Can supervise: YES
Morns, M, Bowman, D & Steel, A 2019, 'Breastfeeding difficulties: The role of integrative medicine (IM) in breastfeeding support', Advances in Integrative Medicine, vol. 6, no. 1, pp. 3-4.View/Download from: UTS OPUS or Publisher's site
The benefits of breastfeeding for mother and child have been well documented, yet only a small percentage of mothers reach their own breastfeeding goals. In part, this disconnect is due to women's need for ongoing clinical breastfeeding support, however there is a marked difference between the type of care required by mothers and the lactation support provided in primary care settings. If appropriately trained, integrative medicine (IM) practitioners are uniquely positioned to fill this gap and provide the care nursing mothers need to meet World Health Organisation (WHO) recommendations for breastfeeding.
Many women access IM for preconception and pregnancy care [1,2]. This role in women's maternity care offers IM practitioners an opportunity to broaden their clinical focus during this period to address the modifiable risk factors which may influence breastfeeding success in the postnatal period. With a patient-centred approach, long-standing therapeutic relationships and longer consult duration, IM lends itself to uncovering deeper issues relating to breastfeeding that may not be identified during routine antenatal check-ups or postnatal visits with a doctor. For these reasons, IM practitioners are well-positioned to holistically address breastfeeding issues, avert many common breastfeeding difficulties before they arise and provide the level of woman-centred support needed to assist women towards breastfeeding success.
Breastfeeding complications are often complex with varied and individual underlying causes which can be physical, social and/or emotional in nature. Many women experience a lack of confidence as a result of a perceived difference between their actual and expected milk supply while breastfeeding . They often do not receive adequate ongoing clinical support to increase milk supply in a way that facilitates natural, physiological mechanisms and emphasises the health of the mother and baby. Research examining infant feeding practices has found t...
McIntyre, E, Adams, J, Foley, H, Harnett, J, Leach, MJ, Reid, R, Schloss, J & Steel, A 2019, 'Consultations with Naturopaths and Western Herbalists: Prevalence of Use and Characteristics of Users in Australia.', Journal of Alternative and Complementary Medicine, vol. 25, no. 2.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES:To report the prevalence of naturopathic and Western herbal medicine service utilization in Australia, and describe the characteristics of individuals who use these services. DESIGN:This is a national cross-sectional study. SETTINGS:Online survey platform. SUBJECTS:Purposive convenience sampling was used to recruit 2025 adults who were matched to Australian population demographics by gender, age, and state of residence. INTERVENTIONS:A survey instrument consisting of 50 items covering demographics, health service utilization, health status, health literacy, and medicine disclosure to complementary healthcare providers. OUTCOME MEASURES:The prevalence, frequency, and cost of naturopathy and Western herbal medicine consultations and sociodemographic characteristics of users of naturopathic and Western herbalist services and associations between these factors. RESULTS:The final data set included 2019 participants: 6.2% (n = 126) consulted a naturopath and 3.8% (n = 76) a Western herbalist. These health services were most commonly used to improve well-being. An average of AUD$102.67 and AUD$49.64 was spent per user on consultations with naturopaths and Western herbalists, respectively, in the previous year. The most prevalent users were those between 18 and 29 years of age (39.3%), in a relationship (51%), employed (70%), and held a bachelor degree or higher (40.5%). Some degree of financial difficulty was reported by 65.4% of users. Having a chronic illness (p < 0.01) and using both conventional and complementary medicines (p = 0.05) were both associated with using naturopathic or Western herbal medicine services. Less than 40% of participants disclosed their use of conventional medicines to Western herbalists. CONCLUSIONS:Naturopathy and Western herbal medicine services are used by a substantial number of Australian adults who also use conventional health services. Accordingly, research is needed to determine how these health professions can be better in...
Leech, B, Schloss, J & Steel, A 2019, 'Association between increased intestinal permeability and disease: A systematic review', Advances in Integrative Medicine, vol. 6, no. 1, pp. 23-34.View/Download from: UTS OPUS or Publisher's site
© 2018 Elsevier Ltd Objective: Increased intestinal permeability (IP) may play an important role in health and disease. The purpose of this review is to explore the association between IP and diseases frequently found within clinical practice. Design and methods: A systematic literature search was conducted up until July 2018 in MEDLINE, PubMed, EMBASE and AMED. A total of 48 articles met the inclusion/exclusion criteria. Results: IP is strongly associated with autoimmune disease and liver conditions, with the estimated prevalence of 25–87.5% and 17–65% respectively. IP also correlates with diabetes (30–65%), food allergies/hypersensitivity, irritable bowel syndrome (35.6%), polycystic ovary syndrome and autism (36.7%). Disease severity in addition to clinical symptoms of menstrual disorders, food allergy or hypersensitivity directly correlates with IP. Finally, the severity of IP appears to be exacerbated by the presence of dysbiosis, inflammation and glucose metabolism disorders. Conclusions: IP is a potentially influential factor that coincides with a variety of health conditions and diseases. IP should be considered as a factor in the pathophysiology and differential diagnosis for patient's presenting with autoimmune diseases, non-alcoholic fatty liver disease, liver cirrhosis, polycystic ovary syndrome, irritable bowel syndrome, diabetes, autism, food allergies and food hypersensitivity. Further research is required to determine if IP plays a pathogenic role in the progression and development of disease or whether the disease causes IP. While the clinical significance between IP and these diseases is unclear, the findings of the review suggest the treatment of IP in patients presenting with these conditions may warrant the consideration of clinicians.
Reid, R, Steel, A, Wardle, J & Adams, J 2019, 'Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis.', Journal of Alternative and Complementary Medicine.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES:To explore the recommendations of naturopathic medicine for the management of endometriosis, dysmenorrhea, and menorrhagia, drawing on traditional and contemporary sources. DESIGN:Content analysis. SETTING:Australia, Canada, and the United States of America (USA). SUBJECTS:Contemporary sources were identified from reviewing naturopathic higher education institutions' recommended texts, while traditional sources were identified from libraries which hold collections of naturopathic sources. Sources were included if they were published from 1800 to 2016, were in English, published in Australia, Canada, or the USA, and reported on the topic. Included sources were as follows: 37 traditional texts; 47 contemporary texts; and 83 articles from naturopathic periodicals. RESULTS:Across included sources, the most reported disciplines were herbal medicine, clinical nutrition, mineral medicines, homeopathy, hydrotherapy, and chemical-based medicines. Herbal medicines were extensively reported from all sources for the management of endometriosis, dysmenorrhea, and menorrhagia. Clinical nutrition was only recommended from contemporary sources for all three conditions. Mineral medicines were mentioned in both traditional and contemporary sources, but were only recommended for dysmenorrhea and menorrhagia. There were limited recommendations for homeopathy and hydrotherapy treatments in all conditions across all sources. Chemical-based medicines were only mentioned for dysmenorrhea and menorrhagia, and recommendations ceased after 1922. Recommendations for endometriosis were not present in any of the traditional sources, across all reported disciplines. CONCLUSIONS:The findings of this article provide insights into the documented historical and contemporary treatments within naturopathic medicine for endometriosis, dysmenorrhea, and menorrhagia. While philosophical principles remain the core of naturopathic practice, the therapeutic armamentarium appears to have changed...
Agu, JC, Hee-Jeon, Y, Steel, A & Adams, J 2019, 'A Systematic Review of Traditional, Complementary and Alternative Medicine Use Amongst Ethnic Minority Populations: A Focus Upon Prevalence, Drivers, Integrative Use, Health Outcomes, Referrals and Use of Information Sources.', Journal of Immigrant and Minority Health.View/Download from: Publisher's site
Ethnic minority populations have been identified as high users of traditional, complementary and alternative medicine (TCAM). This paper reports the systematic review of TCAM use amongst ethnic minorities. A comprehensive literature search was conducted in Ovid, PubMed and CINAHL. Included studies were original, peer-reviewed, English language articles with the primary focus on TCAM use amongst ethnic minority populations. A total of 17 articles met the inclusion criteria and were included in the systematic review. A considerable level of TCAM use was observed amongst ethnic minority populations usually attributed to its perceived safe and natural properties. Ethnic minority populations predominantly used TCAM concurrently with conventional medicine and primary TCAM referral sources were family and friends. A substantial level of TCAM integration with conventional medicine is common practice amongst these populations and the lack of disclosure about TCAM use raises an important area for further research inquiry.
Steel, A, Peng, W, Gray, A & Adams, J 2019, 'The Role and Influence of Traditional and Scientific Knowledge in Naturopathic Education: A Qualitative Study.', Journal of Alternative and Complementary Medicine.View/Download from: UTS OPUS or Publisher's site
OBJECTIVES:To explore the perceptions, experiences, and attitudes toward scientific and traditional knowledge within contemporary naturopathic education. DESIGN:A qualitative focus group and semistructured individual interview study. SETTINGS/LOCATION:Naturopathic educational organizations and institutions in North America (United States/Canada) and Australia. SUBJECTS:Seven focus groups (three in Australia and four in the United States/Canada) involving a total of 29 students, and one-on-one interviews with 28 faculty and professional leaders of the naturopathic profession from Australia, Canada, and the United States. RESULTS:Four themes have been identified in this study, including finding the balance between traditional and scientific knowledge; supporting the balance through critical appraisal in the curriculum; the exception of traditional knowledge in the critical gaze; and focusing on critical thinking in the naturopathic curriculum. Both naturopathic students and leaders highlight the significance of balancing tradition and science in the naturopathic educational context, although they hold diverse differing viewpoints. The importance of critical appraisal skills as well as the differentiation between critical thinking and critical appraisal have also been emphasized by participants with regard to the future development of naturopathic curriculum. CONCLUSIONS:This is the first study focusing on the interface between traditional and scientific knowledge within the naturopathic education setting. The development of a framework for the critical appraisal of traditional naturopathic knowledge is required to help navigate the variety of knowledge sources available to naturopathic students and to help deliver the best outcomes for their future clinical practice.
Foley, HM & Steel, AE 2019, 'Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence', COMPLEMENTARY THERAPIES IN MEDICINE, vol. 42, pp. 65-81.View/Download from: Publisher's site
Adams, J & Steel, A 2019, 'Future-Proofing the Field of Naturopathy Research: Nurturing International Research Leadership in an Evolving Profession.', Journal of Alternative and Complementary Medicine.View/Download from: Publisher's site
Steel, A, Hall, H, Diezel, H, Wardle, J & Adams, J 2019, 'Filling the gaps in contemporary maternity care: The perceptions of complementary medicine practitioners providing care to women during pregnancy', COMPLEMENTARY THERAPIES IN CLINICAL PRACTICE, vol. 34, pp. 174-178.View/Download from: Publisher's site
Lee, H, Peng, W, Steel, A, Reid, R, Sibbritt, D & Adams, J 2019, 'Complementary and alternative medicine research in practice-based research networks: A critical review', COMPLEMENTARY THERAPIES IN MEDICINE, vol. 43, pp. 7-19.View/Download from: Publisher's site
Schloss, J, McIntyre, E, Steel, A, Bradley, R, Harnett, J, Reid, R, Hawrelak, J, Goldenberg, J, Van De Venter, C & Cooley, K 2019, 'Lessons from outside and within: Exploring advancements in methodology for naturopathic medicine clinical research', Journal of Alternative and Complementary Medicine.View/Download from: UTS OPUS
Foley, H, Steel, A, Cramer, H, Wardle, J & Adams, J 2019, 'Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis', SCIENTIFIC REPORTS, vol. 9.View/Download from: UTS OPUS or Publisher's site
Reid, R, Steel, A, Wardle, J, McIntyre, E, Harnett, J, Foley, H & Adams, J 2019, 'The prevalence of self-reported diagnosed endometriosis in the Australian population: Results from a nationally-representative survey 11 Medical and Health Sciences 1117 Public Health and Health Services', BMC Research Notes, vol. 12, no. 1.View/Download from: UTS OPUS or Publisher's site
© 2019 The Author(s). Objective: Currently, it is estimated that one in 10 women of reproductive age are affected by the reproductive condition known as endometriosis. However, there has been limited research and policy attention on the prevalence of endometriosis in Australia. Utilising a nationally-representative Australian sample (N = 2025), this study aimed to report on the prevalence of endometriosis in the general population and to examine the sociodemographic factors associated with the condition. Results: The results identified a prevalence rate for endometriosis of 3.4%, which aligns with previous Australian research on this topic. However, the prevalence rate from this data set is lower than the estimate prevalence from the Global Burden of Disease Study. In addition, this study reported that women self-reporting diagnosis of endometriosis, were between 40-49 years of age, with a higher proportion living in South Australia (18.2%) compared to women within the general population (8.4%). The findings highlight endometriosis as a significant health care issue warranting further research and policy attention. While acknowledging some limitations, the study provides an important foundation for further large-scale research to be conducted on this important women's health topic.
