Needs Assessment: Research Literacy and Capacity Amongst Complementary and Alternative Health Care Providers

June 2002

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Table of Contents

• Executive Summary
• 1.0 Introduction
• 2.0 Methods
• 3.0 Results
  • 3.1 Interviews of Naturopath Participants
    • 3.1.1 Participant Profile
    • 3.1.2 Basic Training Programs with Respect to Research
    • 3.1.3 Defining & Valuing Research
    • 3.1.4 Research Literacy (accessing, understanding & applying research)
    • 3.1.5 Research Capacity (conducting & disseminating research)
    • 3.1.6 Research Needs
  • 3.2 Interviews of Massage Therapy Participants
    • 3.2.1 Participant Profile
    • 3.2.2 Basic Training Programs with Respect to Research
    • 3.2.3 Defining & Valuing Research:
    • 3.2.4 Research Literacy (accessing, understanding & applying research)
    • 3.2.5 Research Capacity (conducting & disseminating research)
    • 3.2.6 Research Needs
  • 3.3 Interviews of Chiropractic Participants
    • 3.3.1 Participant Profile
    • 3.3.2 Basic Training Programs with Respect to Research
    • 3.3.3 Defining & Valuing Research
    • 3.3.4 Research Literacy (accessing, understanding & applying research)
    • 3.3.5 Research Capacity (conducting & disseminating research)
    • 3.3.6 Research Needs
• 4.0 Discussion
• 5.0 Recommendations
• 6.0 Conclusions
• Appendix 1: Terms of Reference and Membership of the Project Advisory Committee
• Appendix 2: Interview Guide for Practitioners
• Appendix 3: Interview Guide for Educational Colleges
• Appendix 4: Interview Guide for National Assocations

Executive Summary

The purpose of this project was to conduct a needs assessment / environmental scan of research literacy and capacity needs amongst complementary and alternative health care practitioners (CAHC). The approach used was to interview 34 representatives from clinical practice, educational colleges and national associations for three specific disciplines (naturopathy, massage therapy and chiropractic), the results of which are presented in this report.

Although there was variation in the themes identified during the interviews of each of the three disciplines, there were more similarities than differences. The differences that did exist were a reflection of several variables, including:

• differing levels of prerequisite qualifications to enter the educational programs for the respective professions
• differing lengths of educational programs of each of the respective professions, impacting on the degree of focus on research
• differing levels of complexity within each of the disciplines, including the range and type of therapies offered and the potential for research
• differing stages of maturation of each of the disciplines

These differences would likely have been further exaggerated if other CAHC disciplines had been included in this study, reflecting the wide range and the complexity of the CAHC field.

Despite these differences, many of the themes identified during this needs assessment were similar across disciplines and were similar to those identified in previous surveys/workshops/ forums. Common themes are outlined in detail in this report and are summarized below for each of the project objectives.

Current level and perceived adequacy of research training

Some level of research training is incorporated into the current curricula in each of the naturopathy, massage therapy and chiropractic training programs. As might be expected, the focus of research courses in the basic training programs is on accessing, understanding and applying - as opposed to conducting or disseminating - research. Chiropractic participants perceived the adequacy of their training to be the highest of the three disciplines, followed by naturopathy, then massage therapy. For all disciplines, representatives from the educational colleges perceived the adequacy of the training to be higher than that perceived by the practitioners. The majority of those interviewed indicated that while research training is improving, it is still lacking in many areas at all levels (undergraduate, graduate and post graduate).

Current level of perceived research literacy and capacity in practice

Levels of perceived research literacy and capacity differed amongst the professions, with the highest being perceived amongst the chiropractic profession. Similarly, the level of support provided by the literature to make treatment related decisions varied significantly between the disciplines, with the highest being reported by chiropractors and naturopathic physicians and the lowest by massage therapists. Interestingly, even those reporting that the literature provided support only infrequently changed treatment decisions as a result. The most significant barriers to accessing, understanding, applying, conducting and disseminating research were time and money. Dedicated research related funds are increasing but are still very limited for all CAHC disciplines.

Perceived research needs

Although research was reported to be highly valued by all participants, the level of understanding concerning what constitutes research varied, particularly with respect to qualitative research. The importance of cultivating a research culture, beginning in the educational colleges with faculty and students and continuing throughout practitioner careers, was unanimously endorsed by all participants ("professional socialization of research into the profession"). There was strong interest amongst all participants in all disciplines to acquire more research related skills (with a caveat of response bias). While the educational college participants were equally interested in increasing the knowledge level of their faculty in all topic areas, the practitioner participants were most interested in learning more about accessing research-based information, understanding research studies and learning more about research design and statistics.

Perceived willingness and opportunities to build bridges and share curricula

Given the commonalities of the responses from the different disciplines, there is likely significant potential to strengthen partnerships and to potentially share at least some core research related content across undergraduate, graduate and continuing education programs (e.g., critical appraisal of research, statistics, research design and methodologies). Although the question about willingness to build partnerships and share research related content was not asked explicitly, the perception of the interviewers was that there would be (and has been) a willingness to do so. This perception was validated recently in the Research Literacy for Complementary and Alternative Health Care Practitioners report (CMTA, May 7, 2002).

Information resources

Although an intensive review of access to information sources was beyond the scope of this project, a brief review suggests that access to multiple sources of information is available to CAHC practitioners, faculty, researchers, clinical investigators and students through the educational college libraries (for example, the libraries at the Canadian Memorial Chiropractic College and The Canadian College of Naturopathic Medicine). Despite the availability of information, comments from practitioner participants consistently pointed to the need to better co-ordinate and support delivery of information resources to practitioners. These libraries are well positioned to carry out this work but are generally funded to carry out mandates within educational institutions. The potential exists to build upon and expand services already available to promote, fund and provide equitable access.

Recommendations

Several recommendations arise from this needs assessment and are summarized below. Efforts are already underway to address many of these recommendations at local, provincial and/or national levels - for example, the establishment of a Centre of Excellence for natural health products, the creation of research related networks and the establishment of partnerships with various universities.

CAHC Research Infrastructure (priority no. 1)

1. Establish an advisory committee to follow up on strategies and recommendations arising from this report and earlier reports on promoting CAHC research. This group might include a combination of CAHC and conventional providers, all with an interest in CAHC research, and might include representative students, faculty, researchers, clinician investigators and practitioners.

2. Support the development of a network(s) of CAHC researchers and clinician investigators.

3. Support the establishment of a formal CAHC research foundation with appropriate funding.

CAHC Curriculum Collaboration (priority no. 2)

4. Identify desired core research competencies for CAHC students, faculty, researchers and practitioners.

5. Compare existing undergraduate, graduate, post graduate and continuing education programs to the core research competencies identified, and identify gaps and opportunities.

6. Develop common content that can be accessed by a variety of CAHC institutions - and regulatory bodies, national associations and other interested groups - to promote the development of core research competencies listed above for students, faculty, researchers and practitioners.

CAHC Continuing Education Collaboration

7. Support ongoing linkages with universities and ongoing collaboration with faculty within university settings.

8. Support the development of CAHC research training programs specifically for faculty, researchers and clinician investigators.

9. Assess the need for CAHC conferences/workshops and online courses (perhaps in modular format) as vehicles for increasing research related skills (including application to practice) amongst CAHC practitioners.

10. Provide funding support for students, faculty, researchers, clinical investigators and practitioners to access research related educational programs (e.g., CIHR partnerships for faculty to advance their careers).

11. Identify ways to increase the profile and incorporate research into conferences and continuing education workshops on a regular basis.

12. Increase the availability of and access to baccalaureate education for CAHC practitioners where it does not currently exist, and graduate and post graduate programs for all CAHC practitioners.

Increasing the Availability of Research Funding

13. Identify ways to facilitate access to existing research funding sources by CAHC researchers and clinician investigators (e.g., CIHR grants).

14. Provide seed grants for students, faculty, researchers, clinical investigators and practitioners to develop research proposals and applications for external funding.

Increasing Access to Research Findings

15. Support the ongoing development of multi-disciplinary and discipline-specific research-based clinical practice guidelines.

16. Market the availability of, and provide funding support for, existing library access (physical and virtual access) to research-based information (e.g., CMCC and CCNM libraries).

17. Sort, consolidate and make available summaries of results of research-based studies on key topics (e.g., database of abstracts of review articles) for practitioners in each of the disciplines. Utilize professional journals and the Internet/e-mail as primary vehicles for disseminating this information.

18. Support the establishment of an electronic distribution list for the dissemination of research findings to practitioners, faculty and students.

19. Assess the need for a research focused web site with links to other professional web sites, which would include the following:

• information on locations of existing sources of research-based information
• content reflecting basic research skills (e.g., critical appraisal, research design and research methodology)
• calendar of upcoming conferences and research related events
• database of results of research-based studies and abstracts on key topic areas applicable to practitioners
• listing of research studies currently underway, including the principal investigator, a summary of the study and the funding source and amount

1.0 Introduction

The purpose of this project was to conduct a needs assessment / environmental scan of research literacy and capacity needs amongst complementary and alternative health care practitioners (CAHC).

Research literacy and capacity was defined as including the following four dimensions:

• identifying the need for research
• conducting the research
• disseminating the results of research
• applying research data

The need to conduct this needs assessment/environmental scan was identified as a key recommendation arising from a Health Canada-sponsored invitational roundtable held in August 2001, entitled, "Assessing Research Literacy in Complementary and Alternative Health Care Products and Practice."

Specific objectives of the needs assessment/environmental scan were identified as follows:

1. to assess the current level of research training in undergraduate, graduate and continuing education programs as well as current levels of research literacy and capacity in practice
2. to identify both short and long term research literacy and capacity needs, according to the dimensions listed above
3. to identify a willingness and opportunities for building bridges or sharing curricula across different training programs
4. to identify programs and facilities dedicated to information resources for the specific groups of complementary and alternative health care providers being studied. Potential programs and facilities outside the regular programs may also be identified

2.0 Methods

A Project Advisory Committee (see Appendix 1 for a copy of the terms of reference) was established in early January 2002 to guide the project and to provide input and advice at various critical points of the project, including feedback into the final report.

A Project Coordinator was hired to oversee the project, including organizing the Project Advisory Committee activities, developing the survey tools, ensuring completion of the interviews and compiling the final report.

