian Journal of Herbal and Naturopathic Medicine 2019 31(1)
11© NHAA 2019
Article
Academic Clinics (IRCNAC), a collaboration (based on
homogeneity of education standards) of college clinics
in Australia, Canada, New Zealand and the United
States, which is now being used for multiple projects,
including several funded by the US National Institutes
of Health17.The Australian naturopathic profession is also
the only Australian CM profession conducting research
into critical assessment in education18. Ironically this
internal self-critique — a recognised essential element of
professionalisation but absent in most CM professions —
was used by the NHMRC Review to dismiss the evidence
base for naturopathy19.
Regulation of naturopathic practice in
Australia
Registration focuses on providing several safeguards to
ensure the public are accessing safe and effective health
care from appropriately qualied health practitioners.
Every evaluation under these criteria has recommended
that naturopaths warrant registration20,21.
Naturopathic practitioners have consistently identied
regulation of the profession as the major challenge the
profession faces and support the implementation of
regulation to ensure practice standards and promote
public safety3.
Our concerns are that untrained and unethical practitioners
are also able to practise using the title of ‘naturopath’
the professional naturopathic community in Australia
and globally does not consider these practitioners as
part of the profession. For the last 20 years, the industry
standard of naturopathic education has been a 4-year
bachelor degree in Australia. Since 2015, government
legislation and accreditation have mandated requirements
that naturopathic education must be delivered within a
degree model.
The Australian naturopathic profession has demonstrated
an understanding of the need for registration through
the establishment of Australian Register of Naturopaths
and Herbalists (ARONAH) to mirror the regulatory
framework of the National Registration and Accreditation
Scheme (NRAS). ARONAH’s standards were developed
through benchmarking against the Association of
Accredited Naturopathic Medical Colleges (AANMC)
standards in North America as part of their development
and the ARONAH model is recommended by the WNF to
countries seeking to further professionalise naturopathy
in the absence of government registration. Equally in
Australia, the ARONAH model has been mentioned in
the Australian Health Ministers’ Advisory Council report
on Options for Unregistered Health Practitioners22 as an
ideal model for professions not included in the NRAS.
ARONAH and the NHAA — recognised by the WNF
as the pre-eminent naturopathic association representing
naturopaths in Australia — are actively lobbying for the
inclusion of naturopaths and Western herbalists in the
NRAS.
Evidence for the safety, effectiveness
and cost-effectiveness of naturopathic
treatments
The Natural Therapies Review limited its search
for evidence of the safety, effectiveness and cost-
effectiveness of naturopathy to “whole practice” studies
only (meaning specic treatments commonly used by
naturopaths were not considered). Even with this limited
inclusion criteria, the Review found 6 RCTs (comprising
692 patients) which suggested naturopathy may be
effective for a range of chronic conditions, including
anxiety, multiple sclerosis, cardiovascular disease and
musculoskeletal conditions. Since the Natural Therapies
Review was conducted (in 2013) a more recent review
has identied 31 RCTs with 9798 patients, adding type
2 diabetes, polycystic ovarian syndrome, depression,
anxiety and a range of complex chronic conditions to
the evidence base7. Where economic analyses have been
conducted, naturopathy has also shown cost-benet:
a systematic review of cost-effectiveness studies,
conducted in complementary therapies with research
evidence suggesting cost-effectiveness (specically for
treatment of low-back pain and anxiety)23.
However, a sole focus on “whole practice” research is not
likely to capture the full extent of naturopathic evidence.
There are numerous trials registered as evaluating
naturopathy practice in the Australian and New Zealand
Clinical Trials Registry (ANZCTR), yet none of them
identify “whole-practice” research. Even when trials
explicitly evaluate the intervention of a naturopathic
practitioner, they may identify as other interventions.
