Jon Adams

Prevalence and determinants of complementary and alternative medicine use during pregnancy: Results from a nationally representative sample of Australian pregnant women

Pregnant women have been identified as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women.

Primary care as intersecting social worlds

An enhanced role for primary health care (PHC) is currently a matter of political priority in the UK. This higher profile is drawing attention to a range of unresolved challenges and issues, relating to both the structure and content of provision, which currently permeate the system. Running in parallel with this is a recognition that: to date, PHC has been under-researched; that, as a result, our understanding of it is frequently poor; and that, as a consequence, fresh perspectives are needed in order to effectively research this uncertain, evolving and increasingly important healthcare sector. In this paper we argue that social worlds theory (SWT) provides, albeit in a suitably modified form, an ideal conceptual framework for the analysis of contemporary primary care. SWT is an approach which assumes complexity and constant evolution, and its core concepts are directed towards unravelling the consequences of encounters between different interest groups--something which is of particular utility at this time given the increasing attention to user participation, and an ongoing questioning of established patterns of professional authority. It is an approach which has rarely been employed empirically, even beyond medicine. In order to illustrate the wide relevance of the approach, we discuss how it can facilitate research at all levels of PHC: i.e., in relation to aspects of medical practice (the case of medically unexplained symptoms); shifts in service organisation (changing professional roles and the introduction of policy reforms); and issues which straddle both organisation and content (the increasing use of complementary medicine in primary care). In each case the approach is able to embrace the complexity of situations characterised by the intersection of professional and lay social worlds and is able to provide the conceptual tools through which resultant processes can be tracked and investigated.

Utilisation of complementary and alternative medicine (CAM) practitioners within maternity care provision: results from a nationally representative cohort study of 1,835 pregnant women

BackgroundThere is little known about women’s concurrent use of conventional and complementary health care during pregnancy, particularly consultation patterns with complementary and alternative medicine (CAM). This study examines health service utilisation among pregnant women including consultations with obstetricians, midwives, general practitioners (GPs) and CAM practitioners.MethodsA sub-study of pregnant women (n=2445) was undertaken from the nationally-representative Australian Longitudinal Study on Women’s Health (ALSWH). Women’s consultations with conventional practitioners (obstetricians, GPs and midwives) and CAM practitioners for pregnancy-related health conditions were analysed. The analysis included Pearson chi-square tests to compare categorical variables.ResultsThe survey was completed by 1835 women (response rate = 79.2%). A substantial number (49.4%) of respondents consulted with a CAM practitioner for pregnancy-related health conditions. Many participants consulted only with a CAM practitioner for assistance with certain conditions such as neck pain (74.6%) and sciatica (40.4%). Meanwhile, women consulted both CAM practitioners and conventional maternity health professionals (obstetricians, midwives and GPs) for back pain (61.8%) and gestational diabetes (22.2%). Women visiting a general practitioner (GP) 3–4 times for pregnancy care were more likely to consult with acupuncturists compared with those consulting a GP less often (p=<0.001, x2=20.5). Women who had more frequent visits to a midwife were more likely to have consulted with an acupuncturist (p=<0.001, x2=18.9) or a doula (p=<0.001, x2=23.2) than those visiting midwives less frequently for their pregnancy care.ConclusionsThe results emphasise the necessity for a considered and collaborative approach to interactions between pregnant women, conventional maternity health providers and CAM practitioners to accommodate appropriate information transferral and co-ordinated maternity care. The absence of sufficient clinical evidence regarding many commonly used CAM practices during pregnancy also requires urgent attention.

Contextualizing integration: a critical social science approach to integrative health care.

This article argues for the importance of examining the phenomenon of integrative health care in broader social and historical contexts. The authors examine mainstream approaches to identify patterns of integrative medicine and criticize them for their neglect of clashes among different philosophical paradigms and the wider social contexts that govern health care in practice. The authors outline a framework and highlight the values of a critical social science perspective in deepening our understanding of recent transformations in health care practice and issues surrounding biomedicine and complementary/alternative medicine (including chiropractic, naturopathy, massage, acupuncture/oriental medicine, etc) and traditional medicine. A critical social science perspective pays special attention to complex power relations, inclusionary/exclusionary strategies, and interprofessional dynamics in medicine. Drawing upon recent research findings, the authors illustrate how such a perspective reveals the intricacies and tensions that surround the integration of different paradigms of health care practice. The authors summarize the importance of situating integrative health care in structural contexts and affirm their commitment to a critical social science approach.

