Theses and dissertations (Health Sciences)
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Item The perception of selected chiropractors, medical doctors, health maintenance organisation representatives and chiropractic patients regarding the integration of the chiropractic profession in the Israeli health care system(2009) Bar-Gil, Moshe Charley; Pratt, Deirdre DeniseChiropractic in Israel has become a more integrated part of many aspects of health care policies, in that it is practised in multidisciplinary medical teams, is now included in HMOs and hospitals services, and has contributed to research and military programmes. However, the chiropractic profession still has its problems. Without laws or legitimate recognition to protect chiropractors, the playing fields could never be levelled for all chiropractors in Israel. Patient use and demand for complementary and alternative practitioners, including chiropractors, is gradually increasing. However, there has been no research to investigate the perceptions of chiropractors, medical doctors and chiropractic patients (i.e. key stakeholders) regarding the integration of the chiropractic profession in the Israeli health care system. The purpose of this study was to explore and describe the perceptions of a selected group of stakeholders about the integration of the chiropractic profession in the Israeli health care system. Such an exploration might help the profession to secure its position and claim a higher status in society. This is desirable to educate the public and the authorities on the many positive advantages of chiropractic, include access to chiropractic services for people who traditionally have not been able to use these services because of economic barriers or internal government and authorities limiting laws, as well to enhance its public image such as honesty, integrity and objectivity in the health care, and to avoid any criticism of organized medicine. It therefore stands to reason that the factors that might contribute to this type of development should be considered as soon as possible in those countries where chiropractors practise. This type of investigation is important not only in the Israeli setting, but indeed in every country where the profession is aiming toward increased recognition and awareness of the contribution of chiropractic to health care. Chiropractic now has the opportunity to expand its influence and take a more active role in health care issues. Therefore, although geographically removed, South Africa stands to gain interesting and useful information from an investigation of this nature. The investigation was carried out within a post positivist approach close to that of critical realism, using an interpretive methodology. The sampling was purposive as individuals were targeted for their knowledge in three main topics, these being the scope of chiropractic practice, inter-professional relations between Doctors of Chiropractic (DCs) and Medical Doctors (MDs), and developmental issues. The participants included five chiropractors, three medical doctors and three chiropractic patients, who all resided in the metropolitan area of Tel Aviv. were presented in tabular form in order to facilitate analysis and interpretation. Although there were some discrepancies regarding the knowledge and background of the participants about the topics discussed, all the participants met the inclusion criteria. The results show that chiropractic stands at the crossroads of mainstream and alternative medicine. Therefore it is important to establish a leading statement on identity, which must be clear, concise and immediately relevant to both the public and the profession. Although inter-professional relations between MDs and DCs in Israel are improving, further research should be conducted to provide suggestions on how chiropractors can overcome barriers and improve communication with MDs and other health care professionals in the Israeli health care system. In general, the participants agreed that governmental legislation, recognition and support are important endorsements with respect to the societal relevance and development of the profession. Therefore issues such as public awareness of chiropractic education and scope of practice, research and evidence-based practice must be emphasized accordingly in order to facilitate the development of chiropractic practice in Israel.Item Knowledge, perception and utilisation of chiropractic by National Olympic Committees(2009) Labuschagne, Kerry; Korporaal, Charmaine MariaIntroduction: National Olympic Committees (NOCs) select medical personnel to support their athletes at the Olympic Games. To best support athletes the knowledge, perception and utilisation of all medical professions is assumed to be high, however literature seems to indicate that this is not so. Objective: To determine the knowledge, perception and utilisation of Chiropractic by NOCs in order to develop a better relationship so that more athletes can benefit from Chiropractic care. Methods: A questionnaire was emailed to the 205 NOCs worldwide. Respective executive committee and medical commission members were asked to complete the questionnaires. Results: 76 NOCs responded (37%), returning 27 questionnaires. 30% of the respondents were high ranking members. 