Integrative Medicine Attitude Questionnaire Research Articles

Inconsistency between physicians' attitudes and behaviors toward TCM: A questionnaire survey in Chengdu.

Although Western Medicine is considered as the mainstream medicine in China, Traditional Chinese Medicine (TCM) still has its own advantages and characteristics. The attitudes and behaviors to TCM are divided, some West Medicine Doctors prefer TCM during treatment, while others consider it not effective. The objective of this study is to find out the attitudes and treatment behaviors of Chengdu physicians toward TCM, and identify factors associated with their attitude and behaviors. A representative sample of 2049 Chengdu physicians were recruited online to investigate their attitudes and behaviors toward TCM. During this research, previous Integrative Medicine Attitude Questionnaire were referred and modified, and adjusted questionnaire was made based on the actual situation of TCM in Chengdu. This questionnaire contains 3 distinct parts. The first part aimed at the attitudes of respondents toward TCM, and contains 15 questions in 3 sections, Holism, Knowledge, and Evidence. The second part tried to determine the behaviors toward TCM in terms of self-use, recommendations, as well as prescriptions. In addition, 6 modalities including Chinese Patent Medicine, Chinese Herbal Medicine, Acupuncture, Massage & Bone Setting, Qigong, and TCM diet were introduced in the behavioral part. In the third part, we aimed to collect personal, professional, and structural factors that may significantly influence TCM attitudes and behaviors. Physicians hold positive attitudes toward TCM in general, all the mean/highest possible subscales scores value of Holism (90.53%), Knowledge (63.77%), and Evidence (62.73%) domain were over 60%. On the other hand, physicians were more positive on self-use (49.40%) and recommendation (55.98%) of TCM than giving TCM prescriptions (36.60%) to patients. The attitudes and behaviors toward may not be consistent, which means physicians may not give prescriptions to patients even they have good attitudes to TCM. Education and self-use of TCM are important positive factors that influence the behaviors of physicians.

Knowledge, perceptions, interest, and use of integrative medicine among U.S. allopathic medical students

Background: Acceptance, interest, and demand for Complementary Integrative Medicine (CIM) has been steadily growing within the US. Yet despite increased use, patient non-disclosure and physician lack of comfort in discussion is common. Medical students (MS) express interest in CIM. Educational exposure affects attitudes, cultural competence, interprofessional education, knowledge, and clinical skills. A few studies include US MS; however, most studies have been done outside the US. Aims: Our study examined first year US allopathic MS knowledge, perception, and attitudes toward IM for patient care, current personal use, and modalities of interest. Methods: The study was conducted on first year MS from 2020-2022 who participated in a 3-hour IM session within the required Essential Principles of Medicine course at a US allopathic medical school. Five questions were disseminated through Poll Everywhere during a lecture given by an IM board certified physician and students were invited to respond. Questions assessed student definition of IM, perception of patient barriers in discussing IM, perception of physician barriers in discussing IM, personal use, and modalities of interest. Results: MS attitude toward IM was generally positive based on word choice. MS perception of patient barriers in discussing IM focused on emotional factors rather than knowledge and understanding, whereas medical student perception of physician barriers revolved around lack of familiarity, knowledge, and training. Students self-reported physical activity and sleep as the top ranked favorite stress-reducing self-care practice followed by cooking/eating, music, and yoga. Students were most interested in exploring pet therapy, Traditional Chinese Medicine (TCM) and yoga. Conclusions: Further study with the integrative medicine attitude questionnaire (IMAQ) is recommended to determine whether results are generalizable. Integrating IM education and experience into the conventional medical curriculum is of interest to allopathic US MS and may prepare students for optimizing future patient care as well as clinician wellness.

Attitude of Medical Students and Doctors towards Complementary, Alternative and Integrative Medicine: A Single-Center, Questionnaire-Based Study.