Steel, A, Munk, N, Wardle, J, Adams, J, Sibbritt, D & Lauche, R 2019, 'Generational differences in complementary medicine use in young Australian women: Repeated cross-sectional dataset analysis from the Australian longitudinal study on women's health', COMPLEMENTARY THERAPIES IN MEDICINE, vol. 43, pp. 66-72.View/Download from: Publisher's site
Steel, A, Vaughan, B, Orrock, P, Peng, W, Fleischmann, M, Grace, S, Engel, RM, Sibbritt, D & Adams, J 2019, 'Prevalence and profile of Australian osteopaths treating older people', COMPLEMENTARY THERAPIES IN MEDICINE, vol. 43, pp. 125-130.View/Download from: Publisher's site
Gan, WC, Smith, L, McIntyre, E, Steel, A & Harnett, JE 2019, 'The prevalence, characteristics, expenditure and predictors of complementary medicine use in Australians living with gastrointestinal disorders: A cross-sectional study', COMPLEMENTARY THERAPIES IN CLINICAL PRACTICE, vol. 35, pp. 158-169.View/Download from: Publisher's site
Malhotra, V, Harnett, J, McIntyre, E, Steel, A, Wong, K & Saini, B 2019, 'The prevalence and characteristics of complementary medicine use by Australians living with sleep disorders – Results of a cross-sectional study', Advances in Integrative Medicine.View/Download from: Publisher's site
© 2019 Elsevier Ltd Objectives: To report the prevalence and characteristics of complementary medicine use and product utilization by Australians living with sleep disorders. Design: A cross-sectional study. Methods: 2025 adults representative of the Australian population by age, gender and state/territory of residence completed a survey consisting of 50 items including demographic, health services and complementary product/service utilization and health status items. The sociodemographic characteristics, prevalence and frequency of complementary medicine (CM) use, and out of pocket CM expenses were compared between those reporting a sleep disorder to those without a sleep disorder. Results: Of the 2019 respondents completing the online survey, 265 (13%) reported sleep disorders. Of these 265 respondents, the median age bracket was 40–50 years; 54.7% were females. The mean health-related quality of life score in this group was 44.8 ± 23.3; the group had a higher level of comorbid conditions compared to those without sleep disorders (p < 0.001). Two thirds (63.8%) of participants with a sleep disorder used complementary medicine compared to 52% of those without a sleep disorder (p < 0.001). Massage therapists and chiropractors were the main complementary medicine practitioners consulted by the group with sleep disorders; the average annual amount spent on visits to complementary medicine practitioners was significantly higher in this group (Australian dollars, AUD 160.0 ± 545.0) than in participants without sleep disorders (AUD 62.8 ± 251.0), p < 0.001. There were no significant differences in spending on complementary medicine products annually - those with a sleep disorder spent on average AUD 59.73 ± 266.38 annually, whilst those without spent AUD 62.8 ± 251.0 (p = 0.42). Of those with a sleep disorder, 97% reported consulting a general practitioner compared with 89.3% in the non-sleep disorders group (p < 0.001). Conclusion: Both complementary medicine and con...
Steel, A, Rainforest, J & Schloss, J 2019, 'Verifying the validity of urinary kryptopyrrole (UKP) testing in an adult population: Protocol for a multi-stage research project', Advances in Integrative Medicine.View/Download from: Publisher's site
© 2019 Elsevier Ltd Introduction: Urinary kryptopyrroles (UKP) are described as pyrrole compounds excreted in urine and have been associated with a broad range of signs and symptoms. However, causality between elevated UKP and the described symptoms of pyrrole disorder have not been established. A four stage project has been developed to verify the validity of a urinary kryptopyrroles test and attempt to establish a reference range for a healthy population. Methods: Stage one will consist of a survey to clinicians who are currently using UKP testing in their practice to understand their perceptions of the clinical value and applicability of the test in addition to identifying the condition for stage three. Stage two consists of a clinical trial to establish a normal reference range for UKP in a healthy population. Stage three is a clinical trial exploring the correlation, if any, between UKP in a diagnosed health condition to the healthy population group. Stage four is a pragmatic trial assessing UKP levels in patients as used by clinicians as part of routine clinical practice. Recruitment: Recruitment for stage one will be via email invitation to SAFE Analytical laboratories Pty Ltd customer database. Stage two and three will be targeting the wider community in the greater Brisbane area in Queensland and aims to recruit 120 participants per stage. Recruitment for stage four will be conducted through community based clinical practices. Conclusion: At the conclusion of all stage, the validation of the UKP test from SAFE Analytical laboratories will be analysed. Formulation of a reference range for a healthy population range will be explored and compared to a diagnosed condition and other conditions as tested by clinicians in practice.
Gray, AC, Diezel, H & Steel, A 2019, 'The use of learning technologies in complementary medicine education: Results of a student technology survey', Advances in Integrative Medicine.View/Download from: Publisher's site
© 2019 Background: Learning technologies are becoming universal in health professional education. Despite the potential philosophical and ideological dissonance between CM and technology, the actual use of learning technologies by CM students is currently unknown. As such, there is a need to explore the prevalence and nature of use of educational technologies by CM students. Methods: A cross-sectional survey examining students' behaviours and attitudes to learning technologies at the Endeavour College of Natural Health. Survey items focused on student demographic and educational background, and their use of technology. Chi-square tests were used to examine bivariate relationships and the characteristics of technology use based on respondents' age were determined using a backward stepwise logistic regression. Results: There were 576 responses to the survey. The majority of respondents reported having a mobile phone (96.2%) or a laptop (85.9%), rather than a desktop computer (24.7%). Of those with phones, 92% had a smart phone. Almost all students access their emails every day (84%). Older students (>35 years old) were found to be more likely to have a desktop computer (OR 1.9) and access LinkedIn (OR 2.95), but were less likely to use an eBook reader (OR 2.63) or Facebook (OR 0.21). Discussion: CM educational institutions need to adapt in relation to teaching and learning due to the changing use of and impact of technologies by more non- traditional students. This study points to the need for further research to explore the values, attitudes and use of technology by faculty in complementary medicine institutions.
Steel, A, Diezel, H, Wardle, J & Adams, J 2019, 'Working with women: Semi-structured interviews with Australian complementary medicine maternity care practitioners', Women and Birth.View/Download from: Publisher's site
© 2019 Australian College of Midwives Problem: Despite the known prevalence of complementary medicine use by women during pregnancy and childbirth and the evolution of preferred models of maternity care, very little is known about the nature and characteristics of the care provided to women by complementary medicine practitioners during this important life stage. Background: Woman-centred care is a speciation of person-centred care which has achieved prominence in maternity care policy in recent years. There is also evidence that the core principles of some complementary medicine systems of medicine emphasise patient-centredness and that these principles are core drivers toward complementary medicine use in multiple populations. Aim: This study aims to explore the approach to care delivered by complementary medicine practitioners to women during pregnancy and birth. Methods: Semi-structured individual interviews were conducted with 23 complementary medicine practitioners who identified as specialising in maternity care. Data from the interviews were analysed using a framework approach. Findings: The analysis of the perspective of complementary medicine practitioner's experiences providing care to pregnant and birthing women identified three main themes: Responding to women's expectations of care; providing woman-centred care; and the therapeutic relationship at the heart of woman-centred care. Discussion: The approach to maternity care reported by complementary medicine practitioners aligns with the principles of woman-centred care, possibly due to the similarities between woman-centred care and the core features of many systems of medicine within complementary medicine. Conclusion: Complementary medicine practitioners may contribute to an overall experience of woman-centred maternity care for pregnant and birthing women.
Leech, B, McIntyre, E, Steel, A & Sibbritt, D 2019, 'Risk factors associated with intestinal permeability in an adult population: A systematic review.', International journal of clinical practice, p. e13385.View/Download from: Publisher's site
BACKGROUND:Increased intestinal permeability (IP) involves the loss of integrity between the cells of the small intestine. IP has been suggested to contribute to the pathogenesis and exacerbation of many chronic diseases. Many potential risk factors for IP are proposed in contemporary literature. The purpose of this review is to identify the most significant risk factors for IP. METHODS:A systematic search of literature published up until September 2018 in the PubMed, EMBASE, CINAHL, and Scopus databases was conducted. RESULTS:A total of 47 articles met the inclusion criteria. Elevated levels of proinflammatory markers, dyslipidaemia, hyperglycaemia, insulin resistance, anthropometric measurements resembling obesity, advanced disease severity, comorbidity and the consumption of a Western-style diet were identified as the strongest risk factors for altered intestinal integrity. The risk of IP increases when coupled with a multiple disease state or combined with other environmental risk factors. Furthermore, many of the identified risk factors such as anthropometric measurements and biomarkers were external from intestinal health and rather resembled a metabolic-like condition. CONCLUSIONS:This review identified a number of potential risk factors for IP, ranging from biomarkers to anthropometric measurements, demographics, dietary intake and chronic diseases. These risk factors warrant the attention of clinicians and other healthcare providers to aid the identification of potential patients at risk of altered IP. Further research needs to examine whether the identified risk factors are homogeneous with the diagnosis of IP or whether the disease state influences the association.
Steel, A, Leach, M, Wardle, J, Sibbritt, D, Schloss, J, Diezel, H & Adams, J 2018, 'The Australian Complementary Medicine Workforce: A Profile of 1,306 Practitioners from the PRACI Study.', Journal of alternative and complementary medicine (New York, N.Y.), vol. 24, no. 4, pp. 385-394.View/Download from: UTS OPUS or Publisher's site
This study aims to describe the Australian complementary medicine (CM) workforce, including practice and professional characteristics.National cross-sectional survey.Australia.Any individual who self-identified as a practitioner qualified in any one of 14 CM professions and working in any state or territory of Australia was eligible to participate in the survey.A 19-item online survey was developed following a review of existing CM workforce data and in alignment with other CM workforce survey projects in progress at the time. The survey items were presented under three main constructs: demographic characteristics, professional characteristics, and practice characteristics.Descriptive statistical analysis, including frequencies and percentages, of multiple choice survey items was used. Open response items were analyzed to determine the mean, standard deviation (SD), minimum, and maximum. The demographic data were evaluated for representativeness based on previously reported CM workforce figures.The survey was completed by 1306 CM practitioners and was found to be nationally representative compared with the most recent registrant data from the Chinese Medicine Board of Australia. Participants primarily practiced in the most populous Australian states and worked in at least one urban clinical location. Most participants held an Advanced Diploma qualification or lower, obtained their qualification ten more years ago, and practiced in a clinical environment alongside at least one other practitioner from another health profession. Participants reported diverse clinical practice specialties and occupational roles. Per week, participants worked an average of 3.7 days and treated 23.6 clients.The results from this survey of practitioners from most complementary professions in Australia provide new insights into the national complementary medicine workforce. Further exploration of the CM workforce is warranted to inform all who provide patient care and develop health poli...
Leech, B, Schloss, J & Steel, A 2018, 'Health services research as a framework for expanding a whole systems research agenda in complementary and integrative medicine: The example of intestinal permeability', European Journal of Integrative Medicine, vol. 17, pp. 22-25.View/Download from: UTS OPUS or Publisher's site
© 2017 Elsevier GmbH Introduction Two of the three pillars of evidence-based practice emphasise the importance of using the best available academic research and experience from clinical practice to inform patient care. This paper aims to outline the potential value of exploring and describing insights from clinical practice through health services research to inform whole system research. Methods Concepts and ideas were developed from non-systematic review of published literature and extensive academic and clinical experience within the disciplines of health services research and clinical trials. Results Through deductive reasoning, complementary and integrative medicine (CIM) practitioners may have identified new understanding of the management of disease not yet seen in published literature. The area where investigating CIM practitioners in clinical practice may advance the clinical understanding of particular conditions is extensive. For instance, increased intestinal permeability (IP) is speculated to be involved in diseases frequently seen within clinical practice. IP is considered multifactorial with involvement from genetic and environmental factors. Conclusions CIM practitioners report clinical experience in the management of digestive disorders; their practice wisdom may add new knowledge to the significance of IP within clinical practice and outline testing parameters. Furthermore, the whole system treatment approach used by CIM practitioners may provide insight into new options for the management of IP not known or shared in published literature. Investigating the approaches CIM practitioners use within clinical practice may provide advancements in the clinical understanding of IP and other conditions. Exploring clinical practice may identify new knowledge that may translate to improvement in patient care.
James, PB, Kamara, H, Bah, AJ, Steel, A & Wardle, J 2018, 'Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone.', Complementary therapies in clinical practice, vol. 31, pp. 7-15.View/Download from: UTS OPUS or Publisher's site
This study aimed to determine the prevalence, determinants and pattern of herbal medicine use among hypertensive patients in Freetown.We conducted a cross-sectional study among hypertensive patients attending public and private health facilities in Freetown, Sierra Leone between August and October 2016. We analyzed the data using SPSS version 24. We used Chi-square, Fisher exact two-tailed test and regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant.Out of 260 study participants, over half (n = 148, 56.9%) reported using herbal medicine for the treatment of hypertension alone or together with comorbid condition(s). The most commonly used herbal medicine among users were honey (n = 89, 33.3%), moringa (n = 80, 30.0%) and garlic (n = 73, 27.3%). No significant difference existed between users and non-users of herbal medicine with regards to socio-demographic and health-related factors. The majority (n = 241, 92.7%) of respondents considered herbal medicine beneficial if it was recommended by a healthcare provider yet 85.1% (n = 126) did not disclose their herbal medicine use to their health care provider.There is a high use of herbal medicines among hypertensive patients in Freetown, Sierra Leone. It is essential for healthcare providers to take heed of the findings of this study and routinely ask their patients about their herbal medicine use status. Such practice will provide the opportunity to discuss the benefits and risks of herbal medicine use with the aim of maximizing patient desired therapeutic outcomes.
James, PB, Bah, AJ, Tommy, MS, Wardle, J & Steel, A 2018, 'Herbal medicines use during pregnancy in Sierra Leone: An exploratory cross-sectional study', Women and Birth.View/Download from: UTS OPUS or Publisher's site
© 2017 Australian College of Midwives. Background: The influence of complementary therapies on maternal health has attracted the attention of policy makers, health professionals and researchers globally especially in developing countries. However, there is lack of evidence on whether Sierra Leonean women use herbal medicine during pregnancy which limit the chance of providing better maternity care. Aim: This study was conducted to determine the prevalence and pattern of herbal medicines use among pregnant women attending an antenatal clinic at a tertiary maternal hospital in Sierra Leone. Methods: A cross-sectional study was conducted among pregnant women (n = 134) who were at least 18 years of age and who have had at least one previous pregnancy, using face to face interview. Descriptive statistics, univariate and multivariate logistic regression analysis were used for data analysis. Results: The response rate was 82.7%. Nearly two-thirds of pregnant women reported using herbal medicine (62.7%). Herbal medicine users were more likely to be Muslim than Christian. Luffa acutangula (L.) Roxb was the most cited herbal medicine used and was mostly indicated for urinary tract infection and pedal oedema. Perceived effectiveness and safety over conventional medicine (70.2%) was key driver for use, and majority did not disclose their use of herbs to their maternal health professional (95.2%). Conclusion: Herbal medicine use among pregnant women in this study was widespread. Maternal health providers should be aware of this relatively common practice and routinely discuss and educate pregnant women on the potential risks and benefits associated with the use of herbs.
