Abstract
BackgroundNon-pharmacological therapies and practices are commonly used for both health maintenance and management of chronic disease. Patterns and reasons for use of health practices may identify clinically meaningful subgroups of users. The objectives of this study were to identify classes of self-reported use of conventional and complementary non-pharmacological health practices using latent class analysis and estimate associations of participant characteristics with class membership.MethodsA mailed survey (October 2015 to September 2016) of Minnesota National Guard Veterans from a longitudinal cohort (n = 1850) assessed current pain, self-reported overall health, mental health, substance use, personality traits, and health practice use. We developed the Health Practices Inventory, a self-report instrument assessing use of 19 common conventional and complementary non-pharmacological health-related practices. Latent class analysis was used to identify subgroups of health practice users, based on responses to the HPI. Participants were assigned to their maximum-likelihood class, which was used as the outcome in multinomial logistic regression to examine associations of participant characteristics with latent class membership.ResultsHalf of the sample used non-pharmacological health practices. Six classes of users were identified. “Low use” (50%) had low rates of health practice use. “Exercise” (23%) had high exercise use. “Psychotherapy” (6%) had high use of psychotherapy and support groups. “Manual therapies” (12%) had high use of chiropractic, physical therapy, and massage. “Mindfulness” (5%) had high use of mindfulness and relaxation practice. “Multimodal” (4%) had high use of most practices. Use of manual therapies (chiropractic, acupuncture, physical therapy, massage) was associated with chronic pain and female sex. Characteristics that predict use patterns varied by class. Use of self-directed practices (e.g., aerobic exercise, yoga) was associated with the personality trait of absorption (openness to experience). Use of psychotherapy was associated with higher rates of psychological distress.ConclusionsThese observed patterns of use of non-pharmacological health practices show that functionally similar practices are being used together and suggest a meaningful classification of health practices based on self-directed/active and practitioner-delivered. Notably, there is considerable overlap in users of complementary and conventional practices.
Highlights
Non-pharmacological therapies and practices are commonly used for both health maintenance and management of chronic disease
Development of Health Practices Inventory We developed the Health Practices Inventory (HPI) to facilitate valid self-report assessment of non-pharmacological therapies and health-related practices, including complementary and conventional approaches
An initial list of 28 therapies and practices with brief definitions was developed after review of the National Health Interview Survey Complementary and Alternative Medicine (CAM) supplement, questionnaires used by prior studies, and chronic pain management guidelines
Summary
Non-pharmacological therapies and practices are commonly used for both health maintenance and management of chronic disease. The objectives of this study were to identify classes of self-reported use of conventional and complementary non-pharmacological health practices using latent class analysis and estimate associations of participant characteristics with class membership. Non-pharmacological therapies and self-management practices include approaches considered “conventional,” such as exercise and manual physical therapy, and those considered “complementary,” such as yoga and chiropractic manipulation. These health practices are commonly used by American adults [1, 2] and are recommended for prevention and management of a wide variety of illnesses, including, for example, hypertension [3], chronic musculoskeletal pain [4,5,6] and depression [7]. Understanding factors associated with these patterns could help tailor care for patients and increase uptake of evidence-based practices
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