The growing population of individuals with chronic pain presents a challenge to a globally overburdened health care workforce. Naturopaths are trained as primary health care providers who manage patients with chronic pain and, yet, are often overlooked in health care teams. This scoping review aims to identify barriers and facilitators affecting naturopathic inclusion into interprofessional health care teams managing patients with chronic pain.
Methods:
This study protocol was registered a priori through Open Science (https://doi.org/10.17605/OSF.IO/2G3JT). A search was conducted using databases AMED, CINAHL, MEDLINE, SCOPUS, Web of Science, APA PsycInfo, and Health Business Elite. Search limits included English language from 2012 to 2023. Included publications were from academic and gray literature. Search terms used included the following: “Naturopath*” OR “Integrative medicine” AND “Health care system*” OR “Health system*” OR “Models of health care” OR “Professional autonomy” OR “Professional regulation” OR “Professional govern*” OR “Interprofessional practice (IPP)” OR “Multidisciplinary communication.” The scoping review utilized Covidence software and was analyzed using thematic analysis. Themes were identified following Arksey and O’Malley’s (2005) framework to inform a narrative approach.
Results:
Five themes emerged that relate to the inclusion of naturopaths in health care teams as follows: (1) perceptions of naturopathy, (2) practice standards, (3) legitimacy, (4) resources, and (5) shifting power dynamics and cooperation.
Conclusions:
Barriers for naturopathic inclusion into health care teams are influenced by perceptions of naturopathy, naturopathic education standards, regulations, research, and patient equity and access. Facilitators for inclusion include the growing shift toward person-centered care, greater interprofessional education, and shared assets, including colocation.
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References
1.
CohenSP, VaseL, HootenWM. Chronic pain: An update on burden, best practices, and new advances. Lancet, 2021; 397(10289):2082–2097; doi: 10.1016/S0140-6736(21)00393-7
2.
PainAustralia. The cost of pain in Australia. 2019.
3.
Miller-MateroLR, SantullanoD, RichM, et al.Association of health literacy with chronic pain and pain-related distress. Profe Psychol: Rese Pract, 2024; 55(2):89–94; doi: 10.1037/pro0000539
4.
FoleyH, SteelA, AdamsJ. Consultation with complementary medicine practitioners by individuals with chronic conditions: Characteristics and reasons for consultation in Australian clinical settings. Health Soc Care Community, 2021; 29(1):91–103; doi: 10.1111/hsc.13072
5.
Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the Knee Clinical Care Standard. Australian Commission on Safety and Quality in Health Care; 2017.
6.
ColeL. Non-allopathic interventions for the management of acute and chronic pain: A brief review. Online J Issues Nurs, 2020; 25(2); doi: 10.3912/OJIN.Vol25No02PPT15
7.
World Naturopathic Federation. Naturopathy Practice, Effectiveness, Economics & Safety. 2021.
8.
WardleJ, SteelA, CasteleijnD. An evidence based overview of naturopathic practice in Australia. Ajhnm, 2019; 31(1):9–13; doi: 10.33235/ajhnm.31.1.9-13
9.
Ryan BradleyEBO. Estimated effects of whole-system naturopathic medicine in select chronic disease conditions: A systematic review. Altern Integr Med, 2015; 04(02); doi: 10.4172/2327-5162.1000192
10.
TayeI, GraceS, BradburyJ. Empowerment in naturopathy: A qualitative analysis of practitioner perspectives. Complement Ther Clin Pract, 2022; 49:101652; doi: 10.1016/j.ctcp.2022.101652
11.
MunnZ, PetersMDJ, SternC, et al.Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol, 2018; 18(1):143; doi: 10.1186/s12874-018-0611-x
PetersM, GodfreyC, McInerneyP, et al.Manual for Evidence Synthesis. JBI: 2020.
14.
The EndNote Team. EndNote. Clarivate: Philadelphia, PA; 2013.
15.
TriccoAC, LillieE, ZarinW, et al.PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med, 2018; 169(7):467–473; doi: 10.7326/M18-0850
16.
PopayJ, RobertsH, SowdenA, et al.Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme. Lancaster University; 2006.
17.
ArkseyH, O’MalleyL. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol, 2005; 8(1):19–32; doi: 10.1080/1364557032000119616
18.
MoolaS, MunnZ, TufanaruC, et al.Systematic reviews of etiology and risk. In: JBI Manual for Evidence Synthesis. (Aromataris EMZ ed.) JBI: 2020.
19.
GomersallJS, JadotteYT, XueY, et al.Conducting systematic reviews of economic evaluations. Int J Evid Based Healthc, 2015; 13(3):170–178; doi: 10.1097/XEB.0000000000000063
20.
