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Aust. J. Rural Health (2000) 8, 194–200

Original Article

PATTERNS OF USE OF COMPLEMENTARY HEALTH SERVICES IN THE SOUTH-WEST OF WESTERN AUSTRALIA

Patricia Sherwood

Edith Cowan University, Bunbury Campus, Bunbury, Western Australia, Australia

ABSTRACT: The objective of this research was to identify patterns of complementary health service usage by rural Western Australians in the south-west of the State. Complementary health providers identified by health users included homeopaths, chiropractors, naturopaths, acupuncturists, faith healers, herbalists, reiki or energy workers, counsellors, physiotherapists, osteopaths, podiatrists and reflexologists. More than half of the health provider usage in the region was with complementary therapists and the remainder with medical doctors. The main reason identified for using complementary therapists was their level of skills and the main reason identified for not using them was a lack of knowledge about what their services could provide.

KEY WORDS: alternative medicine, complementary health services, rural health.

INTRODUCTION

The relationship between what has been termed conven- tional scientific medicine and alternative medicine, more recently labelled complementary medicine, has been con- troversial since the re-emergence of the holistic paradigm in the 1960s. Joske and Segal outline the traditionally competitive relationship between these two models:

The bulk of people, particularly in the state of illness, prefer to turn to medical practitioners. Nevertheless there has been an erosion of this position. Why do so many people, voting with their feet, reject what medicine can offer more effectively than any other institution or group, namely the precise scientific diagnosis and man-

agement of disease?

is necessary to seek understand-

ing of why so many people, including highly intelligent people, find greater satisfaction in the operations of alternative healers than they do in the practices of ortho- dox physicians. 1

it

Correspondence: Dr Patricia Sherwood, Edith Cowan Uni- versity, Bunbury Campus, Robertson Drive, Bunbury, Western Australia 6230, Australia. Email: p.sherwood@cowan.edu.au

Accepted for publication October 1999.

Joske and Segal suggest that alternative practitioners better address the psycho-social and emotional dimen- sions of human need. Alternative medicine provides unique benefits that are lacking in the normal doctor–patient relationship, which include time, empathy, personalisation, counselling and an emphasis on health. Easthope recognised that the debate is more deeply rooted in the controversy between the allopathic and homeo- pathic models of the 19th century; the former arguing that healing should aim to exterminate germs, the latter that it should concentrate on building up the life forces of the individual. 2 Ullman further distinguishes between conven- tional and alternative models: the former relies on defin- ing health in terms of the absence of symptoms, the latter in terms of a continuum. 3 The former views the body mechanistically as a physiological entity, the latter holisti- cally as a physiological process surrounded by subtle energy fields. While the conventional medical model relies on the rational analysis of objectives and data and a reductionist interpretation of this data for diagnosis, the alternative medical model relies on subjective empirical findings and a holistic profile. Grossman describes the emerging complementary use of previously defined alternative medical methods in the UK:

COMPLEMENTARY HEALTH SERVICES: P. SHERWOOD

In March 1985 the council for complementary and alter-

native medicine was launched

survey of general practitioners found that around half of them either already practised or would have liked to practise acupuncture, hypnotherapy, osteopathy and other therapies. 4

at the same time a

and

Ullman discusses the progressive change from alterna- tive to complementary labelling, also noting the increasing adoption by medical doctors of so-called alternative thera- pies. 3 He points out that more than 39% of French doctors practice homeopathy, as do 20% of German doctors. Clearly, the cutting edge model for the 1990s is about integrating relevant healing modalities. In 1994, the British Medical Journal published an article by Fischer and Ward that delineated the use of complementary medicines and their relative popularity in different European countries. 5 In their consumer survey, they found that 49% of French, 46% of German, 34% of American, 31% of Belgian, 26% of British and 25% of Swedish people surveyed had used complementary medi- cine. Sommer cites a survey conducted in Melbourne and Sydney in 1994, which revealed that 50% of the general public had used alternative health providers and 25% had done so in the preceding 12 months. 6 In a survey con- ducted in South Australia in 1993, Maclennan et al. found that 20% of respondents had consulted alternative practi- tioners. 7 The objective of this survey was to begin to explore some patterns of use of complementary therapies in rural communities in the south-west of Western Australia and to compare these patterns with use of medical doctors.

