The latest articles profiled by the Primary Health Care Research & Information Service include:
• A study suggesting that patients with chronic conditions value the sense of control they gain from using complementary and alternative medicines
• Five suggestions for how primary health care researchers can boost global health.
How patients use complementary and alternative medicines for a sense of control
Christina Hagger writes:
Self-management is touted as an ideal in chronic disease control and yet some patients find the reality offers a very constrained experience in which success is measured by adherence to the bio-medical model.
Many see the use of complementary and alternative medicines (CAM) as a way of establishing autonomy and control of their disease management – and their lives.
A recent study by researchers from Monash University examines how Australians with Type 2 diabetes and/or cardiovascular disease supplement medical care with CAM use.
It illustrates how people not only utilise medical providers and pharmaceuticals but concurrently consult with CAM practitioners and use non-biomedical therapies to enhance their well-being. Their use of CAM is framed in the context of reclaiming personal control.
The authors maintain that a sense of loss of personal control, even powerlessness, often accompanies illness, particularly chronic and degenerative conditions.
This sense of powerlessness can be heightened when people feel they are placed in a position of reliance on practitioners for advice, recommendations and medications.
Their choice of CAM is seen as ‘taking control’ by ‘doing something extra’ towards self-care and better health. These choices included strategies ranging from prayer, yoga and meditation through to over-the-counter products.
A significant observation from participants in the study is that they felt ‘having time’ and ‘being heard’ were central to their relationships with their CAM practitioners.
It is of some concern that a number of participants chose to further establish their sense of autonomy and control of their disease by controlling the flow of information on their CAM usage to their doctor.
They argued such lack of information exchange was to avert negative feedback from doctors who may be dismissive or disapproving of such choices, and reported enjoying a ‘quiet triumph’ when certain CAMs ‘worked’.
However, lack of disclosure about CAMs use may be problematic. Not only are the effects of common CAMs products and services unknown (and untested), but also combining CAMs with other medications may be contraindicated.
• Dr Christina Hagger, PHC RIS Research Fellow (Knowledge Exchange)
CAM – an indication of non-compliance or self-management? Warren N, Canaway R, Unantenne N, Manderson L. (2012). Taking control: Complementary and alternative medicine in diabetes and cardiovascular disease management. Health, published on-line 26 Sept 2012 doi: 10.1177/1363459312460699
Boosting the international capacity of primary health care research
Melissa Raven writes:
Leaders in primary health care research should prioritise global research capacity development, and should support more international research collaborations, with researchers from low-income countries included both as collaborators and in capacity building.
That is according to a recent article by researchers from England, Australia, Norway, the Netherlands, and the UK.
The authors, all members of the Oxford International Primary Care Research Leadership Programme, argue that primary health care research is an international responsibility.
They give five examples of how primary health care researchers can contribute to improving health globally:
1. Providing all patients with the opportunity to participate in research and to influence the research agenda. This will increase generalisability.
2. Responding more rapidly to changes in the global healthcare environment, e.g. the emergence of infectious diseases with the potential to become epidemics or pandemics.
3. Developing better understanding of how risk factors at the environment, population, and individual level influence health. This should include often-ignored factors such as domestic violence and access to health education.
4. Harnessing new technologies such as mobile phones, which should increasingly influence research, from initiation to dissemination.
5. Developing strategies to facilitate implementation of evidence-based treatments and other interventions into primary health care practice. The decentralisation and diversity of primary health care means that this will require tailoring and targeting of strategies for different systems and settings.
The authors acknowledge some criticisms of primary health care research, but argue that it performs well when it is well funded.
They are themselves critical of the World Health Organization for not including research and academic capacity building among the five key elements of primary health care involved in achieving the goal of better health for all.
More generally, they also argue that primary health care researchers should engage more in social and political debate.
They illustrate this by provocatively arguing that the gross inequity in health globally affects everyone and, rather than being merely a local problem in low-income countries, is a threat to global stability, one which PHC can help to address.
• Melissa Raven, PHC RIS Research Fellow
Primary health care research: an international responsibility. Hay AD, Rortveit G, Purdy S, Adams J, Sanci LA, Schermer TR, Schers HJ, van der Windt DA. (2012). Primary care research – an international responsibility. Family Practice, 29(5), 499-500
These articles featured in October 2012 editions of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php. The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php.
Previous PHC RIS columns at Croakey