For example, an ANZCTR-listed naturopathic trial of
122 women with polycystic ovarian syndrome (which
reported improvements in symptoms and risk factors)
did not report as a “whole-practice” naturopathic
intervention, but rather a “combined lifestyle and herbal
medicine intervention”, even though this intervention
was delivered by naturopathic practitioners24. Where
naturopathic care is integrated into conventional health
settings it may also be obscured. For example, a trial of
naturopathic care for 922 cardiac post-surgical patients
at the Alfred Hospital found naturopathic care improved
post-operative heart function, reduced post-surgical
complications and improved adherence and compliance
to hospital rehabilitation services, yet was reported as a
nutritional wellness intervention rather than a naturopathic
intervention, despite the intervention being developed
and implemented by naturopathic practitioners25.
Australia and Canada are recognised as the two global
centres of naturopathic research by the WNF, which is
currently conducting an audit of global naturopathic
research. This audit has already identied 2150 research
articles published by naturopathic researchers in peer-
reviewed medical journals, of which 623 (28.9%) are by
Australian authors, and 596 (27.7%) are conducted in
Australian settings. Of the 10 most published naturopathic
authors in peer-reviewed medical journals, Australia
is the most represented country with four. However,
despite this audit identifying naturopathic researchers
Australian Journal of Herbal and Naturopathic Medicine 2019 31(1)
12 © NHAA 2019
Figure 2: Cumulative NHMRC grants secured by CAM professional faculties within the university sector. TCM =
traditional Chinese medicine. *Naturopathy no longer has a university-based faculty, 2007–2017
conducting research into naturopathic treatments or
topics, only 157 articles (7.3%) explicitly acknowledge
naturopathy as a whole-practice system of medicine. This
is primarily because research in specic naturopathic
modalities (for example, herbal medicine, hydrotherapy)
or approaches (for example, dietary or lifestyle care
recommended by naturopaths) may be rebadged under
these specic categories. Even in the absence of having
specic university departments, naturopaths are the
most active CM profession involved in research in
Australia, with more naturopaths undertaking research
higher degree programs at Australian universities than
any other CM profession26. Naturopathic researchers
have successfully secured more National Health and
Medical Research Council grants than all other CM
professions (TCM, chiropractors, osteopaths, massage
— Figure 2)27. However, as noted earlier, it is unlikely
that naturopathic research funded by the NHMRC would
be captured as “whole-practice” naturopathic research.
Funding for Australian naturopathic research can also
be seen through PhD scholarships. For example, every
naturopath graduating from the Endeavour honours
program has not only continued on to enrol in a PhD at
a leading Australian university but has also been offered
competitive PhD scholarships — such as the Australian
Government Research Training Program Scholarship —
to support them during their research degree.
Acknowledgements
We are grateful to Endeavour College of Natural Health
and the Practitioner Research and Collaboration Initiative
(PRACI) for providing unpublished data for inclusion in
this document.
Notes
* The Scopus database is the pre-eminent database and quality
metric for peer-reviewed journals. The AJHNM has a score of
0.27, the Journal of the Australian Traditional Medicine Society
a score of 0.09, the Chiropractic Journal of Australia a score
of 0.07 and the Australian Journal of Acupuncture and Chinese
Medicine a score of 0.04. For reference, the median score for
general medical journals is 0.26, which places AJHNM in the top
50% of peer-reviewed medical journals internationally.
The AANMC regulates the educational standards and delivery of
naturopathic education in Canada and the United States.
Three authors from the top 10 are from the United States, two
from Canada and one from Germany.
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0
2
4
6
8
10
12
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
NHMRCGrants(cumulative)byCMprofession
Naturopathy TCM Chiropractic Osteopathy
Figure 2: Cumulative NHMRC grants secured by CAM professional faculties within the university sector. TCM
= traditional Chinese medicine. *Naturopathy no longer has a university-based faculty, 2007-2017
Article
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The process of applying new scientific knowledge to clinical decision-making is critical for the provision of optimal healthcare delivery; however, this process is often slow or inconsistent. Knowledge mobilization is the iterative and bidirectional process that involves the generation, dissemination, and translation of knowledge between researchers and knowledge users. Incorporation and application of knowledge mobilization in health care is being increasingly recognized across all fields, including naturopathic medicine. This review explores generally employed knowledge mobilization approaches. Additionally, it summarizes the knowledge mobilization strategies currently being used by the Canadian naturopathic profession and makes recommendations on the strategies which might be used in the future to bridge the gap between research evidence and clinical practice.