METHOD

Of the 268 people surveyed, 30% were resident in Bun- bury, 19% were resident in Busselton, 6% in Dunsbor- ough, 20% in Margaret River and 25% in the rural hinterland of these shires. These regions were chosen as representative for the survey because the following range of complementary health providers were resident in the regions: homeopaths, chiropractors, naturopaths, acupuncturists, faith healers, herbalists, reiki/energy workers, counsellors, osteopaths and reflexologists. Podia- trists and physiotherapists were categories added post sur- vey and were derived from the category ‘others’ identified by respondents. The respondents were chosen randomly in street sur- veys during 1995. Of the total number of respondents (n = 268), 66% (177) were female and 34% (91) were male. Surveys were conducted during weekday working hours

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and on weekends, so this may partially account for the fewer number of available male respondents. In addition, there was a greater reluctance by males to participate in the street surveys on health. The age distribution of respondents (n = 268) was con- centrated (54%; 144) in the 21–40-year-old category. Eighteen per cent (48) of respondents were in the 15–20- year-old category, 13% (35) were in the 41–50-year-old category, while 15% (42) were 50 years or older. Only 2% (5) of respondents were more than 70 years old. Clearly, the street survey sample was skewed toward youths and young adults, with 72% of the sample being between the ages of 15 and 40. The occupational profile of respondents (n = 268) was as follows: 17% (45) described themselves as profession- als, 15% (41) full-time parents, 13% (35) students, 12% (33) in the trades, 9% (25) retired, 8% (21) clerical work- ers, 7% (19) in retail, 5% (12) in the service industry, 5% (12) unemployed and 9% (12) other. Four issues were surveyed. First, respondents were asked to provide information on their actual use of med- ical doctors and complementary health providers over the preceding 12 months. Second, respondents were asked to name the type of health issues about which each health provider was approached. Third, respondents were asked their reasons for having selected a particular health provider. Fourth, respondents were asked the reasons for not choosing certain health providers. For each of the above questions, multiple responses were permitted.

RESULTS

Actual choice of a particular health provider and frequency of consultation

When asked ‘which type of health provider have you con- sulted over the past 12 months when you have had health problems?’, of the total responses (488), approximately 49% stated ‘medical doctor’. While this is by far the largest category of responses, it is significant that more than half of the responses (51%) referred to the complementary health providers. This is analysed further in Table 1. When respondents were asked the total number of times they had used each of the above health provider’s ser- vices over the past 12 months, of the 1977 times services had been used, 49% were with medical doctors and the remaining 51% with complementary providers (Table 2).

Types of health issues about which particular providers were consulted

Responses to the question ‘for what types of health issues would you consult the above providers?’ are tabulated in

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Table 3. The category ‘general’ was used by respondents to imply generalised feelings of unwellness. It may also have included issues that clients did not wish to discuss with the interviewer or issues they could not specifically recall. The figures are expressed as percentages of the total number of times each health provider was chosen by the respondents. Generalised health issues formed the majority of the issues for which clients consulted the medical doctors (93%), homeopaths (67.1%), naturopaths (72%), herbal- ists (73.3%) and reiki workers (78%). Back and neck problems made up 100% of the issues for which clients consulted osteopaths and physiotherapists and 98% of the

TABLE 1:

Type of health provider chosen

Service provider

No. times service chosen

%

Medical doctor

238

48.80

Homeopath

24

4.90

Chiropractor

53

10.85

Naturopath

32

6.50

Acupuncturist

48

9.85

Faith healer

15

3.00

Herbalist

15

3.00

Reiki/energy

18

3.65

Counsellor

24

4.90

Physiotherapist

16

3.30

Osteopath

2

0.50

Podiatrist

2

0.50

Reflexologist

1

0.25

Total

488

TABLE 2:

Actual use of health services over 12 months

Service provider

No. times service used

%

Medical doctor

972

49.30

Homoeopath

68

3.40

Chiropractor

295

15.00

Naturopath

114

6.00

Acupuncturist

140

7.00

Faith healer

25

1.20

Herbalist

45

2.20

Reiki/energy

52

2.60

Counsellor

174

8.80

Physiotherapist

65

3.20

Osteopath

9

0.40

Podiatrist

8

0.40

Reflexologist

10

0.50

Total

1977

AUSTRALIAN JOURNAL OF RURAL HEALTH

issues for which chiropractors were consulted, with the remaining 2% of issues being headaches thought to be related to neck problems. While doctors, homeopaths, naturopaths, herbalists and reiki workers were confronted with generalised issues, chiropractors, physiotherapists, podiatrists, reflexologists and counsellors were consulted for single issues of expertise. Acupuncturists were the providers consulted about the most diverse range of issues, including general unwellness, arthritis, back and neck problems, nutrition, allergies, asthma, stress and smoking. Counsellors, reiki providers and faith healers were consulted about issues relating to emotional and spiritual health. Only naturopaths, herbalists, acupunctur- ists and naturopaths were consulted about health matters relating to nutrition.