ObjectivesOur study aimed to determine the attitudes of second- and final-year medical students and doctors (teaching faculty) of modern medicine towards complementary and alternative medicine (CAM) using the Complementary, Alternative, and Integrative Medicine Attitude Questionnaire (CAIMAQ).MethodsWe invited 248 second-year medical students, 245 final-year medical students, and 48 faculty members to participate in the study. The CAIMAQ consists of 30 items, divided into five categories assessing various aspects of CAM, and scored using a 7-point Likert scale. The median scores obtained were compared between groups; a p-value < 0.05 was considered statistically significant.ResultsA total of 138 medical students and faculty responded and participated in the study, of which, 24 (17.4%) were faculty, 40 (29%) were final-year medical students and 74 (53.6%) were second-year medical students. The overall attitude towards the various CAM concepts and therapies was positive. In general, the faculty were significantly less likely to consider referring patients for CAIM treatments, integrating them with conventional medicine, referring patients to alternative healthcare providers, considering the use of subtle energy fields as an ethical form of treatment, or considering CAIM treatments to be less invasive and harmful compared with conventional medicine. There was no significant difference in the attitudes of second- and final-year students.ConclusionThe attitude of medical students and doctors towards CAM is positive, and although the medical faculty have reservations in recommending specific types of CAM therapies or integrating them with conventional care, building evidence for supporting CAM therapies in specific diseases is likely to increase its uptake among health care professionals.

Validity evidence for a novel instrument assessing medical student attitudes toward instruction in implicit bias recognition and management

BackgroundImplicit bias instruction is becoming more prevalent in health professions education, with calls for skills-based curricula moving from awareness and recognition to management of implicit bias. Evidence suggests that health professionals and students learning about implicit bias (“learners”) have varying attitudes about instruction in implicit bias, including the concept of implicit bias itself. Assessing learner attitudes could inform curriculum development and enable instructional designs that optimize learner engagement. To date, there are no instruments with evidence for construct validity that assess learner attitudes about implicit bias instruction and its relevance to clinical care.MethodsThe authors developed a novel instrument, the Attitude Towards Implicit Bias Instrument (ATIBI) and gathered evidence for three types of construct validity- content, internal consistency, and relationship to other variables.ResultsAuthors utilized a modified Delphi technique with an interprofessional team of experts, as well as cognitive interviews with medical students leading to item refinement to improve content validity. Seven cohorts of medical students, N = 1072 completed the ATIBI. Psychometric analysis demonstrated high internal consistency (α = 0.90). Exploratory factor analysis resulted in five factors. Analysis of a subset of 100 medical students demonstrated a moderate correlation with similar instruments, the Integrative Medicine Attitude Questionnaire (r = 0.63, 95% CI: [0.59, 0.66]) and the Internal Motivation to Respond Without Prejudice Scale (r = 0.36, 95% CI: [0.32, 0.40]), providing evidence for convergent validity. Scores on our instrument had low correlation to the External Motivation to Respond Without Prejudice Scale (r = 0.15, 95% CI: [0.09, 0.19]) and the Groningen Reflection Ability Scale (r = 0.12, 95% CI: [0.06, 0.17]) providing evidence for discriminant validity. Analysis resulted in eighteen items in the final instrument; it is easy to administer, both on paper form and online.ConclusionThe Attitudes Toward Implicit Bias Instrument is a novel instrument that produces reliable and valid scores and may be used to measure medical student attitudes related to implicit bias recognition and management, including attitudes toward acceptance of bias in oneself, implicit bias instruction, and its relevance to clinical care.

Integrative and complementary practices: interest of the academic community and challenges of medical education

Abstract: Introduction: Traditional Complementary and Alternative Medicine (TCAM) encompass therapeutic resources of complex medical systems from different medical rationalities. This field of practice has gained greater visibility in recent times, with the increase in demand for health care that prioritizes a more comprehensive approach of human beings, encouraging the health professionals themselves to seek better training. Objective: To evaluate the interest, the degree of knowledge and the attitude of students and teachers of the medical course towards the TCAM and the challenges for their effective teaching. Method: This is a cross-sectional, descriptive study with a quantitative approach, which was carried out with 214 individuals, 21 of which were teachers and 193 students attending the first to the twelfth semesters of the medical course at a health education institution in Recife-PE. An online survey was used to assess the study participants regarding their learning sources and the level of interest on this topic, as well as the Portuguese version of the Integrative Medicine Attitude Questionnaire (IMAQ). The data were submitted to descriptive statistical analysis (frequency and percentage), using software R, version 3.4.3. and LibreOffice. Result: Among the study participants, 57.14% of teachers and 35.42% of students were aware of the Nacional TCAM Policy (PNPIC, Política Nacional de Práticas Integrativas e Complementares), 85.71% of the teachers and 91.7% of students considered TCAM to be crucial for Brazilian Unified Health System (SUS). Most considered the teaching of TCAM an important subject for the undergraduate medical course (90.48% of teachers and 89.58% of students). The best known practices were yoga, phytotherapy and TCM/acupuncture and there was greater interest to learn yoga and TCM/acupuncture. Conclusion: A large number of students and teachers have never had contact with TCAM. However, most are willing to recommend them to patients and family members and are willing to learn about the topic. Thus, it is recommended that more studies be performed on this topic and that it can corroborate for their inclusion in health courses’ curriculum.