... It also may reflect the focus placed on herbal and nutritional prescription within naturopathic curricula in the countries producing the majority of the articles (Canada, United States, and Australia). 21 It may also reflect external influences on research funding decisions-for example, research agency priority setting-which may not necessarily align with clinical areas of focus. ...
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Objectives: This study aims to describe the characteristics of published peer-reviewed journal articles authored by naturopathic practitioners (NPs) Design: The study used bibliometric analysis of data extracted from journal articles. Settings/Location: International Subjects: Articles were included if they had at least one author with a naturopathic qualification and were published in a peer-reviewed, indexed journal. Data collection: A snowballing method was used between June 2018 and July 2019 to identify relevant articles. Outcome measures: Data related to geography, affiliation, year of publication, article type or research design, article topic, and journal were extracted from each included article. Results: Identified articles (n = 2,218) were published by NP from 22 countries between 1987 and 2019, with 80.9% published in the last 10 years. Most articles were published by NP from the America (52.5%) and Western Pacific (28.3%) World Health Organization regions. The most common type of study design or article type was reviews and meta-analyses (23.2%) and clinical trials or intervention studies (19.4%). Explicit mention of naturopathy was reported in 8.1% of articles. Almost half (48.4%) of all included articles were published in 40 journals, and 56.9% of these were published in journals ranked in the first quartile of at least one subject area. Articles focused on mental health were more likely to be conducted in Australia (odds ratio [OR] 3.3) and focused on lifestyle behavior (OR 2.5) or clinical nutrition (OR 1.6). Articles about cancer or cancer-related conditions were more likely to include lifestyle behavior (OR 2.0) and less likely to be conducted in Australia (OR 0.1) or Germany (OR 0.5). Conclusions: The international naturopathy research community has produced peer-reviewed literature for over 30 years and has demonstrated sustained commitment to codifying existing knowledge, generating new knowledge, and disseminating this knowledge to the wider clinical and research community.
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Background This descriptive study provides the first examination of global naturopathic education, regulation and practice frameworks that have potential to constrain or assist professional formation and integration in global health systems. Despite increasing public use, a significant workforce, and World Health Organization calls for national policy development to support integration of services, existent frameworks as potential barriers to integration have not been examined. Methods This cross-sectional survey utilized purposive sampling of 65 naturopathic organisations (educational institutions, professional associations, and regulatory bodies) from 29 countries. Organizational representatives completed an on-line survey, conducted between Nov 2016 – Aug 2019. Frequencies and cross-tabulation statistics were analyzed using SPSSv.25. Qualitative responses were hand-coded and thematically analysed where appropriate. Results Sixty-five of 228 naturopathic organizations completed the survey (29% response rate) from 29 of 46 countries (63% country response rate). Most education programs (68%) were delivered via a national framework. Higher education qualifications (60%) predominated. Organizations influential in education were professional associations (75.4%), particularly where naturopathy was unregulated, and accreditation bodies (41.5%) and regulatory boards (33.8%) where regulated. Full access to controlled acts, and to health insurance rebates were more commonly reported where regulated. Attitude of decision-makers, opinions of other health professions and existing legislation were perceived to most impact regulation, which was globally heterogeneous. Conclusion Education and regulation of the naturopathic profession has significant heterogeneity, even in the face of global calls for consistent regulation that recognizes naturopathy as a medical system. Standards are highest and consistency more apparent in countries with regulatory frameworks.