Activities completed as part of this project were:

• to conduct a literature review to identify the process and outcomes of similar research literacy and capacity needs assessments, which focused on conventional practitioner groups (specifically nursing and rehabilitation)
• to contact key researchers to obtain their perspective on the success of their chosen process and outcome and obtain copies of their needs assessment tools. Contacts included Kerrie Pain et al (University of Alberta, Rehabilitation), Maureen Dobbins (McMaster University, Nursing) and Carole Eastabrook (University of Alberta, Nursing)
• to contact Rona Achilles, Project Leader of the "Massage Therapy Research Literacy and Capacity Needs Assessment" that was being simultaneously conducted by the Canadian Massage Therapist Alliance Research Committee (grant provided by Human Resources Development Canada) to discuss potential areas for collaboration
• to develop drafts of interview tools, circulated to the Project Advisory Committee for feedback and updated and pilot tested the tools for the following groups:
  • practitioners (see Appendix 2)
  • deans or chairs of educational colleges (see Appendix 3)
  • executive directors or presidents of national associations (see Appendix 4)
• to conduct interviews of practitioners and representatives of educational colleges and national associations.

Obtaining the target numbers of interviewees proved to be a challenge, given people's busy schedules and the timelines required to complete this project. For practitioners where contact was attempted, 17% agreed to participate; 25% (approximately) responded but declined participation (citing lack of time as their reason); and 58% did not respond after three attempts (by e-mail and/or telephone). For educational colleges, 26% agreed to participate and the remaining 74% did not respond.¹ All national association contacts agreed to participate. A comparison of the target and actual number of interviews conducted as well as the number of prospective interviewees approached is summarized as follows:

Needs Assessment: Research Literacy and Capacity Amongst Complementary and Alternative Health Care Providers

A comparison of the target and actual number of interviews conducted as well as the number of prospective interviewees approached.

Practitioners Group

Discipline	Target # of Interviews	# of Interviews Completed	# of Candidates Contacted2 for Interviews
Chiropractic	7	9	53
Naturopathy	7	8	57
Massage Therapy	6	8	37
Total	20	25	147

 

Educational Colleges

Discipline	Target # of Interviews	# of Interviews Completed	# of Candidates Contacted2 for Interviews
Chiropractic	2	1	2
Naturopathy	2	2	2
Massage Therapy	6	2	15
Total	10	5	19

 

National Associations Group

Discipline	Target # of Interviews	# of Interviews Completed	# of Candidates Contacted2 for Interviews
Chiropractic	1	1	1
Naturopathy	1	1	1
Massage Therapy	2	2	2
Total	4	4	4

 

	Target # of Interviews	# of Interviews Completed	# of Candidates Contacted2 for Interviews
Grand Total	34	34	170

It is important to note that the numbers of interviews conducted only represents a miniscule proportion of the overall population of naturopaths, massage therapists and chiropractors. Further, there is likely a response bias in the interviews, whereby those most interested and/or active in research were willing to participate in the interviews. These two factors make it impossible to generalize these results to the entire population of naturopaths, massage therapists and chiropractors in Canada; however, because limited other studies have been done with similar groups of CAHC practitioners, the interview results are of interest despite these limitations.

3.0 Results

3.1 Interviews of Naturopath Participants

3.1.1 Participant Profile

Practitioners:

In total, eight practitioners (five females, three males) were interviewed from four different provinces (two from British Columbia, two from Alberta, three from Ontario and one from Nova Scotia). Each graduated with a professional degree (ND): six from The Canadian College of Naturopathic Medicine and two from Bastyr University (US).³ Most were relatively recent graduates with graduating years of 1989, 1993, 1994, 1998, 1999, 2000 and 2001 (x2). The majority were aged 31-40 (five out of eight), two were aged 21-30 and one was aged 41-50.

Work arrangements for participants varied, with three working as sole practitioners, two working privately but co-locating with other NDs (or in some cases, a chiropractor) and three working in partnership with other NDs (and in some cases, other conventional and CAHC providers). The majority (five out of eight) reported spending at least 90% of their time on clinical practice; two reported spending at least some time on research related activities (5% and 40% of their time respectively); and two reported spending 10% or more of their time on professional development activities.

Educational Colleges:

Representatives from two naturopathic colleges - The Canadian College of Naturopathic Medicine (CCNM) and the Boucher Institute⁴ (BI) - were interviewed. Both schools offer four-year programs and are the only two naturopathic colleges existing in Canada. While the CCNM program is well established and accredited, the BI has only been in operation for three years and has yet to graduate its first group of students (also, it is not yet accredited by CNME)⁵. A summary of information provided by each of the colleges is listed in the next table:

Needs Assessment: Research Literacy and Capacity Amongst Complementary and Alternative Health Care Providers

A summary of information provided by each of the colleges.

	Canadian College of Naturopathic Medicine (CCNM)	Boucher Institute (BI)
# of enrolled students (01/02)	120	27
# of graduates (01/02)	60	0 (new)
Prerequisites to enroll in program	3 years of univ education with some science prerequisites (although most, if not all, enter with a BSc)	Basic university science courses (no BSc req)
# of faculty	60	20
Profile of students	Mostly BSc, some MSc, PhD, MD	Young, many who have still to complete a BSc

National Association:

A representative was interviewed from the Canadian Naturopathic Association (CNA), the national association representing naturopaths in Canada. Requirements for membership in the CNA include graduation from a CNME accredited naturopathic medical education college (there is one in Canada and four in the United States) and passing the NPLEX (naturopathic physician licensing) exams.

3.1.2 Basic Training Programs with Respect to Research

Practitioners:

Five out of eight participating practitioners reported taking a course in research design and three out of eight reported taking a course in statistics during their basic training. None of the participants reported taking any additional research related university/college courses since graduation.

Educational Colleges:

Of the two Canadian educational programs, one (CCNM) offers a formal research course (28 hours, didactic teaching plus assignments). The other (BI) does not offer a formal course but incorporates content on the interpretation/evaluation of research studies into its core courses. Notably, starting next year, CCNM plans to increase its offering of research courses to four and to add the completion of a research project as a graduation requirement.

Practitioners, Educational Colleges & National Associations:

Not surprisingly, all participants perceived that basic training programs do a better job of preparing graduates to access, read and understand research than to conduct or apply research to practice. The adequacy of this preparation is lacking, however, even for the former, as is evidenced by the following graph:

View the graph "Perceived Adequacy of Naturopathy Training Programs with Respect to Research"
(You may have to use the scroll bar to see the entire graph.)

Comments made by the CNA (ratings not provided):

• Accessing research: students enter into naturopathy programs with a science degree and should therefore be well versed in accessing research related information.
• Conducting research: room for improvement exists; additional funding is needed.

In terms of participants' ratings of specific research related skills, both practitioner and college representatives perceived this to be lacking. Interestingly, educational college participants perceived the lack to be greater than practitioner participants (exception: preparation on ethical procedures), as evidenced on the next graph:

View the graph "Perceived Level of Knowledge of Specific Research Related Skills Amongst Naturopaths"
(You may have to use the scroll bar to see the entire graph.)

3.1.3 Defining & Valuing Research

Conducting and applying research to practice was defined in a variety of ways by all participant groups. The majority of definitions were fairly traditional and included concepts such as the use of scientific methods and double blinded studies and ensuring findings are reproducible and peer reviewed. None of the participants distinguished between qualitative vs quantitative research.

Research was valued by all participant groups. For most, it was reported to guide thinking and to increase confidence in making treatment related decisions. Some saw research as influencing treatment decisions, while others saw it as "supporting" treatment decisions. Some commented on the importance of research in justifying what they do to "disbelievers" as well as increasing the credibility of their profession to external eyes.

3.1.4 Research Literacy (accessing, understanding & applying research)

On average, practitioners reported searching the literature for research-based information in their field three to four times per month (range was from once per month to 10 times per week). All participants rated themselves as highly computer literate (average rating was 8.8 out of 10) and reported that the most commonly utilized method to access research related information was through the Internet (identified by seven out of eight participants), followed by professional journals and conferences/workshops (five out of eight). Other methods identified included talking to colleagues (three out of eight), reading the CCNM newsletter (two out of eight) and reading newspapers and magazines (one out of eight). More time and living in a better location (less remote) were identified as ways to facilitate access to research information.

In terms of utilizing research findings in clinical practice, practitioner participants rated the level of support provided by the literature for the treatment utilized for both their most recent and most complex patients as relatively high (7.4 out of 10). In treating their most recent patient with a complex or unusual condition, two out of eight reported utilizing the literature to plan their treatment; in some cases, the practitioner changed his/her plan of care based on the information learned. Most reported supplementing (or, in some cases, substituting) this review of the literature with contacting a colleague(s) for advice. Overall, participants rated the level of support provided by research for the treatments they utilize as 5.5 (out of 10).

When asked about barriers to accessing, understanding and applying research, practitioner and national association participants identified access, time and money as the most significant barriers, as shown on the next graph:

View the graph "Naturopath Participants Perceived Barries to the Utilization of Research"
(You may have to use the scroll bar to see the entire graph.)

3.1.5 Research Capacity (conducting & disseminating research)

Of the eight practitioner participants, none has ever taken part in or conducted a research study (this was inconsistent with the answer provided by one participant in the subsequent question who reported taking part in six research projects). Two out of eight practitioner participants reported having made research presentations to professional groups and/or clients during the past two years.

Dedicated funds are available at both of the educational colleges to try to increase the capacity of students and faculty to conduct and disseminate research. The amount of financial assistance varies, but includes seed grants to develop proposals for grant or industry funding. Starting next year, one of the colleges (CCNM) plans to offer a 20-week post graduate course for faculty and students, entitled, "Certificate in Clinical Epidemiology." Collaboration and partnerships with researchers from university programs were also reported as strategies used by CCNM.

Within the educational colleges, 10% to 15% of faculty and students were reported to be involved in research projects (e.g., proposal/grant writing, analyzing data, interpreting findings or writing journal articles), while 2% to 20% were reported to have presented research findings at conferences, to professional groups, groups, groups of clients and/or the public.

The national association views its primary role with respect to research as supporting and facilitating the use of research-based practice. Conducting research, in its view, would best be done under the leadership of the educational colleges. In this regard, the association is very supportive of CCNM's move to seek university status and believes that this will assist in strengthening research within the profession.

Examples of ways that the national association has been working to support and facilitate the use of research-based practice include supporting the provincial development of evidence based practice guidelines; developing national position papers on various naturopathy related topics (e.g., vaccinations); organizing and/or supporting national and provincial continuing education conferences; establishing a web site; and circulating a monthly newsletter.