Integrative and complementary practices: interest of the academic community and challenges of medical education

Abstract: Introduction: Traditional Complementary and Alternative Medicine (TCAM) encompass therapeutic resources of complex medical systems from different medical rationalities. This field of practice has gained greater visibility in recent times, with the increase in demand for health care that prioritizes a more comprehensive approach of human beings, encouraging the health professionals themselves to seek better training. Objective: To evaluate the interest, the degree of knowledge and the attitude of students and teachers of the medical course towards the TCAM and the challenges for their effective teaching. Method: This is a cross-sectional, descriptive study with a quantitative approach, which was carried out with 214 individuals, 21 of which were teachers and 193 students attending the first to the twelfth semesters of the medical course at a health education institution in Recife-PE. An online survey was used to assess the study participants regarding their learning sources and the level of interest on this topic, as well as the Portuguese version of the Integrative Medicine Attitude Questionnaire (IMAQ). The data were submitted to descriptive statistical analysis (frequency and percentage), using software R, version 3.4.3. and LibreOffice. Result: Among the study participants, 57.14% of teachers and 35.42% of students were aware of the Nacional TCAM Policy (PNPIC, Política Nacional de Práticas Integrativas e Complementares), 85.71% of the teachers and 91.7% of students considered TCAM to be crucial for Brazilian Unified Health System (SUS). Most considered the teaching of TCAM an important subject for the undergraduate medical course (90.48% of teachers and 89.58% of students). The best known practices were yoga, phytotherapy and TCM/acupuncture and there was greater interest to learn yoga and TCM/acupuncture. Conclusion: A large number of students and teachers have never had contact with TCAM. However, most are willing to recommend them to patients and family members and are willing to learn about the topic. Thus, it is recommended that more studies be performed on this topic and that it can corroborate for their inclusion in health courses’ curriculum.

Dispositional Humility Of Clinicians In An Interprofessional Primary Care Environment: A Mixed Methods Study.

ObjectivesDispositional humility in professionals is a character trait that allows one to monitor self-centered occupational drive and to pay attention to the needs of other professionals. The aim of this study is to test whether or not clinicians working in interprofessional team care environments identify the character trait of humility as an important factor for successful collaborative relationships. This study aimed to revise a concept map of dispositional humility created through literature review.DesignAn explanatory sequential mixed-methods study was composed of the HEXACO personality test and the Integrative Medicine Attitude Questionnaire, followed by summative and directed content analyses of one-on-one interview data in order to identify the element of dispositional humility.SettingIn the State of Washington, USA, where physicians (MD/DO), nurse practitioners (NP) and naturopathic clinicians (ND) serve Medicaid patients in community clinics.Participants6 MDs, 4 NPs, and 11 NDs.ResultsTwenty-one primary care clinicians were enrolled. Fifteen clinicians completed the interview. It was observed that the: 1) honesty-humility trait (p<0.01), conscientiousness (&p<0.01), and openness to experience (p<0.05) domains of primary care clinicians were statistically significantly higher than the reference standards; 2) attitudes toward integrative medicine did not differentiate the different clinician types; and 3) qualitative data supported the component of dispositional humility as a desirable trait in professionals with whom they would like to work.ConclusionTo maintain high-quality patient care while working as a team, limiting self-interest while focusing on the needs of others may be necessary and in the best interest of patients. An attitude of accepting the principles of integrative medicine has permeated this sample of primary healthcare workers. Both quantitative and qualitative analyses revealed that humility was viewed as an important character trait for successful interprofessional collaboration. A revised concept map of dispositional humility to enhance collaborative relationships was created.

