The naturopathic profession in Australia: A secondary analysis of the Practitioner Research and Collaboration Initiative (PRACI)

Mental Health Literacy and Education of Complementary Medicine Practitioners: A Cross-Sectional Study

An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners' mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health-including suicide risk-were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner's surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.

What preconception health services would the public find when searching the internet in Australia?: results from a simulated internet-search study

BACKGROUND

Australian preventive health strategy outlines the importance of preconception health in improving health in the community, across multiple generations and places primary and community healthcare services as a central pillar to effective preconception care. However, there is no national implementation plan to see preconception care proactively offered in healthcare settings in Australia. Instead, there is evidence that most women search the internet for information about pregnancy planning and preparation. In response, this study explores the availability and characteristics of health services found by searching for preconception care online in Australia.

METHOD

Simulated Google searches were conducted using search terms 'preconception' and the name of a city/town with a population > 50,000. Related terms, 'fertility' and 'pregnancy' were also searched. Characteristics of the health services and the information available on relevant websites were extracted and reported descriptively.

RESULTS

The searches identified 831 website links, including 430 websites for health services. The health services were most often located in cities/towns with populations equal to or less than 200 000 (54.2%), and housing multiple health professionals (69.8%) including a specialist doctor (66.5%), nurse (20.9%), psychologist/counsellor (2.0%) and/or naturopath (13.0%). All the health services identified online explicitly mentioned women among their target populations, while 69.1% (n = 297) also referred to providing services for men or partners. More than one third of websites included blogs (36.9%) while external links were included in 10.8% of the online sites.

CONCLUSIONS

This study provides a preliminary examination of health services that may be found through internet-based searching by Australian consumers seeking health advice or support prior to becoming pregnant. Our descriptive results suggest couples may find a variety of health professionals when seeking health services for preconception care. Future research involving co-design of search terms with consumers, ongoing monitoring of health services and ensuring access to meaningful, and accurate information found through internet-searching are all necessary to ensure people of reproductive age are able to access the preconception health information and care they need.

Evaluation of home-based naturopathic telehealth clinic: an innovative COVID-19 pandemic response

OBJECTIVES

The COVID-19 pandemic in Australia disrupted usual clinical training placements for naturopathic students. An innovative, remote Telehealth clinic was developed and implemented. This pilot study evaluates student and educator learning and teaching experiences in Telehealth. A survey assessed Likert and qualitative written responses to student and staff interaction with the Telehealth clinic.

RESULTS

Nine student and 12 educator responses were included in the analysis. All students positively rated Telehealth training resources and the educator support provided. Students rated the Telehealth learning experience as 'very good' (78%) or 'good' (22%) with educator ratings of 'very good' (67%) or 'good' (33%). Thematic analysis of student written responses showed increased client diversity, collaboration, peer learning, increased feedback, and improved digital and technology skills. Virtual physical examination and infrastructure limitations were reported as Telehealth clinical practicum challenges. Naturopathic Telehealth clinic practicum is a valuable alternative to in-person clinical practicums for Australian students. It enhances student collaboration and peer learning. Challenges of technology, infrastructure and incorporating Telehealth in curriculum may be barriers to implementation of Telehealth. However, Telehealth is an important clinical training option to prepare student practitioners for contemporary professional practice if in-person consultation is prohibitive, such as during the COVID-19 pandemic.

Effectiveness of aromatherapy for prevention or treatment of disease, medical or preclinical conditions, and injury: protocol for a systematic review and meta-analysis

BACKGROUND

Aromatherapy - the therapeutic use of essential oils from plants (flowers, herbs or trees) to treat ill health and promote physical, emotional and spiritual well-being - is one of the most widely used natural therapies reported by consumers in Western countries. The Australian Government Department of Health (via the National Health and Medical Research Council) has commissioned a suite of independent evidence evaluations to inform the 2019-20 Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies. This protocol is for one of the evaluations: a systematic review that aims to examine the effectiveness of aromatherapy in preventing and/or treating injury, disease, medical conditions or preclinical conditions.

METHODS

Eligibility criteria: randomised trials comparing (1) aromatherapy (delivered by any mode) to no aromatherapy (inactive controls), (2) aromatherapy (delivered by massage) to massage alone or (3) aromatherapy to 'gold standard' treatments.

POPULATIONS

any condition, pre-condition, injury or risk factor (excluding healthy participants without clearly identified risk factors).

OUTCOMES

any for which aromatherapy is indicated. Searches: Cochrane Central Register of Controlled Trials (CENTRAL), with a supplementary search of PubMed (covering a 6-month lag period for processing records in CENTRAL and records not indexed in MEDLINE), AMED and Emcare. No date, language or geographic limitations will be applied.

DATA AND ANALYSIS

screening by two authors, independently (records indexed by Aromatherapy or Oils volatile or aromatherapy in title; all full text) or one author (remaining records) with second author until 80% agreement. Data extraction and risk of bias assessment (ROB 2.0) will be piloted by three authors, then completed by a single author and checked by a second. Comparisons will be based on broad outcome categories (e.g. pain, emotional functioning, sleep disruption) stratified by population subgroups (e.g. chronic pain conditions, cancer, dementia) as defined in the analytic framework for the review. Meta-analysis or other synthesis methods will be used to combine results across studies. GRADE methods will be used to assess certainty of evidence and summarise findings.

DISCUSSION

Results of the systematic review will provide a comprehensive and up-to-date synthesis of evidence about the effectiveness of aromatherapy.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021268244.

Transitioning to practice: a qualitative investigation of Australian graduate naturopath's experiences of being in practice

BACKGROUND

The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation.

METHODS

Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach.

RESULTS

A total of 19 new graduates (94.7% female; 57.9% aged 40-59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively.

