Objective
The objective of the study was to evaluate the use and attitudes of nurse-midwives in Israel toward complementary and alternative medicine (CAM).
Study Design
In a cross-sectional study, nurse-midwives from 5 Israeli medical centers completed the CAM Health Belief Questionnaire, a validated tool examining data regarding personal health behavior, use of CAM therapies, and attitudes toward CAM.
Results
One hundred seventy-three of 238 potential respondents completed the questionnaires (72.7%). Most (87.3%) reported using CAM (67.1% massage, 48.6% herbal medicine, 42.2% meditation, 40.5% touch therapies, and 39.9% prayer) and agree with many fundamental tenets of CAM such as the existence of energy forces, self-healing, and integrating patients’ health beliefs and values into their care.
Conclusion
The majority of nurse-midwives studied reported using and recommending CAM to their patients and believe that CAM can complement conventional medical therapies. Health care providers could benefit from education with regard to the efficacy and safety of CAM modalities during pregnancy and childbirth.
The use of complementary and alternative medicine (CAM) has risen significantly over the years for most CAM modalities. These treatments are a group of diverse medical and health care systems, practices, and products that are not generally considered an integral part of conventional medicine. It is thought that patients are turning to CAM treatments because they are more congruent with their values and health beliefs and because they seek control over illness.
Women use CAM significantly more often than men, especially during their reproductive years. Attitudes of physicians toward CAM are often negative, which is thought to be a major reason why 60% of patients using CAM do not report this use to their physicians. As many as 30% of obstetric patients self-administer remedies or consult independent therapists without informing their midwives or doctors, in the belief that, because they are natural, CAM treatments are also safe.
The use of CAM by child-bearing women has been investigated as well. Pettigrew et al found that nearly 70% of women waiting to be seen by either a nurse-midwife or obstetrician-gynecologist had used at least 1 CAM treatment during the previous year. Allaire et al observed that the most common CAM treatments used by pregnant women are herbal medicine, massage therapy, chiropractic, mind-body interventions (hypnosis, biofeedback, and relaxation techniques), and acupuncture.
Nurse-midwives, who play an important role in the health of their patients during pregnancy, were found to be avid supporters of CAM. As many as 93.9% of US nurse-midwives recommend CAM treatments to their pregnant patients, and 89% were found to have referred patients to CAM providers. McFarlin et al found that more than half use herbal preparations to stimulate labor. CAM modalities such as touch, massage, and stress management are similar to common nursing interventions, and both CAM and nursing incorporate holistic principles. Nurses generally integrate diverse therapies into the plan of care, and Adams found that CAM provides patients with an increased sense of autonomy, enabling them to move beyond the control of the doctor and promoting empowerment.
In many countries health care providers, patients, and the general population are reluctant to use CAM treatments. In Israel a study conducted in 2000 among the general population found relatively low rates of reported use of CAM, increasing from 6% in 1993 to 10% in 2000. Israeli nurse-midwives are registered nurses, most with a bachelor’s degree in nursing science who have undergone training and certification in midwifery. Although their training does include the full spectrum of pre-, intra-, and postpartum care, these midwives are employed by hospitals to work exclusively in the delivery ward, in which they are the primary care-givers.
In recent years, nurse-midwives in Israel have been exposed to courses in the efficacy and safety of CAM treatments in their initial and ongoing training, although the effects of this training have not been studied sufficiently. The purpose of this study was to evaluate the use and attitudes of nurse-midwives in Israel toward CAM treatments.
Materials and Methods
Study population
Participants were hospital nurse-midwives from 5 large medical centers in Israel, 3 in Jerusalem and two in the central/Tel Aviv area of the country. A total of 238 nurse-midwives were listed as being on staff during the study period (2008) and were employed at the time in the labor and delivery wards of their respective hospitals, where they manage the intrapartum care of their pregnant patients.
Ethical considerations
Participation in the study was voluntary, and no identifying or sensitive information was collected. Institutional ethical requirements for all participating hospitals were met by providing a statement at the front of the questionnaire regarding the purpose of the study and what the data will be used for as well as the voluntary and anonymous nature of the study. In accordance with ethical requirements to maintain respondent anonymity, signed consent forms (which necessitate revealing the identity of the participant) were not used. Respondents were not offered any incentive for study participation.
Measure: CAM Health Belief Questionnaire (CHBQ)
The CHBQ was developed by Lie and Boker and was originally evaluated among medical students and later with pharmacy students. The questionnaire is comprised of 3 sections, the first regarding demographic data such as years of education, training, and work experience as well as questions regarding personal health behavior (routine medical examinations, exercise, and smoking habits).
The second section is the CAM Needs Assessment, evaluating 14 CAM treatment modalities based on the categories of CAM treatments as listed by the National Institutes of Health National Center for Complementary and Alternative Medicine, which consists of at least 40 items. Personal use of CAM is examined as well as whether the respondent has or would consider recommending each of the therapies listed.
