Advising on Prevention in Chiropractic: A Look at Public Health Promotion
SOURCE: Topics in Integrative Health Care 2011: 2 (1)
Harrison Ndetan, M.Sc., MPH, DrPH, Michael Ramcharan, DC,
Marion Willard Evans, Jr., DC, PhD, MCHES, CWP
Chiropractic care is among the more commonly used Complementary and Alternative Medical (CAM) therapies. Spinal co-morbidities include many of the most common causes of premature death and disability. Health promotion and disease prevention have been used in the profession and taught in educational settings but not yet fully embraced in usual practice. This manuscript reviews areas in which health promotion has been emphasized in chiropractic education along with instances in which health behavior theories (HBTs) have been applied. Chiropractic clinical and educational programs should consider application of HBTs to move clinicians and interns forward regarding better advising roles with patients related to prevention and health promotion.
Introduction
The actual causes of death in the United States include many chronic diseases that are attributable to modifiable behavioral risk factors such as tobacco use, physical inactivity or sedentary lifestyle, alcohol consumption, poor nutrition or eating habits. [1]An increased emphasis on prevention, health promotion (HP), and education has been recommended for decades but has failed to reduce many of the threats related to premature morbidity and mortality. [2,3]Complementary and alternative medicine (CAM) use has also increased; in many cases aimed at chronic disease management. [4-7]
Chiropractic care is one of the most frequently used professional CAM health care systems in the U.S. [4,5,7]Musculoskeletal conditions such as low back and neck pain, which are among the most common reasons patients visit medical physicians in the U.S., [8]are also among the conditions most frequently treated with chiropractic care. [7-9]The relative efficacy and cost effectiveness of chiropractic and medical care have emerged as important issues in the broader debate on evidence-based healthcare. [10,11]
Chiropractors and health promotion
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Chiropractic principles claim to emphasize wellness, prevention and, to a certain degree, health promotion. In addition, chiropractors report providing a substantial portion of prevention and wellness-based care in the U.S. [12-14]Several studies have investigated whether doctors of chiropractic (DCs) perform HP and most report some health educational activities in practice. [14,15]However, the question as to whether chiropractic care influences modifiable risk behavior is largely unanswered, especially from the perspective of the patients.
The Job Analysis of Chiropractic, 2005 reported that the percentage of patients receiving some HP advice ranged from 40% receiving advice on disease prevention to 65% on general physical fitness and exercise. [13]Interestingly, a study by Jamison in Australia gives some indication as to the type of health information DCs are most comfortable providing from a self-reported, self-efficacy perspective. [16]It should be noted that self-efficacy is simply the feeling one can replicate the behavior desired such as advising adequately in this case. Her study suggests that DCs are very comfortable with giving advice on exercise, for instance, but much less comfortable with advice on other “wellness” topics. While 91% said they felt comfortable giving advice on exercise, only 13% felt comfortable giving advice on alcohol use and only 12% regarding substance abuse.
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