Leech, B, Schloss, J & Steel, A 2018, 'Investigation into complementary and integrative medicine practitioners' clinical experience of intestinal permeability: A cross-sectional survey.', Complementary therapies in clinical practice, vol. 31, pp. 200-209.View/Download from: UTS OPUS or Publisher's site
This study aims to explore the conditions complementary and integrative medicine (CIM) practitioners associate with increased intestinal permeability (IP) and the methods they employ to assess IP.A cross-sectional survey of naturopaths, nutritionists and Western herbal medicine practitioners was undertaken (n = 227) through the Practitioner Research and Collaboration Initiative (PRACI) network.CIM practitioners (n = 36, response rate 15.9%) associate IP with gastrointestinal (100.0%), autoimmune (91.7%), skin (91.7%), neurological (80.6%), respiratory (55.6%) and liver-related conditions (44.4%). CIM practitioners frequently treat IP (72.7%); observing a minimum 3 months of treatment is required to resolve IP. Patient's signs and symptoms were the main reasons CIM practitioners suspected IP (94.1%).CIM practitioners observe a clinical link between IP and a wide range of conditions, including those not yet recognised within the literature. The clinical experience of CIM practitioners holds substantial value to the advancement of research and the clinical management of IP.
Steel, A, Tricou, C, Monsarrat, T, Ruer, M, Deslandes, C, Sisoix, C & Filbet, M 2018, 'The perceptions and experiences of osteopathic treatment among cancer patients in palliative care: a qualitative study.', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, vol. 26, no. 10, pp. 3627-3633.View/Download from: UTS OPUS or Publisher's site
PURPOSE:This research aimed to explore the perceptions and experiences of cancer patients receiving osteopathic treatment as a complementary therapy when it is used in addition to conventional treatment for cancer pain. METHODS:This qualitative study employed semi structured interviews of cancer patients in a palliative care unit in Lyon, France, who received treatment from an osteopath alongside their conventional cancer treatment. We analysed data using grounded theory and qualitative methods. RESULTS:We interviewed 16 patients. The themes identified through the analysis included a low awareness of osteopathy among the population and an accompanying high level of misconceptions. The benefits of osteopathy were described as more than just the manual treatments with participants valuing osteopathy as a holistic, meditative, and non-pharmaceutical approach. Participants also described the osteopathic treatments as assisting with a range of cancer-related health complaints such as pain, fatigue, and sleep problems. Offering osteopathic treatment at an accessible location at low or no cost were identified by participants as enablers to the continued use of osteopathy. CONCLUSIONS:The findings of this study provides preliminary data which suggests, when delivered alongside existing medical care, osteopathy may have health benefits for patients with complex conditions such as cancer.
Adams, J, Sibbritt, D, Steel, A & Peng, W 2018, 'A workforce survey of Australian osteopathy: analysis of a nationally-representative sample of osteopaths from the Osteopathy Research and Innovation Network (ORION) project.', BMC health services research, vol. 18, no. 1, pp. 352-352.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Limited information is available regarding the profile and clinical practice characteristics of the osteopathy workforce in Australia. This paper reports such information by analysing data from a nationally-representative sample of Australian osteopaths. METHODS:Data was obtained from a workforce survey of Australian osteopathy, investigating the characteristics of the practitioner, their practice, clinical management features and perceptions regarding research. The survey questionnaire was distributed to all registered osteopaths across Australia in 2016 as part of the Osteopathy Research and Innovation Network (ORION) project. RESULTS:A total of 992 Australian osteopaths participated in this study representing a response rate of 49.1%. The average age of the participants was 38.0 years with 58.1% being female and the majority holding a Bachelor or higher degree qualification related to the osteopathy professional. Approximately 80.0% of the osteopaths were practicing in an urban area, with most osteopaths working in multi-practitioner locations, having referral relationships with a range of health care practitioners, managing patients a number of musculoskeletal disorders, and providing multi-model treatment options. CONCLUSIONS:A total of 3.9 million patients were estimated to consult with osteopaths every year and an average of approximate 3.0 million hours were spent delivering osteopathy services per year. Further research is required to provide rich, in-depth examination regarding a range of osteopathy workforce issues which will help ensure safe, effective patient care to all receiving and providing treatments as part of the broader Australian health system.
Leach, MJ & Steel, A 2018, 'The potential downstream effects of proposed changes in Australian private health insurance policy: The case for naturopathy', Advances in Integrative Medicine, vol. 5, no. 2, pp. 48-51.View/Download from: UTS OPUS or Publisher's site
© 2018 Elsevier Ltd The Australian government has recently announced major reforms to the private health insurance (PHI) system. Amongst the changes are the removal of government-subsidised PHI rebates for consultations with most unregistered complementary medicine practitioners, including naturopathy. However, there are several doubts about these reforms, as this commentary explains, which primarily relate to (1) the basis of the decision, and (2) the consequences of the proposed changes. In terms of the former, an insufficient clinical evidence base was claimed to be the main driver of this decision. However, the evidence informing this decision had several limitations, and in the case of naturopathy, was somewhat contradictory. The absence of enforceable standards (from statutory registration) was another factor contributing to the decision; yet, for naturopathy, this has largely been the product of government inaction, rather than a lack of action from the profession. In terms of the downstream effects of these reforms, these could be considerable, including mass membership withdrawal from ancillary (extras) cover and cost-shifting to the public health sector; potentially leading to a rise in PHI premiums, increased demand for general practice services, and a rise in the number of avoidable hospitalisations. The proposed changes also deviate from international standards and declarations, and contravene key performance indicators of a quality health care system. In light of these concerns, the commentary calls for an immediate rethink of the intended PHI reforms, at least for naturopathy.
Steel, A, Rapport, F & Adams, J 2018, 'Towards an implementation science of complementary health care: Some initial considerations for guiding safe, effective clinical decision-making', Advances in Integrative Medicine, vol. 5, no. 1, pp. 5-8.View/Download from: UTS OPUS or Publisher's site
© 2018 Elsevier Ltd Background: The effective translation of research findings into clinical practice is a significant challenge to the evidence-based practice movement. In response, implementation science (IS) – the study and application of methods to facilitate the integration of research findings and evidence into healthcare policy and practice – has emerged over recent years. Discussion: While IS has been developed for a wide range of health care settings and disciplines, there has been a paucity of critical discourse on the role of IS in complementary medicine (CM) practice – an area of health care that has gained increasing popularity across many countries and in addition, introduces a number of unique and significant challenges with regards to IS and research translation. In addressing this significant knowledge gap, this paper identifies a number of core features and considerations instrumental in progressing the examination and application of IS to CM-related practice and clinical decision-making. IS (and its scientific study/practice) is a contemporary scholarly field that cannot be dismissed by those invested in ensuring that CM research is, and remains, practice-, practitioner- and patient-relevant.
Steel, A, Jackson, N, Blaich, R, Kirk, M & Wardle, J 2018, 'Impact of the workforce distribution on the viability of the osteopathic profession in Australia: results from a national survey of registered osteopaths.', Chiropractic & Manual Therapies, vol. 26, pp. 34-34.View/Download from: UTS OPUS or Publisher's site
Workforce distribution has an important influence on the quality of healthcare delivered in a region, primarily because it impacts access to health services in the community and overall health equity in the population. Distribution of osteopaths in Australia does not appear to follow the Australian population with the majority of osteopaths located in Victoria. The implications of this imbalance on the osteopathic workforce have not yet been explored.A secondary analysis of data from a survey of 1531 members of Osteopathy Australia in 2013. The analysis focused on the practice and occupational characteristics associated with practice locality.The survey was completed by a representative sample of 432 osteopaths. Respondents practicing outside Victoria were more likely to report higher income across all income brackets, and were less likely to report a preference for more patients.The Australian osteopathic profession should examine the issue of imbalanced workforce distribution as a priority. The results of this study are worth considering for all stakeholders as part of a coordinated approach to ensure the ongoing health of the Australian osteopathic workforce.
Steel, A, Wardle, J, Frawley, J, Adams, J, Sibbritt, D & Lauche, R 2018, 'Associations between complementary medicine utilisation and the use of contraceptive methods: Results of a national cross-sectional survey', Complementary Therapies in Clinical Practice, vol. 33, pp. 100-106.View/Download from: UTS OPUS or Publisher's site
Background and purpose
This study examines the relationship between the use of complementary medicine (CM) interventions or consultations with CM practitioners and women's choice of contraceptive method.
Materials and methods
A secondary analysis of a cross-sectional survey of Australian Women aged 34–39 years from the Australian Longitudinal Study on Women's Health (ALSWH) was conducted. Associations between use of CM and contraception were analysed using Chi-squared tests and multivariate logistic regression.
Based on the responses from the included women (n = 7299), women who consulted a naturopath/herbalist were less likely to use implant contraceptives (OR 0.56; 95% confidence interval (CI) 0.33; 0.95). Those consulting a chiropractor (OR 1.54; 95%CI 1.05; 2.25) or an osteopath (OR 2.16; 95% CI 1.32; 3.54) were more likely to use natural contraception.
There may be a link between women's choice of contraceptive method and their use of CM, in particular, with CM practitioner consultations.
Blaich, R, Steel, A, Clark, D & Adams, J 2018, 'Challenges and opportunities for Australian osteopathy: A qualitative study of the perceptions of registered osteopaths', International Journal of Osteopathic Medicine, vol. 30, pp. 18-24.View/Download from: UTS OPUS or Publisher's site
© 2018 Elsevier Ltd Background: The professional landscape of osteopathy in Australia has evolved substantially over recent years including changes in research, education and integration within the wider healthcare system. The challenges and opportunities experienced by members of the Australian osteopathic profession warrant closer examination. Objective: Explore the perceptions of registered practising osteopaths in Australia regarding challenges and opportunities for the profession. Design and setting: The study employed a qualitative inductive design and approach through which three focus groups of registered practicing osteopaths were convened across three Australian locations. Methods: The data were collected through semi-structured thematic guides. Data were analysed from transcripts using framework analysis. Participants: Registered osteopaths (n = 17) participated in the focus group representing a range of gender, age, education, and years of practice amongst participants. Results: Thematic descriptive analysis of the osteopaths' accounts identified different perspectives about whether the osteopathic profession was moving in the optimal direction. These included a question about whether osteopaths were best placed as generalists or specialists; the importance of quality education and relevant, rigorous research as pillars for the sustainability of osteopathy; a need for clarity about the place of osteopathy in the healthcare system; and the need to increase public awareness about osteopathy. Conclusion: This study highlights a number of these challenges and in doing so, provides an opportunity for stakeholders to find appropriate solutions to support the advancement of the profession. To this end there needs to be more effective communication/liaison between the osteopathic profession and education providers, regulators, Government departments, and other healthcare professionals.
James, PB, Wardle, J, Steel, A & Adams, J 2018, 'Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review.', BMJ global health, vol. 3, no. 5, pp. e000895-e000895.View/Download from: UTS OPUS or Publisher's site
Background:The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods:We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. Results:Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%-100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers' negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion:TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
Steel, A, McIntyre, E, Harnett, J, Foley, H, Adams, J, Sibbritt, D, Wardle, J & Frawley, J 2018, 'Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey', Scientific Reports, vol. 8, no. 1, pp. 1-7.View/Download from: UTS OPUS or Publisher's site
In order to describe the prevalence and characteristics of complementary medicine (CM) practice and product use by Australians, we conducted a cross-sectional online survey with Australian adults aged 18 and over. Rates of consultation with CM practitioners, and use of CM products and practices were assessed. The sample (n = 2,019) was broadly representative of the Australian population. Prevalence of any CM use was 63.1%, with 36% consulting a CM practitioner and 52.8% using any CM product or practice. Bodywork therapists were the most commonly consulted CM practitioners (massage therapists 20.7%, chiropractors 12.6%, yoga teachers 8.9%) and homeopaths were the least commonly consulted (3.4%). Almost half of respondents (47.8%) used vitamin/mineral supplements, while relaxation techniques/meditation were the most common practice (15.8%). CM users were more likely to be female, have a chronic disease diagnosis, no private health insurance, a higher education level, and not be looking for work. Prevalence of CM use in Australia has remained consistently high, demonstrating that CM is an established part of contemporary health management practices within the general population. It is critical that health policy makers and health care providers acknowledge CM in their attempts to ensure optimal public health and patient outcomes.
Morns, M & Steel, A 2018, 'Naturopathic support for nursing aversion associated with tandem breastfeeding', Australian Journal of Herbal and Naturopathic Medicine, vol. 30, no. 2, pp. 74-76.View/Download from: UTS OPUS
Goldenberg, JZ, Steel, A, Day, A, Yap, C, Bradley, R & Cooley, K 2018, 'Naturopathic approaches to irritable bowel syndrome: protocol for a prospective observational study in academic teaching clinics', Integrative Medicine Research, vol. 7, no. 3, pp. 279-286.View/Download from: UTS OPUS or Publisher's site
Frawley, J, Sibbritt, D, Steel, A, Chang, S & Adams, J 2017, 'Complementary and Conventional Health-care Utilization Among Young Australian Women With Urinary Incontinence.', Urology, vol. 99, pp. 92-99.View/Download from: UTS OPUS or Publisher's site
OBJECTIVE: To examine the relationship between health status and health service utilization (including conventional and complementary and alternative medicine [CAM]) accessed by women experiencing urinary incontinence (UI). Although a high number of younger women report symptoms of UI, such as leaking urine, only a small proportion seek help for these symptoms. MATERIALS AND METHODS: The Australian Longitudinal Study on Women's Health is a large nationally representative study that investigates the health and well-being of women. The 2 most recent surveys (2006 and 2009) of the young cohort (women aged 28-33 and 31-36 respectively) were analyzed. RESULTS: The presence of UI was 8.5% in 2006 (n = 859) and 23.3% in 2009 (n = 1878), whereas the percentage of women who sought help for their UI was 18.6% (n = 160) and 2.2% (n = 182) respectively. Women with UI had poorer health compared with women without UI (P < .005), and women who sought help for their symptoms had poorer physical functioning than women who did not (P < .005). Women who sought help were greater users of conventional and CAM health services (P < .005), including a general practitioner, specialist, hospital doctor, physiotherapist, and naturopath. CONCLUSION: UI is relatively common in younger women. However, many do not seek help. Of the women who do seek care, a large number visit CAM professionals as well as conventional medical professionals, despite a lack of research evaluating the efficacy of CAM treatment. Research is needed to explore CAM practitioner approaches to the treatment of UI and to evaluate the efficacy of these treatments.