CONCLUSIONS

Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.

Exploring the educational needs of Australian naturopaths (eNAT): A cross-sectional study

INTRODUCTION

To ensure clinical competency, and to facilitate the delivery of safe and effective care, it is important that continuing professional development (CPD) offerings for health professionals are relevant, appropriate and accessible. In the field of naturopathic medicine, there has been no research seeking to understand the educational needs and preferences of this workforce. This cross-sectional study aims to address this knowledge gap.

METHODS

Australian adults holding a formal qualification in naturopathy were invited to complete a novel 29-item online questionnaire, comprising items on knowledge/skill gaps, knowledge/skill development, education delivery preferences and education barriers.

RESULTS

One-hundred-ten naturopaths completed the survey. The most frequently reported knowledge and skills gaps of undergraduate naturopathic training were pathology test interpretation and business development/administration, respectively. Across the four broad areas of professional/clinical skills, clinical specialities, populations and clinical settings, respondents rated, respectively, effective patient education, mental health, care of adult populations, and working in integrative health care settings as high value or important areas for further education. Respondents indicated a preference for CPD to be delivered via seminars/workshops, webinars, journals and conferences, with a penchant for blended or online delivery. Correspondingly, most respondents reported cost and distance as major/moderate barriers to further education.

DISCUSSION

This study has identified several important knowledge/skills deficits in Australian undergraduate naturopathic medicine education. An important next step of this work is the translation of findings into future naturopathic medicine curricula and CPD offerings.

A cross-sectional workforce survey of three traditional and complementary medicine professions in Ontario, Canada

BACKGROUND

Workforce studies about traditional and complementary medicine (T&CM) occupations in industrialized countries are scant; and, these occupations' position within the broader occupational workforce remains unclear. This study aims to address these gaps using a comparative approach.

METHODS

Naturopaths, traditional Chinese medicine (TCM) / acupuncture practitioners, and homeopaths in Ontario, Canada were surveyed regarding their demographics, practice characteristics and self-reported income. Results were compared with parallel data from within and outside of Ontario.

RESULTS

Study response rate: 23.3% (n = 1205). While predominantly female (57.9%), Ontario's TCM/acupuncture profession was less feminized than the naturopathic (77.1%) and homeopathic (78.3%) groups. Naturopaths were significantly younger than, and reported fewer years of clinical experience than, the other two groups. About half of TCM/acupuncture practitioners, and almost one-third of homeopaths had trained outside of Canada, predominantly in East and South Asia, respectively. More TCM/acupuncture practitioners (58.9%) and homeopaths (57.6%) had multilingual clinical practices than naturopaths (19.1%). Homeopaths worked fewer hours and saw fewer patients per week than the other occupations. Self-reported mean incomes varied across groups, with naturopaths earning more on average ($63,834, SD $57,101) than did TCM/acupuncture practitioners ($45,624, SD $44,081) or homeopaths ($29,230, SD $41,645). Holding other variables constant, internationally-trained practitioners reported earning one-third less than their Canadian-trained counterparts.

DISCUSSION & CONCLUSIONS

Study findings echo occupationally-specific data from other industrialized jurisdictions; and, affirm that different T&CM occupations have distinctive demographic and practice characteristics. The demographic makeup of Ontario's TCM/acupuncture and homeopathy occupations suggests a role for these groups in delivering culturally-responsive care within Asian ethnic communities. T&CM practitioner incomes, in particular for internationally-trained practitioners, fell below the provincial population income median, and in many cases below the poverty line. T&CM occupations' relative socio-political marginality may be impacting clinicians' ability to earn a viable living.

Do women who consult with naturopaths or herbalists have a healthy lifestyle?: a secondary analysis of the Australian longitudinal study on women's health

Background

Australians report consulting with a naturopaths or herbalists to improve their wellbeing, yet little is known about the associations between these consultations and the patients’ health behaviours. This cross-sectional study aimed to examine the relationship between health behaviour and consultations with naturopaths or herbalists in three age cohorts of Australian women.

Methods

Women aged 19–25 years, 31–36 years, and 62–67 years from the Australian Longitudinal Study on Women’s Health (ALSWH) were surveyed regarding smoking, alcohol or drug use, physical activity and dietary behaviour; and whether they consulted with naturopath/herbalists in the last 12 months. Associations were analysed using multivariable logistic regression.

Results

A total of 9151 (19–25 years), 8200 (31–36 years) and 11,344 (62–67 years) women were included in the analysis. Between 7.3 and 11.9% of women reported to have consulted with naturopaths/herbalists in the last 12 months. Women of all cohorts consulting with naturopath/herbalist were less likely to smoke (19-25 yrs.: Odds Ratio [OR] 0.61; 31–36 years: OR 0.58; 62–67 years: OR 0.29), more likely to report at least moderate levels of physical activity (19-25 yrs.: OR 1.41; 31–36 years: OR 1.34; 62–67 years: OR 1.34), and the use of vegetarian diets(19-25 yrs.: OR 1.40; 31–36 years: OR 1.77; 62–67 years: OR 2.28), compared to women not consulting with naturopaths/herbalists. Women consulting with naturopaths/herbalists however were also more likely to have used marijuana (19-25 yrs.: OR 1.18; 31–36 years: OR 1.42), or illicit drugs in the last 12 months (19-25 yrs.: OR 1.24; 31–36 years: OR 1.40).

Conclusions

Consultations with a naturopath or herbalist are associated with positive health behaviours that are protective of internationally important non-communicable diseases. Psychoactive drug use is also reported among women visiting a naturopath or herbalist. Further research is needed to understand the role naturopaths play in advising patients with regards to health and non-healthy behaviours.