MunnZ, MoolaS, LisyK, et al.Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc, 2015; 13(3):147–153; doi: 10.1097/XEB.0000000000000054
21.
McArthurA, KlugarovaJ, YanH, et al.Innovations in the systematic review of text and opinion. Int J Evid Based Healthc, 2015; 13(3):188–195; doi: 10.1097/XEB.0000000000000060
22.
HongQN, Gonzalez-ReyesA, PluyeP. Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the Mixed Methods Appraisal Tool (MMAT). J Eval Clin Pract, 2018; 24(3):459–467; doi: 10.1111/jep.12884
23.
BaethgeC, Goldbeck-WoodS, MertensS. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev, 2019; 4(1):5; doi: 10.1186/s41073-019-0064-8
24.
ArentzS, SmithC, RedmondR, et al.A cross-sectional study of traditional Chinese medicine practitioner’s knowledge, treatment strategies and integration of practice of chronic pelvic pain in women. BMC Complement Med Ther, 2021; 21(1):174; doi: 10.1186/s12906-021-03355-6
25.
AvilaC, GraceS, BradburyJ. How do patients integrate complementary medicine with mainstream healthcare? A survey of patients’ perspectives. Complement Ther Med, 2020; 49:102317; doi: 10.1016/j.ctim.2020.102317
26.
BasuP, TripathiR, MehrotraR, et al.Role of integrative medicine in the continuum of care of breast cancer patients in the Indian context. Cancer Causes Control, 2021; 32(5):429–440; doi: 10.1007/s10552-021-01399-0
27.
BichoM, NikolaevaR, LagesC. Complementary and alternative medicine legitimation efforts in a hostile environment: The case of Portugal. Sociol Health Illn, 2023; 45(4):890–913; doi: 10.1111/1467-9566.13625
28.
ChowdhuriPD, KunduK, MeyurS. Dynamics of decision-making in medical pluralism: A systematic review of conceptual models. Altern Ther Health Med, 2022; 28(7):178–183.
29.
ChowdhuryS, KunduP. Alternate systems of medicine in India—How pervasive and why? J Health Manag, 2018; 20(2):178–189; doi: 10.1177/0972063418763653
30.
ChungVCH, HoLTF, LeungTH, et al.Designing delivery models of traditional and complementary medicine services: A review of international experiences. Br Med Bull, 2021; 137(1):70–81; doi: 10.1093/bmb/ldaa046
31.
DavisMA, MartinBI, CoulterID, et al.US spending on complementary and alternative medicine during 2002-08 plateaued, suggesting role in reformed health system. Health Aff (Millwood), 2013; 32(1):45–52; doi: 10.1377/hlthaff.2011.0321
32.
DunnJM, SteelAE, AdamsJ, et al.Characteristics of global naturopathic education, regulation, and practice frameworks: Results from an international survey. BMC Complement Med Ther, 2021; 21(1):67; doi: 10.1186/s12906-021-03217-1
33.
Ericksen-PereiraW, RomanNV, SwartR. The effect of legislation on the treatment practices and role of naturopaths in South Africa. BMC Complement Med Ther, 2020; 20(1):139; doi: 10.1186/s12906-020-02916-5
34.
GoldblattE, WilesM, SchwartzJ, et al.Competencies for optimal practice in integrated environments: Examining attributes of a consensus interprofessional practice document from the licensed integrative health disciplines. Explore (NY), 2013; 9(5):285–291; doi: 10.1016/j.explore.2013.06.006
35.
GopichandranV, Satish KumarC. Mainstreaming AYUSH: An ethical analysis. Indian J Med Ethics, 2012; 9(4):272–277; doi: 10.20529/IJME.2012.091
36.
GraceS. Interprofessional competencies in the curriculum: Interpretations of educators from five health professions. J Interprof Care, 2015; 29(5):499–500; doi: 10.3109/13561820.2014.994200
37.
GraceS, BradburyJ, AvilaC, et al.‘The healthcare system is not designed around my needs’: How healthcare consumers self-integrate conventional and complementary healthcare services. Complement Ther Clin Pract, 2018; 32:151–156; doi: 10.1016/j.ctcp.2018.06.009
38.
GreenJ, WrightH, SeelyD, et al.A survey of multidisciplinary healthcare providers utilizing the KNOWintegrativeoncology.org educational platform. BMC Complement Med Ther, 2022; 22(1):118; doi: 10.1186/s12906-022-03601-5
39.
HabimoradPHL, CatarucciFM, BrunoVHT, et al.Implementation of Brazil’s national policy on complementary and integrative practices: Strengths and weaknesses. Cien Saude Colet, 2020; 25(2):395–405; doi: 10.1590/1413-81232020252.11332018
40.