In the third and final section, 10 items examine respondents’ attitudes toward CAM, using a 7 point, Likert-type rating scale (in which 1 means “absolutely disagree” and 7 means “absolutely agree”). Items 6, 7, and 8 are worded negatively to minimize the acquiescence response set, requiring that the scores of these questions be reversed prior to data analysis.
The CHBQ was developed for use among all health professionals. It is a concise and easy-to-use measure. The internal consistency of the measure (using a Cronbach’s alpha) was found to be 0.75. In the current study, Cronbach’s alpha was found to be 0.81.
Procedure
Permission for translation and use of the CHBQ was granted by the authors of the original English version. The questionnaire was translated from English into Hebrew by 2 fully bilingual medical professionals and then backtranslated by 2 other fully bilingual medical professionals, in accordance with acceptable measurement translation methods.
All nurse-midwives working at the 5 medical centers during the study period (2008) were asked to anonymously and voluntarily complete the structured questionnaires. The completed questionnaires were placed in a sealed envelope and sent by mail or courier to the central study location. Questionnaires took between 10 and 20 minutes to complete.
Data management and analysis
The data were entered and managed using the Microsoft Excel 2003 program (Richmond, CA), and later analyzed using SPSS version 16 (SPSS, Inc, Chicago, IL). All data were examined for univariate and selected items for bivariate statistics, with the CHBQ items tested for reliability and validity. For all 10 items regarding attitudes toward CAM, we calculated the overall CHBQ scores (reversing scores for items Q6-8) and individual item mean scores and SDs. Construct validity was assessed by conducting an exploratory factor analysis of these 10 items calculated using a Varimax rotation factor analysis with a set eigenvalue of 1.
Results
Demographic data, training, and personal health behavior
Of the 238 nurse-midwives currently employed at the 5 study centers, 173 completed the questionnaires for a response rate of 72.7%, with no correction made for those on vacation or sick leave at the time of questionnaire distribution. The demographic data, description of professional training, work experience, and personal behavior regarding health maintenance of the respondents are presented in Table 1 .
| Demographic | n (%) |
|---|---|
| Age group, y | |
| 20-39 | 53 (31.4) |
| 40-59 | 112 (66.3) |
| ≥60 | 4 (2.3) |
| Country of birth | |
| Israel | 113 (65.3) |
| Outside Israel | 60 (34.7) |
| Family status | |
| Married | 144 (83.7) |
| Single, divorced, widowed | 28 (16.3) |
| Country of training | |
| Israel | 156 (90.2) |
| Outside Israel | 17 (9.8) |
| Work experience, y | |
| ≤10 | 36 (20.9) |
| 10-20 | 63 (36.7) |
| ≥21 | 73 (42.4) |
| Last routine medical checkup | |
| Never | 13 (7.6) |
| Within last 5 y | 124 (72.5) |
| >5 y | 34 (19.9) |
| Cholesterol checked within last 5 y | 122 (70.5) |
| Blood pressure checked periodically | 43 (25.0) |
| Exercise for ≥30 minutes 3 times a week | 74 (43.0) |
| Currently a cigarette smoker | 16 (9.3) |
a Work experience refers to both general nursing and nurse-midwifery.
Use and recommendation of CAM therapies
Nearly 70% of respondents reported that they recommend CAM use, and nearly half would recommend or consider recommending CAM treatments to their patients ( Table 2 ). The most popular therapy was massage followed by herbal medicine and then meditation/yoga/imagery and therapeutic touch/Reiki and spirituality/prayer. A small percentage of respondents (12.7%) use none of the treatments listed.
| Modality | Have you ever used it or are currently using it? | Would you recommend using it? | Have you ever recommended it to patients or would you consider recommending it? |
|---|---|---|---|
| Biofeedback | 6.4 | 21.4 | 16.8 |
| Hypnosis | 8.1 | 16.2 | 11.0 |
| Meditation/yoga/imagery | 42.2 | 49.1 | 34.1 |
| Tai chi/chi gong | 10.4 | 17.3 | 10.4 |
| Chinese medicine (acupuncture) | 32.9 | 47.4 | 28.3 |
| Ayurveda | 8.7 | 12.1 | 5.2 |
| Chiropractic | 17.9 | 20.8 | 17.9 |
| Massage | 67.1 | 68.8 | 49.1 |
| Osteopathy | 9.2 | 10.4 | 7.5 |
| Therapeutic touch/Reiki | 40.5 | 36.4 | 29.5 |
| Spirituality/prayer | 39.9 | 41.0 | 28.9 |
| Herbal/supplements | 48.6 | 41.6 | 37.0 |
| Homeopathy | 38.7 | 39.3 | 33.5 |
| No treatments | 12.7 | 11.0 | 25.4 |
| At least 4 treatments | 48.6 | 51.4 | 38.2 |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