Reasons why a particular health provider was chosen

Clients were asked to state the reasons they had chosen a particular health provider. The results are summarised in Table 4 and expressed as a percentage of the total number of reasons. In terms of the overall pattern of choice across providers, a few factors emerged as particularly signifi- cant. With all providers, the highest percentage of responses focused on category C, ‘very skilled service provider’. Clearly this was the most significant factor in directing clients’ choice. The next most frequently men- tioned factor, which included all providers except the podiatrist, was D, ‘the client experienced best results’ as a result of consulting that particular provider for that issue. The local availability of the service, followed by less side effects from remedies were the next most significant fac- tors directing clients’ choices. Over the whole profile, the least significant factor motivating choice was the negative ‘no other alternative choice provided’. Only one respon- dent in the entire survey saw the health services as offer- ing no choice or alternatives to the medical doctor. In terms of the range of positive reasons (excluding category K) given for choosing a particular health provider, the greatest range of reasons given was for the acupuncturist, where every reason was mentioned excepting H (routine/I’ve always been there). Reason H was given only by people attending medical doctors and chiropractors. This suggests that for the respondents in this survey sam- ple, their initial health provider was probably a medical doctor and the move to use complementary health providers reflects a move away from their traditional pat- tern of the medical doctor being their sole health provider. Following the acupuncturist, the health providers selected for the greatest range of reasons were the homeopaths,

COMPLEMENTARY HEALTH SERVICES: P. SHERWOOD

faith healers and herbalists (eight reasons), followed by medical doctors and chiropractors (7), naturopaths and counsellors (6), Reiki (5), reflexologists (4, physiothera- pists (3), osteopaths (2) and podiatrists (1). In terms of individual health providers, doctors were selected for their skill level, followed by the service being

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available locally and the affordability of the service. These three factors accounted for 75.2% of the clients’ responses when asked why they chose a medical doctor. The cheapness of the service was not a significant factor cited for any other health provider and this is no doubt related to the Medicare subsidy for doctors’ visits, which

TABLE 3:

Types of issues about which each health provider was consulted

Percentage

 

Doc.

Hom.

Chir.

Natu.

Acu.

Faith

Herb.

Reiki

Phys.

Oste.

Cou.

Podi.

Refle.

General

93.3

67

72

8.3

33.3

73.3

78

Arthritis

0.5

4.1

3

2.1

Back/neck

1.6

4.1

98

6

70.9

5.5

100

100

Nutrition

8.3

13

2.1

26.7

Sinus

4.1

Women’s

3.6

3

Allergy

0.5

2.1

Headache

0.5

8.3

2.0

Asthma

4.1

3

6.2

Stress

4.2

11.0

Smoking

4.2

Emotional/mental

40.1

100

Spiritual

26.6

5.5

Feet

100

100

Doc., medical doctor; hom., homeopath; chir., chiropractor; natu., naturopath; acu., acupuncturist; faith, faith healer; herb., herbalist; reiki, reiki/energy worker; phys., physiotherapist; oste., osteopath; cou., counsellor; podi., podiatrist; refle., reflexologist.

TABLE 4:

Reasons why a particular type of health provider was selected

Percentage

 

Doc.

Hom.

Chir.

Natu.

Acu.

Faith

Herb.

Reiki

Phys.

Cou.

Podi.

Refle.

