Health Behavior Change and Complementary Medicine Use: National Health Interview Survey 2012

Complementary and Integrative Health Use in Binge Eating Disorder: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts' Perspectives

Introduction

Binge Eating Disorder (BED) has high lifetime prevalence rates, low treatment success rates, and high rates of treatment dissatisfaction, early discontinuation of care, and recurrence. Complementary and integrative health (CIH) interventions (non-mainstream practices used with conventional approaches for whole-person treatment) hold potential to overcome many treatment barriers and improve BED treatment outcomes. Some CIH interventions have empirical support for use in eating disorders. However, little is known about the current state of CIH use in BED.

Methods

This mixed-methods cross-sectional study collected information from BED experts about CIH use in adult BED treatment. Fourteen expert BED researchers and clinicians were identified based on federal funding, PubMed-indexed publications, practice in the field, leadership in professional societies, and/or popular press distinction. Anonymously recorded semi-structured interviews were analyzed by ≥2 investigators using reflexive thematic analysis and quantification.

Results

Expert opinions and experiences on/with CIH use were generally positive/supportive (64%) with mixed views (36%) varying by intervention and empirical support. The interventions most commonly described were mindfulness (71%), yoga (64%), and supplements/vitamins/pre-/probiotics/herbs (64%). Supplements/vitamins/pre-/probiotics/herbs had mixed views; all other interventions were generally viewed positively. The benefits most commonly associated with specific interventions (e.g., mindfulness, yoga, supplements) were: regulating/tolerating emotions/mood/stress/anxiety (50%); healing the relationship with the body/body image/movement/exercise-trauma (29%); biological/physiological benefits (29%); and directly supporting treatment ("space for self-separate from treatment," behavior change, "tolerating treatment") (29%). Intrinsic self-healing (e.g., patient-driven healing that comes from the patient's innate desire to heal based on the patient's lived experience(s)) and investigative research were also associated with CIH use broadly. Most experts (57%) expressed familiarity with existing literature/research for ≥1 CIH intervention; 50% identified a need for empirical testing. Half (50%) spontaneously described using ≥1 CIH intervention in their own clinical practice/center. The most used interventions were yoga (43%), meditation/mindfulness (29%), and acupuncture (21%). Eight experts (57%) endorsed the importance of correct implementation; 43% acknowledged CIH use in conventional treatments (2nd-wave CBT, 3rd-wave behavior therapies).

Discussion & Conclusions

CIH interventions can complement current BED treatments to improve clinical outcomes, particularly managing anxiety/stress/mood, healing the relationship with the body, addressing biological/physiological deficiencies, and tolerating treatment (thus reducing treatment dropout). Empirical testing is warranted with a particular need for randomized controlled trials and guidelines on implementation and use.

Adherence to lifestyle recommendations among Norwegian cancer survivors and the impact of traditional and complementary medicine use: the Tromsø Study 2015-2016

INTRODUCTION

Adherence to healthy lifestyle recommendations has positive effects on cancer outcomes yet adherence is low among cancer survivors. Differences in adherence between women and men, phase of survivorship, and other factors that might increase adherence, like the use of traditional and complementary medicine (T&CM), need to be explored. We aimed to study the adherence to national recommendations for a healthy diet (daily intake of ≥ 5 portions of fruit/vegetables), physical activity (150 min of moderate-intensity or 75 min of high-intensity/week), normal body mass index (BMI) (18.5-24.9 kg/m2), non-smoking, and low-risk alcohol consumption (women ≤ 10 g/day, men ≤ 20 g/day) among Norwegian cancer survivors and their associations with sex, the use of T&CM, and survivorship phase.

METHODS

We used logistic regression, independent sample t-test, and chi-square test to study self-reported (diet, physical activity, smoking, alcohol consumption) and measured (BMI) adherence in 1530 cancer survivors (40 years and above, participating in the population-based Tromsø Study conducted in 2015-2016 (65% attendance). We dichotomized all assessed lifestyle recommendations (adherence = 1 point, non-adherence = 0 points), and created a score for every recommendation (0-5 points). Adherence to individual lifestyle recommendations and the use of T&CM as well as the phase of survivorship was adjusted for sex, age, income, and living with a partner.