When asked about barriers to conducting and disseminating research, both the educational colleges and national association participants identified financial barriers as the most significant, as shown on the following graph:

View the graph "Naturopath Participants Perceived Barriers to Conducting Research"
(You may have to use the scroll bar to see the entire graph.)

3.1.6 Research Needs

There was a strong interest amongst both practitioner and educational college participants in learning more about accessing, understanding, applying and conducting research. While the educational college participants were equally interested in increasing the knowledge level of their faculty in all topic areas, the practitioner participants were most interested in learning more about accessing research-based information (six out of eight participants) and understanding research studies and learning more about research design and statistics (five out of eight participants).

In terms of the ways participants would like to receive this information, the majority were interested in a workshop or classroom course and some in on-line courses or reading journals or textbooks. Little interest was expressed in paper based distance courses.

In terms of suggestions for assisting to incorporate research information into practice, the following were made:

• improve access to a good library (x3), including access to more research information in layperson's terms (interestingly, The Canadian College of Naturopathic Medicine has a good library)
• provide ongoing education on accessing, understanding and applying research for practitioners (e.g., workshops)
• offer more research courses as electives in basic training programs
• increase the profile of research reviews at conferences
• establish a web-based database of abstracts of review articles with references and/or summaries of various information pertinent to naturopathic practice (note: a prototype exists as "ND Notes" from   the CCNM library)

In terms of suggestions to increase the amount and quality of research conducted, the following were made:

• organize national summits to discuss what is new and where the profession should be going with respect to research
• establish a research network
• create a research culture within the basic training program. Have students participate in research studies as part of their basic training
• provide ongoing education on topics such as study methods, statistical analysis and funding options (e.g., weekend courses, on-line courses)
• increase funding support for conducting research studies
• create incentives to conduct research (including faculty stipends to conduct research)
• strengthen linkages with universities
• develop a web-based database of studies underway.

3.2 Interviews of Massage Therapy Participants

3.2.1 Participant Profile

Practitioners:

In total, eight practitioners (five females, three males) were interviewed from six different provinces (two from B.C., one from Alberta, one from Manitoba, one from Quebec, two from Ontario and one from Nova Scotia). Of these, six hold their massage therapy certificates, one holds a bachelor's degree and one holds a doctorate degree. Three graduated from the Sutherland Chan School, two graduated from the Darcy Lane Institute, one graduated from College Marie, one graduated from the Alberta Institute of Massage and one graduated from the West Coast College of Massage Therapy. Most were relatively recent graduates with graduation dates of 1987, 1992 (x2), 1996 (x3) and 2000 (x2). The majority were aged 31-40 (five out of eight), two were aged 21-30 and one was aged 41-50.

Work arrangements for participants varied, with two working as sole practitioners, three working privately but co-locating with other RMTs (or in some cases, a chiropractor, midwife and/or psychologist) and three working in partnership with other RMTs (+/- a chiropractor, naturopath). The majority (five out of eight) reported spending at least 75% of their time each week on clinical practice; three reported spending at least some time on research related activities (5%, 20% and 30% of their time respectively); and four reported spending 10% or more of their time on professional development activities.

Educational Colleges:

Representatives from two massage therapy colleges were interviewed: the Centennial College (CC) and the Sutherland Chan School and Teaching Clinic. These colleges are two of several public and private colleges in Canada, with the Centennial College program having been in operation for six years and the Sutherland Chan program having been in operation for 27 years. A summary of information provided by each of the colleges is listed on the next table:

Needs Assessment: Research Literacy and Capacity Amongst Complementary and Alternative Health Care Providers

A summary of information provided by each of the colleges.

	Centennial College	Sutherland Chan School & Teaching Clinic
Length of program	3 years (25 teaching hrs/wk)	2 years (2,200 teaching hours)
# of enrolled students (01/02)	180	204
# of graduates (01/02)	50	93
Prerequisites to enroll in program	2 years of senior (advanced level) science courses in high school	High school diploma with OAC science and grade 12 English
# of faculty	21/22 (6 FT, 15/16 PT)	22 (14 salaried; 8 sessional)
Profile of students	Wide range in ages and educ'nal backgrounds; 70% female; as a group have similar characteristics such as a common interest in health care, "people oriented" and "desire to help."	Mixed high school and career change with broad age range.

National Association:

Two representatives were interviewed from the Canadian Massage Therapy Alliance (CMTA), an association that is an alliance of provincial associations of massage therapists (excludes Quebec).

3.2.2 Basic Training Programs with Respect to Research

Practitioners:

Four out of eight participants reported taking a course in research design (one participant reported taking two) and two out of eight in statistics during their basic training. None of the participants reported taking any additional research related university/college courses since graduation from their basic training.

Educational Colleges:

Of the two Canadian educational programs, one (Sutherland Chan) offers one half-credit, 48-hour course on research methods (they plan to increase this to one credit next year). The other (CC) offers a 28-hour "Trends and Issues in Massage Therapy" course in third year, of which about two-thirds of the course content focuses on research, particularly critical appraisal of research studies. In addition, results of research studies are incorporated into classroom teaching throughout the core courses. Both colleges hope to place a greater emphasis on research in their curriculum in the future.

Practitioners, Educational Colleges & National Association:

Practitioner, educational college and national association participants alike perceived that basic training programs do a better job of preparing graduates to access, read and understand research than to conduct or apply research to practice. Similar to the naturopathy field, the adequacy of this preparation is lacking, however, even for the former, as is evidenced by the next graph:

View the graph "Perceived Adequacy of Massage Therapy Training Programs with Respect to Research"
(You may have to use the scroll bar to see the entire graph.)

In terms of participants' ratings of specific research related skills, both practitioner and college representatives perceived this to be lacking in a number of areas, as evidenced by the following graph:

View the graph "Perceived Level of Knowledge of Specific Research Related Skills Amongst Massage Therapists"
(You may have to use the scroll bar to see the entire graph.)

3.2.3 Defining & Valuing Research:

The definitions of conducting and applying research of the massage therapy participants were similar to those of the naturopath participants. Again, definitions were fairly traditional and no distinction was made between quantitative and qualitative research.

All practitioner participants noted the value of research, although two out of eight could not think of ways that research or research results might have influenced their practice. For the other six, all reported an increase in their level of confidence as a result of reading about and applying research.

Educational colleges and the CMTA reinforced the value of research, but commented on the need for funding to establish a research infrastructure, both within the college and clinical settings, as well as to further education at a MSc or PhD level.

3.2.4 Research Literacy (accessing, understanding & applying research)

Five out of eight practitioner participants reported searching the literature for research-based information during the past month. Of these, most searched three to four times per month (the range was from once per day to once per month). To access this research information, the most common means was through reading professional journals (seven out of eight participants), followed by searching the Internet (six out of eight), going to the library (six out of eight), talking to colleagues (three out of eight), attending conferences/workshops and reading the newspaper (two out of eight each). The level of computer literacy was lower than that of the naturopath participants, with the average rating being 5.3 (vs 8.8 out of 10 for naturopath participants). A website, improved skills in utilizing the Internet and better journals reporting practical research were identified as ways to facilitate better access to research information.

In terms of utilizing research findings in clinical practice, most practitioner participants reported that the literature did not support them in treating either their most recent patient (six out of eight participants) or their most recent complex patient (five out of eight). Of those that did feel the literature supported them, the strength of the support was not very high (4.5 and 4 out of 10 respectively). Very infrequently did reading the literature result in a decision to change a treatment. Most reported supplementing (or, in some cases, substituting) this review of the literature with contacting a colleague(s) for advice. Overall, participants rated the level of support provided by research for the treatments they utilize as 4 (out of 10). Given that research as a discipline is newly emerging within the field of massage therapy (particularly with respect to time and dosage), these results are not surprising.

When asked about barriers to accessing, understanding and applying research, practitioner and national association participants identified financial barriers and a lack of research skills as the most significant, as shown on the following graph:

View the graph "Massage Therapy Participants Perceived Barries to the Utilization of Research"
(You may have to use the scroll bar to see the entire graph.)

3.2.5 Research Capacity (conducting & disseminating research)

Of the eight participants, four reported either taking part in or conducting one or two research studies. Three out of eight reported having made research presentations to professional groups and/or clients during the past two years.

Within the educational colleges, 5% to 15% of faculty and students were reported to be involved in research projects (e.g., proposal/grant writing, analyzing data, interpreting findings or writing journal articles), while 0 to 15% were reported to have presented research findings at conferences, to professional groups, groups of clients and/or the public.

Limited funding is available within the educational colleges to support increasing research capacity amongst students and faculty. One college (CC) provides support via an in-house research officer as well as release time for faculty. Initiatives completed by the CMTA to increase research capacity include the establishment of a national research committee (June, 2000), an assessment of the research needs of its members (currently underway) and an application for funding from the HRDC to conduct specific initiatives to increase research capacity amongst its members.

Similar to the CNA, the CMTA views its primary role with respect to research as supportive and facilitating the use of research-based practice. Examples of initiatives undertaken to this end (in addition to those listed above) include the distribution of a semi annual member's newsletter, distribution of a summary of research literature during National Massage Therapy Awareness week and advertising for continuing education courses.

When asked about barriers to conducting and disseminating research, educational colleges and national association participants identified time, knowledge and skills as the most significant barriers, as shown on the following graph:

View the graph "Massage Therapy Participants Perceived Barries to Conducting Research"
(You may have to use the scroll bar to see the entire graph.)

3.2.6 Research Needs

There was a strong interest (100%) amongst both practitioner and educational college participants in learning more about accessing, understanding, applying and conducting research. In terms of the ways participants would like to receive this information, there was high interest in workshops and classroom or on-line courses and moderate interest in reading journals or textbooks.

In terms of suggestions for assisting to incorporate research information into practice, the following were made:

• keep the research-based practice agenda in the forefront (continue to increase awareness and support for training)
• include a current article in a monthly newsletter or some other mailing by the professional association
• offer workshops or on-line courses on research methods and use the Internet to seek out evidence based research
• provide a synthesis of current, relevant information that is available at a central location
• offer tips on how to do practical research (participant comment: "research seems to be so theoretical and wordy making it intimidating")
• have available a research resource person with a good understanding of research
• increase the funding to allow for clinicians to participate in research
• include research courses as part of basic training

In terms of suggestions to increase the amount and quality of research conducted, the following were made:

• improve linkages with universities
• offer advanced training for faculty on conducting research
• sponsor PhD students
• develop a web based summary and critique of current research studies/articles (note: CMTA has information on how to assess research articles on its web site)
• offer more training in basic programs on the "how tos of research" as well as statistical methods and design
• offer continuing education courses to assist with understanding why research is needed, ways to incorporate research into practice, reading research articles and performing basic computer searches. Include a hands-on component where ideas can be brought forward and assistance provided as to the necessary steps to carry out a research study (i.e., "hand holding!")