Steel, A, Adams, J & Sibbritt, D 2017, 'The Characteristics of Women Who Use Complementary Medicine While Attempting to Conceive: Results from a Nationally Representative Sample of 13,224 Australian Women.', Womens Health Issues, vol. 27, no. 1, pp. 67-74.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: Preconception is acknowledged globally as an important part of ensuring health for the next generation and is underpinned by principles of health promotion and preventive medicine. There is a demand for more holistic, preventive health care within preconception health services. Many women are also using complementary medicine during their reproductive years. MATERIALS AND METHODS: This paper presents a longitudinal analysis of women's consultations with a complementary medicine practitioner while attempting to become pregnant, and the characteristics of women who choose to consult a complementary medicine practitioner during the preconception period. The cross-sectional and longitudinal analyses conducted in this study utilise data from the 1973 through 1978 cohort of the Australian Longitudinal Study on Women's Health (n = 13,224). Multivariate logistic regression models and generalized estimating equation models, with and without time lag, were used. RESULTS: Women who identified as attempting to conceive were more likely to consult with an acupuncturist (adjusted odds ratio, 1.46) or a naturopath/herbalist (adjusted odds ratio, 1.30). Women who consulted with an acupuncturist were likely to be consulting with a specialist doctor (odds ratio, 3.73) and/or have previous fertility issues (odds ratio, 2.30). Women who consulted with a naturopath were more likely to report experiencing premenstrual tension (odds ratio, 2.30) but less likely to have had a previous miscarriage (odds ratio, 0.18). CONCLUSIONS: Policymakers and other health professionals need to be aware that health professionals who are largely unregulated and structurally isolated from conventional health care may be actively contributing to women's reproductive and physical health during the preconception period.
Steel, A, Sundberg, T, Reid, R, Ward, L, Bishop, FL, Leach, M, Cramer, H, Wardle, J & Adams, J 2017, 'Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research.', Musculoskeletal Science and Practice, vol. 27, pp. 165-175.View/Download from: UTS OPUS or Publisher's site
In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treatments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified economic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n = 9) and economic evaluation (n = 7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n = 6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT.
Adams, J, Lauche, R, Peng, W, Steel, A, Moore, C, Amorin-Woods, LG & Sibbritt, D 2017, 'A workforce survey of Australian chiropractic: the profile and practice features of a nationally representative sample of 2,005 chiropractors.', BMC Complementary and Alternative Medicine, vol. 17, no. 1, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: This paper reports the profile of the Australian chiropractic workforce and characteristics of chiropractic care from a large nationally-representative sample of practitioners. METHODS: A 21-item questionnaire examining practitioner, practice and clinical management characteristics was distributed to all registered chiropractors (n = 4,684) in Australia in 2015 via both online and hard copy mail out. RESULTS: The survey attracted a response rate of 43% (n = 2,005), and the sample is largely representative of the national chiropractic workforce on a number of key indicators. The average age of the chiropractors was 42.1 years, nearly two-thirds are male, and the vast majority hold a bachelor degree or higher qualification. Australian chiropractors are focused upon treating people across a wide age range who mainly present with musculoskeletal conditions. Australian chiropractors have referral relationships with a range of conventional, allied health and complementary medicine (CAM) providers. CONCLUSION: The chiropractic profession represents a substantial component of the contemporary Australian health care system with chiropractors managing an estimated 21.3 million patient visits per year. While the Australian chiropractic workforce is well educated, research engagement and research capacity remains sub-optimal and there is much room for further capacity building to help chiropractic reach full potential as a key integrated profession within an evidence-based health care system. Further rich, in-depth research is warranted to improve our understanding of the role of chiropractic within the Australian health care system.
Steel, A, Sibbritt, D, Schloss, J, Wardle, J, Leach, M, Diezel, H & Adams, J 2017, 'An Overview of the Practitioner Research and Collaboration Initiative (PRACI): a practice-based research network for complementary medicine.', BMC Complementary and Alternative Medicine, vol. 17, no. 1, pp. 87-87.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: The Practitioner Research and Collaboration Initiative (PRACI) is an innovative, multi-modality practice-based research network (PBRN) that represents fourteen complementary medicine (CM) professions across Australia. It is the largest known PBRN for complementary healthcare in the world and was launched in 2015. The purpose of this paper is to provide an update on the progress of the PRACI project, including a description of the characteristics of PRACI members in order to facilitate further sub-studies through the PRACI PBRN. METHODS: A CM workforce survey was distributed electronically to CM practitioners across fourteen disciplines, throughout Australia. Practitioners electing to become a member of PRACI were registered on the PBRN database. The database was interrogated and the data analysed to described sociodemographic characteristics, practice characteristics, professional qualification and practice interest of PRACI members. RESULTS: Foundational members of PRACI were found to be predominately female (76.2%) and middle-aged (82.5%). Members were primarily located in urban settings (82.5%) across the Eastern seaboard of Australia (82.5%), with few working remotely. The main modalities represented include massage therapists (58.5%), naturopaths (26.4%) and nutritionists (14.4%). The primary area of clinical interest for PRACI members were general health and well-being (75.4%), musculoskeletal complaints (72%) and pain management (62.6%). CONCLUSIONS: PRACI provides an important infrastructure for complementary healthcare research in Australia and its success relies on CM practitioners being involved in the research being conducted through the PBRN. The aim of this database is to ensure that the research conducted through PRACI is rigorous, robust, clinically relevant and reflects the diversity of clinical practice amongst CM practitioners in Australia.
Steel, A, Sundberg, T, Reid, R, Ward, L, Bishop, FL, Leach, M, Cramer, H, Wardle, J & Adams, J 2017, 'Reply to the letter to the editor: 'Systematic review of comparative effectiveness and health economics research relating to osteopathic manipulative treatment'.', Musculoskeletal Science and Practice, vol. 29, pp. e18-e18.View/Download from: UTS OPUS or Publisher's site
Cramer, H, Park, CL, Steel, A, Gangadhar, BN & Pilkington, K 2017, 'Yoga in Prevention and Therapy', Evidence-Based Complementary and Alternative Medicine, vol. 2017.View/Download from: UTS OPUS or Publisher's site
Steel, A, Sundberg, T, Reid, R, Ward, L, Bishop, F, Leach, M, Cramer, H, Wardle, J & Adams, J 2017, 'Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research (vol 27, pg 165, 2017)', MUSCULOSKELETAL SCIENCE AND PRACTICE, vol. 30, pp. 86-86.View/Download from: Publisher's site
Steel, A, Blaich, R, Sundberg, T & Adams, J 2017, 'The role of osteopathy in clinical care: Broadening the evidence-base', International Journal of Osteopathic Medicine, vol. 24, pp. 32-36.View/Download from: UTS OPUS or Publisher's site
© 2017 Elsevier Ltd.Osteopathy is a system of health care practiced in various countries throughout the world that focuses on osteopathic manual techniques as a cornerstone of patient care. However, we still know little about the practice, role and use of osteopathy within the broader health system in most countries. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with core stakeholders including health consumers, osteopaths, other health professionals, and policymakers and funding bodies. The development of a rigorous health services research agenda around this topic has much to offer and the framework outlined here is offered with the hope of inspiring a broader field of inquiry into osteopathy in the clinical care setting.
Adams, J, Steel, A, Frawley, J, Broom, A & Sibbritt, D 2017, 'Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia.', BMC Pregnancy and Childbirth, vol. 17, no. 114, pp. 1-8.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: A wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women's decision to access health services outside of conventional maternity care provision. METHODS: Women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy. RESULTS: A total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337 M on out-of-pocket health services. CONCLUSION: While the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women - a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals.
Foley, H & Steel, A 2017, 'Patient perceptions of clinical care in complementary medicine: A systematic review of the consultation experience', PATIENT EDUCATION AND COUNSELING, vol. 100, no. 2, pp. 212-223.View/Download from: UTS OPUS or Publisher's site
Foley, H & Steel, A 2017, 'Patient perceptions of patient-centred care, empathy and empowerment in complementary medicine clinical practice: A cross-sectional study', Advances in Integrative Medicine, vol. 4, no. 1, pp. 22-30.View/Download from: UTS OPUS or Publisher's site
© 2017 Elsevier Ltd Objective Patient-centred care (PCC) is increasingly recognised as a valuable paradigm of clinical care, particularly in the field of chronic disease. As the use of complementary medicine (CM) grows, so does the need to explore the clinical experience of CM patients. This study aims to provide an examination of patient perceptions of the degree to which CM practitioners employ a patient-centred approach during consultation. Design Cross-sectional survey preliminary study. Methods A patient-reported survey was administered to assess perceptions of practitioner empathy and support, patient empowerment, and PCC in a multi-profession CM student clinic offering acupuncture, homeopathy, naturopathy, nutrition and myotherapy. The survey was comprised of four existing measures: the Consultation and Relational Empathy (CARE) measure, Patient-Centred Care scale, Perceived Provider Support scale and Empowerment scale. Results Amongst 252 respondents, positive perceptions towards all five professions were consistently reported by participants for all four measures. A higher proportion of positive experiences of practitioner empathy and PCC were reported by participants consulting with a naturopath, nutritionist or homeopath compared to those consulting with a myotherapist or acupuncturist. Participants who visited the clinic for assistance with a chronic health condition reported more positive perceptions for items regarding communication from the Patient-Centred Care scale (p = 0.02) and self-efficacy from the CARE measure (p = 0.04). Conclusion CM clinical care appears to be characterised by a patient-centred, empathic and empowering approach. CM may present a valuable resource of PCC, particularly within the field of chronic disease management. Further research is required in order to explore this approach in the wider CM community.
Foley, H & Steel, A 2017, 'The Nexus Between Patient-Centered Care and Complementary Medicine: Allies in the Era of Chronic Disease?', Journal of Alternative and Complementary Medicine, vol. 23, no. 3, pp. 158-163.View/Download from: UTS OPUS or Publisher's site
Complementary medicine (CM) holds an established place of value for health care consumers around the world. Consumers seek CM specifically for the type of clinical care provided by CM practitioners, which is perceived as holistic and individualized. The holistic approach of CM has been described as patient-centered and there are indeed many parallels between the philosophy of holism and the paradigm of patient-centered care (PCC). In light of the contemporary movement toward PCC as a means of improving health care delivery, it is worth exploring CM as a potential existing resource of PCC. This is of particular interest with consideration to the growing burden of chronic disease, the emphasis of PCC in chronic disease management, and the high representation of chronic disease sufferers among CM users. However, there has been minimal investigation into the question of whether the holistic philosophies of CM are translated by CM practitioners into practical, clinical application. The changing landscape of CM practice necessitates a deeper understanding of the nature of CM clinical care to assess the role of CM in the contemporary health care environment.
Steel, A & Reid, R 2017, 'A need for a better understanding of the role, value and effectiveness of complementary and integrative medicine for women with endometriosis', Advances in Integrative Medicine, vol. 4, no. 1, pp. 3-4.View/Download from: UTS OPUS or Publisher's site
Wardle, J, Steel, A, Lauche, R & Adams, J 2017, 'Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system', Journal of Interprofessional Care, vol. 31, no. 6, pp. 734-743.View/Download from: UTS OPUS or Publisher's site
Complementary and alternative medicine (CAM) is an increasingly prevalent part of contemporary health care. Whilst there have been some attempts to understand the dynamics of CAM integration in the health care system from the perspective of conventional care providers and patients, little research has examined the view of CAM practitioners. This study aims to identify the experiences of integration within a conventional healthcare system as perceived by naturopaths. Qualitative semi-structured interviews were conducted using a purposeful sample of 20 practising naturopaths in South East Queensland, Australia to discuss their experiences and perceptions of integrating with conventional medical providers. Analysis of the interviews revealed five broad challenges for the integration of CAM according to naturopaths: competing paradigms between CAM and conventional medicine; co-option of CAM by conventional medical practitioners; the preservation of separate CAM and conventional medical worlds by patients and providers due to lack of formalised relations; negative feedback and biases created through selective or limited experience or information with CAM; and indifferent, reactive and one-sided interaction between CAM and conventional medical providers. Naturopaths support the integration of health services and attempt to provide safe and appropriate care to their patients through collaborative approaches to practice. The challenges identified by naturopaths associated with integration of CAM with conventional providers may impact the quality of care of patients who choose to integrate CAM and conventional approaches to health. Given the significant role of naturopaths in contemporary health-care systems, these challenges require further research and policy attention.