HallH, BrosnanC, CantR, et al.Nurses’ attitudes and behaviour towards patients’ use of complementary therapies: A mixed methods study. J Adv Nurs, 2018; 74(7):1649–1658; doi: 10.1111/jan.13554
41.
HappellB, Platania-PhungC, BockingJ, et al.Consumers at the centre: Interprofessional solutions for meeting mental health consumers’ physical health needs. J Interprof Care, 2019; 33(2):226–234; doi: 10.1080/13561820.2018.1516201
42.
HealeyDK. Attitudes, expectations and plans of entering medical students toward complementary and alternative medicine. ProQuest Infor Learn, 2015.
43.
DoddsSE, HermanPM, SechrestL, et al.When a whole practice model is the intervention: Developing fidelity evaluation components using program theory-driven science for an integrative medicine primary care clinic. Evid Based Complement Alternat Med, 2013; 2013:652047; doi: 10.1155/2013/652047
44.
PatelA, CarruthersR, HillW, et al.Exploring why individuals utilise naturopathic treatment and choose to combine naturopathy with biomedicine. Eur J Integr Med, 2024; 67:102347; doi: 10.1016/j.eujim.2024.102347
45.
IjazN, BoonH, WelshS, et al.Supportive but “worried”: Perceptions of naturopaths, homeopaths and Chinese medicine practitioners through a regulatory transition in Ontario, Canada. BMC Complement Altern Med, 2015; 15(1):312; doi: 10.1186/s12906-015-0846-6
46.
KimS, Capo-LugoC, ReedWR, et al.Using a survey to characterize rehabilitation professionals’ perceptions and use of complementary, integrative, and alternative medicine. J Altern Complement Med, 2020; 26(8):663–665; doi: 10.1089/acm.2019.0383
47.
LakshmiJK. Less equal than others? Experiences of AYUSH medical officers in primary health centres in Andhra Pradesh. Indian J Med Ethics, 2012; 9(1):18–21; doi: 10.20529/IJME.2012.005
48.
LanniT, AndersonM, ArmstrongH, et al.Incorporating naturopathic medicine into a hospital setting: One institution’s experience. J Altern Complement Med, 2016; 22(4):153–158; doi: 10.1089/act.2016.29064.tla
49.
LloydI, WardleJ. World naturopathic federation: The central role of research in the growth of the global naturopathic profession. J Altern Complement Med, 2019; 25(2):129–132; doi: 10.1089/acm.2018.29055.ljw
50.
MeilingB. Bastyr fills niche for naturopathic doctors. San Diego Business Journal, 2015; 36(8):1–48.
51.
MuthappanS, BagepallyBS, PonnaiahM. Promoting health economic evaluation studies in the AYUSH system of medicine: The need of the hour. Int J Technol Assess Health Care, 2021; 37(1):e82; doi: 10.1017/S0266462321000386
52.
OoiSL, McLeanL, PakSC. Naturopathy in Australia: Where are we now? Where are we heading? Complement Ther Clin Pract, 2018; 33:27–35; doi: 10.1016/j.ctcp.2018.07.009
53.
Organizing CommitteeWC. The Berlin agreement: Self-responsibility and social action in practicing and fostering integrative medicine and health globally. J Altern Complement Med, 2017; 23(5):320–321; doi: 10.1089/acm.2017.29024.jjw
54.
OrrDE, Bravo GutierrezG, FetteD. From parallel to partnership. Leadersh Health Serv (Bradf Engl), 2019; 32(4):493–508; doi: 10.1108/LHS-12-2018-0063
55.
ParkYL, CanawayR. Integrating traditional and complementary medicine with national healthcare systems for universal health coverage in Asia and the Western Pacific. Health Syst Reform, 2019; 5(1):24–31; doi: 10.1080/23288604.2018.1539058
56.
RomeykeT, StummerH. Evidence-based complementary and alternative medicine in inpatient care: Take a look at Europe. J Evid Based Complementary Altern Med, 2015; 20(2):87–93; doi: 10.1177/2156587214555714
57.
RoyV. Integrating Indigenous Systems of Medicines in the Healthcare System in India: Need and Way Forward. In: Herbal Medicine in India. Springer, 2020, pp. 69–87.
58.
FHdES. Integrative and Complementary Practices in Health (ICPS). Online Braz J Nurs, 2019; 18(2):11–11.
59.
SeelyDM, WeeksLC, YoungS. A systematic review of integrative oncology programs. Curr Oncol, 2012; 19(6):e436–e461; doi: 10.3747/co.19.1182
60.