3.3 Interviews of Chiropractic Participants

3.3.1 Participant Profile

Practitioners:

In total, nine practitioners (three females, six males) were interviewed from three different provinces (four from B.C., four from Alberta and one from Ontario). Of these, all held professional degrees (DC), eight from the Canadian Memorial Chiropractic College (CMCC) and one from a college outside Canada. For most, the dates of graduation were earlier than for the naturopath or massage therapy participants, with graduation dates of 1979, 1984, 1986, 1990 (x3), 1997, 1999 and 2001. The majority were aged 31-40 (five out of 9), two were aged 21 - 30 and two were aged 41-60.

Work arrangements for participants varied, with none working as a sole practitioner; seven working privately but co-locating with other chiropractors (or, in some cases, a massage therapist and/or kinesiologist); and two working in partnership with other chiropractors (and in some cases, a naturopath, massage therapist, psychologist and/or yoga instructor). The majority (five out of nine) reported spending at least 70% of their time each week on clinical practice; five out of nine reported spending at least some time on research related activities (10%, 10%, 30%, 35%, and 40% of their time respectively); and four out of nine reported spending 10% or more of their time on professional development activities.

Educational College:

A representative from one of two chiropractic colleges in Canada⁶ was interviewed: the Canadian Memorial Chiropractic College (CMCC), which has been in existence for nearly 60 years. A summary of information provided by the college is provided below:

Needs Assessment: Research Literacy and Capacity Amongst Complementary and Alternative Health Care Providers

A summary of information provided by the college.

	Canadian Memorial Chiropractic College
Length of program	4 years (4,497 teaching hours)
# of enrolled students (01/02)	618
# of graduates (01/02)	151
Prerequisites to enroll in program	Min.3 years of undergrad univ study in Canada, or equivalent. Recommended that organic chemistry and biology, psychology and humanities/social sciences be included in the course work. Admission is also dependent upon a successful interview.
# of faculty	145 (63 FT, 63 PT, 14 adjunct faculty, 5 asssociate research faculty)
Qual's of research faculty	PhD or a DC + fellowship design'n or a DC + grad degree (MSc or PhD)
Profile of students	Average 25 years old; 53%/47% female/male; average GPA on admission: 3.3 on a 4.0 scale; 91% with undergrad degrees and 7% with graduate degrees on admission.

National Association:

A representative was interviewed from The Canadian Chiropractic Association (CCA), a member-based association representing 5,000 of the 6,000 chiropractors from across Canada.

3.3.2 Basic Training Programs with Respect to Research

Practitioners:

Eight out of nine participants reported taking at least one course in research design and five out of eight participants reported taking at least one course in statistics (one participant reported taking three) during their basic education program. Two out of nine participants reported taking additional university/college research related courses since graduation.

Educational College:

The CMCC program has a well-established research curriculum, which is part of both the basic and post basic education programs. Within the basic education program, there is a requirement to complete two research related courses: (1) one 26-hour lecture course which focuses on critical appraisal and research design; and (2) one 10-hour, self-directed research course which includes an additional 100 hours of applied research related activity (e.g., conducting a study or literature review).

In addition to the research related courses in the basic education program, CMCC offers three full time graduate certificate programs, each with specific course and research requirements. As part of the program, residents are required to include three research related courses, one in critical appraisal, one in basic statistics and one in research design. Additionally, as a requirement of program completion, residents must submit a full proposal. Successful completion of one of these certificate programs makes graduates eligible to sit Fellowship examinations. As a requirement for Fellowship, applicants must complete and defend a research study.

Practitioners, Educational College & National Association:

Although there was a range of responses, the overall perception of participants about the adequacy of their basic education program with respect to research was higher for chiropractic than for naturopathy or massage therapy participants. Average ratings are summarized on the following graph:

View the graph "Perceived Adequacy of Chiropractic Training Programs with Respect to Research"
(You may have to use the scroll bar to see the entire graph.)

Chiropractic college and practitioner participants provided a higher rating of their knowledge of specific research related than did naturopathy or massage therapy participants. Chiropractic ratings are shown on the following graph:

View the graph "Perceived Level of Knowledge of Specific Research Related Skills Amongst Chiropractors"
(You may have to use the scroll bar to see the entire graph.)

3.3.3 Defining & Valuing Research

The definitions of conducting and applying research provided by chiropractic participants were similar to those provided by naturopath and massage therapy participants. Again, definitions were fairly traditional and no distinction was made between quantitative and qualitative research. All participants reported on the value of research and all but one reported that research or research results influenced his/her practice. Several emphasized the importance of research in maintaining up-to-date knowledge and skills, providing patients with the most up-to-date and effective treatments, validating existing treatments, expanding the chiropractic knowledge base and pushing existing limits of practice.

Similar to naturopathy and massage therapy, research is highly valued by all chiropractic participants. In addition, research is integral and specifically acknowledged in the mission statements of both the CMCC and CCA (also part of the strategic goals for the CMCC). The mission of the CMCC is supported through the Office of the Dean of Graduate Studies and Research, which provides the infrastructure and resources for the continued growth of scholarly activity and research (including literature reviews, annotated bibliographies, meta-analyses, development of concepts to explain underlying therapies, acting as consultants with local, provincial and national organizations), ongoing research development of faculty and staff and support for faculty in their research pursuits (including release time). Four areas of concentration have been identified: basic sciences, clinical sciences, outcomes research and education. CMCC regularly collaborates with faculty in universities, mostly locally. One of the stated goals of the CMCC is to become a world leader in chiropractic research.

The CCA has also taken an active role in promoting all aspects of research amongst its members. A "standing" Research Committee has been established and has undertaken a number of activities to promote research, including the development of a research focused strategic plan and research agenda; the establishment of a research program co-ordinator position; the creation of a partnership with the Canadian Institutes of Health Research; the founding of a research centre with linkages to university based researchers (Consortium of Canadian Chiropractic Research Centre); the ongoing production of clinical practice guidelines; and the active dissemination of research findings through avenues such as the CCA professional journal, research bulletins and CCA web site.

3.3.4 Research Literacy (accessing, understanding & applying research)

Five out of nine practitioners reported searching the literature for research-based information during the past month. Of these, most searched three to four times per month (range: one to 10 times per month).

The most common means of accessing research identified by practitioner participants was through reading professional journals (nine out of nine participants), followed by searching the Internet (seven out of nine), talking to colleagues (five out of nine), attending conferences/workshops (five out of nine) and reading the newspaper (two out of nine). The level of computer literacy was highly variable with the average rating being 7.7 (range 1 to 10). A website with relevant articles, continuing education seminars, greater on-line access to full text articles and having a research associate were identified as ways to facilitate better access to research information.

In terms of utilizing research findings in clinical practice, most practitioner participants reported that the literature did support them in treating both their most recent patient (nine out of nine participants) and their most recent complex patient (seven out of nine participants). Of those that did feel the literature supported them, the strength of the support was quite high (7.4 out of 10 for both situations). Very infrequently (one out of seven) did reading the literature result in a decision to change a treatment. Several reported on the use of clinical protocols and evidence-based guidelines. A couple reported supplementing (or, in some cases, substituting) this review of the literature with contacting a colleague(s) for advice. Overall, participants rated the level of support provided by research for the treatments they utilize as 5.8 (out of 10).

When asked about barriers to accessing, understanding and applying research, practitioner and national association participants identified time and financial barriers as the most significant, as shown on the following graph:

View the graph "Chiropractic Participants Perceived Barriers to the Utilization of Research"
(You may have to use the scroll bar to see the entire graph.)

Other barriers identified include lack of mentors; lack of an infrastructure to support development of faculty research programs; lack of a clearly defined research culture; lack of track records and the inherent challenges in developing one (time, expertise and resources needed to develop the expertise and obtain the resources so that one frees up more time); lack of being a part of a university environment/milieu; and lack of public funding support.

3.3.5 Research Capacity (conducting & disseminating research)

Of the nine practitioner participants, one reported either taking part in or conducting at least one research study. two out of nine reported having made research presentations to professional groups and/or clients during the past two years.

CMCC allocates approximately 13% of its $10.76 million yearly operating budget. These funds include support for postgraduate residency programs and university-based chiropractic-related research programs. Approximately $140, 000 per year is allocated to support faculty pursuing graduate research degrees. Also included is about $35,000 per year in seed funding to support pilot projects and presentations at scientific conferences. In addition, a yearly competition is held to fund the purchase of capital (i.e., equipment) for the building of the requisite infrastructure to support growth and development of research programs.

Within the CMCC, approximately 50% full time faculty and 24% of students were reported to be involved in research projects (e.g., proposal/grant writing, analyzing data, interpreting findings or writing journal articles), while 45% were reported to have presented research findings at conferences, to professional groups, groups, groups of clients and/or the public.

While most chiropractors in Canada are involved in clinical practice on a full time basis, the CCA reports that the establishment and promotion of a research culture over the past five years has resulted in the attraction of full time chiropractic researchers with a dedicated commitment to a career in research. A CCA member division is involved in allocating the $3 million of designated research funds.

When asked about barriers to conducting and disseminating research, educational college and national association participants identified time and funding as the most significant barriers, as shown on the following graph:

View the graph "Chiropractic Participants Perceived Barriers to Conducting Research"
(You may have to use the scroll bar to see the entire graph.)

3.3.6 Research Needs

There was a strong interest amongst both practitioner and educational college participants in learning more about accessing, understanding, applying and conducting research. While the educational college participants were equally interested in increasing the knowledge level of their faculty in all topic areas, the practitioner participants were most interested in learning more about accessing research-based information (75%) and understanding research studies and learning more about research design and statistics (63%).

In terms of the ways participants would like to receive this information, the majority were interested in a workshop or classroom or on-line course. A few were interested in reading journals or textbooks or taking a paper based distance course.