... remedies or dietary/lifestyle advice that patients must self-administer outside of the consultation)an approach requiring the naturopath to engage the patient in the treatment process, which typically involves provision of patient education and detailed discussion of the patient's individual circumstances. 28 Previous studies show such patient education by naturopaths may improve the patient's self-efficacy and sense of empowerment, while time spent discussing the patient's needs may result in the patient feeling heard and supported, 17,23 leading to a particularly high degree of perceived PCC during consultation with naturopaths. ...
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Objectives Chronic conditions require continuous, multi-factorial care – such as person-centred care – to address patients’ individual health needs and quality of life. Many patients with chronic conditions seek additional care outside mainstream medicine, often consulting complementary medicine (CM) practitioners. This study examines person-centred care experienced by patients with chronic conditions consulting CM practitioners. Design Cross-sectional survey. Setting CM clinics around Australia, conducted November 2018 to March 2019. Participants Patients with chronic conditions (n = 153) consulting osteopaths (n = 39), naturopaths (n = 33), massage therapists (n = 29), chiropractors (n = 28) and acupuncturists (n = 24). Main outcome measures Patient-Centred Care Scale, Perceived Provider Support Scale, Empowerment Scale, and Patient Assessment of Chronic Illness Care measure. Results Patient perceptions of person-centred care were consistently high during consultation with CM practitioners (Patient-centred Care scale mean range 4.22 to 4.70; Perceived Provider Support scale mean range 4.39 to 4.69; Empowerment scale mean range 2.20 to 2.50; Patient Assessment of Chronic Illness Care mean summary 3.33). Ratings of person-centred care were higher for consultations with CM practitioners than for medical doctors. Patients of naturopaths reported the highest means for perceived person-centred care. Variation in participant ratings for different items between professions indicate nuance in consultation experiences across different CM professions. Conclusions Person-centred care appears characteristic of CM consultation, which may reflect holistic philosophies. Variations in patient experiences suggest diverse practices across CM professions. CM practitioners may present a resource of person-centred care for addressing unmet needs of individuals with chronic conditions, and reducing the health burden associated with rising rates of chronic conditions.
... Naturopaths were an influential source of information, and this could be due to them being the second largest CAM practitioners in Australia [49] as well as their popularity. In Australia, naturopaths are one of the top five CAM practitioners consulted by 6.2% of adults [50,51]. These findings might correspondingly indicate there is no one singular source of information and CAM consumers might use several sources when making health care decisions. ...
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Background Acute respiratory tract infection (ARTI) is a prevalent condition associated with serious health and economic implications. A range of strategies is used to manage ARTI in children, including complementary and alternative medicines (CAM). There has been little investigation into this area, and this study aims to address this knowledge gap. Methods Primary carers of children aged from 0 to 12 years that utilised CAM for ARTI were invited to participate in the online survey in 2019. Survey data were analysed descriptively. Results The 246 surveyed parents specified the types of CAM frequently used to manage ARTI in their children were home-remedies. Reasons parents reported using CAM were personal-beliefs and positive past-experience with CAM practitioners. Information sources that parents consulted when decision-making were education, naturopaths, and journals. Conclusion Parents utilised diverse interventions, with home-remedies dominating the choice. Parents were most likely well-informed. Notably, parents indicated a preference for an integrative healthcare approach.
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... There is also range of topics beyond clinical efficacy that relate to the practice and provision of osteopathic care in the community requiring researcher attention, including: a better understanding of the use and users of osteopathy; an exploration of the practice and practices of osteopaths; the positioning of osteopaths alongside other health professionals within different health systems; and the place of osteopathic care within diverse health policy environments 7 . Further infrastructure is needed to build upon the resources and capacity currently available in both Australia and New Zealand to effectively support the breadth and scale of research required to address these and other research topics 22,23 . ...