The I-ONE trial: Integrative oncology education for patient navigators—A randomized pilot trial of web-based distance learning with or without small group retreat.

171 Background: One of the major barriers to implementation of an integrative oncology (IO) approach is appropriately trained providers. This trial investigated the effectiveness of a mixed method educational program versus web based learning only for oncology patient navigators relative to knowledge and application of IO modalities. Methods: Patient navigators were randomized 1:1 to Web based education only (WEB) vs. WEB plus residential retreat (WEB+R). The trial was conducted as a randomized, two-group, pre-test/post-test design with 4 repeated measures. The primary study outcomes were knowledge and attitudinal beliefs about the perceived efficacy of IO approaches, as well as clinical and personal practices related to IO. Results: 24 patient navigators from varied educational backgrounds and practice settings were randomized to WEB vs. WEB+R. Referrals to complementary therapies increased by 104% immediately after training (p = .013) and by 77.4% 30 days out. (p = .013). There was a statistically significant increase in attitudinal beliefs about the perceived efficacy of IO approaches as measured by the Integrative Medicine Attitude Questionnaire (IMAQ) from baseline to posttest (p = .013). There were no significantly different values between randomized groups in any of the areas surveyed, however internal group pre and post test comparisons had multiple statistically significant improvements in the WEB + R group while there were no such changes in the WEB group, suggesting a trend toward increased educational efficacy for WEB + R that was likely the major driver of entire group educational improvements. Conclusions: Both Web based and Web based plus small group retreat programs were found to be effective in increasing clinical application and attitudinal beliefs about IO in patient navigators. There was a trend toward improved educational efficacy with WEB +R likely related to shared group and personal experience. As IO approaches become part of standard of care, mixed method online plus small group retreat programs would be useful for widespread dissemination of medical knowledge and increased clinical application of IO approaches.

Attitudes of medical students toward the practice and teaching of integrative medicine

The General Medical Council encourages the integration of complementary and alternative medicine (CAM) teaching into basic medical education. We wished to explore the attitudes of medical students to CAM and its inclusion in their undergraduate curriculum. Medical students were invited to complete the validated Integrative Medicine Attitude Questionnaire (IMAQ) and to state whether they considered it appropriate for them to learn about CAM in medical school. The questionnaire was completed by 308 students (65.8% response rate). CAM had been received by a majority of respondents and their families. Participants believed that doctors with knowledge of CAM provide better patient care and that it is desirable for physicians to exploit the placebo effect. Most students expressed the view that doctors should be able to answer patients' questions about herbal medicines. There was a belief that patients should be warned to avoid using supplements which have not undergone rigorous testing. Students who were current or previous users of CAM or whose family members used CAM had higher total IMAQ scores and openness subscale scores than those who did not report use of CAM. Two-hundred and nine (68%) students expressed a desire to study CAM as part of their medical curriculum. This study reveals a positive attitude towards a holistic approach to patient care which embraces CAM. Medical students believe that integrative medicine should be taught in medical school.

Attitudes/beliefs towards CAM among Croatian healthcare professionals

Purpose: Croatian healthcare system has seen an ever increasing number of patients seeking opinion and advice on complementary and alternative treatment options. For years only some of the traditional treatments had been practiced in local communities though, but on the verge of law and mostly in rural areas. Post-socialist settings and transition processes have facilitated and strengthened the pluralism of the healthcare system. However, despite recommendations of the European Commission (EC, 1997) and WHO, Croatia has insofar failed to regulate CAM by law. This study brings the results of the attitudes and believes of healthcare professionals: physicians, nurses/paramedics and physiotherapists towards CAM. Methods: The study was carried out on a sample of 325 healthcare professionals affiliated with either private or public healthcare facilities divided into three groups based on their professional and educational background, gender, the number of years in service and their responses to IMAQ (Integrative Medicine Attitude Questionnaire) items. Results: Our study proved the existence of differences in CAM-related attitudes expressed by physicians as opposed to nurses and physiotherapists (F=7.853921 ; p=0.000) ; however, differences in attitudes expressed by nurses and physiotherapists failed to be found (=1.531 ; p=1.000). This study failed to reveal any gender-based (T=-1.411 ; p=0.159), education al background-based (F=2.372303 ; p=0.095) and years-in-servicebased (F=0.833 ; p=0.436) differences in CAM-related attitudes expressed by healthcare providers under study. The most striking differences in attitudes were found to arise on the grounds of various professional backgrounds of healthcare providers comprised by the study. Significant differences in CAM-related attitudes were proven to exist between physicians and nurses/physiotherapists (F=7.853921, p=0.000), but not between nurses and physiotherapists (=1.531, p=1.000). Conclusion: Physicians are far less prone to support alternative and spiritual treatment practices than nurses/paramedics and physiotherapists. The reason should probably be sought in the traditional formal education and curricula of academic institutions educating Croatian healthcare professionals with the lack of formal CAM education.