In terms of suggestions for assisting to incorporate research information into practice, the following suggestions were made:

• increase opportunities to share information amongst chiropractors ("chiros tend to be autonomous")
• increase involvement of practitioners in projects
• increase access to published studies (regrettably, much of the new research is not accessed because there is a cost to access the material)
• "wire" all chiropractic members to allow for timely dissemination of relevant materials
• increase research related workshops and rounds
• establish a CAM research network (in progress)
• establish a formal research foundation (have one but financing is very limited)
• establish a clinical residency program that is both research-based and available to CAM clinicians
• better libraries (interestingly, the Canadian Memorial Chiropractic College does provide library services to chiropractors in the community. Some fees may apply)
• increase the research focus at conferences
• increase research electives in the basic training program
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In terms of suggestions to increase the amount and quality of research conducted, the following suggestions were made:

• increase linkages between researchers and conventional university settings
• offer workshops in research from all different aspects (e.g., grant writing, methodology, how to do scientific presentations)
• increase access to funding (both for proposal writing, research design, stats support)
• form a local research association
• review research methods and grant writing
• improve knowledge in Internet and in library
• offer funding to partially replace practice income. Other incentives (opportunities) for a stable career in CAM research

4.0 Discussion

Although there was some variation in the themes identified during the interviews of each of the three disciplines, there were more similarities than differences.

Many of the themes (and resulting recommendations) arising from this needs assessment/environmental scan are similar to those identified in previous surveys/workshops/forums, including the following:

• Assessing Research Literacy in Complementary and Alternative Health Care Products and Practice - Roundtable Discussion (August, 2001)
• Complementary/Alternative Health Care (CACH) and Natural Health Products (NHPs) Strategic Research Priorities Consensus Workshop (February 10/11, 2002)
• Research Literacy for Complementary and Alternative Health Care Practitioners report (CMTA, May 7/02).

Although there was variation in the themes identified during the interviews of each of the three disciplines, there were more similarities than differences. The differences that did exist were a reflection of several variables, including differing:

• levels of pre requisite qualifications to enter the educational programs for the respective professions
• lengths of educational programs of each of the respective professions, impacting on the degree of focus on research
• levels of complexity within each of the disciplines, including the range and type of therapies offered and the potential for research
• stages of maturation of each of the disciplines

For these reasons, research appears most developed within the chiropractic profession, then naturopathy, then massage therapy. These differences would likely have been further exaggerated if other CAHC disciplines had been included in this study, reflecting the wide range and the complexity of the CAHC field.

Despite these differences, many of the themes identified during this needs assessment were similar across disciplines and were similar to those identified in previous surveys/workshops/forums. Common themes are summarized below for each of the project objectives.

Objective #1:
To assess the current level of research training in undergraduate, graduate and continuing education programs as well as current levels of research literacy and capacity in practice.

Current level and perceived adequacy of research training:

• Some level of research training is incorporated into the current curricula in each of the naturopathy, massage therapy and chiropractic training programs. The number of dedicated research courses varies, with both naturopathy and massage therapy offering one 28-hour course and chiropractic training offering two courses for a combined total of 136 hours.
  
• As might be expected, the focus of research courses in the basic training programs tends to be on accessing, understanding and applying - as opposed to conducting or disseminating - research. Content in these courses is at a high level and emphasizes critical appraisal and research design. In addition to dedicated research courses, all programs reported incorporating research findings into core course content on an ad hoc basis. Representatives from both the naturopathy and massage therapy educational colleges reported plans (naturopathy) or at least aspirations to increase the research focus in their basic training programs in the future.
  
• The perception of those interviewed (practitioners, educational college and national association representatives) was that basic training programs for all disciplines did a better job of preparing graduates to access, read and understand research than to conduct or apply it (related to the point above). Despite this, the adequacy of the preparation was lacking for all disciplines, with the deficit being the greatest for massage therapy, then for naturopathy. Chiropractic participants perceived the adequacy of their training to be the highest of the three groups. Representatives from the educational colleges perceived the overall adequacy of the training to be higher than that perceived by the practitioners.
  
• Graduate and postgraduate (fellowship) programs exist for chiropractic training but are not yet offered for naturopathy (although one of the naturopathy colleges has plans to offer a 20-week postgraduate course next year) or massage therapy. For chiropractic training, these programs have a significant research focus and offer an in-depth understanding of critical appraisal, statistics and research design. Developing a research proposal, conducting a study and defending the results are requirements for completion of a chiropractic fellowship.
  
• Few participants have participated in additional university/college research related courses since graduation (unable to ascertain whether this is due to lack of program offerings or other barriers).

Current level of perceived research literacy and capacity in practice:

• The majority of practitioners reported accessing published research-based information about three to four times per month. Professional journals and the Internet were the most common sources. Talking to colleagues and attending conferences were also identified. The degree of computer literacy was relatively high amongst participants, particularly the naturopaths.
  
• The level of support provided by the literature to make treatment related decisions varied significantly between the disciplines, with the highest level reported by chiropractors and naturopathy and the lowest for massage therapy. Interestingly, even among those reporting that the literature provided support, only infrequently did treatment decisions change as a result.
  
• The most significant barriers to access to accessing, understanding, applying, conducting and disseminating research were time and money. The ability to evaluate the quality of research material was also identified as a significant barrier for massage therapy participants (consistent with the perceived gaps in massage therapy training programs with respect to research). Interestingly, resistance to change within each of the practice fields was not identified as a significant barrier, which is in contrast to barriers reported by conventional health care disciplines.
  
• Only a minority of practitioner participants has taken part in or conducted research studies (interestingly, levels of participation were highest for massage therapy participants) although higher numbers reported having made research presentations to professional groups and/or clients. Involvement in research studies was higher for faculty and students (ranged from 5% to 15% in massage therapy to 24% to 50% in chiropractic colleges). Interestingly, practitioners that had been involved in a research study did not perceive participation changes the way they practiced.
  
• Dedicated, although limited, funds are available at both naturopathy and chiropractic colleges to support research related activities, including seed funding for the development of research proposals and support for faculty to pursue graduate studies. Less dedicated funds are available for advancing research-related activities at the massage therapy colleges that were interviewed.

Objective #2:
To identify both short and long term research literacy and capacity needs, according to the dimensions listed above.

• Research was highly valued by practitioner, educational college and national association participants in all disciplines. Research enables practitioners to offer the most current and effective treatments for their clients and provides practitioners with confidence, assurance and validation for their treatment decisions. Further, research is perceived to add strength and credibility to the profession in external eyes (particularly noted in the naturopathy and massage therapy interviews).
  
• Although research was reported to be highly valued by all participants, the level of understanding of what constitutes research varied, particularly with respect to qualitative research. The importance of cultivating a research culture, beginning in the educational colleges with faculty and students and continuing throughout practitioner careers, was unanimously endorsed by all participants ("professional socialization of research into the profession").
  
• There appeared to be a strong interest amongst all participants in all disciplines to acquire more research-related skills - as discussed earlier, this perception needs to be considered in the context of potential response biases of those interviewed.
  
• While participants from all three disciplines perceived a strong and active role for the educational colleges in promoting the access, understanding, application and conducting of research, there was less consensus on the level of activity for national associations. While the national chiropractic association and, to a lesser extent, the massage therapy association have taken active roles in promoting each of these dimensions, the national naturopathy association views its role as more supportive or secondary to the educational college.
  
• While the educational college participants were equally interested in increasing the knowledge level of their faculty in all topic areas, the practitioner participants were most interested in learning more about accessing research-based information, understanding research studies and learning more about research design and statistics.
  
• There was a high interest in workshops and classroom courses to learn more research-based skills, moderate to high interest in on-line courses, low to moderate interest in reading professional journals or textbooks and low interest in taking paper based distance courses.
  
• Other suggestions of ways to increase research related skills, support the incorporation of research information into practice and increase the amount and quality of research conducted were relatively consistent amongst all participants and are included in the section under "recommendations."
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Objective #3:
To identify a willingness and opportunities for building bridges or sharing curricula across different training programs.

• Given the commonalties of the responses of the different disciplines, there is likely significant potential to strengthen partnerships and potentially share at least some core research related content across undergraduate, graduate and continuing education programs (e.g., critical appraisal of research, statistics, research design and methodologies).
  
• Although the question about willingness to build partnerships and share research related content was not asked explicitly, the perception of the interviewers was that there would be (and has been) a willingness to do so. This was validated recently in the Research Literacy for Complementary and Alternative Health Care Practitioners report (CMTA, May 7/02).

Objective #4:
To identify programs and facilities dedicated to information resources for the specific groups of complementary and alternative health care providers being studied. Potential programs and facilities outside the regular programs may also be identified.

• Although an intensive review of access to information sources was beyond the scope of this project, a brief review suggests access to multiple sources of information is available to CAHC practitioners, faculty, researchers, clinical investigators and students through the educational college libraries (for example, the libraries at the CMCC and CCNM). Both physical and virtual support for research from these libraries is extensive, including web site access to sections dedicated to research, tips/instructions for self on-line searching, literature searching and document delivery services, courses/workshops for members on increasing research literacy and distribution of an electronic newsletter to subscribers.
  
• Other existing information sources that have resource collections and the potential to provide information services to CAHC practitioners include Tzu Chi Institute for CAM Integrative Health Institute (primarily consumer focused); community college and university libraries (especially those which train CAHC practitioners); public libraries (e.g., Consumer Health Information Service, Toronto); and a website, CAMLine.org.
  
• Despite the availability of the above, comments from practitioner participants consistently pointed to the need to better co-ordinate and support the delivery of information resources to practitioners. These libraries are well positioned to carry out this work but are generally funded to carry out mandates within educational institutions. The potential exists to build upon and expand services already available to promote, fund and provide equitable access.

5.0 Recommendations

Several recommendations arise from this needs assessment. Efforts are already underway to address many of these recommendations at local, provincial and/or national levels - for example, the establishment of a Centre of Excellence for natural health products, the creation of research related networks and the establishment of partnerships with various universities.

For the purposes of this report, the recommendations are presented on the upcoming pages and are grouped under topic headings:

5.1 CAHC Research Infrastructure⁷

1. Establish an Advisory Committee to follow up on strategies and recommendations arising from this report and earlier reports on promoting CAHC research. This group might include a combination of CAHC and conventional providers, all with an interest in CAHC research, and might include representative students, faculty, researchers, clinician investigators and practitioners.