Wardle, J, Frawley, J, Adams, J, Sibbritt, D, Steel, A & Lauche, R 2017, 'Associations between complementary medicine utilization and influenza/pneumococcal vaccination: Results of a national cross-sectional survey of 9151 Australian women', Preventive Medicine, vol. 105, pp. 184-189.View/Download from: UTS OPUS or Publisher's site
Influenza and pneumococcal vaccination is recommended for all adults, with older adults considered a high-risk group for targeted intervention. As such it is important for factors affecting vaccine uptake in this group to be examined. Complementary medicine (CM) use has been suggested as a possible factor associated with lower vaccination uptake. To determine if associations exist between influenza and pneumococcal vaccine uptake in older Australian women and the use of CM, data from women aged 62–67 years surveyed as part of the Australian Longitudinal Study on Women's Health (ALSWH) were analyzed in 2013 regarding their health and health care utilization. Associations between the uptake of influenza and pneumococcal vaccinations and the use of CM were analyzed in 2016 using chi-squared tests and multiple logistic regression modelling. Of the 9151 women, 65.6% and 17.7% reported that they had influenza and pneumococcal vaccination within the past 3 years respectively. Regression analyses show that women who consulted naturopaths/herbalists (OR = 0.64) and other CM practitioners (OR = 0.64) were less likely to have vaccination (influenza only), as were women who used yoga (OR = 0.77–0.80) and herbal medicines (OR = 0.78–0.83) (influenza and pneumococcal). Conversely, women using vitamin supplements were more likely to receive either vaccination (OR = 1.17–1.24) than those not using vitamin supplements. The interface between CM use and influenza and pneumococcal vaccination uptake in older women appears complex, multi-factorial and often highly individualized and there is a need for further research to provide a rich examination of the decision-making and motivations of stakeholders around this important public health topic.
Adams, J, Peng, W, Steel, A, Lauche, R, Moore, C, Amorin-Woods, L & Sibbritt, D 2017, 'A cross-sectional examination of the profile of chiropractors recruited to the Australian Chiropractic Research Network (ACORN): a sustainable resource for future chiropractic research', BMJ Open, vol. 2017, no. 7.View/Download from: UTS OPUS or Publisher's site
The Australian Chiropractic Research Network (ACORN) practice-based research network (PBRN) cohort was established to provide sustainable infrastructure necessary to address lack of rigorous investigation and to bridge the research–practice gap focused on chiropractic care for future years. This paper presents the profile of chiropractors recruited to the ACORN PBRN, a nationally representative sample of chiropractors working in Australia.
Cross-sectional analysis of baseline data from a cohort study of chiropractors in Australia.
All registered chiropractors in Australia were invited to participate in the ACORN study and those who completed a practitioner questionnaire and consent form were included in the PBRN cohort.
A total of 1680 chiropractors (36%) were recruited to the cohort database. The average age of the PBRN participants is 41.9 years and 63% are male. The vast majority of the PBRN participants hold a university degree.
General practitioners were identified as the most popular referral source for chiropractic care and low back pain and neck pain were the most common conditions 'often' treated by the PBRN chiropractors. The chiropractors in this PBRN cohort rated high velocity, low amplitude adjustment/manipulation/mobilisation as the most commonly used technique/method and soft tissue therapy as the most frequently employed musculoskeletal intervention in their patient management.
The ACORN PBRN cohort constitutes the largest coverage of any single healthcare profession via a national voluntary PBRN providing a sustainable resource for future follow-up. The ACORN cohort provides opportunities for further nested substudies related to chiropractic care, chiropractors, their patients and a vast range of broader healthcare issues with a view to helping build a diverse but coordinated research programme and further research capacity building around Australian chiropractic.
Schloss, J & Steel, A 2017, 'Quince fruit compared to Vitamin B6 for treatment of nausea and vomiting in Pregnancy', Advances in Integrative Medicine, vol. 4, no. 2, pp. 80-81.View/Download from: UTS OPUS or Publisher's site
The synopsis is based on the following article: Jafari-Dehkordi,
E, Hashem-Dabaghian F, Aliasl F, Aliasl J, Taghavi-Shirazi M,
Sadeghpour O, Sohrabvand F, Minaei B, Ghods R. Comparison of
quince with vitamin B6 for treatment of nausea and vomiting in
pregnancy: a randomised clinical trial.
Steel, A, Goldenberg, J & Cooley, K 2017, 'Establishing an international research collaborative for naturopathy: The International Research Consortium of Naturopathic Academic Clinics (IRCNAC)', Advances in Integrative Medicine, vol. 4, no. 3, pp. 93-97.View/Download from: UTS OPUS or Publisher's site
© 2017 Elsevier Ltd Naturopathy is a system of healthcare through which practitioners apply core philosophies, theories and principles to integrate medical knowledge with natural treatment options. In recent years the naturopathic community has developed a stronger international coherence. Alongside this growing connectivity in the global naturopathic profession, there have been a number of calls for more systematic research attention to be devoted to naturopathy as a substantive research topic, as well as a need for the naturopathic profession to hone a culture of research and evidence-based practices and skillsets. Progress in this area has been made through the development of more pragmatic and whole systems naturopathic research. One aspect which is currently missing in the global naturopathic research landscape despite this growing pattern of practice-based, whole systems research is the application of international multicentre research projects. In response, we have established a research consortium for naturopathic academic clinics in four countries and across multiple world regions. This paper serves to overview the mission, scope and membership of the research consortium and explore some of the research designs and questions which it may support.
Wardle, JL, Sibbritt, D, Broom, A, Steel, A & Adams, J 2016, 'Is Health Practitioner Regulation Keeping Pace with the Changing Practitioner and Health-Care Landscape? An Australian Perspective', FRONTIERS IN PUBLIC HEALTH, vol. 4.View/Download from: UTS OPUS or Publisher's site
Reid, R, Steel, A, Wardle, J, Trubody, A & Adams, J 2016, 'Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use.', BMC Complementary and Alternative Medicine, vol. 16, pp. 1-23.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years. METHODS: A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia. RESULTS: The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government. CONCLUSIONS: This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.
Wardle, J, Frawley, J, Steel, A & Sullivan, E 2016, 'Complementary medicine and childhood immunisation: A critical review.', Vaccine, vol. 34, no. 38, pp. 4484-4500.View/Download from: UTS OPUS or Publisher's site
Vaccination is one of the most significant and successful public health measures of recent times. Whilst the use of complementary medicine (CM) continues to grow, it has been suggested that CM practitioners hold anti-vaccination views. The objective of this critical review is to examine the evidence base in relation to CM practitioner attitudes to childhood vaccination alongside attitudes to vaccination among parents who visit CM practitioners and/or use CM products.A database search was conducted in MEDLINE, PubMed, CINAHL, EMBASE and AMED for research articles published between January 2000 and September 2015 that evaluated either CM practitioner or CM user attitudes and intention towards childhood vaccination.A total of 23 articles were found that detailed the attitudes of CM practitioners to vaccination. A further 16 papers examined the association between the use of CM products and visits to CM practitioners, and immunisation. The interface between CM and vaccination is complex, multi-factorial and often highly individualised. The articles suggest that there is no default position on immunisation by CM practitioners or parents who use CM themselves, or for their children. Although CM use does seem positively associated with lower vaccination uptake, this may be confounded by other factors associated with CM use (such as higher income, higher education or distrust of the medical system), and may not necessarily indicate independent or predictive relationships.Although anti-vaccination sentiment is significant amongst some CM practitioners, this review uncovers a more nuanced picture, and one that may be more agreeable to public health values than formerly assumed.
Steel, A, Cramer, H, Leung, B, Lauche, R, Adams, J, Langhorst, J & Dobos, G 2016, 'Characteristics of Homeopathy Users among Internal Medicine Patients in Germany', Forschende Komplementaermedizin: Wissenschaft Praxis Perspektiven, vol. 23, no. 5, pp. 284-289.View/Download from: UTS OPUS or Publisher's site
Homeopathy use continues to grow in many European countries, and some studies have examined the characteristics of patients using homeopathy within the general population. The aim of this study was to identify predictors for homeopathy use among internal medicine patients.
Patients and Methods
A cross-sectional analysis was conducted among all patients being referred to the Department of Internal and Integrative Medicine at Essen, Germany, over a 3-year period. The analysis examined whether patients had used homeopathy for their primary medical complaint before, the perceived benefit, and the perceived harm of homeopathy use. Odds ratios with 95% confidence intervals were calculated using multiple logistic regression analysis.
Of 2,045 respondents, 715 (35.0%) reported having used homeopathy for their primary medical complaint (diagnosis according to the International Statistical Classification of Diseases and Related Health Problems), with 359 (50.2%) reporting perceived benefits and 15 (2.1%) reporting harm. Homeopathy use was positively associated with female gender, high school level education, suffering from fibromyalgia or subthreshold depression, and being fast food abstinent, while patients with osteoarthritis, spinal or other pain, smokers, and patients with a high externalsocial health locus of control were less likely to use homeopathy.
Personal characteristics and health status may impact on the use and the perceived helpfulness of homeopathy.
Adams, J, Steel, A, Moore, C, Amorin-Woods, L & Sibbritt, D 2016, 'Establishing the ACORN National Practitioner Database: Strategies to Recruit Practitioners to a National Practice-Based Research Network', JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, vol. 39, no. 8, pp. 594-602.View/Download from: Publisher's site
Steel, A, Lucke, J, Reid, R & Adams, J 2016, 'A systematic review of women's and health professional's attitudes and experience of preconception care service delivery.', Family practice, vol. 33, no. 6, pp. 588-595.View/Download from: UTS OPUS or Publisher's site
The value and importance of preconception care (PCC) have been acknowledged by leading health organizations as a vital element within preventive medicine and health promotion for the wider population. The translation of PCC from position statement to relevant service and programme delivery is essential for the benefits of PCC to be realized and relies on insights from health services research. This article aims to review contemporary health services research literature examining women's and health professionals' perceptions and experiences of PCC services.A systematic review of original research published between 2003 and 2015 was conducted in November 2015. Multiple databases (PubMed, CINAHL, AMED and Maternity and Infant Care) were searched through two distinct searches to capture research literature reporting the perspective of health professionals and women towards PCC service delivery.The search identified 13 papers (4 reported the perceptions of women, 11 described the views of health professionals [2 papers reported findings from both groups]). The analyses of the contemporary literature revealed five broad areas of focus: women's service needs regarding PCC, PCC training and education requirements, role delineation around PCC, priority and value of PCC and barriers and obstacles to PCC.Despite the mounting evidence supporting the value and importance of PCC, there is insufficient research attention given to the clinical reality of PCC service and programme delivery. The transfer of PCC guidelines from broad policy to grass roots practice requires a more detailed consideration of the practicalities of implementing PCC within contemporary women's health care.
Steel, A, Adams, J, Frawley, J, Wardle, J, Broom, A, Sidebotham, M & Sibbritt, D 2016, 'Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?', BIRTH-ISSUES IN PERINATAL CARE, vol. 43, no. 4, pp. 273-276.View/Download from: UTS OPUS or Publisher's site
Steel, AE 2016, 'Important considerations of the use of complementary and alternative medicine through pregnancy, labour and birth: an update based on recent Australian research', Australian Journal of Herbal Medicine, vol. 28, no. 2, pp. 36-40.View/Download from: UTS OPUS
Wardle, J, Cook, N, Steel, AE & Barker, C 2016, 'The World Naturopathic Federation: global opportunities for the Australian profession', Australian Journal of Herbal Medicine, vol. 28, no. 1, pp. 3-3.
Schloss, J & Steel, A 2016, 'Medical synopsis: Yoga may assist females with multiple sclerosis by influencing cortisol and adrenocorticotropic hormone (ACTH) levels', Advances in Integrative Medicine, vol. 3, no. 3, pp. 112-113.View/Download from: UTS OPUS or Publisher's site
Schloss, J & Steel, A 2016, 'Medical synopsis: Nightly fasting may assist breast cancer patients and other people with cancer', Advances in Integrative Medicine, vol. 3, no. 2, pp. 66-67.View/Download from: Publisher's site
© 2016 Elsevier Ltd Design A multi-site randomised clinical trial. Participants The Women's Healthy Eating and Living (WHEL) study of patients with breast cancer. Data was collected from 2413 women with breast cancer but without diabetes mellitus, aged 27–70 years at diagnosis. A total of 2064 participants (85.5%) were Caucasian with 1335 (55.3%) college educated. Intervention Dietary analysis including timing of consumption at baseline, year 1 and year 4. A 24-h dietary recall collected by telephone on random days during a 3-week period, stratified for weekends vs weekdays. Nightly fasting duration was estimated by calculating the elapsed hours between the first and last eating episode for each day and subtracting that time from 24 h. Potential confounders were identified including daily intake (kilocalories), eating episodes per day and eating after 8 pm. Comparator No comparator was used in this study. Major outcomes Participants reported a mean (SD) nightly fasting duration of 12.5 h and 4.4 eating episodes per day. One-third of the sample consumed 25 kcal or more after 8 pm. A short nightly fasting duration (<13 h per night) was significantly associated with college education, a lower BMI, shorter sleep duration, higher self-reported kilocalorie intake, more eating episodes, and eating after 8 pm. A short nightly fast (<13 h) was significantly associated with an increased risk for breast cancer recurrence (36% higher risk). Each 2-h increase in nightly fasting duration was statistically significant for lower HbA1c level (0.37 mmol/mol lower) and more hours of sleep per night. Nightly fasting was not associated with BMI or CRP concentrations. Eating after 8 pm was significantly associated with increased higher CRP and BMI. Settings The United States of America: Clinical sites included University of California, San Diego; University of California, Davis; Stanford University; Kaiser Permanente, Northern California; M.D. Anderson Cancer Centre; Arizona Cancer Ce...
Steel, A 2016, 'Guest editorial: Consultations with complementary and alternative medicine (CAM) practitioners in pregnancy influenced by women's life circumstances', Australian Journal of Herbal Medicine, vol. 28, no. 1, p. 1.
Frawley, J, Sundberg, T, Steel, A, Sibbritt, D, Broom, A & Adams, J 2016, 'Prevalence and characteristics of women who consult with osteopathic practitioners during pregnancy; a report from the Australian Longitudinal Study on Women's Health (ALSWH).', Journal of Bodywork and Movement Therapies, vol. 20, no. 1, pp. 168-172.View/Download from: UTS OPUS or Publisher's site
The use of complementary medicine (CM) is common during pregnancy with visits to osteopathic practitioners growing in recent years. This study was conducted to investigate the prevalence and characteristics of women who consult osteopathic practitioners during pregnancy.The study sample was obtained via the Australian Longitudinal Study on Women's Health (ALSWH). The women answered questions about consultations with osteopathic practitioners, pregnancy-related health concerns and attitudes to CM use.A total response rate of 79.2% (1835) was obtained. Of these, 104 women (6.1%) consulted with an osteopath during pregnancy for a pregnancy-related health condition. Women were more likely to consult an osteopath if they suffered from back pain, sadness, weight management issues, or had a history of retained placenta.Women are visiting osteopaths for help with common pregnancy health complaints, highlighting the need for research to evaluate the safety, clinical and cost effectiveness of osteopathy in pregnancy.
