Physicians Become Acupuncture Patients—Not Acupuncturists

Healthcare Professionals' Attitudes to Integration of Acupuncture in Western Medicine: A Mixed-Method Systematic Review

BACKGROUND

Acupuncture is practiced in many Western countries with increasing evidence supporting its use across the healthcare system. However, this nonpharmacological intervention is yet to be widely integrated into hospitals. Fundamental to the integration of any innovation into healthcare systems is the attitudes of healthcare professionals.

AIMS

To explore healthcare professionals' attitudes towards acupuncture and identify the enablers and barriers to integration in the hospital setting.

DESIGN

This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines; we conducted a mixed-method systematic review following Joanna Briggs Institute Reviewer's Manual 2017.

DATA SOURCES

PubMed, CINAHL, AMED, EMBASE, Cochrane Library, and SCOPUS were searched from their inception to December 2019 using different combination of keywords.

METHODS

Attitude and perception data were extracted from the articles and constructs were categorized as barriers and enablers. A convergent integrated approach was adopted whereby qualitative data themes were integrated with quantitative data constructs to generate descriptive codes around enablers and barriers at intrapersonal, interpersonal, and environmental levels according to the framework proposed by Manias et al. (2014).

RESULTS

Twenty-six studies comprising 19 survey and seven interview studies were identified, with 24 articles (92%) reporting positive attitudes, supporting the integration of acupuncture into Western medicine. Enablers identified were prior positive experience, belief in the treatment's efficacy, and patient demand. Barriers were lack of evidentiary knowledge or experience; lack of resources such as time, providers, and funding; and paradigm differences. Twenty studies (77%) focused on medical doctors or medical student perceptions. A conceptual framework for implementing and integrating acupuncture into Western medicine is proposed.

CONCLUSION

Healthcare professionals' attitudes to acupuncture are positive. Barriers to integrating acupuncture into the hospital system exist at intrapersonal, interpersonal, and external levels, with lack of resources being the key barrier. Nurses' role in facilitating integration into Western medical pain management practice provides an avenue for future research. The proposed conceptual framework provides guidance for nursing researchers interested in the role of acupuncture and integrated medicine in patient-centric, value-based healthcare.

Perception of acupuncture among users and nonusers: A qualitative study

This study uses a qualitative methodology to examine the perception of acupuncture among users and nonusers. Altogether 37 participants, age 35 or older, were interviewed. Participants' perception of advantages and disadvantages of adopting acupuncture, and their criteria in selecting acupuncturists, were collected. Results found that among the user group, acupuncture was perceived as being effective, having little side effects, and generating lasting impact. Among nonusers, acupuncture was perceived as lacking a clinical base, high risk, and nonstandardized. Nonusers had less confidence in acupuncture than biomedicine. Participants relied on social communication and the practitioner's professional qualifications in choosing acupuncturists. Marketing implications are discussed.

Attitudes toward acupuncture in Hong Kong

Purpose

– This paper aims at describing and exploring how consumers perceive acupuncture as a medical treatment in relation to biomedicine.

Design/methodology/approach

– Data were collected through an online survey using quota sampling. The attitudes of 879 Hong Kong residents aged 20 or above were surveyed. Questions were generated from a previous focus group study.

Findings

– Factor analysis found that attitude toward acupuncture consisted of five underlying dimensions, including trust in biomedicine, risks versus benefits, cure and effectiveness, qualification and skills of acupuncturists, side effects and costs and severe aftereffects. Lack of trust in acupuncturists and perceived inferiority of acupuncture to biomedicine were the major barriers of public acceptance of acupuncture. Perceived strengths of acupuncture identified were not involving taking medicine, fewer side effects and being good for preventive care.

Research limitations/implications

– This study used a convenience sample recruited through personal networks, so the findings cannot automatically be generalized to the rest of the population.

Practical implications

– There is a need to build trust in the therapy and the reputation of acupuncturists through better communication of the profession’s qualification and accreditation system, as well as dissemination of clinical evidence on a long-term basis. Consumers need to be better educated about the sensations to be expected during acupuncture and the criteria for selecting an acupuncturist.

Originality/value

– This has been the first quantitative study focusing on Hong Kong consumers’ perceptions of acupuncture.