2. Support the development of a network(s) of CAHC researchers and clinician investigators.

3. Support the establishment of a formal CAHC research foundation, with appropriate funding.

5.2 CAHC Curriculum Collaboration⁸

4. Identify desired core research competencies for each of CAHC students, faculty, researchers and practitioners.

5. Compare existing undergraduate, graduate, postgraduate and continuing education programs to the core research competencies identified, and identify gaps and opportunities.

6. Develop common content that can be accessed by a variety of CAHC institutions (and regulatory bodies, national associations and other interested groups) to promote the development of core research competencies listed above for each of students, faculty, researchers and practitioners.

5.3 CAHC Continuing Education Collaboration

7. Support ongoing linkages with universities and ongoing collaboration with faculty within university settings.

8. Support the development of CAHC research training programs specifically for faculty, researchers and clinician investigators.

9. Assess the need for CAHC conferences/workshops and on-line courses (perhaps in modular format) as vehicles for increasing research related skills (including application to practice) amongst CAHC practitioners.^{9, 10}

10. Provide funding support for students, faculty, researchers, clinical investigators and practitioners to access research related educational programs (e.g., CIHR partnerships for faculty to advance their careers).

11. Identify ways to increase the profile and incorporate research into conferences and continuing education workshops on a regular basis.

12. Increase the availability of and access to baccalaureate education for CAHC practitioners where it does not currently exist, and graduate and post graduate programs for all CAHC practitioners.

5.4 Increasing the Availability of Research Funding

13. Identify ways to facilitate access to existing research funding sources by CAHC researchers and clinician investigators (e.g., CIHR grants).

14. Provide seed grants for students, faculty, researchers, clinical investigators and practitioners to develop research proposals and applications for external funding.

5.5 Increasing Access to Research Findings

15. Support the ongoing development of multi-disciplinary and discipline-specific research-based, clinical practice guidelines.

16. Market the availability and provide funding support for existing library access (physical and virtual access) to research-based information (e.g., CMCC and CCNM libraries).

17. Sort, consolidate and make available summaries of results of research-based studies on key topics (e.g., database of abstracts of review articles) for practitioners in each of the disciplines. Utilize professional journals and the Internet/e-mail as primary vehicles for disseminating this information.¹¹

18. Support the establishment of an electronic distribution list for disseminating research findings to practitioners, faculty and students.

19. Assess the need for a research focused web site with links to other professional web sites¹², which would include the following:

• information on locations of existing sources of research-based information
• content reflecting basic research skills (e.g., critical appraisal, research design and research methodology)¹³
• calendar of upcoming conferences and research related events.
• database of results of research-based studies and abstracts on key topic areas applicable to practitioners
• listing of research studies currently underway, including the principal investigator, a summary of the study and the funding source and amount

6.0 Conclusions

The focus of this project was to conduct a needs assessment/environmental scan and to make recommendations to increase the research literacy and capacity needs amongst complementary and alternative health care practitioners. The approach used was to interview representatives from clinical practice, educational colleges and national associations for three specific disciplines (naturopathy, massage therapy and chiropractic), the results of that have been presented in this report.

Although there was some variation in the themes identified during the interviews of each of the three disciplines, there were more similarities than differences. The differences that did exist amongst the three disciplines were primarily a result of differing:

• levels of pre requisite qualifications to enter the educational programs for the respective professions
• lengths of educational programs of each of the respective professions, impacting on the degree of attention to research
• stages of maturation of each of the professions

Themes from across the interviews were extracted and developed into recommendations. Many of these themes and recommendations are similar with those identified in previous surveys/workshops/forums. Recommendations are suggestive of a multi-factorial approach, rather than single short interventions, which is consistent with the conclusions of a recently published study, "Teaching Evidence-Based Complementary and Alternative Medicine; Changing Behaviours in the Face of Reticence: a Cross-Over Trial."¹⁴

Appendix 1: Terms of Reference and Membership of the Project Advisory Committee

Purpose of the Advisory Committee:

The Advisory Committee is responsible to oversee and provide advice for the Research Literacy and Capacity among Complementary & Alternative Health Care professions (CACHP) project. This includes advising and providing feedback on:

• The projects' objectives and goals
• The scope of the project (e.g. the inclusion of acupuncture/TCM)
• The procedures (e.g. modes of data collection) to complete the project.
• Data collection instruments.
• Advising on key informants from whom to collect data.

The committee will also monitor compliance to established objectives and timelines and provide feedback on the draft (or drafts of the) report.

Meeting Schedule:

In total, three, 1.5 hour meetings will be held, one in January, one in mid March and one in early May (by teleconference).

Membership:

Heather Boon

Assistant Professor, Faculty of Pharmacy, University of Toronto; and Director, CAM Research Network

Silvano Mior

Dean of Research, Canadian Memorial Chiropractic College

Wayne Steinke

President, Canadian Naturopathic Association

Sarah Hayward

Director, Applied Health Research Programs, Alberta Heritage Foundation for Medical Research

Peter Harasym

Professor, Faculty of Medicine, University of Calgary

Trish Dryden

Faculty, Centennial College, Massage Therapy program, Community Health and Wellness; Co-Chair, Research Committee of the CMTA

Joan Simpson

Health Canada

Project Team:

Janet Williams, Project Co-ordinator, TCI
Andrea Mulkins, Research Associate, TCI
Marja Verhoef, Senior Researcher, TCI
Debbie Monkman, Manager, Information Resources/Services, TCI
Barb Findlay, Executive Director, TCI

Interviews completed by:

Andrea Mulkins, Research Associate, TCI
Debbie Monkman, Manager, Information Resources/Services, TCI
Marja Verhoef, Senior Researcher, TCI

Appendix 2: Interview Guide for Practitioners

Needs Assessment: Research Literacy and Capacity
(Massage Therapy, Naturopathy and Chiropractic)

Unless otherwise specified, questions were taken from Transfer & Uptake of Research Knowledge Among Rehabilitation Therapists, developed by Kerrie Pain, Joyce Magill-Evans, Johanna Darrah, Paul Hagler & Sharon Warren.

Interview Protocol and Guide:

Instructions to the interviewer:

• If the participant does not know the answer to any question, please mark "don't know."

Key points to review with the participant:

• We hear a lot about research-based practice, but every practitioner knows how hard it is to carry out.
  
• There is no time to research every topic and no one can become an expert in every area. It is hard to know what research is out there.
  
• The purpose of this project is to learn more about the abilities of chiropractors, naturopaths and massage therapists to conduct, access, read, understand and apply research in their daily practice. From this study, we are hoping to identify perceived gaps and suggestions to reduce these gaps. This will help policy makers, educators and researchers find ways to increase the utilization of research in practice.
  
• I am going to ask you questions about each of these areas, as well as about the kind of research support there is for your practice.
  
• The purpose of this study is to find out what really happens in the clinical settings. If the people that we interview tell us only what they think we want to hear, then the information won't help at all in formulating ways of helping clinicians stay up to date.
  
• By agreeing to participate in this study you are consenting to having this telephone interview audio-taped and transcribed for analysis purposes only. You have the right to terminate the interview at any time and to refuse to answer specific questions. Every effort will be made to ensure your comments remain confidential.
  
• Do you have any questions at this time? Then let us begin.

SECTION A: Demographic Profile and Brief Overview

Background information (complete prior to interview)

1. Clinical training (please check one):

• Chiropractor
• Massage Therapist
• Naturopath

2. Sex:

• Female
• Male

I would like to start by asking you some questions that will provide us with baseline information about you and the type of work that you do as a (chiropractor, massage therapist or naturopath).

3. Where do you currently work as a (Chiropractor, Massage Therapist or Naturopath)?

• Town/city
• Province
  Top of Page

4. What is your highest level of formal education (may include their professional degree)?

• High school
• College
• Bachelor's Degree
• Master's Degree
• Doctorate Degree
• Other (please specify)

5. Have you obtained any relevant degrees as a (chiropractor, massage therapist or naturopath)?

• Yes
• No

If so, what?

6. Are you currently pursuing a degree?

• Yes
• No

If Yes: Degree sought

7. What school did you graduate from as a (chiropractor, massage therapist or naturopath)?

8. What year did you graduate as a (chiropractor, massage therapist or naturopath)?

9. What age category you are in (in decades)?

• 21-30
• 31-40
• 41-50
• 51-60
• 60+

Practice information

10. What percentage of your time do you spend on the following in an average week?

% clinical practice

% teaching

% conducting research/presenting results

% doing professional development activities

11. What is your primary clinical practice arrangement?

• 1 (solo practice)
• Private but practicing with other practitioner
  If so, type of practitioners
  # of practitioners (including yourself)
• Partnership
  If so, type of practitioners
  # of practitioners (including yourself)

12. Did you take any courses in research design and/or statistics in your (chiropractic, massage therapy or naturopathy) training?

• Research design; if yes, how many
• Statistics; if yes, how many

13. On a scale from 1 to 10, where 1 means poor and 10 means very well, how would you rate the adequacy of your (chiropractic, massage or naturopathy) training program in terms of learning how to access research-based results/evidence?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

14. On a scale from 1 to 10, where 1 means poor and 10 means very well, how would you rate the adequacy of your (chiropractic, massage or naturopathy) training program in terms of learning how to read & understand research results?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

15. On a scale from 1 to 10, where 1 means poor and 10 means very well, how would you rate the adequacy of your (chiropractic, massage or naturopathy) training program in terms of learning how to use research results?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

16. On a scale from 1 to 10, where 1 means poor and 10 means very well, how would you rate the adequacy of your (chiropractic, massage or naturopathy) training program in terms of learning how to conduct research?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

17. Have you taken any university/college courses in research design and/or statistics since your (chiropractic, massage or naturopathy) training?

• Research design; if yes, how many & date of most recent course
• Statistics; if yes, how many & date of most recent course
  

18. On a scale of 1 to 5 with 1 being very poor and 5 being very good, please rate your understanding of the following (1 = Very poor, 5 = Very good):

A. Research articles you read in journals

1 2 3 4 5

B. Research design

1 2 3 4 5

C. Data collection methods

1 2 3 4 5

D. Statistics

1 2 3 4 5

E. Grant application procedures

1 2 3 4 5

F. Ethical review procedures

1 2 3 4 5

SECTION B: Defining & Valuing Research

In the next set of questions, I would like to learn more about what the term research means to you.