Oste

A

11

1.9

3.6

0.9

4.7

6.5

2.6

B

22.7

1.9

11.5

6.9

8.4

18.8

6.5

2.6

25

C

41.5

31.4

52.5

32.9

35.7

33.3

25.8

37.3

57.9

76.6

100

25

50

D

9

17.7

24.3

21.9

24.5

4.7

25.8

33.3

21

2.6

25

50

E

2.2

35.3

1.2

31.5

22.4

9.4

25.8

21

25

F

7

7.8

4.1

3.6

9.4

3.2

5.2

G

6

1.8

4.7

3.2

4.2

21

10.4

H

6

1.2

I

1.9

2.7

1.8

14.2

3.3

4.2

J

1.9

0.9

K

0.5

n

400

51

78

73

107

21

31

24

19

38

2

4

4

198

is not available for other health providers in this sample. For homeopaths, the three key factors, which accounted for 84.4% of the reasons, were the skill of the service provider, best results and less side effects from remedies. Significantly, homeopaths had the highest percentage of their responses to ‘less side effects from remedies’. The top three factors governing the choice to attend a chiro- practor were the skill of the service provider, best results and local availability of the service (88.3%). The top three reasons for choosing a naturopath were similar to those for homeopaths, namely, the skill of the provider, best results and less side effects (82.6%). These three reasons also dominated the rationale of those choos- ing acupuncturists (82.6%), herbalists (77.4%) and reiki providers (91.6%). It is interesting that less side effects from remedies was a major reason in the choice of natur- opaths, homeopaths, acupuncturists and herbalists. The three major reasons for choosing a faith healer included skill level, local availability and curiosity (66.3%). Phys- iotherapists were selected primarily for their level of skill, best results and referrals (100%). Physiotherapists, chiro- practors and counsellors had numerically more referrals each than the other complementary health providers. When asked the source of referral, respondents indicated medical doctors. One possible explanation is that these complementary health practitioners are perceived by doc- tors as being closer to the end of the continuum that relates to traditional medicine. There was one major factor in the choice of a counsellor, namely level of skill (76.6) and likewise with the podiatrist (100%). Reflexologists were chosen because of local availability, skill, best results and less side effects (100%) and osteopaths for skill and good results (100%).

Reasons for not choosing a particular health provider

Respondents were asked to give reasons why they would not use a particular type of health provider. Multiple responses were accepted. The results are tabulated in Table 5. In terms of the total number of responses, it is evident from Table 5 that both doctors and physio- therapists had significantly fewer responses as to why they would not be chosen as health providers. Doctors had the lowest number of responses with only one respondent claiming they did not know enough about what their local doctor did. Of the complementary providers, the single greatest category of response, for all providers except counsellors, as to why they were not chosen, was that the respondents ‘do not know enough about what they do’. This was the case for 100% of the responses for osteopaths, podiatrists and reflexologists, 67.5% of the

AUSTRALIAN JOURNAL OF RURAL HEALTH

responses for homeopaths, 63.9% of the responses for reiki providers, 64.2% of the responses for physio- therapists, 55.5% of the responses for naturopaths, 54% of the responses for herbalists, 39.8% of the responses for faith healers and 33.1% of the responses for chiropractors. It is very clear from these data that complementary thera- pists would be able to raise their client numbers through a public education program about what their particular health service offers for clients. This is the case with all groups except counsellors, where the principal reasons for not using this service are that the service provider is unskilled (41.3%) and the clients do not believe the coun- sellors can do anything for them (38.2%). Significantly, for none of the complementary providers was cost mentioned as a significant reason not to use their services. One possible explanation is the expectation among users that one must pay for complementary services because these practitioners, unlike doctors, are not subsidised. For homeopaths, naturopaths, acupuncturists, herbalists and physiotherapists, the second major category of responses was that the clients did not believe the health providers could do anything for their particular problem. The skill level of complementary health providers was questioned only by a minority of the responses as follows: chiro- practors, 15.8%; faith healers, 34.4%; acupuncturists, 16%; herbalists, 15.3%. The numbers of responses for doctors and physiotherapists are too small to draw any conclusions about how these percentages relate to their perceived lack of skills. The data for the doctors are notable because of the absence of reasons for not choosing medical doctors. Given the normative expectations that in illness one consults a medical doctor, it is understandable that there are few reasons why one would not go to a med- ical doctor. As complementary therapy is a new and rela- tively unknown field, it seems people need reasons to go to complementary practitioners over and above social norms and custom. In addition, many of the reasons for not choosing a complementary therapist relate to igno- rance about what the therapist has to offer.

DISCUSSION

This survey of complementary therapies in rural commu- nities in the south-west of Western Australia indicates that the use of complementary therapies is high. Fifty-one per cent of respondents had used complementary therapies in the 12 months preceding the survey, compared to 25% in the Sydney and Melbourne surveys of the same year. 6 The shires surveyed in this study had some unique character- istics, which would have contributed to a high usage of complementary therapies. These shires are located in the

COMPLEMENTARY HEALTH SERVICES: P. SHERWOOD

 

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TABLE 5:

Reasons for not choosing a particular health provider

 
 

Percentage

 

Doc.

Hom.

Chir.

Natu.

Reiki

Acu.

Faith

Herb.

Phys.

Oste.

Cou.

Podi.

Refle.