Differences in attitudes towards/beliefs on complementary and alternative medicine witnessed between physiotherapists, nurses/paramedics and physicians

Background: The change in social order that took place in Croatia in the 1990s made medical pluralism in terms of coexistence of various treatment options apparent. In spite of the European Commission and WHO recommendations, complementary and alternative medicine (CAM) failed to be regulated by the law, even upon EU accession. Materials and Methods: This study aimed at investigating the attitudes of healthcare professionals towards CAM, as well as possible differences in attitudes expressed by physicians, nurses/paramedics and physiotherapists and comprised a total of 325 healthcare professionals affiliated with either private or public healthcare facilities and belonging to one of the three major categories of healthcare providers under study. The study was carried out throughout 2011 2012, and made use of IMAQ (Integrative Medicine Attitude Questionnaire). Results: A total score seen in the physicians’ arm was statistically lower (M 91.76) when compared to that obtained in the nurses/paramedics’ (M 97.28) and the physiotherapists’ arm (M 97.27). Significant differences in CAM-related attitudes were proven to exist between physicians and nurses/physiotherapists (F=7.853921, p=0.000), but not between nurses and physiotherapists (δ=1.531, p=1.000). These differences boil down to higher criticism expressed by physicians as regards CAM efficiency, especially the therapeutic value of spiritual & intuitive curing methods and osteopathic & laying-on-hands treatments, while significant differences in attitudes towards acupuncture, chiropractic and massage failed to be found. Differences in healthcare professionals’ attitudes arising on the grounds of gender (T=-1.411, p=0.159), educational background (F=2.372303, p=0.095) and the number of years in service (F=0.833, p=0.436), failed to be seen as well. Conclusion: Despite the fairly high IMAQ score obtained in the study sample that speaks in favour of a positive rather than neutral CAM-related attitude of healthcare providers under study, the very structure of the IMAQ tool prevents us from the unbiased conclusion that Croatian healthcare providers support CAM. Physicians are far less prone to support alternative and spiritual treatment practices than nurses/paramedics and physiotherapists.

Differences In Attitudes Towards/Beliefs On Complementary And Alternative Medicine Witnessed Between Physiotherapists, Nurses/Paramedics And Physicians

Background: The change in social order that took place in Croatia in the 1990s made medical pluralism - in terms of coexistence of various treatment options apparent. In spite of the European Commission and WHO recommendations, complementary and alternative medicine (CAM) failed to be regulated by the law, even upon EU accession. Materials and Methods: This study aimed at investigating the attitudes of healthcare professionals towards CAM, as well as possible differences in attitudes expressed by physicians, nurses/paramedics and physiotherapists and comprised a total of 325 healthcare professionals affiliated with either private or public healthcare facilities and belonging to one of the three major categories of healthcare providers under study. The study was carried out throughout 2011 - 2012, and made use of IMAQ (Integrative Medicine Attitude Questionnaire). Results: A total score seen in the physicians’ arm was statistically lower (M 91.76) when compared to that obtained in the nurses/paramedics’ (M 97.28) and the physiotherapists’ arm (M 97.27). Significant differences in CAM-related attitudes were proven to exist between physicians and nurses/physiotherapists (F=7.853921, p=0.000), but not between nurses and physiotherapists (δ=1.531, p=1.000). These differences boil down to higher criticism expressed by physicians as regards CAM efficiency, especially the therapeutic value of spiritual & intuitive curing methods and osteopathic & laying-on-hands treatments, while significant differences in attitudes towards acupuncture, chiropractic and massage failed to be found. Differences in healthcare professionals’ attitudes arising on the grounds of gender (T=-1.411, p=0.159), educational background (F=2.372303, p=0.095) and the number of years in service (F=0.833, p=0.436), failed to be seen as well. Conclusion: Despite the fairly high IMAQ score obtained in the study sample that speaks in favour of a positive rather than neutral CAM-related attitude of healthcare providers under study, the very structure of the IMAQ tool prevents us from the unbiased conclusion that Croatian healthcare providers support CAM. Physicians are far less prone to support alternative and spiritual treatment practices than nurses/paramedics and physiotherapists.

