The Perceptions and Experiences of Acupuncture users PDF
Preview The Perceptions and Experiences of Acupuncture users
The Perceptions and Experiences of Acupuncture users A New Zealand Perspective A thesis submitted in partial fulfillment of the requirements for the Degree Master of Health Sciences University of Canterbury Dan Jakes 2014 Table of Contents LIST OF TABLES AND FIGURES v ACKNOWLEDGEMENTS vi DEDICATION vii LIST OF ABBREVIATIONS viii NOTES TO THE READER ix ABSTRACT x 1. THE PROBLEM 1 1.1 Introduction 1 1.2 Research question 3 1.3 Purpose 3 1.4 My interest in the topic and pre-‐understandings 3 1.5 Chapter summary 4 2. REVIEW OF RELATED LITERATURE AND RESEARCH 5 2.1 Introduction 5 2.2 Situating acupuncture as a CAM 5 2.3 Acupuncture in New Zealand 7 2.4 Safety and efficacy of acupuncture 8 2.5 Qualitative systematic review of acupuncture patients’ experiences 19 2.6 Chapter summary 41 3 METHODS AND PROCEDURES 43 3.1 Introduction 43 i 3.2 Ethics 49 3.3 Sampling and recruitment 52 3.4 Participants 53 3.5 Data collection 54 3.6 Transcription 56 3.7 Data management 56 3.8 Rigour 56 3.9 Chapter summary 60 4 ANALYSIS AND INTERPRETATION OF THE DATA 61 4.1 Introduction 61 4.2 Usage 61 4.3 Components of therapy 70 4.4 Effects of treatment 78 4.5 Health system and integration 83 4.6 Health beliefs 94 4.7 Chapter summary 102 5 DISCUSSION 103 5.1 Introduction 103 5.2 Usage 103 ii 5.3 Components of therapy 110 5.4 Effects of treatment 114 5.5 Health system and integration 121 5.6 Health beliefs 127 5.7 Chapter summary 131 6 STRENGTHS AND LIMITATIONS OF THE STUDY 133 6.1 Strengths of the Study 133 6.2 Limitations of the Study 133 7 CONCLUSIONS AND IMPLICATIONS 136 7.1 Conclusions 136 7.2 Implications for practice and IM 137 7.3 Implications for research 140 8 REFERENCES 143 9 APPENDICES 180 Appendix A – Medical Subject Heading (MeSH) scope notes 180 Appendix B – Ethics approval letter 182 Appendix C – Ethics approval amendment 183 iii Appendix D – Letter to practitioners 184 Appendix E – Poster to advertise study 185 Appendix F – Patient information sheet 186 Appendix G – Health and Disability Ethics Committees (HDEC ) flowchart 188 Appendix H – Informed consent sheet 189 Appendix I – Pages from ACC acupuncture treatment profiles 190 Appendix J – Transcription confidentiality agreement 193 Appendix K -‐ Interview questions prompt sheet 194 Appendix L – Scenarios of possible integration 195 iv List of Tables Table Title Chapter Page 1 Types of CAM 2.2 6 2 Classification of Risk in Acupuncture Practice 2.4 9 3 Cochrane Reviews of Acupuncture Interventions 2.4 11 4 Search Strategy 2.5 20 5 Search Outcome 2.5 21 6 Summary of Qualitative Studies Examining Patients' 2.5 23 Experiences of Acupuncture 7 Quality Appraisal of Studies 2.5 26 8 Examples of Reporting Bias 2.5 41 9 Study Participants 3.4 54 10 Data Collection Timeline 3.5 55 11 Rigour in Qualitative Research 3.8 58 12 What Respondents Said Chinese Medicine Care Does and 5.4 116 Why They Liked It v Acknowledgements Completing this thesis would not have been possible without the support and participation of many colleagues, friends and family members. Firstly, I would like to thank the participants of this study for their insightful observations and willingness to contribute to this piece of research. I must also acknowledge my supervisors, Assoc. Prof Ray Kirk and Dr Lauretta Muir, who have both offered their support and guidance and contributed uniquely to different aspects of this study. I am grateful to Amy Collings, whose advice, help with transcription, and friendship made the writing process so much less daunting, and to Katie Collucio for her meticulous editing and assistance with formatting. The financial support from the University of Canterbury Master’s Scholarship is also gratefully acknowledged. Lastly, I am immeasurably grateful to my wife Anna, whose support, patience, insight and love continuously inspires me. vi Dedication To my Parents ‘The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow.’ -‐ William Osler, Canadian physician vii List of Abbreviations ACC: Accident Compensation Corporation CAM: Complementary and Alternative Medicine CER: Comparative Effectiveness Research EBP: Evidence Based Practice EHR: Electronic Health Record GPs: General Practitioners IM: Integrative/Integrated Medicine NZRA: New Zealand Register of Acupuncturists NZASA: New Zealand Acupuncture Standards Authority OPP: Out of Pocket Payment QARI: Qualitative Assessment and Review Instrument RA: Rheumatoid Arthritis RCTs: Randomised Controlled Trials TCM: Traditional Chinese Medicine WHO: World Health Organisation viii Notes to the reader While there are many different styles of acupuncture (TCM, five element, Japanese, etc.) and it is widely debated whether “Chinese medicine” can be accurately conceptualised as a singular discipline, it is generally agreed that the various schools of acupuncture adhere to a common unifying conceptual framework (yīn/yáng, qì, meridians, etc.). Throughout this thesis the terms “traditional” and “Chinese medicine” are thus used somewhat interchangeably. I have chosen, for the sake of consistency, to use pinyin Romanisation of all Chinese terms, so while some commonly used Chinese words such as Taoism, or Ch’I, are often rendered in their historic Wade-‐Giles form, I have used Daoism, and qì, etc. To facilitate the fluidity of reading, I have tried to keep capitalisation to a minimum. It is conventional however, that English transliterations of Chinese medicine terms are capitalised where they do not correspond directly to biomedical meanings. Spleen for example is used when it refers to the Chinese medicine notion of the Spleen system. In the analysis of results my explanations and interpretations within participants’ quotes are parenthesised in square brackets and intentionally omitted phrases are depicted by ellipses. ix
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