Qualitative methods in radiography research: a proposed framework

ntroduction: While radiography is currently developing a research base, which is important in terms of professional development and informing practice and policy issues in the field, the amount of research published by radiographers remains limited. However, a range of qualitative methods offer further opportunities for radiography research. Purpose: This paper briefly introduces a number of key qualitative methods (qualitative interviews, focus groups, observational methods, diary methods and document/text analysis) and sketches one possible framework for future qualitative work in radiography research. The framework focuses upon three areas for study: intra-professional issues; inter-professional issues; and clinical practice, patient and health delivery issues. While the paper outlines broad areas for future focus rather than providing a detailed protocol for how individual pieces of research should be conducted, a few research questions have been chosen and examples of possible qualitative methods required to answer such questions are outlined for each area. Conclusion: Given the challenges and opportunities currently facing the development of a research base within radiography, the outline of key qualitative methods and broad areas suitable for their application is offered as a useful tool for those within the profession looking to embark upon or enhance their research career.

The use of complementary and alternative therapies by patients with cancer

The aim of this research was to assess the prevalence and predictors of complementary and alternative therapy (CAT) use among cancer patients in Australia. A total of 1492 cancer patients attending nine major public cancer treatment centers in New South Wales, Australia, were asked to complete the Supportive Care Needs Survey. Of the 1354 consenting patients, 888 (65%) returned a completed survey. This article reports the secondary analyses of the survey data, specifically focusing on CAT use. For all cancers, 17.1% of patients were using at least one CAT. The two main demographic characteristics of CAT users were gender and age, where females were more likely to use CAT than males and that CAT use declined as age increased. Time since diagnosis was identified as the only significant clinical predictor of CAT use, where CAT use increased with time until 5 years since diagnosis. Our research shows that herbal treatments and naturopathy are the most popular CAT used by cancer patients (constituting over 30% of all CAT use recorded). The use of CAT among cancer patients is a significant issue in cancer care, especially considering the potential interactions between CAT and conventional medicines. Given that many cancer patients may not be aware of potential risks associated with these interactions it is important that oncologists and others involved in cancer patient care are informed about CAT and its use amongst their patients.

A comparison of complementary and alternative medicine users and use across geographical areas: A national survey of 1,427 women

BackgroundEvidence indicates that people who reside in non-urban areas have a higher use of complementary and alternative medicine (CAM) than people who reside in urban areas. However, there is sparse research on the reasons for such differences. This paper investigates the reasons for geographical differences in CAM use by comparing CAM users from four geographical areas (major cities, inner regional, outer region, rural/remote) across a range of health status, healthcare satisfaction, neighbourhood and community factors.MethodsA cross-sectional survey of 1,427 participants from the Australian Longitudinal Study on Womens Health (ALSWH) conducted in 2009.ResultsThe average total cost of consultations with CAM practitioners was

Exploring the relationship between women's health and the use of complementary and alternative medicine

416 per annum and was highest for women in the major cities, declining with increasing distance from capital cities/remoteness (p < 0.001). The average total cost of self-prescribed CAM was

The Use of Complementary and Alternative Medicine During Pregnancy: A Longitudinal Study of Australian Women

349 per annum, but this did not significantly differ across geographical areas. The increased use of CAM in rural and remote areas appears to be influenced by poorer access to conventional medical care (p < 0.05) and a greater sense of community (p < 0.05) amongst these rural and remote residents. In contrast to the findings of previous research this study found that health status was not associated with the differences in CAM use between urban and non-urban areas.ConclusionIt appears that a number of factors influence the different levels of CAM use across the urban/non-urban divide. Further research is needed to help tease out and understand these factors. Such research will help support health care policy and practice with regards to this topic.

A Longitudinal Analysis of Mid-Age Women's Use of Complementary and Alternative Medicine (CAM) in Australia, 1996–1998

In this paper we identify the need for further research exploring the relationship between complementary and alternative medicine (CAM) use and womens health. We offer our personal thoughts on the direction such future research might take outlining a number of research domains (type of CAM consumption, longitudinal analysis of womens use of CAM, cross-cultural analysis of womens CAM consumption, reasons for womens CAM consumption). We hope that this brief paper helps inspire greater research attention upon what we believe to be a well deserving sub-field of study within the social science of CAM.