A

10

4

5.8

4.4

1.5

2.6

1

1.2

1.2

B

2

3.5

1.1

1.3

1.3

2

0.6

C

30

8.8

15.8

12.3

19

16.1

34.4

15.3

14.2

41.3

D

30

1.2

17.8

2.2

1.1

3.9

0.3

1.6

3.7

E

20

13.6

2.5

19.8

12.9

35.4

21.8

24.5

21.4

38.2

F

10

67.5

33.1

55.5

63.9

38.4

39.8

54

64.2

100

8.6

100

100

G

2.8

2.4

2.2

1.4

2.1

1.3

1.6

6.1

n

10

249

202

227

263

229

294

248

14

90

162

80

60

Doc., medical doctor; hom., homeopath; chir., chiropractor; natu., naturopath; acu., acupuncturist; faith, faith healer; herb., herbalist; reiki, reiki/energy worker; phys., physiotherapist; oste., osteopath; cou., counsellor; podi., podiatrist; refle., reflexologist. A, service too costly; B, service unavailable locally; C, service provider is unskilled; D, experienced bad results; E, do not believe they can do anything for me; F, do not know enough about what they do; G, no health need to use this service.

scenic south-west coastal area of the State and are partic- ularly attractive to four types of persons. First, alternative lifestylers attracted by the natural environment; second, youth attracted by the beaches and the lifestyle; third, rural resettlers who include significant numbers of profes- sional persons leaving the city to settle in rural communi- ties for lifestyle reasons; and fourth, retirees. These population movements have resulted in a very diversified population base and a wide range of professional skills, including a diversity of health practitioners, which is atypical of most WA shires. These shires are also charac- terised by population growth, while the majority of rural shires in WA are experiencing population decline. These factors mean that this is a unique rural region in WA and the demand for complementary therapists in this region cannot be generalised to other rural regions of the State, where populations are declining and the composition of the population is more homogenous and conservative. The findings of Maclennan et al. in South Australia that females were more likely to use alternative health services 7 further explains the high use of complementary therapies. This sample was biased by the high proportion of females (64%) in the survey sample of respondents. In addition, Maclennan et al. indicate that alternative medi- cine users are more likely to be young 7 and this sample was relatively youthful. However, their hypothesis that rural respondents have little choice when selecting health-care services is not supported by this survey, where not a single respondent stated that they had no other choice as their reason for using a complementary thera- pist. Furthermore, it needs to be stated that the surveyed towns in this south-west region have had significant

influxes of alternative settlers, who are known to generally prefer alternative or complementary health providers. However, there are no census data that identify these persons, nor research on their health preferences. This could provide an interesting area of research. Given that complementary therapies actually comprise the majority of health-care services delivered in this sample, these findings have significant implications for the health-care industry. For example, insurance funds that provide pack- ages covering complementary health services could have a competitive edge in the marketplace with some con- sumers. Also, the complementary therapy field is likely to provide increasing opportunities for employment in future years. This is already evident in the large range of com- plementary medical practitioner training programs being provided throughout Australia. Another finding with significant implications is that the principal reason given for not using particular types of complementary health providers is that the client does not know what the service provides. All complementary thera- pists could better market their services as part of their advertising and public education programs. This is most likely to further increase demand for their services. This survey confirms findings in Europe, Britain, the United States and urban eastern Australia, that the demand for complementary therapies is rising rapidly. Clients are increasingly choosing health providers who can deliver these services. This survey indicates that cur- rently in rural south-west Western Australia, these service providers are not doctors. The growing demand for com- plementary therapies suggests that the doctors who choose to integrate complementary medicine in their service

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delivery will be at the growing point of demand in Aus- tralia, as they are currently in Europe. Finally, there is a high demand for complementary health providers and if such providers were to conduct a major public education program about their services, indications are that demand would grow even stronger.

REFERENCES

1 Joske R, Segal W. Ways of Healing. Melbourne: Penguin,

1982.

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2 Easthope G. Healers and Alternative Medicine. Aldershot, UK: Gower, 1986.

3 Ullman D. The mainstreaming of alternative medicine. Healthcare Forum Journal 1993; Nov: 24–30.

4 Grossman R. The Other Medicines. London: Pan, 1986.

5 Fischer P, Ward A. Complementary medicine in Europe. British Medical Journal 1994; 309: 107–110.

6 Sommer S. Integrative medicine: The way of the future. The Lamp 1994; 52: 31–32.

7 Maclennan A, Wilson D, Taylor A. Prevalence and cost of alternative medicine in Australia. Lancet 1996; 347: 569.