SeidmanMD, van GrinsvenG. Complementary and integrative treatments: Integrative care centers and hospitals: One center’s perspective. Otolaryngol Clin North Am, 2013; 46(3):485–497; doi: 10.1016/j.otc.2013.02.010
61.
ShankarD. Health sector reforms for 21(st) century healthcare. J Ayurveda Integr Med, 2015; 6(1):4–9; doi: 10.4103/0975-9476.154214
62.
SmithK, FirthK, SmeedingS, et al.Guidelines for creating, implementing, and evaluating mind-body programs in a military healthcare setting. Explore (NY), 2016; 12(1):18–33; doi: 10.1016/j.explore.2015.10.002
63.
SundbergT, HökJ, FinerD, et al.Evidence-informed integrative care systems—The way forward. Eur J Integr Med, 2014; 6(1):12–20; doi: 10.1016/j.eujim.2013.09.005
64.
ValentiniJ, KlockeC, GuthlinC, et al.Integration of complementary and integrative medicine competencies in general practice postgraduate education - development of a novel competency catalogue in Germany. BMC Complement Med Ther, 2021; 21(1):250; doi: 10.1186/s12906-021-03419-7
65.
WardleJL, AdamsJ, LuiCW, et al.Current challenges and future directions for naturopathic medicine in Australia: A qualitative examination of perceptions and experiences from grassroots practice. BMC Complement Altern Med, 2013; 13:15; doi: 10.1186/1472-6882-13-15
66.
WardleJ, SteelA, LaucheR, et al.Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system. J Interprof Care, 2017; 31(6):734–743; doi: 10.1080/13561820.2017.1351424
67.
WardleJL, SibbrittDW, AdamsJ. Primary care practitioner perceptions and attitudes of complementary medicine: A content analysis of free-text responses from a survey of non-metropolitan Australian general practitioners. Prim Health Care Res Dev, 2018; 19(3):246–255; doi: 10.1017/S1463423617000664
68.
WeeksJ. Systems issues in burnout and safety: Potential integrative health contributions. J Altern Complement Med, 2017; 23(7):497–498; doi: 10.1089/acm.2017.29031.jjw
69.
WeeksJ. The American medical association exposes barriers to integrative health in economic impact paper. Integr Med (Encinitas), 2018; 17(3):30–33.
70.
WeydertJA, BrownML, McClaffertyH. Integrative medicine in pediatrics. Adv Pediatr, 2018; 65(1):19–39; doi: 10.1016/j.yapd.2018.04.011
71.
WhedonJ, TostesonTD, KizhakkeveettilA, et al.Insurance reimbursement for complementary healthcare services. J Altern Complement Med, 2017; 23(4):264–267; doi: 10.1089/acm.2016.0369
72.
ZhangQ, SharanA, EspinosaSA, et al.The path toward integration of traditional and complementary medicine into health systems globally: The world health organization report on the implementation of the 2014-2023 strategy. J Altern Complement Med, 2019; 25(9):869–871; doi: 10.1089/acm.2019.29077.jjw
73.
HowickJ, ChalmersI, GlasziouP, et al.The Oxford 2011 Levels of Evidence. University of Oxford; 2011.
74.
AromatarisE, FernandezR, GodfreyCM, et al.Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach. Int J Evid Based Healthc, 2015; 13(3):132–140; doi: 10.1097/XEB.0000000000000055
75.
MadsenC, VaughanM, KoehlmoosTP. Use of Integrative Medicine in the United States Military Health System. Evidence-Based Complementary and Alternative Medicine, 2017; 2017; doi: 10.1155/2017/9529257
76.
NadareishviliaI, PkhakadzeaG, TskitishviliaA, et al.Georgia’s healthcare system and integration of complementary medicine. Complementary Therapies in Medicine, 2019; 45:205–210; doi: 10.1016/j.ctim.2019.06.016
77.
EeC, TemplemanK, GrantS, et al.Informing the model of care for an academic integrative healthcare centre: A qualitative study exploring healthcare consumer perspectives. BMC Complement Med Ther, 2020; 20(1):58; doi: 10.1186/s12906-019-2801-4
78.
NgJY. The regulation of complementary and alternative medicine professions in Ontario, Canada. Integrative Medicine Research, 2020; 9:12–16; doi: 10.1016/j.imr.2020.01.001
79.
LeachMJ, SteelA. The potential downstream effects of proposed changes in Australian private health insurance policy: The case for naturopathy. Adva Integrative Medi, 2018; 5(2):48–51; doi: 10.1016/j.aimed.2018.04.001
80.