DIFFERENCES IN ATTITUDES TOWARDS/BELIEFS ON COMPLEMENTARY AND ALTERNATIVE MEDICINE WITNESSED BETWEEN PHYSIOTHERAPISTS, NURSES/PARAMEDICS AND PHYSICIANS

Background: The change in social order that took place in Croatia in the 1990s made medical pluralism - in terms of coexistence of various treatment options apparent. In spite of the European Commission and WHO recommendations, complementary and alternative medicine (CAM) failed to be regulated by the law, even upon EU accession.&#x0D; Materials and Methods: This study aimed at investigating the attitudes of healthcare professionals towards CAM, as well as possible differences in attitudes expressed by physicians, nurses/paramedics and physiotherapists and comprised a total of 325 healthcare professionals affiliated with either private or public healthcare facilities and belonging to one of the three major categories of healthcare providers under study. The study was carried out throughout 2011 - 2012, and made use of IMAQ (Integrative Medicine Attitude Questionnaire).&#x0D; Results: A total score seen in the physicians’ arm was statistically lower (M 91.76) when compared to that obtained in the nurses/paramedics’ (M 97.28) and the physiotherapists’ arm (M 97.27). Significant differences in CAM-related attitudes were proven to exist between physicians and nurses/physiotherapists (F=7.853921, p=0.000), but not between nurses and physiotherapists (δ=1.531, p=1.000). These differences boil down to higher criticism expressed by physicians as regards CAM efficiency, especially the therapeutic value of spiritual &amp; intuitive curing methods and osteopathic &amp; laying-on-hands treatments, while significant differences in attitudes towards acupuncture, chiropractic and massage failed to be found. Differences in healthcare professionals’ attitudes arising on the grounds of gender (T=-1.411, p=0.159), educational background (F=2.372303, p=0.095) and the number of years in service (F=0.833, p=0.436), failed to be seen as well. &#x0D; Conclusion: Despite the fairly high IMAQ score obtained in the study sample that speaks in favour of a positive rather than neutral CAM-related attitude of healthcare providers under study, the very structure of the IMAQ tool prevents us from the unbiased conclusion that Croatian healthcare providers support CAM. Physicians are far less prone to support alternative and spiritual treatment practices than nurses/paramedics and physiotherapists.

Primary Care Providers’ Attitudes and Beliefs About Patients’ Complementary and Alternative Medicine Use for Asthma Self-Management

Background: Asthma is a major cause of health resource utilization, poor quality of life and disability. However, adherence to asthma treatments remains relatively poor, partially because patients often prefer to use complementary and alternative medicine (CAM) instead of conventional therapies. Moreover, individuals with asthma are reluctant to disclose CAM use with their providers. It was suggested that providers’ negative attitude towards CAM is one barrier to creating an open dialogue. Purpose: The aim of this exploratory study was to identify primary care providers’ attitudes and beliefs about their asthma patients’ CAM use. Methods: Providers who referred patients into a research study about asthma self-management, including CAM, completed three surveys: the revised Integrative Medicine Attitude Questionnaire (r-IMAQ) ; the 10-item CAM Health Belief Questionnaire (CHBQ); and the 30-item Morehouse College Survey of CAM Practices (MCSCAMP). Results: Of the 21 referring providers, 14 physicians and 2 nurse practitioners were enrolled. Seven were male (44%); 13 White (81%), 2 Asian (13%), 1 Black (6%); mean age was 45.7. All providers endorsed the majority of r-IMAQ items and an additional CHBQ item. The MCSCAMP found fitness and nutritional approaches to be the most common health practice (94%), followed by counseling (56%), and prayer/spiritual healing (50%). Conclusions: The results of this exploratory study suggest that providers have positive opinions about CAM, uniformly endorsing items related to spirituality, the importance of patient-provider partnerships and patients’ beliefs. However, there was relatively low personal use of CAM by providers.