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Both the Osteopathic Research Innovation Network (ORION) and the Osteopathy Research Connect-New Zealand (ORC-NZ) are practice-based research networks (PBRNs) recently established in Australia and New Zealand. This paper highlights the profile of the osteopaths participating in each PBRN in order to encourage and facilitate further related research in osteopathy. All registered osteopaths in Australia and New Zealand were invited to participate in the ORION and ORC-NZ PBRNs, respectively. This paper presents practice and sociodemographic characteristics of the osteopaths that elected to join the PBRN in their country. A total of 253 registered osteopaths in New Zealand (48.7%) agreed to join ORC-NZ while 992 registered osteopaths in Australia (44.5%) joined ORION. Membership of both PBRNs reflect national geographical spread, and diverse personal and practice characteristics. Combined membership of both PBRNs represents 45.3% of all registered osteopaths in Australasia and 7.7% of the global osteopathic profession. The PBRNs, independently and in combination, hold much potential to advance the evidence-base and capacity of osteopathy research. Both ORION and ORC-NZ PBRNs are powerful, innovative resources available to other interested parties to help conduct further osteopathy research in Australia and New Zealand.
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Background and purpose: Naturopathic practitioners (NPs) in the United States (US) and Australia are consulted for the prevention and management of a range of health conditions, including cardiovascular disease (CVD). Despite this, little is known about how NPs approach the management of CVD risk factors. The aim of this study was to explore NPs approach to the care of people with CVD risk factors. Materials and methods In 2018, Australian and US NPs were recruited via professional representative organisations. A survey was developed containing four domains; naturopathic approaches to the clinical management of CVD risk factors, communication and sharing of information; professional-client relationship factors; and demographic information. The data analysis was conducted using the appropriate statistical tests. Results A total of 151 NPs completed the survey (Australia n = 75, US n = 76). NPs reported employing dietary, and multiple behavioural and natural product interventions to treat CVD risk factors. The most frequently recommended products by US and Australian NPs were fish oils (87%), magnesium (83%) and coenzyme Q10 (87%). Differences in what US and Australian NPs recommended were identified. NPs reported limited communication with medical doctors about their clients. NPs placed high importance on the relationship quality with their clients. Conclusion US and Australian NPs represent an aspect of primary care and disease prevention that warrants further research that evaluates the potential risks and benefits of NP care, and challenges and opportunities associated with NPs integration into the healthcare systems, for populations with CVD risk factors.
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Objective: To summarize the current state of the research evidence for whole-system, multi-modality naturopathic medicine. Design: A systematic search for research articles from around the world was undertaken using MEDLINE, Embase, CINAHL, AMED, and WHO regional indexes. Naturopathic journals and gray literature were hand searched. No language restrictions were imposed. Interventions: All human research evaluating the effectiveness of naturopathic medicine, where two or more naturopathic modalities are delivered by naturopathic clinicians, were included in the review. Case studies of five or more cases were included. Results: Thirty-three published studies (n = 9859) met inclusion criteria (11 American; 4 Canadian; 6 German; 7 Indian; 3 Australian; 1 United Kingdom; and 1 Japanese) across a range of mainly chronic clinical conditions. The studies predominantly showed evidence for the efficacy of naturopathic medicine for the conditions and settings in which they were based. Conclusions: To date, research in whole-system, multi-modality naturopathic medicine shows that it is effective for treating cardiovascular disease, musculoskeletal pain, type 2 diabetes, polycystic ovary syndrome, depression, anxiety, and a range of complex chronic conditions.