CareJ, SteelA, WardleJ. Stakeholder attitudes to the regulation of traditional and complementary medicine professions: A systematic review. Hum Resour Health, 2021; 19(1):42; doi: 10.1186/s12960-021-00579-y
81.
BradburyJ, AvilaC, GraceS. Practice-based research in complementary medicine: Could N-of-1 trials become the new gold standard? Healthcare (Basel), 2020; 8(1):15; doi: 10.3390/healthcare8010015
82.
HermanPM. Evaluating the economics of complementary and integrative medicine. Glob Adv Health Med, 2013; 2(2):56–63; doi: 10.7453/gahmj.2013.002
83.
JongaMC, BuschM, BaarsEW. Integrative medicine in Dutch curative and long-term healthcare centres: Mapping the field. European Journal of Integrative Medicine, 2019; 28:14–19; doi: 10.1016/j.eujim.2019.04.003
84.
GuedrySE, LangleyBO, SchaeferK, et al.Patient experience of chronic illness care and complementary integrative health use: A cross-sectional study of patients with Hypermobility Spectrum Disorders (HSD) and Ehlers-Danlos syndromes (EDS). Disabil Rehabil, 2023; 45(21):3549–3559; doi: 10.1080/09638288.2022.2131003
85.
KhalilMKM, Al-EidiS, Al-QaedM, et al.The future of integrative health and medicine in Saudi Arabia. Integrative Medicine Research, 2018; 7:316–321; doi: 10.1016/j.imr.2018.06.004
86.
JansenC, BakerJD, KodairaE, et al.Medicine in motion: Opportunities, challenges and data analytics-based solutions for traditional medicine integration into western medical practice. J Ethnopharmacol, 2021; 267:113477; doi: 10.1016/j.jep.2020.113477
87.
RussoR, DienerI, StitcherM. The low risk and high return of integrative health services. Healthc Financ Manage, 2015; 69(11):114–120.
88.
BarrettB, MarchandL, SchederJ, et al.What complementary and alternative medicine practitioners say about health and health care. Ann Fam Med, 2004; 2(3):253–259; doi: 10.1370/afm.81
89.
BabisD. The role of civil society organizations in the institutionalization of indigenous medicine in Bolivia. Soc Sci Med, 2014; 123:287–294; doi: 10.1016/j.socscimed.2014.07.034
90.
SylvainB, BarbaraB, Jean-MichelG, et al.Complementary and alternative medicines in patients with alcohol or tobacco use disorder: Use, expectations and beliefs. Eur J Integr Med, 2022; 51:102115; doi: 10.1016/j.eujim.2022.102115
91.
HuberBM, von Schoen-AngererT, HasselmannO, et al.Swiss paediatrician survey on complementary medicine. Swiss Med Wkly, 2019; 149(23–24):w20091; doi: 10.4414/smw.2019.20091
92.
HeusserP, EberhardS, BergerB, et al.The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: The example of anthroposophic hospitals. BMC Complement Altern Med, 2014; 14(1):191; doi: 10.1186/1472-6882-14-191
93.
LedererAK, SchmuckerC, KousoulasL, et al.Naturopathic treatment and complementary medicine in surgical practice. Dtsch Arztebl Int, 2018; 115(49):815–821; doi: 10.3238/arztebl.2018.0815
94.
CardiniF, GuerzoniG, RuoziC. Experimental models of integrative healthcare in a regional health system: A complex innovation path. Forsch Komplementmed, 2014; 21(2):84–86; doi: 10.1159/000362182
95.
JansenE. The role of complementary and alternative medicine in the healthcare system: A German paradox. Complement Med Res, 2017; 24(5):290–294; doi: 10.1159/000475549
96.
GiuriatoR, PatherN, AshwellK, et al.The role of anatomy education in facilitating multidisciplinary collaboration in the treatment of musculoskeletal conditions—An example from Australia. Int J Morphol, 2016; 34(4):1424–1428; doi: 10.4067/s0717-95022016000400041
97.
ChungV, YipBH, GriffithsSM, et al.Patients’ experience of Chinese medicine primary care services: Implications on improving coordination and continuity of care. Sci Rep, 2015; 5:18853; doi: 10.1038/srep18853
98.
BlockKI, GyllenhaalC, LoweL, et al.Designing a broad-spectrum integrative approach for cancer prevention and treatment. Semin Cancer Biol, 2015; 35(Suppl):S276–S304; doi: 10.1016/j.semcancer.2015.09.007
99.
BarnesL, GraceS. The dietetics and naturopathy professions: Perceptions of role boundaries. Health Sociol Review, 2019; 28(1):85–102; doi: 10.1080/14461242.2018.1539916
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