Use of and attitudes toward complementary and alternative medicine among osteopathic medical students.

Complementary and alternative medicine (CAM) has grown into a huge health care industry in the United States, with 91.5 million people (38% of adults) using CAM in 2007. Given the increase in CAM use and the need for CAM education for health professionals, it is important to understand the baseline attitudes and beliefs of osteopathic medical students regarding CAM, as well as the factors that may have formed them. (1) To determine osteopathic medical students' use of different CAM modalities. (2) To assess osteopathic medical students' attitudes toward CAM using a previously validated instrument. A previously validated, 29-item Integrative Medicine Attitude Questionnaire and a 10-item CAM Health Belief Questionnaire were administered to osteopathic medical students. Demographic and other data were collected on student use of and recommendations for CAM modalities as well as student awareness and use of primary CAM information resources. Survey respondents were 635 osteopathic medical students from 7 osteopathic medical schools and additional locations in the United States. Osteopathic medical students demonstrated positive attitudes toward CAM use. A total of 527 osteopathic medical students (83.0%) self-reported the use of at least 1 CAM modality, whereas 69 students (10.9%) used just 1 CAM modality and 458 (72.1%) used 2 or more modalities. The most commonly used CAM modalities--meditation/yoga/relaxation/imagery, massage, and spirituality/prayer--were also most likely to be suggested to patients by osteopathic medical students. Sex, age, and the use of CAM modalities were significantly correlated with attitudes toward CAM modalities. Osteopathic medical students had a positive attitude toward CAM and had high levels of self-reported CAM knowledge and use. Osteopathic medical students who acquire professional training and have personal experience with CAM may be in a better position to discuss CAM with future patients.

Emotionless holism: Factor and rasch analysis of the Chinese Integrative Medicine Attitude Questionnaire

To examine the Eastern-Western difference in the interpretation of Integrative Medicine Attitude Questionnaire (IMAQ) by assessing the psychometric properties of a revised Chinese medicine (CM)-specific version of IMAQ (CM-IMAQ). Factor and Rasch analysis were performed with data collected from a mail survey of 165 Hong Kong Western medical doctors (WMD) randomly sampled from the official registry. The structural validity, unidimensionality, item fit, and differential item functioning (DIF) of the Hong Kong CM-IMAQ were evaluated. Confirmatory factor analysis (CFA) demonstrated that the original IMAQ factor structure was not concordant with our data on Chinese WMD, and subsequent explanatory factor analysis (EFA) validated a new three-factor model for CM-IMAQ: (1) attitude towards "tonification", (2) attitude towards the effectiveness of CM, and (3) attitude towards CM knowledge. The original IMAQ factor on holism and doctor-patient relationship disappeared. Rasch analysis confirmed the unidimensionality of "tonification" and the effectiveness domains, but further refinement of the knowledge domain is needed. Cultural adaptation of the IMAQ has demonstrated differences between Eastern and Western doctors trained in allopathic medicine in their interpretations of holism in healthcare. For Chinese WMD, the emphasis of holistic care is placed on "tonifying" the body rather than on nurturing the mind and spirit. Confucian and Taoist conceptualizations of mental health as well as the persistent stigma towards mental illness within modern Chinese culture may explain why Chinese WMD do not regard mental health promotion as part of routine healthcare.

P04.03. Primary care providers’ attitudes and beliefs about, and personal use of, complementary and alternative medicine (CAM)

Methods PCPs who referred patients into a research study about asthma self-management, including CAM, completed three surveys. The modified Integrative Medicine Attitude Questionnaire (m-IMAQ) is a 23-item survey that solicits beliefs about CAM and its role in treatment. The 10-item CAM Health Belief Questionnaire (CHBQ) asks about CAM attitudes and beliefs not included in the m-IMAQ. Lastly, the 30-item Morehouse College Survey of CAM Practices (MCSCAMP) characterizes PCPs personal CAM use. All subjects received a $100 gift card for participation.