Hall, H, Lauche, R, Adams, J, Steel, A, Broom, A & Sibbritt, D 2016, 'Healthcare utilisation of pregnant women who experience sciatica, leg cramps and/or varicose veins: A cross-sectional survey of 1835 pregnant women', Women and Birth, vol. 29, no. 1, pp. 35-40.View/Download from: UTS OPUS or Publisher's site
Lauche, R, Hall, H, Adams, J, Steel, A, Broom, A & Sibbritt, D 2016, 'Health-care utilisation amongst pregnant women who experience sleeping problems and/or tiredness or fatigue: secondary analysis of a cross-sectional survey of 1835 pregnant women.', Sleep and Breathing, vol. 20, no. 1, pp. 355-362.View/Download from: UTS OPUS or Publisher's site
Sleeping problems and fatigue in pregnancy are often accepted as a normal part of pregnancy; however, these conditions can be linked to serious consequences for both the mother and child. Despite established links between sleeping disturbance and a wide range of pregnancy complications, little is known about the health-care utilisation of women experiencing sleeping problems and fatigue. This study addresses the existing gap in the literature by examining cross-sectional data to identify health service utilisation patterns of pregnant women experiencing sleeping problems and/or tiredness or fatigue.In 2010, a sub-study of the Australian Longitudinal Study on Women's Health was conducted as a cross-sectional survey of 2445 women who had recently given birth. Associations between reported symptoms of sleeplessness and/or tiredness or fatigue and health service utilisation were determined using logistic regression analysis.During their pregnancy, 15.2 % of women experienced sleeping problems while 35.4 % experienced tiredness or fatigue. Women most commonly consulted with an obstetrician (n = 96) or a general practitioner (GP) (n = 74) for their tiredness or fatigue rather than a midwife (n = 56). A substantial number of women sought help from a complementary and alternative medicine (CAM) practitioner for sleeping problems (33 %) or tiredness/fatigue (28 %).Sleeping problems and/or tiredness or fatigue is reported by a reasonable percentage of pregnant women, and women obtain assistance from conventional and CAM practitioners for their symptoms, but not all seek help. Given the serious implications of untreated sleep- and fatigue-related symptoms for mother and baby, this area of research deserves and requires more attention.
Frawley, J, Sibbritt, D, Broom, A, Gallois, C, Steel, A & Adams, J 2016, 'Women's attitudes towards the use of complementary and alternative medicine products during pregnancy.', Journal of Obstetrics and Gynaecology, vol. 36, no. 4, pp. 462-467.View/Download from: UTS OPUS or Publisher's site
The aim of this study was to analyse women's attitudes towards the use of complementary and alternative medicine (CAM) products during pregnancy. The study sample was obtained via the Australian Longitudinal Study on Women's Health or ALSWH. A response rate of 79.2% (n = 1,835) was attained. Women who use herbal medicines (34.5%, n = 588) view CAM as a preventative measure, are looking for something holistic and are concerned about evidence of clinical efficacy when considering the use of these products during pregnancy. Women who use aromatherapy (17.4%, n = 319) and homoeopathy (13.3%, n = 244) want more personal control over their body and are concerned more about their own personal experience of the efficacy of CAM than clinical evidence of efficacy. As CAM use in pregnancy appears to be increasingly commonplace, insights into women's attitudes towards CAM are valuable for maternity healthcare providers.
Cramer, H, Ward, L, Steel, A, Lauche, R, Dobos, G & Zhang, Y 2016, 'Prevalence, Patterns, and Predictors of Yoga Use Results of a US Nationally Representative Survey', AMERICAN JOURNAL OF PREVENTIVE MEDICINE, vol. 50, no. 2, pp. 230-235.View/Download from: UTS OPUS or Publisher's site
Frawley, J, Sibbritt, D, Broom, A, Gallois, C, Steel, A & Adams, J 2016, 'Complementary and alternative medicine practitioner use prior to pregnancy predicts use during pregnancy.', Women and Health, vol. 56, no. 8, pp. 926-939.View/Download from: UTS OPUS or Publisher's site
The objective of this study was to determine if prior visits to a complementary and alternative medicine (CAM) practitioner were associated with CAM use during pregnancy. The study sample comprised the Australian Longitudinal Study on Women's Health. Women were surveyed prior to pregnancy in 2006, and then again in 2010 if they were pregnant or had recently given birth, and asked a range of questions relating to demographic variables, health status and use of CAM. A multivariable analysis identified significant covariates associated with visits to specific CAM practitioner modalities during pregnancy. Of the 447 women who consulted a CAM practitioner prior to pregnancy, 62.4% (n = 279) continued this use during pregnancy. Prior use of massage therapy, acupuncture, herbalist/naturopath or chiropractor was related to use of the same service during pregnancy. Higher income and working full-time were associated with the continued use of massage, while continued visits to a chiropractor were associated with having depressive symptoms, a urinary tract infection and living in a rural community. Prior use of CAM was highly related to continuing use during pregnancy. Further research is required to elucidate the benefits women attain from a CAM-model of care that they do not get from their conventional maternity care providers alone.
Steel, A, Frawley, J, Sibbritt, D, Broom, A & Adams, J 2016, 'The characteristics of women who use hypnotherapy for intrapartum pain management: Preliminary insights from a nationally-representative sample of Australian women', Complementary Therapies in Medicine, vol. 25, pp. 67-70.View/Download from: UTS OPUS or Publisher's site
Schloss, J & Steel, A 2015, 'Thriving after cancer: The role of integrative medicine (IM) in cancer survivorship and wellbeing programs', Advances in Integrative Medicine, vol. 2, no. 3, pp. 123-124.View/Download from: Publisher's site
Steel, A, Frawley, J, Adams, J & Diezel, H 2015, 'Trained or professional doulas in the support and care of pregnant and birthing women: A critical integrative review', Health and Social Care in the Community, vol. 23, no. 3, pp. 225-241.View/Download from: UTS OPUS or Publisher's site
© 2014 John Wiley & Sons Ltd. The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.
Adams, J, Steel, A, Chang, S & Sibbritt, D 2015, 'Helping address the national research and research capacity needs of Australian chiropractic: introducing the Australian Chiropractic Research Network (ACORN) project.', Chiropractic and Manual Therapies, vol. 23, no. 12.View/Download from: UTS OPUS or Publisher's site
Chiropractic is a popular health care choice in Australia and yet major gaps in our empirical understanding of this area of practice remain. Furthermore, while some research excellence exists, a largely uncoordinated approach to research activity and development has in effect led to silos of interest and a lack of strategic 'big-picture' planning essential to producing a sustainable research culture and capacity for the profession. This commentary identifies the significance of a number of key features - including a national, coordinated focus, and a rich engagement with the practitioner and patient base amongst others - arguably important to the future development of research and research capacity within Australian chiropractic. The design features and phases of the Australian Chiropractic Research Network (ACORN) project are also outlined. ACORN is one contemporary initiative specifically developed to address chiropractic's research and research capacity building needs and help grow a broad evidence-base to inform safe, effective patient care.
Adams, J, Frawley, J, Steel, A, Broom, A & Sibbritt, D 2015, 'Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: Examination of a nationally representative sample of 1835 pregnant women', Midwifery, vol. 31, no. 4, pp. 458-463.View/Download from: UTS OPUS or Publisher's site
© 2015 Elsevier Ltd. Women use various labour pain management techniques during birth. The objective of this study is to investigate women's use of pharmacological and non-pharmacological labour pain management techniques in relation to birth outcomes. Methods: a sub-survey of a nationally representative sample of pregnant women (. n=1835) from the Australian Longitudinal Study on Women's Health. Results: our analysis identified women's use of water for labour pain management as decreasing the likelihood of their baby being admitted to special care nursery (OR=0.42, p<0.004) whereas the use of epidural increased this likelihood (OR=3.38, p<0.001) as well as for instrumental childbirth (OR=7.27, p<0.001). Epidural and pethidine use decreased women's likelihood of continuing breast-feeding (ORs=0.68 and 0.59, respectively, both p<0.01) whereas the use of breathing techniques and massage for pain control increased the likelihood of women continuing breast-feeding (ORs=1.72 and 1.62, respectively, both p<0.01). Conclusions: our study illustrates associations between the use of both pharmacological and non-pharmacological labour pain management techniques and selected birth outcomes while controlling for confounding variables. There remain significant gaps in the evidence base for the use of non-pharmacological labour pain control methods and our findings provide a platform with which to develop a broad clinical research programme around this topic.
Steel, A, Lucke, J & Adams, J 2015, 'The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review.', BMC Women's Health, vol. 15, pp. 1-12.View/Download from: UTS OPUS or Publisher's site
BACKGROUND: There is growing evidence that preconception care may have an important role in preventing short and long term adverse health consequences for women and their offspring. This is particularly the case for women with chronic health conditions due to the rising prevalence of chronic disease in global populations. With this in mind, this paper presents an integrative systematic review of contemporary research outlining the use of preconception services and practices by women with chronic health conditions. METHODS: A search was conducted through PubMed, CINAHL, AMED, and Maternity and Infant Care databases which identified 672 papers examining preconception care and preconception services for women with chronic health conditions. Fourteen papers which were written in English, presented original research, and reported on the prevalence or nature of use of preconception care by women with chronic health conditions were included in the review. Critical appraisal of study quality and thematic categorical grouping of identified papers was undertaken. RESULTS: Current research evidence, as identified through this review, examines three major topic areas: the prevalence of preconception care practices, use of services and characteristics of users; knowledge of the value and impact of preconception care and availability of preconception services for women with chronic health conditions; and women's attitudes, approaches and experiences of preconception care and preconception services. Prevalence estimates of engagement with preconception care range between 18.1% and 45%, with most studies focusing on women with type 1 or 2 diabetes. Significant gaps in women's knowledge of preconception care for women with chronic health conditions were also identified. Women with chronic health conditions reported experiencing emotional distress as a result of their engagement with preconception care services. They also commonly described feeling a need to employ discipline to c...
Frawley, J, Adams, J, Steel, A, Broom, A, Gallois, C & Sibbritt, D 2015, 'Women's Use and Self-Prescription of Herbal Medicine during Pregnancy: An Examination of 1,835 Pregnant Women', Women's Health Issues, vol. 25, no. 4, pp. 396-402.View/Download from: UTS OPUS or Publisher's site
Steel, A, Hemmings, B, Sibbritt, D & Adams, J 2015, 'Research challenges for a complementary medicine higher education institution: Results from an organisational climate survey', EUROPEAN JOURNAL OF INTEGRATIVE MEDICINE, vol. 7, no. 5, pp. 442-449.View/Download from: UTS OPUS or Publisher's site
Steel, A, Adams, J, Sibbritt, D & Broom, A 2015, 'The outcomes of complementary and alternative medicine use among pregnant and birthing women: current trends and future directions.', Women's Health, vol. 11, no. 3, pp. 309-323.View/Download from: UTS OPUS or Publisher's site
Complementary and alternative medicine is used by a substantial number of pregnant women and maternity care providers are often faced with the task of ensuring women are using safe and effective treatments while respecting a woman's right to autonomous decision-making. In the era of evidence-based medicine maternity health professionals are expected to draw upon the best available evidence when making clinical decisions and providing health advice. This review will outline the current trends in research evidence associated with the outcomes of complementary and alternative medicine use amongst pregnant and birthing women as well as highlight some potential directions for future development in this important yet largely unknown topic in contemporary maternity care.
Cramer, H, Frawley, J, Steel, A, Hall, H, Adams, J, Broom, A & Sibbritt, D 2015, 'Characteristics of women who practice yoga in different locations during pregnancy', BMJ Open, vol. 5, no. 8, pp. e008641-e008641.View/Download from: UTS OPUS or Publisher's site
Steel, A, Adams, J, Frawley, J, Broom, A & Sibbritt, D 2015, 'The characteristics of women who birth at home, in a birth centre or in a hospital labour ward: A study of a nationally-representative sample of 1835 pregnant women', Sexual & Reproductive Healthcare, vol. 6, no. 3, pp. 132-137.View/Download from: UTS OPUS or Publisher's site
Steel, AE, Adams, J, Sibbritt, D, Broom, A, Gallois, C & Frawley, JE 2015, 'Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women.', Health Expectations, vol. 18, no. 5, pp. 1633-1644.View/Download from: UTS OPUS or Publisher's site
Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use. ... Examine the determinants associated with women's use of labour pain management. ... Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH). ... Women aged 3135 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).
Reid, RJ & Steel, AE 2015, 'The importance of the PRACI project for grass roots complementary medicine practice: A call for practitioner involvement', Australian Journal of Herbal Medicine, vol. 27, no. 3.
Wardle, J & Steel, A 2015, 'Systematic reviews in integrative medicine: A clinician's guide to publication', Advances in Integrative Medicine, vol. 2, no. 2, pp. 103-109.View/Download from: UTS OPUS or Publisher's site
© 2015. The role of evidence-based medicine in integrative medicine is becoming increasingly important, and with this increasing comes a need for succinct summaries of research evidence. Systematic reviews are essential to summarise evidence relating to efficacy and safety of healthcare and to summarise health care trends and phenomena accurately and reliably. However, reviews can bring with them numerous biases and methodological issues, particularly related to the sourcing of information used, and therefore need to be conducted in a systematic and methodical process. Specialised fields such as integrative medicine bring with them their own unique challenges in conducting an accurate and reliable review. This article describes practical and academic insights into writing a systematic review for publication.