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Abstract In order to describe the prevalence and characteristics of complementary medicine (CM) practice and product use by Australians, we conducted a cross-sectional online survey with Australian adults aged 18 and over. Rates of consultation with CM practitioners, and use of CM products and practices were assessed. The sample (n = 2,019) was broadly representative of the Australian population. Prevalence of any CM use was 63.1%, with 36% consulting a CM practitioner and 52.8% using any CM product or practice. Bodywork therapists were the most commonly consulted CM practitioners (massage therapists 20.7%, chiropractors 12.6%, yoga teachers 8.9%) and homeopaths were the least commonly consulted (3.4%). Almost half of respondents (47.8%) used vitamin/mineral supplements, while relaxation techniques/meditation were the most common practice (15.8%). CM users were more likely to be female, have a chronic disease diagnosis, no private health insurance, a higher education level, and not be looking for work. Prevalence of CM use in Australia has remained consistently high, demonstrating that CM is an established part of contemporary health management practices within the general population. It is critical that health policy makers and health care providers acknowledge CM in their attempts to ensure optimal public health and patient outcomes.
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Objectives: This study aims to describe the Australian complementary medicine (CM) workforce, including practice and professional characteristics. Design: National cross-sectional survey. Settings/location: Australia. Subjects: Any individual who self-identified as a practitioner qualified in any one of 14 CM professions and working in any state or territory of Australia was eligible to participate in the survey. Interventions: A 19-item online survey was developed following a review of existing CM workforce data and in alignment with other CM workforce survey projects in progress at the time. The survey items were presented under three main constructs: demographic characteristics, professional characteristics, and practice characteristics. Statistical analysis: Descriptive statistical analysis, including frequencies and percentages, of multiple choice survey items was used. Open response items were analyzed to determine the mean, standard deviation (SD), minimum, and maximum. The demographic data were evaluated for representativeness based on previously reported CM workforce figures. Results: The survey was completed by 1306 CM practitioners and was found to be nationally representative compared with the most recent registrant data from the Chinese Medicine Board of Australia. Participants primarily practiced in the most populous Australian states and worked in at least one urban clinical location. Most participants held an Advanced Diploma qualification or lower, obtained their qualification ten more years ago, and practiced in a clinical environment alongside at least one other practitioner from another health profession. Participants reported diverse clinical practice specialties and occupational roles. Per week, participants worked an average of 3.7 days and treated 23.6 clients. Conclusions: The results from this survey of practitioners from most complementary professions in Australia provide new insights into the national complementary medicine workforce. Further exploration of the CM workforce is warranted to inform all who provide patient care and develop health policy for better patient and public health outcomes.
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Polycystic ovary syndrome (PCOS) is a common, complex reproductive endocrinopathy characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries. Lifestyle modification is a first-line intervention; however, there are barriers to success for this form of self-care, and women often seek adjunct therapies including herbal medicines. This pragmatic, randomized controlled trial, delivered in communities of Australia in overweight women with PCOS, compared the effectiveness and safety of a lifestyle intervention plus herbal medicine against lifestyle alone. All participants were helped to construct a personalized lifestyle plan. The herbal intervention consisted of two tablets. Tablet 1 contained Cinnamomum verum, Glycyrrhiza glabra, Hypericum perforatum and Paeonia lactiflora. Tablet 2 contained Tribulus terrestris. The primary outcome was oligomenorrhoea/amenorrhoea. Secondary outcomes were hormones; anthropometry; quality of life; depression, anxiety and stress; pregnancy; birth outcomes; and safety. One hundred and twenty-two women gave their consent. At 3 months, women in the combination group recorded a reduction in oligomenorrhoea of 32.9% (95% confidence interval 23.3-42.6, p < 0.01) compared with controls, estimated as a large effect (ηp(2) = 0.11). Other significant improvements were found for body mass index (p < 0.01); insulin (p = 0.02) and luteinizing hormone (p = 0.04); blood pressure (p = 0.01); quality of life (p < 0.01); depression, anxiety and stress (p < 0.01); and pregnancy rates (p = 0.01). This trial provides evidence of improved effectiveness and safety for lifestyle intervention when combined with herbal medicines in women with PCOS. © 2017 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd.