19. What does the term "conducting research" mean to you? (adapted from: Dobbins, Jan 2002)

20. What does the term "applying research to practice" mean to you? (adapted from: Dobbins, Jan 2002)

21. Research can influence practice in a lot of different ways besides helping to decide what type of treatment should be provided. Some people have told us that reading research helps them feel more confident, others have said that it makes them feel more uncertain about what to do. Some people have talked about research changing how they feel about themselves as a practitioner. Have research or research results influenced you? If yes, could you please explain how?

22. We all differ as to our opinions on the importance of research, and there is no right or wrong to this judgement. During these interviews, we are hoping to get opinions both from those that think it is important and those that do not. What are your thoughts on the importance of research? If you think it is important, why?

SECTION C: Research Literacy (accessing, understanding & applying research)

The next set of questions is to find out from you how easy it is for you to access research information and then to apply it to your daily practice.

Accessing Research Information

23. Generally how do you access or find research information?
(prompters: library, Internet, professional journals, newspaper, conferences/workshops, talking to colleagues)

24. What would make it easier for you to get this information?

25. On a scale from 1 to 10, where 1 is low and 10 is high, how would you rate your ability to use a computer (web searches, e mail)?

Low 1 2 3 4 5 6 7 8 9 10 High

26. Are you doing anything to keep up with new information in your field?

• Yes; if so, then what:
• No

(note: examples might include reading or taking courses).

27. Over the past month, have you searched the literature for research-based information in your field?

• Yes; if so, then how often:
• No

Understanding & Applying Research:

Some practitioners tell us that they use research as one of the ways they make treatment choices, while others tell us that research is not useful and they make treatment choices in different ways.

28. Think about the last patient you treated. What kind of treatment did you provide? How did you decide which treatment to use? (if mention research, probe to get a sense of the depth of research support).

29. Did the literature support you in the treatment that you provided this patient?

• Yes; if so, see qu #30
• No; if not, skip to qu #31

30. On a scale from 1 to 10, where 1 means no support and 10 means very strong support, how much did the literature support you in the treatment that you provided to THIS patient?

No support 1 2 3 4 5 6 7 8 9 10 Very strong support

31. Think about the last time that you had a patient who presented with an unusual condition or with unusual challenges. What did you do to plan your treatment for this patient?

32. Did you use literature to plan your treatment for this patient?

• Yes; if so, see qu #33
• No; if not, skip to qu #34

33. On a scale from 1 to 10, where 1 means non use and 10 means very high use, to what extent did you use research to plan the treatment that you provided to THIS patient?

No use 1 2 3 4 5 6 7 8 9 10 Very high use

34. Sometimes practitioners decide to change the type of treatment that they provide for certain groups of patients. Sometimes they decide to change the type of treatment provided for a particular condition, or perhaps to stop doing something that they had previously done. For example, antibiotics used to be prescribed "just in case" and now people are being asked to use them more selectively. Can you think of a time when you decided to change a treatment that you commonly provide? (if no, skip to # 36). Why did you decide to change treatments? How did you decide what should be done?

35. Did the literature influence your decision to change treatments?

• Yes; if so, see qu #36
• No; if not, skip to qu #37

36. On a scale from 1 to 10, where 1 means no influence and 10 means very strong influence, to what extent did research findings influence these changes?

No influence 1 2 3 4 5 6 7 8 9 10 Very strong influence

37. On a scale from 1 to 10, where 1 means no support and 10 means very strong support, if you consider all of your patients, to what extent are the treatments you provide based on research evidence?

No support 1 2 3 4 5 6 7 8 9 10 Very strong support

38. From the list of potential barriers below, how would you rate each for you personally on a scale of 1 to 5 where 1 means that it is "not an barrier" and 5 means that it is a "very serious barrier" (taken from: Dobbins, Jan 2002)

A. Availability of research information is...

1 2 3 4 5

B. Time is...

1 2 3 4 5

C. Financial resources are...

1 2 3 4 5

D. Access to research information is...

1 2 3 4 5

E. My ability to evaluate the quality of research material is...

1 2 3 4 5

F. Resistance to change within my practice field is...

1 2 3 4 5

39. Are there other barriers that keep you from being able to use and apply research in your work?

SECTION D: Research Capacity (conducting & disseminating research)

40. Have you ever had a chance to conduct or to be part of a research study?

• Yes; if so, see qu #41
• No; if not, skip to qu #42

41. If yes, what did it involve? (if many projects ask about the last one) Did it change the way you practice? Affect what you do? (probe if they answer "no" and you know that they have a master's degree)

42. Please indicate your research involvement below. [Number (last 2 years)]

A. Research projects (involved in proposal/grant writing, analysing data, interpreting findings, writing journal articles)

B. Research presentations at conferences

C.Presentations to communities of professional groups or to a group of clients and/or the public, based on a review of the research literature.

D. Other (e.g., participated as a research subject; recruited patients for a study)

SECTION E: Research Needs

43. What kind of programs need to be put into place to help you and other practitioners incorporate research information into daily practice decisions? (probes: What about your professional association? the University/educational college? Is there anything that you are going to do, yourself?) (Pain, TURK project, 1999)

44. What kind of programs need to be put into place to encourage you and other practitioners to conduct and participate in research studies?

45. Would you be interested in learning more in any of the following areas? (adapted from: Massage Therapy survey, 2002)

Yes No Not sure
1 2 8 A. How to find research-based information?
1 2 8 B. How to understand research studies in your field?
1 2 8 C. How to develop research questions
1 2 8 D. Research design & statistics

46. If interested in learning more about any of these topic areas, how would you like to receive the information? (adapted from: Massage Therapy survey, 2002)

Yes No Not sure
1 2 8 A. Reading a journal or textbook?
1 2 8 B. Attendance at a workshop or classroom course?
1 2 8 C. Taking a paper based distance course?
1 2 8 D. Taking an on-line computer based course?

47. Other Comments:

This is the end of the interview. On behalf of Barb Findlay & Marja Verhoef and the project team, I would like to thank you for participating in this interview today. Your responses will contribute greatly to our understanding of the abilities of chiropractors, naturopaths and massage therapists to conduct, access, read, understand and apply research in their daily practice. Your input will help policy makers, educators and researchers find ways to increase the utilization of research in practice.

Appendix 3: Interview Guide for Educational Colleges

Needs Assessment: Research Literacy and Capacity
(Massage Therapy, Naturopathy and Chiropractic)

Interview Protocol and Guide:

Key points:

• The purpose of this project is to learn more about the abilities of chiropractors, naturopaths and massage therapists to conduct, access, read, understand and apply research in their daily practice.
  
• I am going to ask you questions about the level of training provided to students in each of these areas, as well as about the kind of support there is to conduct research at your college.
  
• From this study, we are hoping to identify perceived gaps and suggestions to reduce these gaps. This will help policy makers, educators and researchers find ways to increase the utilization of research in practice.
  
• You have the right to terminate the interview at any time and to refuse to answer specific questions. Every effort will be made to ensure your comments remain confidential.
  
• Do you have any questions at this time? Then let us begin.

SECTION A: Demographic Profile and Brief Overview

I would like to start by learning more about your curriculum and whether and/or how research is incorporated into it.

1. Name of Educational Institution:

2. What certificate/diploma/degree is awarded following graduation from your basic level training program (e.g., certificate or Bachelor's degree)?

3. Are post basic training certificates/degrees available at your institution? If so, is there a research component? If so, please summarize.

The next set of questions refer to your (chiropractic, massage therapy or naturopathy) training program.

4. Please briefly describe your program.

Ask the following questions, if the answers are not provided under the general question:

• Length of time program has been in existence
  
• Number of students enrolled in 2001/02
  
• Number of graduates in 2001/02
  
• Pre-requisites to enroll in the program
  
• # of faculty(part time, full time, FTEs, # of adjunct research faculty)
  
• Qualifications of faculty, specifically with respect to research
  
• Brief profile of the students
  
• Student entry requirements (e.g., grade point averages, degree, etc)
  
• Length of the program
  
• Number of teaching hours
  
• Instructional format

5. Is research part of your curriculum? If so, in what way? (probe for evidence of both qualitative and quantitative research)

6. To the best of your knowledge, what is the vision for research within your school?

SECTION B: Defining & Valuing Research

In the next set of questions, I would like to learn more about what the term research means to you.

7. To the best of your knowledge, how does your school define the term "conducting research"? (adapted from: Dobbins, Jan 2002)

8. To the best of your knowledge, how does your school define "applying research to practice"? (adapted from: Dobbins, Jan 2002)

9. We all differ as to our opinions on the importance of research, and there is no right or wrong to this judgment. During these interviews, we are hoping to get opinions both from those that think it is important and those that do not. What are your thoughts on the importance of including research in an educational curriculum for (chiropractors, massage therapists or naturopaths)?

10. On a scale of 1 to 5, with 1 being not at all and 5 being extensively, please rate the degree to which the following topics are included in your educational curriculum (either as dedicated research courses or the principles integrated into other courses)?

A. Research design

1 2 3 4 5

B. Data collection methods

1 2 3 4 5

C. Statistics

1 2 3 4 5

D. Grant application procedures

1 2 3 4 5

E. Ethical review procedures

1 2 3 4 5

F. Searching the literature for evidence based information

1 2 3 4 5

G. Critically evaluating research studies

1 2 3 4 5

11. Does your curriculum include dedicated research courses? If so, please estimate the # of courses and teaching hours for the following research related topic areas:

A. Research design

# of courses
# of teaching hours

B. Data collection methods

# of courses
# of teaching hours

C. Statistics

# of courses
# of teaching hours

D. Other (please specify)

# of courses
# of teaching hours

12. Does your school dedicate funds to increase the capacity of students and faculty to conduct, understand and apply research? If so, how much or what % of your operating budget would be allocated to such activities?

Ask the following questions, if the answers are not provided under the general question:

• Are funds available for faculty or students to apply for seed grants to develop research proposals?
  
• Are funds or release time available for faculty to pursue graduate degrees?
  
• Does your institution provide postgraduate training? If yes, describe research component
  
• Does your school collaborate with university based faculty in research projects? If so, how?

SECTION C: Research Literacy (accessing, understanding & applying research)

Note:If research is not included as part of the training program, go to section D.