Diezel, H, Adams, J, Wardle, J & Steel, A 2014, 'Does Complementary and Alternative Medicine Exist in Australian Nursing and Midwifery Courses?', The Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. A100-A100.View/Download from: Publisher's site
Frawley, J, Adams, J, Broom, A, Steel, A, Gallois, C & Sibbritt, D 2014, 'Majority of Women Are Influenced by Nonprofessional Information Sources When Deciding to Consult a Complementary and Alternative Medicine Practitioner During Pregnancy', Journal of Alternative and Complementary Medicine, vol. 20, no. 7, pp. 571-577.View/Download from: UTS OPUS or Publisher's site
Steel, A, Adams, J, Sibbritt, D, Broom, A, Gallois, C & Frawley, J 2014, 'Determinants of Women Consulting with a Complementary and Alternative Medicine Practitioner for Pregnancy-Related Health Conditions', Women and Health, vol. 54, no. 2, pp. 127-144.View/Download from: UTS OPUS or Publisher's site
Steel, A, Adams, J, Sibbritt, D, Broom, A, Frawley, J & Gallois, C 2014, 'The Influence of Complementary and Alternative Medicine Use in Pregnancy on Labor Pain Management Choices: Results from a Nationally Representative Sample of 1,835 Women', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 20, no. 2, pp. 87-97.View/Download from: UTS OPUS or Publisher's site
Steel, A, Adams, J, Sibbritt, D, Broom, A, Frawley, J & Gallois, C 2014, 'Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: An examination of a nationally representative sample of 1835 Australian women', Midwifery, vol. 30, no. 12, pp. 1157-1165.View/Download from: UTS OPUS or Publisher's site
Objective: there is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy.
Design: a survey based cohort sub study from the nationally representative Australian Longitudinal Study on Women's Health (ALSWH) was undertaken in 2010.
Participants.: women (aged 31-36 years) who identified in 2009 as pregnant or recently given birth (n=2445) from the younger cohort (n=8012) of ALSWH were recruited for the study.
Measurements and findings: participants' responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post parturn/intrapartum haemorrhage.
Key conclusions: the results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes. Implications for practice: health professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth.
Bowman, D, Steel, A, Adams, J, Sibbritt, D & Broom, A 2014, 'The characteristics of women using different forms of botanical medicines to manage pregnancy-related health conditions: A preliminary cross-sectional analysis', Advances in Integrative Medicine, vol. 1, no. 3, pp. 138-143.View/Download from: UTS OPUS or Publisher's site
Objective: To ascertain the attitudes, perceptions and characteristics of women who used varying forms of botanical medicine (herbal extracts and tinctures, herbal teas, aromatherapy oils) during pregnancy, birth and lactation. Methods: Longitudinal data from a sub-study of women (n = 2445) from the Australian Longitudinal Study of Women's Health (ALSWH) was analysed for the characteristics of women who used only one form of botanical medicine (herbal extracts and tinctures, herbal teas or aromatherapy oils), Fisher's exact tests were used to compare categorical variables due to the small cell numbers of the individual categories. A modified Bonferroni correction was used to compensate for multiple testing. All analyses were performed using Stata 11.1 and statistical significance was set at p = 0.05. Results: Women who held private health insurance were more likely to consult with an acupuncturist or naturopath for pregnancy-related health conditions and use herbal extracts and tinctures rather than herbal teas or aromatherapy oils. Women who used herbal extracts and tinctures also reported higher rates of epidural use and were more likely to initiate breastfeeding than those using aromatherapy oils. Women who used herbal teas were more likely to discuss their expectations of their birth with a general practitioner than a midwife and use birthing pools, baths or showers as intrapartum pain management. Women who used herbal teas were also more likely to initiate breastfeeding than those choosing aromatherapy, and moreover, continue breastfeeding for more than 6 months. Women who showed a preference for breathing techniques as intrapartum pain management were more likely to use aromatherapy rather than herbal extracts, tinctures or teas during pregnancy. Conclusions: Our analysis is a preliminary insight into an as yet unassessed aspect of maternity care. More in-depth investigation of the characteristics of women who choose to use herbal medicines, teas and aromat...
Steel, A, Adams, J & Sibbritt, D 2014, 'Developing a multi-modality complementary medicine practice-based research network: The PRACI project', Advances in Integrative Medicine, vol. 1, no. 3, pp. 113-118.View/Download from: UTS OPUS or Publisher's site
© 2014 Elsevier Ltd Objectives Outline the protocol to be used in the establishment of the Practitioner and Researcher Collaboration Initiative (PRACI) – an innovative national practice-based research network (PBRN) for complementary medicine (CM) professions in Australia. Design and methods A multiphase research design will be employed. Phase 1 will involve geographical mapping of CM practitioner workforce population and location across Australia. Phase 2 involves initial practitioner member recruitment encompassing a preliminary workforce survey to allow population of key information for the PRACI database. Phase 3 will employ a comprehensive practitioner member survey which examines the nature and characteristics of contemporary CM practice. Results PRACI will be a multi-modality PBRN which encompasses 14 CM professions: acupuncturists, aromatherapists, Ayurveda practitioners, Bowen therapists, Chinese herbalists, homoeopaths, kinesiologists, massage therapists, musculoskeletal therapists, myotherapists, naturopaths, nutritionists (non-dietetic), reflexologists, Western herbalists, and yoga teachers. Once established, researchers will be able to utilise the PRACI network and infrastructure to undertake CM research which is embedded in, responsive to, and informed by clinical practice. An Expression of Interest (EOI) process by which potential new research through PRACI is vetted based upon feedback by researchers, community representatives and practitioner members. The PRACI network will enable a broad range of research designs including experimental, observational and qualitative research. As such, research conducted through PRACI will be able to examine important research questions and advance new knowledge about contemporary CM practice. Conclusions PRACI is a practice-based research network which has the potential to offer the CM professions a legacy of clinically relevant research which is embedded in the realities of practice and which can provide a plat...
Steel, AE, Wardle, J, Diezel, HM, Johnstone, K & Adams, J 2014, 'Educating for collaboration: The outcomes of an interprofessional education workshop for complementary and alternative maternity care providers', Advances in Integrative Medicine, vol. 1, no. 1, pp. 17-24.View/Download from: UTS OPUS or Publisher's site
Objectives: Despite high community use of complementary and alternative medicine (CAM) poor collaboration between conventional and CAM practitioners have been identified in many health sectors including maternity care. This is in part associated with a deficit in the formal training of CAM practitioners which overlooks collaborative practice skills and guidelines. This study evaluates the outcomes of an interprofessional education workshop which endeavours to improve the collaborative practice of CAM practitioners providing care to pregnant women. Methods: A pre-workshop and post-workshop questionnaire which evaluated the participants' perception of self-proficiency and their interprofessional practice behaviours when providing maternity care. Descriptive and inferential statistical analysis of the data was undertaken. Results: CAM practitioners (n = 30) providing care to pregnant women participated in the project. Prior to taking part in the workshop a low level of confidence in pregnancy-specific physiology and psychology knowledge more broadly but also poor confidence in engaging with conventional maternity care providers and understanding conventional models of maternity care was identified amongst participants. Participants who felt more positive about their knowledge of pregnancy and birth physiology were more likely to enquire about women's conventional care and discuss safety issues with women in their care. Following workshop involvement the participant's awareness of the models of maternity care available to Australian women improved alongside participants' knowledge of the scope and role of obstetricians and midwives. There was a reduced need by participants to have their role acknowledged by conventional care providers as important to enable effective collaboration after workshop completion. Conclusions: Interprofessional education is argued to be a valuable tool to promote interprofessional collaboration and communication. It may be employed as a use...
Steel, A, Adams, J, Broom, A, Sibbritt, D, Frawley, J & Gallois, C 2014, 'Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships with Maternity Care Providers', The Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. A111-A111.View/Download from: UTS OPUS or Publisher's site
Frawley, JE, Steel, A, Adams, J, sibbritt, D, Broom, A & Gallois, C 2014, 'The Association between women's choice of birth setting and their use of CAM during labor and birth.', Journal of Alternative and Complementary Medicine, vol. 20, no. 5, pp. 1-1.View/Download from: UTS OPUS or Publisher's site
Purpose: Contemporary maternity care often means women are
able to choose a number of settings for their birth including
hospitals, birth centers, and community settings. There is also
evidence that many women utilised complementary and alternative
medicine (CAM) during pregnancy and birth. The purpose
of this study is to examine the association between
women's choice of birth setting and their use of CAM during
labor and birth.
Methods: Longitudinal data from a sub-study of women
(n = 2445) from the nationally-representative Australian Longitudinal
Study of Women's Health (ALSWH) was analyzed for
relationships between women's birth setting (hospital, birth
center, or community) and their demographics, attitudes towards
maternity care (including CAM), and use of CAM during
pregnancy and birth.
Results: The characteristics associated with women's choice of
birth setting include some demographic features such as employment
status, health care subsidy, and level of education.
Women's birth setting choice was also linked to a preference for
CAM practitioner by women birthing in birth centers and
community settings. In contrast, women birthing in hospitals
held more positive views towards obstetric care. There was a
higher use of CAM during pregnancy by women birthing in birth
centers and community but this was not consistent across all
CAMs investigated. Naturopaths, herbal medicines, homeopathy
and flower essences were more commonly used by women
birthing in community compared with those in a birth center.
There was also a higher rate of CAM use for intrapartum pain
management for women birthing outside of a hospital setting,
although women attending a birth center were more likely than
those birthing in community to use pharmacological pain management
Conclusion: There are characteristic differences between women
birthing in different birth settings which seems to be
influenced as much by preference for maternity care and interest
in CAM use as it is by...
Steel, AE & McEwen, B 2014, 'The need for higher degrees by research for complementary medicine practitioners', Australian Journal of Herbal Medicine, vol. 26, no. 4, pp. 136-140.View/Download from: UTS OPUS
The need for research in complementary medicine (CM), which is meaningful and relevant within a real world setting, has been
growing since the advent of the evidence-based practice movement. This need has not, however, been successfully addressed
due to both insufficient interest amongst the research population and issues with the usefulness of much of the completed research
to inform the practical needs of clinicians and policy makers. These issues may be attenuated by seeing an increased number of
CM practitioners involved in future research projects. However, the absence of appropriate and focused research training for CM
practitioners may hinder the number of practitioners pursuing research careers. With this in mind, there is a real need to see an
increase in both the availability of higher degrees by research at both undergraduate and postgraduate level for CM practitioners as
well as the institutions offering these degrees. In particular, ensuring that CM practitioners are able to receive primary supervision of
a research project by researchers with a detailed understanding of CM is vital if effective and meaningful CM research, which is wellsupported
within higher education institutions, is to occur.
Wardle, JL, Steel, AE & Adams, J 2013, 'Tensions in Naturopathic Education Response', JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, vol. 19, no. 12, pp. 979-980.View/Download from: Publisher's site
Wardle, J, Steel, A & McIntyre, E 2013, 'Independent registration for naturopaths and herbalists in Australia: The coming of age of an ancient profession in contemporary healthcare', Australian Journal of Herbal Medicine, vol. 25, no. 3.View/Download from: UTS OPUS
Recent changes in the healthcare landscape in Australia have prompted renewed debate regarding the most appropriate regulatory model for naturopaths and herbalists. Numerous government reports have recommended independent statutory regulation yet naturopaths and Western herbalists are yet to be included in the National Registration and Accreditation Scheme. This has left professional associations to carry the administrative burden and manage the conflicting interests of practitioner regulation and professional advocacy. The outcome of this self-regulatory model has damaged advancement of these professions through limiting the scope of professional associations to promote the value of practitioners within contemporary healthcare. It has also left naturopaths and Western herbalists vulnerable to health policy reform which impact on unregistered practitioners. In response, an independent registration body, the Australian Register of Naturopaths and Herbalists (ARONAH) has been established which mirrors the NRAS process and offers legitimacy to the professions whilst also safeguarding the public. This paper outlines: the history of the registration debate in Australia; the scope and role of ARONAH; the relationship between ARONAH and the existing professional associations and the rationale underpinning important standards and guidelines developed by ARONAH for its members. © National Herbalists Association of Australia 2013.
Wardle, J, Adams, J, Lui, C & Steel, AE 2013, 'Current challenges and future directions for naturopathic medicine in Australia: a qualitative examination of perceptions and experiences from grassroots practice', BMC Pregnancy Childbirth, vol. 13, no. 15, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
Naturopaths are an increasingly significant part of the healthcare sector in Australia, yet despite their significant role there has been little research on this practitioner group. Currently the naturopathic profession in Australia is undergoing a period of rapid professional growth and change. However, to date most research exploring the perceptions of naturopaths has been descriptive in nature and has focused on those in leadership positions rather than grassroots practitioners. This article explores the perceptions and experiences of practising naturopaths on the challenges and future directions of their profession.
Diezel, HM, Steel, AE, Wardle, J & Johnstone, K 2013, 'Patterns and influences of interprofessional communication between midwives and CAM practitioners: A preliminary examination of the perceptions of midwives', Australian Journal of Medical Herbalism, vol. 25, no. 1, pp. 4-10.View/Download from: UTS OPUS
Women are increasingly using complementary and alternative medicine (CAM) such as naturopathy and Western herbal medicine during their pregnancy and midwives have described an affinity for CAM. However, the reality of the midwife-CAM practitioner interfa
Frawley, JE, Adams, J, Sibbritt, D, Steel, AE, Broom, A & Gallois, C 2013, 'Prevalence and determinants of complementary and alternative medicine use during pregnancy: Results from a nationally representative sample of Australian pregnant women', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 53, no. 4, pp. 347-352.View/Download from: UTS OPUS or Publisher's site
Background: Pregnant women have been identi?ed 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. Aim: To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. Methods: The study sample was obtained via the Australian Longitudinal Study on Womens Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. Results: Complementary and alternative medicine use was found to be high with 48.1% (n = 623) of pregnant women consulting a CAM practitioner and 52.0% (n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant womens visits to a CAM practitioner. Signi?cant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Conclusion: Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care.