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Background The Practitioner Research and Collaboration Initiative (PRACI) is an innovative, multi-modality practice-based research network (PBRN) that represents fourteen complementary medicine (CM) professions across Australia. It is the largest known PBRN for complementary healthcare in the world and was launched in 2015. The purpose of this paper is to provide an update on the progress of the PRACI project, including a description of the characteristics of PRACI members in order to facilitate further sub-studies through the PRACI PBRN. MethodsA CM workforce survey was distributed electronically to CM practitioners across fourteen disciplines, throughout Australia. Practitioners electing to become a member of PRACI were registered on the PBRN database. The database was interrogated and the data analysed to described sociodemographic characteristics, practice characteristics, professional qualification and practice interest of PRACI members. ResultsFoundational members of PRACI were found to be predominately female (76.2%) and middle-aged (82.5%). Members were primarily located in urban settings (82.5%) across the Eastern seaboard of Australia (82.5%), with few working remotely. The main modalities represented include massage therapists (58.5%), naturopaths (26.4%) and nutritionists (14.4%). The primary area of clinical interest for PRACI members were general health and well-being (75.4%), musculoskeletal complaints (72%) and pain management (62.6%). ConclusionsPRACI provides an important infrastructure for complementary healthcare research in Australia and its success relies on CM practitioners being involved in the research being conducted through the PBRN. The aim of this database is to ensure that the research conducted through PRACI is rigorous, robust, clinically relevant and reflects the diversity of clinical practice amongst CM practitioners in Australia.
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Background Naturopathy forms an increasingly significant part of the Australian healthcare setting, with high utilisation of naturopaths by the Australian public and a large therapeutic footprint in rural and regional Australia. However, despite these circumstances, there has been little exploration of the interface between naturopathy providers and conventional primary health care practitioners in rural and regional Australia. The study reported here examined the referral practices and factors that underlie referral to naturopaths amongst a sample of rural and regional Australian general practitioners (GPs). Methods A 27-item questionnaire was sent to all 1,486 GPs currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. Results A total of 585 GPs responded to the questionnaire, with 49 questionnaires returned as "no longer at this address" (response rate: 40.7%). One-quarter of GPs (25.8%) referred to a naturopath at least a few times per year while nearly half (48.8%) stated that they would not refer to a naturopath under any circumstances. GPs were more likely to refer to a naturopath if the GP: was not initially from a rural area (OR=1.78; 95% CI: 0.95, 3.33); believes in the efficacy of naturopathy (OR=5.62; 95% CI: 2.42, 11.36); has seen positive results from naturopathy previously (OR=2.61; 95% CI: 1.35, 5.05); perceives a lack of other treatment options for their patient (OR=5.25; 95% CI: 2.42; 11.36); uses peer-reviewed literature as their major source of CAM information (OR=3.03; 95% CI: 1.65, 5.55); uses CAM practitioners as a major source of CAM information (OR=6.09; 95% CI: 2.91, 12.72); and does not have an existing relationship with any CAM provider (OR=3.03; 95% CI: 1.53, 6.25). Conclusions There is little interaction (both via referrals as well as the development of professional relationships) between the naturopathic and GP communities in rural and regional Australia, with significant levels of both support and opposition for naturopathic referral amongst GPs. The significant presence and high utilisation of naturopathy in rural primary health care, which appears to work in parallel to conventional medical care rather than in conjunction with it, should serve as an impetus for increased research into naturopathy practice, policy and regulation in rural and regional health.