RESULTS

Adherence to recommendations was 7.5% for diet, 85.3% for physical activity, 30.5% for BMI, 89.3% for non-smoking, and 87.6% for alcohol consumption. In total 2.3% adhered to all five recommendations concurrently (mean score 2.96 [SD = 0.86]). Women adhered to more recommendations concurrently compared to men (3.03 [SD = 0.90] vs. 2.89 [SD = 0.80] points respectively, [p = .012]). In total, 31% reported the use of T&CM and there were no differences in adherence to individual lifestyle recommendations or concurrent adherence in overall T&CM use compared to non-use. Users of self-help techniques were more likely to adhere to the recommendations of diet (aOR 2.69, 95% CI 1.45-4.98) and physical activity (aOR 6.26, 95% CI 1.51-25.92). Users of traditional healers and users of more than one T&CM modality were less likely to adhere to the low-risk alcohol consumption recommendation, (aOR 0.32, 95% CI 0.13-0.77, and aOR 0.53, 95% CI 1.08-2.17, respectively) compared to T&CM non-users. Survivors with cancer previously (1162) had higher odds of adhering to the recommendation of diet (aOR 2.66, 95% CI 1.36-5.19) than survivors with cancer presently (n = 368), but not to other recommendations.

CONCLUSION

The health of cancer survivors can be improved through adherence to lifestyle recommendations, yet our study found partial adherence among survivors in Norway, in accordance with findings from other countries. Although overall T&CM use was not associated with higher adherence to lifestyle recommendations, differences in adherence were seen among individual modalities like the use of self-help techniques and traditional healers. Our results suggest the need for intensified follow-up of lifestyle with attention to male survivors and diet among all survivors throughout the cancer survivorship continuum.

Lifestyle and health behaviour change support in traditional acupuncture: a mixed method survey study of reported practice (UK)

Aims

Complementary medicine therapists such as traditional acupuncturists are a large resource for supporting public health targets to improve health behaviours. Our objectives were to determine the prevalence and patterns of UK acupuncturists’ provision of lifestyle change support, test theory-based hypotheses about facilitators and barriers to supporting lifestyle changes and to explore associated characteristics and attitudes.

Methods

A mixed methods design in which British Acupuncture Council members (Sept 2019-April 2020) completed an online questionnaire assessing prevalence of lifestyle change support, typical patterns across patients and behaviours, Theory of Planned Behaviour constructs, practitioner characteristics and open-text responses regarding additional behaviours and clinical decisions to introduce lifestyle change.

Results

Three hundred fifty-two traditional acupuncturists participated (Mean age = 51.5 years, SD 9.9; 81.8% (n = 288) female). 57.7% (n = 203) reported offering support for lifestyle change during their most recent consultation. 91.7% (n = 323) reported supporting lifestyle change ‘always or most of the time’ for patients with chronic conditions and 67.9% (n = 239) reported this for patients with acute conditions. The pattern of typical support for different health behaviours ranged from 44.6% (n = 157) for smoking reduction (acute conditions) to 95.2% (n = 335) for diet support (chronic conditions). A linear regression model found that frequency of support for lifestyle change in acute patients was predicted by acupuncturists’ attitudes to both clinical role and importance of health behaviours, confidence in their ability to provide lifestyle change support and use of fewer behaviour change techniques. The decision to first offer lifestyle change support was guided by perceived patient receptiveness, whether presenting condition/diagnosis were likely to improve with lifestyle change and whether a strong therapeutic relationship was established.

Conclusions

Traditional acupuncturists’ reports suggest their work supports key public health targets for promoting healthy behaviours. Less frequent support for alcohol/smoking may reflect user characteristics but may suggest training needs for acupuncturists. Increase could be made for support in acute presentations, however the importance of patient receptiveness, linking advice to condition, and therapeutic alliance should be explored further. There may be important differences between acupuncture practice and mainstream healthcare (e.g. high level of contact, longer visits, holistic approach) which impact mechanisms of action of behaviour change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03719-6.

Interventions based on environmental determinants for nutritional and physical activity behaviours in Colombia: a scoping review

OBJECTIVE

To identify, systematically, the interventions based on environmental determinants to improve the nutritional and physical activity (PA) habits available in Colombia.

DESIGN

A scoping review was performed according to the guidelines of the Joanna Briggs Institute.

STUDY SELECTION

All studies about intervention programmes for PA and nutritional behaviours in Colombia were included.

METHODS

Searches in Medline/PubMed, Embase, Cochrane, Scielo and Lilacs, using MeSH, Decs and Emtree terms, were performed up to August 2020. Additionally, a manual search was made in specialised national journals. An internet documentary search of the official websites on policies and programmes by departmental, district and municipal secretariats was also performed.Two reviewers independently screened titles and abstracts. Then, the full texts were reviewed to select documents to be included.Data management relevant information from selected documents and articles was extracted. A descriptive analysis was considered.