Steel, AE, Diezel, HM, Johnstone, K, Sibbritt, D, Adams, J & Adair, R 2013, 'The Value of Care Provided by Student Doulas: An Examination of the Perceptions of Women in Their Care', Journal of Perinatal Education, vol. 22, no. 1, pp. 39-48.View/Download from: UTS OPUS or Publisher's site
This study provides an examination of women's perceptions of care provided by student doulas undertaking a formal qualification in doula support services. Feedback forms completed by women attended by student doulas undertaking a formal qualification in doula support services were analyzed. The women (N = 160) consistently rated the student doulas' contribution to their experience of birth favorably. Qualitative analysis revealed that women value the presence of their student doulas highly with reference to the student doulas' demeanor, support provided to family, interface with other health professionals, and learned skills. Within the Australian context, this study suggests that the support provided by student doulas that have completed a formal training course is held in positive regard by the women receiving their care.
Steel, AE, Frawley, JE, Sibbritt, D & Adams, J 2013, 'A preliminary profile of Australian women accessing doula care: Findings from the Australian Longitudinal Study on Women's Health', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 6, pp. 589-592.View/Download from: UTS OPUS or Publisher's site
Despite growing interest and controversy regarding the value of doulas in contemporary maternity care, little is known about the profile of women who choose to involve a doula in their care team. This preliminary analysis indicates that women's attitudes towards maternity care may influence their use of a doula more so than demographic factors. Further research examining these
Steel, A, Diezel, H, Wardle, J & Johnstone, K 2013, 'Patterns of inter-professional communication between complementary and conventional practitioners providing maternity care services: A preliminary examination of the perceptions of CAM practitioner', Australian Journal of Herbal Medicine, vol. 25, no. 2, pp. 57-61.View/Download from: UTS OPUS
© National Herbalists Association of Australia 2013. Inter-professional communication is well acknowledged as a vital piece in the practice of multi-disciplinary health care.Yet, even in health sectors such as maternity care where high rates of complementary and alternative medicine (CAM) use are well documented, there is little examination of the inter-professional communication patterns between CAM and conventional care providers. This study reports preliminary findings from a survey of CAM practitioners (n=31) which examines their perceived interprofessional communication patterns with conventional maternity care providers. The results indicate CAM practitioners may provide care to women from preconception care through to the postnatal period. The practitioners were most likely to receive referrals from other women or previous clients (sometimes: 41%; often 27%), rather than from health professionals. Formal communication was most likely to be directed to other CAM practitioners (sometimes: 18%; often: 4%) and least likely to be directed to obstetricians (sometimes: 0%; often: 4%). No participants reported receiving formal communications from obstetricians but a small number indicated receiving formal communication from midwives (sometimes: 7%; often: 4%) and other CAM practitioners (sometimes: 17%; often: 4%). These low rates of communication may be impacting on patient safety through overtreatment or therapeutic interactions. There are concerns that policy and legislative barriers may be limiting the inter-professional communication practices of conventional care providers. Similarly, educational and regulatory weaknesses in CAM may be contributing to poor inter-professional communication practices for CAM practitioners. Further substantive research is needed to contextualise and verify these findings.
Pierantozzi, AM, Steel, A & Seleem, M 2013, 'Integrating complementary and alternative medicine into medical intern teaching: Preliminary findings from an Australian Hospital', COMPLEMENTARY THERAPIES IN CLINICAL PRACTICE, vol. 19, no. 4, pp. 237-242.View/Download from: UTS OPUS or Publisher's site
Steel, A, Sibbritt, D, Adams, J & Daley, J 2012, 'P04.80. Navigating the divide: women's engagement with conventional and complementary medicine in pregnancy.', BMC complementary and alternative medicine, vol. 12, no. Suppl 1, pp. P350-P350.View/Download from: Publisher's site
Steel, A, Diezel, H, Sibbritt, D & Adams, J 2012, 'OA13.03. Promoting safe and integrated maternity care through interprofessional education.', BMC complementary and alternative medicine, vol. 12, no. Suppl 1, pp. O51-O51.View/Download from: Publisher's site
Frawley, J, Sibbritt, D, Adams, J, Steel, A, Wardle, J, Broom, A, Lui, C & Murthy, V 2012, 'OA16.04. Women's sources of information for CAM use during pregnancy.', BMC complementary and alternative medicine, vol. 12, no. Suppl 1, pp. O65-O65.View/Download from: Publisher's site
Adams, J & Steel, A 2012, 'Investigating complementary and alternative medicine in maternity care: The need for further public health/health services research', Complementary Therapies in Clinical Practice, vol. 18, no. 2, pp. 73-74.View/Download from: UTS OPUS or Publisher's site
Adams, J & Steel, AE 2012, 'Editorial: Investigating complementary and alternative medicine in maternity care: The need for further public health/health services research', Complementary Therapies in Clinical Practice, vol. 18, pp. 73-74.View/Download from: UTS OPUS
The relationship between complementary and alternative medicine (CAM) and maternity care has attracted much attention over recent years and there has been a movement towards developing and promoting an evidence-base to help understand the interface between CAM, midwifery and wider mainstream maternity care.
Wardle, J, Steel, A & Adams, J 2012, 'A Review Of Tensions And Risks In Naturopathic Education And Training In Australia: A Need For Regulation', Journal Of Alternative And Complementary Medicine, vol. 18, no. 4, pp. 363-370.View/Download from: UTS OPUS or Publisher's site
In line with increasing complementary medicine (CAM) use, the Australian government has committed considerable resources to the training of CAM practitioners.
Steel, AE, Adams, J, Sibbritt, D, Broom, A, Gallois, C & Frawley, JE 2012, 'Utilisation of complementary and alternative medicine (CAM) practitioners within maternitycare provision: results from a nationally representative cohort study of 1,835 pregnant women', BMC Pregnancy and Childbirth, vol. 12, pp. 146-146.View/Download from: UTS OPUS or Publisher's site
Background: There 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.
Steel, AE & Adams, J 2012, 'Developing midwifery and complementary medicine collaboration: The potential of interprofessional education?', Complementary Therapies in Clinical Practice, vol. 18, no. 4, pp. 261-264.View/Download from: UTS OPUS or Publisher's site
A higher percentage of referrals to complementary and alternative medicine (CAM) by midwives can be linked to their af?nity with CAM. However, midwifery education does not commonly include CAM as part of the curriculum leaving potential for misinformation and unsafe practice. An approach to CAM education which encourages collaboration between all care providers is needed to ensure safe, womancentred maternity care. Whilst a number of models have been considered in health education they are not without their limitations when aiming to promote interprofessional collaboration.
Steel, A & Johnstone, K 2011, 'The impact of an inter-professional education workshop on the perceptions of practice behaviours of midwives in relation to complementary and alternative medicine', Women and Birth, vol. 24, pp. S44-S45.View/Download from: UTS OPUS or Publisher's site
Steel, AE & Adams, J 2011, 'The Interface Between Tradition and Science:Naturopaths' Perspectives of Modern Practice', Journal of Alternative and Complementary Medicine, vol. 17, no. 10, pp. 967-972.View/Download from: UTS OPUS or Publisher's site
Objectives: Although there has been much international commentary, little is known about the interface between traditional knowledge and scientific research in modern naturopathic practice. This study aimed to explore this interface from the perspective of naturopaths. Design: Semistructured interviews were conducted with naturopaths in current practice. The participants were selected using purposive sampling, and the data from the interviews were interpreted using thematic analysis. Settings/location: Interviews were conducted in a place suitable to each participant. Subjects: Twelve (12) naturopaths in current clinical practice were interviewed. The participants represented a diversity of characteristics including gender, time in practice, level of qualification, and clinical contact hours per week.
Steel, AE & Adams, J 2011, 'The role of naturopathy in pregnancy, labour and post-natal care: Broadening the evidence-base', Complementary Therapies in Clinical Practice, vol. 17, no. 4, pp. 189-192.View/Download from: UTS OPUS or Publisher's site
It is known that women are high users of complementary and alternative medicine (CAM) including naturopathy and that CAM is frequently used by pregnant women. However, we still know little about the consumption, practice and role of naturopathy in pregnancy, labour and post-natal care. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with three core stakeholder groups-pregnant women, naturopaths/herbalists and other maternity health professionals including obstetricians, midwives and general practitioners. The development of a rigorous health services research agenda around this topic has much to offer maternity-care users, practitioners and policy makers and the framework outlined here is offered with the hope of inspiring further inquiry into this significant issue in women's health.
Steel, AE, Adams, J & Sibbritt, D 2011, 'Complementary and Alternative Medicine in Pregnancy: a Systematic Review', Journal of the Australian Traditional-Medicine Society, vol. 17, no. 4, pp. 205-209.View/Download from: UTS OPUS or Publisher's site
A systematic review of recent peer-reviewed literature exploring womenâs use of complementary and alternative medicine (CAM) in pregnancy, birth and postnatal care.
Steel, A & Adams, J 2011, 'The Application And Value Of Information Sources In Clinical Practice: An Examination Of The Perspective Of Naturopaths', Health Information And Libraries Journal, vol. 28, no. 2, pp. 110-118.View/Download from: UTS OPUS or Publisher's site
Background: The approach of evidence-based medicine (EBM), providing a paradigm to validate information sources and a process for critiquing their value, is an important platform for guiding practice. Researchers have explored the application and value o
Steel, AE & Adams, J 2011, 'Approaches to clinical decision-making: A qualitative study of naturopaths', Complementary Therapies in Clinical Practice, vol. 17, pp. 81-84.View/Download from: UTS OPUS or Publisher's site
The type of information used and its application in clinical practice has generated interest due to its relationship to evidence-based medicine (EBM). However, it is also acknowledged that the principles of EBM place less value on practitioners' experience and intuitive insights when making clinical decisions.
Prior, J, Dunston, R, Kroll, T, Adams, J & Steel, A 2019, 'Traditional, complementary and integrative medicine and global health challenges' in Adams, J & et al (eds), Public Health and Health Services Research in Traditional, Complementary and Integrative Medicine: International Perspectives, Imperial College Press, London.
Adams, J, Sibbritt, D, Prior, JH, Connon, I, McIntyre, E, Dunston, R, Lauche, R & Steel, A 2019, 'The role and influence of women in the workforce and practice of complementary and integrative medicine: Contemporary trends and future prospects' in Adams, J, Steel, A, Broom, A & Frawley, J (eds), Women's Health and Complementary and Integrative Medicine, Routledge, New York, pp. 142-151.View/Download from: UTS OPUS
Adams, J, Hollenberg, D, Broom, A, Steel, AE, Sibbritt, D & Lui, C 2013, 'Integration in Primary Health Care: A focus upon practice and education and the importance of a critical social science perspective' in Adams, J, Magin, P & Broom, A (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 203-227.View/Download from: Publisher's site
In this chapter we argue that the mainstream work and commentary around integrative health care and education has often lacked a critical social science perspective
Steel, AE, Frawley, JE, Adams, J, Sibbritt, D & Broom, A 2013, 'Primary Health Care, Complementary and Alternative Medicine and Women's Health: A Focus Upon Menopause' in Adams, J, Magin, P & Broom, A (eds), Primary Health Care and Complementary and Integrative Medicine, Imperial College Press, London, pp. 11-33.View/Download from: Publisher's site
Australian Women are integrating primary health care and complementary and alternative medicine to alleviate a range of symptoms and conditions. This chapter introduces the use of CAM for women's health in general and more particularly, explores the integration of CAM alongside mainstream primary health care
Adams, J, Lui, C, Sibbritt, D, Broom, A, Wardle, J, Homer, CS, Steel, AE & Beck, S 2012, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature' in Adams, J, Andrews, G, Barnes, J, Broom, A & Magin, P (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 35-43.View/Download from: UTS OPUS
The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Adams, J, Sibbritt, D, Broom, A, Wardle, J, Steel, AE, Murthy, V & Daley, J 2012, 'Research capacity building in traditional, complementary and integrative medicine: Grass-roots action towards a broader vision' in Adams, J, Andrews, G, Barnes, J, Broom, A & Magin, P (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, London, pp. 275-281.View/Download from: UTS OPUS
Developing capacity to undertake health research effectively is an integral component of national and global health research systems (Lansang and Dennis, 2004) and is essential to producing a sound evidence base for decision making in policy and practice (Cooke, 2005). Moreover, research capacity building (RCB) - nurturing and producing sustainable increased capacity for future research endeavours - is important fOr all health research fields and TCIM is no exception (Andrews, 2006; Adams, 2007). There is currently a great opportunity to embrace RCB in relation to TCIM in order to help develop an evidence base and a stronger and more robust research culture among scholars and practitioners alike.
Steel, A, Frawley, J, Adams, J, Sibbritt, D & Broom, A 2015, 'The labour and birth outcomes associated with the use of herbal medicine in pregnancy.', NHAA International Conference on Herbal Medicine., Sydney,.View/Download from: UTS OPUS
Frawley, J & Steel, A 2014, 'Complementary and alternative medicine (CAM) use during pregnancy: Navigating safe maternity care', PHAA 43rd Annual Conference, The future of public health: big challenges, big opportunities, Public Health Association of Australia Annual Conference, Perth, Australia.
Steel, A, Sibbritt, D, Adams, J & Frawley, J 2014, 'The Association Between Women's Choice of Birth Setting and Their Use of CAM During Labor and Birth.', International Research Congress on Integrative Medicine and Health, Miami, Florida, USA.View/Download from: UTS OPUS
Steel, A, Adams, J, Broom, A, Sibbritt, D & Frawley, J 2014, ''Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships with Maternity Care Providers.'', 2014 International Research Congress on Integrative Medicine and Health, Miami, USA.
Steel, A, Adams, J, Sibbritt, D, Broom, A & Frawley, JE 2013, 'The influence of complementary and alternative medicine use in pregnancy on pain management in labour and birth outcomes', International Research Congress on Integrative Medicine and Health, London, UK.
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