13. On a scale from 1 to 10, where 1 means poor and 10 means very well, please rate the following:

A. The adequacy of your (chiropractic, massage therapy or naturopathy) training program in terms of teaching students how to access research-based information?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

B. The adequacy of your (chiropractic, massage therapy or naturopathy) training program in terms of teaching students how to understand & read research-based information?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

C. The adequacy of your (chiropractic, massage therapy or naturopathy) training program in terms of teaching students how to utilize research in their daily practice?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

D. The adequacy of your (chiropractic, massage therapy or naturopathy) training program in terms of teaching students how to conduct research?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

SECTION D: Research Capacity (conducting & disseminating research)

14. Please estimate the following:

% of faculty and students involved in research projects (e.g., proposal/grant writing, analyzing data, interpreting findings, writing journal articles)?

% of Faculty
% of Students

% of faculty who present research findings at conferences

% of Faculty
% of Students

% of faculty who present research findings to professional groups or groups of clients and/or the public?

% of Faculty
% of Students

15. What type of research has been conducted over the past 2 years? (probe: qualitative as well as quantitative; specific topic areas).

16. From the list of potential barriers to conducting research, how would you rate each for your agency/institution on a scale of 1 to 5 where 1 means that it is "not an barrier" and 5 means that it is a "very serious barrier" (taken from: Dobbins, Jan 2002)

A. Time is...

1 2 3 4 5

B. Identification of potential funding sources is...

1 2 3 4 5

C. Securing funding is...

1 2 3 4 5

D. Knowledge & skills about how to conduct research...

1 2 3 4 5

17. Are there other barriers within your institution that keep you from being able to use and apply research in your work?

SECTION E: Research Needs

18. What kind of support needs to be put into place to help educational programs incorporate research information into their curriculum? (probes: What about your professional association? the government?)

19. What kind of support needs to be put into place to encourage faculty within educational programs to conduct and participate in research studies? (probes: research network, career progression)

20. Would there be interest amongst your faculty in learning more in any of the following areas? (adapted from: Massage Therapy survey, 2002)

Yes No Not sure
1 2 8 A. How to find research-based information?
1 2 8 B. How to understand research studies in your field?
1 2 8 C. How to develop research questions
1 2 8 D. Research design & statistics

21. If interested in learning more about any of these topic areas, how do you believe faculty would like to receive the information? (adapted from: Massage Therapy survey, 2002)

Yes No Not sure
1 2 8 A. Reading a journal or textbook?
1 2 8 B. Attendance at a workshop or classroom course?
1 2 8 C. Taking a paper based distance course?
1 2 8 D. Taking an on-line computer based course?

22. Have you any other comments you would like to share?

If available and willing to share, it would be very helpful for us to receive copies of the following:

• Information about your curriculum, but specifically those sections relevant to promoting an understanding and application of research.
  
• Most recent annual program report
  
• Summary of student evaluations of most recent program graduates
  
• Other relevant documents
  
• List of staff research related publications

This is the end of the interview. On behalf of Barb Findlay & Marja Verhoef and the project team, I would like to thank you for participating in this interview today. Your responses will contribute greatly to our understanding of the abilities of chiropractors, naturopaths and massage therapists to conduct, access, read, understand and apply research in their daily practice. Your input will help policy makers, educators and researchers find ways to increase the utilization of research in practice.

Appendix 4: Interview Guide for National Associations

Needs Assessment: Research Literacy and Capacity
(Massage Therapy, Naturopathy and Chiropractic)

Interview Protocol and Guide:

Key points:

• The purpose of this project is to learn more about the abilities of chiropractors, naturopaths and massage therapists to conduct, access, read, understand and apply research in their daily practice.
  
• I am going to ask you questions about the position and activities of your national association college with respect to research and the promotion of evidence based practice amongst your members.
  
• From this study, we are hoping to identify perceived gaps and suggestions to reduce these gaps. This will help policy makers, educators and researchers find ways to increase the utilization of research in practice.
  
• You have the right to terminate the interview at any time and to refuse to answer specific questions. Every effort will be made to ensure your comments remain confidential.
  
• Do you have any questions at this time? Then let us begin.

SECTION A: Demographic Profile and Brief Overview

I would like to start by learning more about your role as an association/regulatory body and whether and/or how research is positioned within it.

1. Name of national association:

2. What pre-requisites are required to become a member in your national association?

Ask the following questions, if the answers are not provided under the general question:

• Is graduation from a specific program or type of program a requirement for registration in your association?
  
• Is successful completion of national exams a requirement for registration in your association?
  
• Are there other pre requisites that are required for registration in your association?
  
• Are there mandatory continuing education requirements to remain in your association?

3. Please briefly describe the activities of your association with respect to research/evaluation?

Ask the following questions, if the answers are not provided under the general question:

• Research/evaluation related positions within the organizational structure of the association.
  
• Research/evaluation related committees of the association.
  
• Position statements related to research/evaluation and/or promotion of evidence based practice.
  
• Written research agenda for the profession.
  
• Development of evidence based practice guidelines and/or treatment protocols.
  
• Organization of continuing education conferences, peer review meetings, etc.
  
• Dissemination of research results and/or information to members (e.g., newsletter, website)

4. To the best of your knowledge, what is the view/position of your association with respect to the use of evidence based guidelines in clinical practice?

Ask the following questions, if the answers are not provided under the general question:

• Does your association support the use of evidence based guidelines in clinical practice?
  Yes
  No
  (if no, proceed to the question #5)
  
  
• Is there a role for a regulatory college/association in the development of evidence based practice guidelines?
  Yes
  No
  (if no, proceed to the question #5)
  
  
• Is your regulatory college/association actively engaged in developing evidence based practice guidelines.
  Yes
  No
  (if no, why not?)
  
  
• Is there a role for a regulatory college/association in the dissemination of evidence based practice guidelines?
  Yes
  No
  (if no, proceed to the question #5)
  
  
• Is your regulatory college/association actively engaged in disseminating evidence based practice guidelines.
  Yes
  No
  (if no, why not?)

5. Does your association have a role with respect to evaluating and/or disseminating information about new modalities/therapies within the profession? If so, what is the role?

Ask the following question, if the answer is not provided under the general question:

• If the role includes evaluation, is research or published literature considered?

6. What body is responsible for approving educational curricula for (chiropractors, massage therapists and naturopaths)? Are there minimum requirements for content with respect to research/evaluation or promoting the use of evidence based practice?

7. Does your association offer members a journal? If so, please describe the nature of the contents of the journal.

Ask the following questions, if the answers are not provided under the general question:

• Does the journal include practice-related information? (as opposed to business information, information about upcoming conferences, etc)
  
• Does the journal include results of research studies? If so, are they peer reviewed?

SECTION B: Defining & Valuing Research

In the next set of questions, I would like to learn more about what the term research means to your association.

8. To the best of your knowledge, how does your association define "conducting research?" (adapted from: Dobbins, Jan 2002)

9. To the best of your knowledge, how does your association define "applying research to practice?" (adapted from: Dobbins, Jan 2002)

10. We all differ as to our opinions on the importance of research, and there is no right or wrong to this judgment. During these interviews, we are hoping to get opinions both from those that think it is important and those that do not. In the context of your role, does your organization believe research is important? If so, why? If not, why not?

Note: if answer question #10 as "no," the survey is complete. If answer as yes, go to question #11.

11. What is the vision of your association with respect to research in the (chiropractic, massage therapy and naturopathy) profession.

SECTION C: Research Literacy (accessing, understanding & applying research)

12. On a scale from 1 to 10, where 1 means poor and 10 means very well, please rate the following:

A. The adequacy of (chiropractic, massage therapy or naturopathy) training programs in terms of teaching practitioners how to access research-based information?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

B. The adequacy of (chiropractic, massage therapy or naturopathy) training programs in terms of teaching practitioners how to read & understand research-based information?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

C. The adequacy of (chiropractic, massage therapy or naturopathy) training programs in terms of teaching practitioners how to use research in their daily practice?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

D. The adequacy of (chiropractic, massage therapy or naturopathy) training program in terms of teaching practitioners how to conduct research?

Poor 1 2 3 4 5 6 7 8 9 10 Very well

13. As a association, do you access research to develop/update policies?

• Yes; if so, then how often (daily, weekly, monthly)
• No

SECTION D: Research Capacity (conducting & disseminating research)

14. To the best of your knowledge, over the last two years, what has been the focus of research conducted in the field of (chiropractic, massage therapy or naturopathy)? (probe: methods, and topics).

15. From the list of potential barriers to conducting research, how would you rate each for your members on a scale of 1 to 5 where 1 means that it is "not an barrier" and 5 means that it is a "very serious barrier" (taken from: Dobbins, Jan 2002)

A. Time is...

1 2 3 4 5

B. Identification of potential funding sources is...

1 2 3 4 5

C. Securing funding is...

1 2 3 4 5

D. Knowledge & skills about how to conduct research...

1 2 3 4 5

16. Are there other barriers that keep your members from being able to conduct research in their work?

17. Does your association provide funds for the development of research proposals or increasing the capacity of members to conduct, understand and apply research? If so, how much or what % of your operating budget is allocated to such activities?

18. From the list of potential barriers to applying research results in their daily practice, how would you rate each for your members on a scale of 1 to 5 where 1 means that it is "not an barrier" and 5 means that it is a "very serious barrier" (taken from: Dobbins, Jan 2002)

A. Availability of research information is...

1 2 3 4 5

B. Time is...

1 2 3 4 5

C. Financial resources are...

1 2 3 4 5

D. Access to research information is...

1 2 3 4 5

E. My ability to evaluate the quality of research material is...

1 2 3 4 5

F. Resistance to change within my practice field is...

1 2 3 4 5

19. Are there other barriers that keep your members from being able to apply research results in their daily practice?

SECTION E: Research Needs

20. As a association, what kind of support would you like to be able to provide members to encourage the conducting, understanding and application of research within the (chiropractic, massage therapy or naturopathic) field?

21. What would it take for you to be able to provide the type of support you indicated you would like to in the previous question?

22. Have you any other comments you would like to share?

23. If available and willing to share, it would be very helpful for us to receive copies of the following:

• Information about your regulatory college, specifically documents, publications, position papers, etc. relevant to promoting an understanding and application of research.
• Most recent annual program report
• Other relevant documents.

This is the end of the interview. On behalf of Barb Findlay & Marja Verhoef and the project team, I would like to thank you for participating in this interview today. Your responses will contribute greatly to our understanding of the abilities of chiropractors, naturopaths and massage therapists to conduct, access, read, understand and apply research in their daily practice. Your input will help policy makers, educators and researchers find ways to increase the utilization of research in practice.