RESULTS

Sixty-seven documents and 70 published articles were found. The programmes were identified in 13 initiatives, 7 in the area of PA and 6 with a nutrition focus. They were on physical and social environmental modifications such as the 'muévete' ('get moving') programmes in Bogota, Quindio and Cartagena; a modification of 'ciclovía'; or bicycle path programmes as well as nutrition programmes in schools, universities and companies.

CONCLUSION

This scoping review identified national programmes and policies in Colombia in the area of nutrition and PA from the environmental perspective in different scenarios: from schools to workplaces and communities. The need to implement such programmes from public and private institutions is also noted, promoting the practice of PA and healthy eating in every scenario in the national territory. New research to determine the impact of these programmes is essential to get a glimpse of the effects of these programmes and the implications for public health.

Naturopathic Doctors: An Underutilized Resource of Whole Health Delivery in Primary Care

Naturopathy, recognized by the National Institutes of Health and the World Health Organization as a distinct system of complementary and integrative health care, is an existing model of whole health delivery. Its unifying principles, respect for the interconnectedness of biological systems, and representation globally uniquely positions naturopathy to serve an integral role in addressing the needs of primary health care. In this viewpoint, we aim to 1) highlight key areas and existing literature supporting the use of naturopathy for health promotion and disease prevention of noncommunicable diseases; 2) describe how naturopathy can addresses the mental health needs of today's societies; and 3) discuss the importance of naturopathy in the access and navigation of complementary and integrative health therapies.

Can sustainable health behaviour contribute to ensure healthy lives and wellbeing for all at all ages (SDG 3)? A viewpoint

Sustainable health behaviours and, specifically, eating a sustainable diet and engaging in regular physical activity are healthpromoting behaviours that can simultaneously contribute to reduction of greenhouse gases which are known to contribute to climate change. Good health usually facilitates societal development, and development often promotes improved health. However, while good health may be a prerequisite for societal development, some behavioural determinants of health, such as attitudes towards the environment, and people’s lifestyles and consumption patterns, can impede the sustainability of the development process in the longer term. This perspective paper argues that there is a need to rethink 21^st century health promotion practices by pairing sustainability literacy with health promotion for changing dietary and physical activity behaviour patterns to improve population health and contribute to the achievement of Sustainable Development Goal 3 (to ensure healthy lives and promote wellbeing for all at all ages).

The impact of Tai Chi and mind-body breathing in COPD: Insights from a qualitative sub-study of a randomized controlled trial

PURPOSE

Chronic obstructive pulmonary disease (COPD) is associated with multiple psychosocial and behavioral factors. Prior research suggests that mind-body interventions may support the development and maintenance of healthy behaviors and improve health-related quality-of-life in such patients. We sought to qualitatively explore cognitive, psychosocial, and behavioral changes in patients with COPD who participated in two different mind-body interventions compared to an education control.

METHODS

We analyzed semi-structured qualitative exit interviews from a prospective, randomized pilot trial (N = 123) investigating 12-weeks of Tai Chi (TC) vs. mind-body breathing (MBB) vs. education (EDU) control in patients with moderate-severe COPD. TC involved traditional movements, that integrate meditative breathing, while MBB focused mainly on meditative breathing techniques alone. Interviews were audio-recorded and transcribed verbatim. Qualitative analysis of randomly selected transcripts was performed by two independent reviewers using an iterative process to identify emergent themes informed by grounded theory methods until thematic saturation was reached.

RESULTS

A total of 66 transcripts were reviewed (N = 22 TC, N = 22 MBB, N = 22 EDU). Participants were mean age = 68.1 years, GOLD Stage = 2.3, baseline FEV11 percent predicted mean (SD): 58% (13.4), 42.4% female. We identified six frequently mentioned themes: 1) overall awareness and understanding, 2) self-care knowledge, skills and behaviors, 3) behavior-related neurocognitive concepts, 4) physical function, 5) psychological well-being, and 6) social support/social function. Compared to EDU, more participants in TC and MBB noted improvements in awareness of self and the mind-body connection (e.g., body and breath awareness), knowledge of breathing techniques and integration of self-care skills with daily activities, self-efficacy for symptom management (particularly managing anxiety and dyspnea), acceptance of disease, physical function improvements (e.g., endurance, dyspnea, fatigue), and psychological well-being (particularly relaxation, emotion regulation and decreased reactivity). Compared to MBB, those in TC shared more intention to continue with self-care behaviors, physical activity self-efficacy, and improved flexibility. All three groups, including EDU, noted increased social support and knowledge of disease. Those in EDU, however, had fewer mentions of processes related to behavior change, and less concrete changes in neurocognitive, psychological, and physical function domains.