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Objectives: To explore the perceptions, experiences, and attitudes toward scientific and traditional knowledge within contemporary naturopathic education. Design: A qualitative focus group and semistructured individual interview study. Settings/location: Naturopathic educational organizations and institutions in North America (United States/Canada) and Australia. Subjects: Seven focus groups (three in Australia and four in the United States/Canada) involving a total of 29 students, and one-on-one interviews with 28 faculty and professional leaders of the naturopathic profession from Australia, Canada, and the United States. Results: Four themes have been identified in this study, including finding the balance between traditional and scientific knowledge; supporting the balance through critical appraisal in the curriculum; the exception of traditional knowledge in the critical gaze; and focusing on critical thinking in the naturopathic curriculum. Both naturopathic students and leaders highlight the significance of balancing tradition and science in the naturopathic educational context, although they hold diverse differing viewpoints. The importance of critical appraisal skills as well as the differentiation between critical thinking and critical appraisal have also been emphasized by participants with regard to the future development of naturopathic curriculum. Conclusions: This is the first study focusing on the interface between traditional and scientific knowledge within the naturopathic education setting. The development of a framework for the critical appraisal of traditional naturopathic knowledge is required to help navigate the variety of knowledge sources available to naturopathic students and to help deliver the best outcomes for their future clinical practice.
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Objectives: To report the prevalence of naturopathic and Western herbal medicine service utilization in Australia, and describe the characteristics of individuals who use these services. Design: This is a national cross-sectional study. Settings: Online survey platform. Subjects: Purposive convenience sampling was used to recruit 2025 adults who were matched to Australian population demographics by gender, age, and state of residence. Interventions: A survey instrument consisting of 50 items covering demographics, health service utilization, health status, health literacy, and medicine disclosure to complementary healthcare providers. Outcome measures: The prevalence, frequency, and cost of naturopathy and Western herbal medicine consultations and sociodemographic characteristics of users of naturopathic and Western herbalist services and associations between these factors. Results: The final data set included 2019 participants: 6.2% (n = 126) consulted a naturopath and 3.8% (n = 76) a Western herbalist. These health services were most commonly used to improve well-being. An average of AUD$102.67 and AUD$49.64 was spent per user on consultations with naturopaths and Western herbalists, respectively, in the previous year. The most prevalent users were those between 18 and 29 years of age (39.3%), in a relationship (51%), employed (70%), and held a bachelor degree or higher (40.5%). Some degree of financial difficulty was reported by 65.4% of users. Having a chronic illness (p < 0.01) and using both conventional and complementary medicines (p = 0.05) were both associated with using naturopathic or Western herbal medicine services. Less than 40% of participants disclosed their use of conventional medicines to Western herbalists. Conclusions: Naturopathy and Western herbal medicine services are used by a substantial number of Australian adults who also use conventional health services. Accordingly, research is needed to determine how these health professions can be better integrated into mainstream healthcare settings to improve patient-practitioner communication and safety related to the use of these health services.
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Naturopathy is a system of healthcare through which practitioners apply core philosophies, theories and principles to integrate medical knowledge with natural treatment options. In recent years the naturopathic community has developed a stronger international coherence. Alongside this growing connectivity in the global naturopathic profession, there have been a number of calls for more systematic research attention to be devoted to naturopathy as a substantive research topic, as well as a need for the naturopathic profession to hone a culture of research and evidence-based practices and skillsets. Progress in this area has been made through the development of more pragmatic and whole systems naturopathic research. One aspect which is currently missing in the global naturopathic research landscape despite this growing pattern of practice-based, whole systems research is the application of international multicentre research projects. In response, we have established a research consortium for naturopathic academic clinics in four countries and across multiple world regions. This paper serves to overview the mission, scope and membership of the research consortium and explore some of the research designs and questions which it may support
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An increasingly large part of health care delivery in Australia is provided by unregistered health practitioners, who have not been historically subject to formal regulatory arrangements and instead have been held to account via a milieu of non-specific regulatory and legislative obligations. This article explores current trends in the regulation of unregistered practitioners in civil law, criminal law and in the development of new regulatory tools such as "negative licensing". In addition, this article conducts an empirical analysis of the favoured model for extending accountability to unregistered health practitioners (negative licensing) by examining its application in New South Wales. Based on this analysis, it is argued that although negative licensing offers greater protections than previous models, it should not be viewed as a replacement for extension of statutory registration to new health disciplines, and instead should be viewed as a complementary measure to existing and new statutory registration arrangements.