Validation of the Korean Integrative Medicine Attitude Questionnaire (IMAQ)

BackgroundTo develop a Korean version of the Integrative Medicine Attitude Questionnaire (IMAQ) in order to evaluate physician attitudes toward integrative medicine/complementary and alternative medicine (CAM).MethodsWe developed a Korean IMAQ through careful translation of the 28-item questionnaire developed by Schmidt et al. A web-based survey was sent via email to 118 primary care physicians in Korea. The complete respose rate wasa 52.5%. The questionnaire's reliability and validity were verified using Cronbach's α, factor analysis, and discriminant analysis.ResultsAlthough the Korean IMAQ exhibited excellent internal consistency, its validity was insufficient. Our results suggest that Western and Korean physicians may have different understandings of CAM and the concept of holism, as factor analysis showed that incorrectly classified items were mainly part of the holism conceptual domain. Furthermore, the sum of the items within the holism conceptual domain was not significantly different for physicians who had previously received CAM education.ConclusionThis study developed and tested the first Korean IMAQ. We found that this version of the questionnaire lacks sufficient validity and requires further modification.

Medical students’ attitudes to complementary and alternative medicine: Further validation of the IMAQ and findings from an international longitudinal study

Background: Current research mainly employs cross-sectional designs to examine changes in medical students’ attitudes towards complementary and alternative medicine (CAM).Aims: This paper reports the findings of a longitudinal study to further validate the Integrative Medicine Attitude Questionnaire (IMAQ) and examine changes in medical students’ attitudes over 3 years.Methods: A total of 154 medical students from four schools in three countries completed a modified version of the IMAQ during their first (T1) and fourth year (T2).Results: We established the validity of a three-factor model for the IMAQ: (1) attitudes towards holism; (2) attitudes towards the effectiveness of CAM therapies, and (3) attitudes towards introspection and the doctor–patient relationship. We found that IMAQ factor scores did not differ significantly from T1 to T2, emphasizing the relative stability in attitudes across time. Various student characteristics were significantly associated with IMAQ factor scores at T2: age, gender, CAM use, CAM education and school; and two variables (gender and CAM use) predicted changes in medical students’ attitudes between T1 and T2.Conclusions: We urge medical educators to continue exploring medical students’ attitude changes towards CAM and we provide examples of what further research is needed.

Content Validity of the Integrative Medicine Attitude Questionnaire: Perspectives of a Hong Kong Chinese Expert Panel

Although the Integrative Medicine Attitude Questionnaire (IMAQ) is a validated instrument developed in the United States for measuring allopathic physicians' attitudes toward complementary and alternative medicine, little is known about attitudes among western-trained doctors in other societies, particularly in the Far East. In Hong Kong, cultural and historical forces have created a unique environment for integration. Thus, consideration of such forces suggests that direct use of the original IMAQ for assessing attitudes of allopathic physicians' views on Traditional Chinese Medicine (TCM) in Hong Kong would be inappropriate. This hypothesis was tested using content validity judgment and local experts' opinions, to assess the three domains of IMAQ: "holism," "introspection and doctor-patient relationship," and "effectiveness of integrative treatment." Standard content validity establishment methodologies were followed. An 8-member panel (4 with TCM and 4 with allopathic medicine backgrounds) was convened to assess the content validity of a modified Hong Kong TCM specific IMAQ. Experts were provided with explicit instructions on how to evaluate the content validity of individual items, and the instrument as a whole, both quantitatively and qualitatively. Of 28 items, 12 items of the modified IMAQ were content validity adequate (Content Validity Index (CVI) > 0.70 and kappa > 0.4). Seven items were considered content invalid and removed. The overall CVI and kappa of the instrument were 0.71 and 0.09, respectively, indicating the need to modify 9 marginally valid items that remained in the questionnaire. Qualitative expert comments were used for the revision. The process of validation showed that it would be inappropriate for the U.S.-derived IMAQ to be used without modification in Hong Kong. Most of the content valid items were in the "effectiveness of integrative treatment" domain, which reflected the influence of the evidence-based TCM movement on the experts' judgment.