CONCLUSIONS

Mind-body interventions including meditative breathing may impact behavior-related neurocognitive and emotional factors that improve self-care management and support positive behavioral changes in patients with COPD.

TRIAL REGISTRATION

This trial is registered in Clinical Trials.gov, ID number NCT01551953.

Association of bowel and tear suppression with coronary artery disease: A case control study

Background

Coronary Artery disease (CAD) accounts for one-third or more of all deaths in individuals over 35 years of age. In Ayurveda, umbrella term Hrdroga encompasses the concept of CAD. Vegadharana, suppression of natural urges is a lifestyle error that has been denoted as a potential risk factor of Hrdroga, but there is a lacuna of convincing research works.

Objective

The present study is designed to assess and evaluate the association of Purisavegadharana, Baspavegadharana (bowel, tear suppression) with CAD.

Materials and methods

Study followed case-control design; Cases (110) were patients aged above 18 years of either sex, diagnosed with CAD in a duration less than or equal to 10 years, attending outpatient department (OPD) of an Allopathy and Ayurveda hospital. The controls (110) included hospital controls from same hospitals. Exposure status was assessed through Case Record Form (CRF), Bowel suppression and Tear suppression assessment Questionnaires, interview with patients and scrutiny of past medical records. Odds ratios and chi-square tests were computed. Receiver Operating Characteristic (ROC) curves of logistic regression models fitted were generated and optimal cut-off points for bowel and tear suppression scores were derived through Youden index.

Results

Tear suppression and bowel suppression showed odds ratio of 4.47 and 2.30 respectively. Other commendable predisposing factors were age above 60 years, family history of disease and use of medication. Highest odds ratio from logistic regression was for palpitation (8.67) and followed by tobacco use (6.23).

Conclusion

Study indicated high association of bowel and tear suppression with CAD along with other predisposing factors, prominent of which were palpitation and use of tobacco use.

Lifestyle and Health Behavior Change in Traditional Acupuncture Practice: A Systematic Critical Interpretive Synthesis

Introduction: Behavioral factors are the leading cause of ill-health worldwide. Diet, physical activity, smoking, and alcohol consumption are the focus of public health targets on promotion of healthy behavior. The science of behavior change is rapidly growing and has largely evolved within mainstream health care treatments. Traditional Chinese Medicine includes self-care practices that encourage healthy behavior alongside treatments such as acupuncture. Exploring behavior change within traditional acupuncture could potentially highlight new techniques and approaches, and contribute to developing models of behavior change. Aims: In this review, the authors aimed to critically appraise research exploring health behavior change within traditional acupuncture, to highlight gaps in the field, identify questions, and enable theory development. Design/Method: The authors were guided by a critical interpretive synthesis (CIS) method to explore a diverse mixture of research including qualitative and quantitative articles. Eight databases were searched up to October 2017 for articles published in English. Eleven thousand four hundred eighty-eight articles were identified (7,149 after deduplication). Titles and abstracts were screened by one reviewer (10% by a second reviewer). Eligible articles were selected using a Population, Intervention, Comparison, Outcome framework. CIS methods, including purposive sampling of eligible articles and a reflexive, dialectic process of critiquing evidence and theory, were used to synthesize the evidence. Results: Several articles examined the prevalence and patterns of behavior change and support for change, although methods varied and reliability of results was limited. There was more evidence concerning diet/exercise than alcohol/smoking. Aspects of acupuncturists' work identified as potential key elements for promoting behavior change included: individualized advice based on symptoms; holistic/biopsychosocial explanations; therapeutic relationship; simultaneous treatment of behavior-limiting symptoms; and patients' physical involvement with intervention. A logic model of the process of behavior change was developed, proposing that perceived support, mutual understanding, and active participation may facilitate change. Possible moderators included: single/multicomponent acupuncture; setting; patient/practitioner characteristics; treatment experience; timing; and treatment duration. Conclusion: These findings suggest behavior change work is a significant part of traditional acupuncture practice, although more reliable evidence is needed to understand the effectiveness, prevalence, and patterns of this work (in particular the patterns suggesting acupuncturists are more likely to work on changes to diet and physical activity than alcohol and smoking behaviors, and more likely to support changes in long-term compared with acute conditions). The proposed model of behavior change should be developed and tested with a view to refining the model and elaborating the suggested links with a wider theory of behavior and behavior change. This review was preregistered with PROSPERO as "Health behaviour change in traditional acupuncture treatment: a protocol for a critical interpretive synthesis": CRD42018099766.