93% were highly educated with a bachelor’s degree or higher and 33% had represented their country as an athlete. Both committees agreed on the importance of a post-graduate sports qualification and perceived the profession to be one of spinal care specialists. Overall knowledge of Chiropractic was poor. A trend was observed among the medical commissions in their choice of Medical Doctors or Physiotherapists over Chiropractors and other professionals. The executive committees in contrast seemed more open-minded in their choice of professionals. No association was found between the knowledge and perception of Chiropractic and use of Chiropractic Conclusion: There is confusion regarding the role and scope of practice of Chiropractic by NOCs. In order to achieve a greater level of acceptance and utilisation of Chiropractic in international sports medical teams the profession needs to clarify their role, better educate NOC members on the benefits of Chiropractic, and obtain sports specific post-graduate programmes that are recognised internationally.Item A survey to determine the knowledge and perceptions of biokineticists with respect to the chiropractic profession(2008) Naidoo, Magashri; Korporaal, Charmaine MariaObjective: To determine the current knowledge and perceptions of biokineticists with respect to the chiropractic profession in South Africa. Design: A descriptive design was utilized in a qualitative questionnaire in order to evaluate, in a structured manner, the knowledge and perceptions of biokineticists with respect to Chiropractic. Subjects: The total population size used in the study was 657 (response rate n=78; 11.87%). Outcome Measures: These were based on a questionnaire which addressed biokineticists knowledge of Chiropractic, interaction with Chiropractic, Chiropractic terminology and scope of Chiropractic practice. Results: Of the 657 questionnaires that were mailed, only 78 questionnaires were returned and this gave a response rate of 11.87%. The most frequent view or attitude towards chiropractic was that it had a valuable role in the health care system (64%). About 50% of the respondents believed chiropractors to be greatly competent in examination and diagnosis whilst 40% felt that chiropractors were moderately competent in examination and diagnosis. Nevertheless, the rate of communication between biokineticists and chiropractors was found to be quite high, in this study. All together, 67% of biokineticists had communicated with chiropractors. Of those that had communicated, the communication was rated as positive (94.4%). Of those who had referred patients to chiropractors, 41.8% had received treatment feedback reports and of those who had received reports, 68.8% said they were concise and valuable. Conclusion: The results of this study show that the mean knowledge score was 60%. Thus the overall knowledge of chiropractic was high. The only factor that significantly affected respondents’ knowledge was their self reported knowledge of chiropractic. In congruence with this, the most common attitude towards chiropractic was that it had a valuable role to play in the health care system (64%).Item A study to determine the international federations' perception and utilization of chiropractors and other sports medical personnel(2008) Cloete, Kirsten Leigh; Korporaal, Charmaine MariaObjectives: To investigate the International Sports Federations’ (IFS) perception and utilization of chiropractors and other sports medical personnel, and to compare results between the executive committees and medical commissions within federations. Methods: A specially designed, quantitative questionnaire was used to collect data from the 65 federations belonging to the General Assembly of International Federations of Sport (GAIFS). The questionnaire distribution took place via e-mail, with the secretary of each federation being requested to forward a copy of the questionnaire to a member of the federation’s executive committee and medical commission respectively. Follow-up telephone calls were also made to further encourage a response from participants. After an 8-week period, returned questionnaires were collected and data was analyzed. Results: From the results obtained (30% response rate), it would seem that perceptions vary greatly. This is most evident when one compares the perceptions of the medical commission members to those of the executive committee members. The medical commission on a whole, appears to favour the more traditional medical professions, while the executive committee seems to be more holistic in their approach to treatment options. In terms of current utilization, chiropractors are currently represented on 16% of medical teams, although chiropractors are able, within their scope of practice, to provide 70% of the federations’ most requested techniques / modalities for competitions. There appears to be little / no criteria governing the selection of medical personnel, however most of the federations agreed that a chiropractor with a post-graduate diploma in sports injuries, would be seen in a more favourable light for selection. Conclusions: The perceptions and utilization of chiropractors and other sports medical personnel varies greatly between federations, which may be due to a number of factors related to the formulation of perception itself. In addition, there appears to be a discrepancy between the opinions of the executive committees and medical commission of the participating federations.Item A retrospective survey of the career paths and demographics of Durban University of Technology (DUT) chiropractic graduates(2008) Black, Elmi; Brunette-de Busser, NikkiAims and Objectives: To assess the demographics, career paths and factors affecting chiropractic graduates of Durban University of Technology (DUT) from June 1994 to June 2007. Method: A retrospective qualitative survey was conducted on 62 chiropractic graduates of DUT. The sample represented 25.5% of the total chiropractic population. Raw data regarding the demographics, respondents’ perception of their education, current career paths, the factors responsible for affecting these career paths, as well as a profile of chiropractic practices in South Africa (SA) was obtained. All data acquired was assessed using SAS (Statistical Analysis System) version 9.1.3. The data was purely descriptive, describing respondents’ career paths and their experiences, and no specific hypothesis was investigated. Results: The average respondent was found to be a married, white male who started his chiropractic career at age 25-26 years. A total of 98.4% (n = 61) of the respondents were currently in practice, with 80.6% (n = 50) indicating career satisfaction. The majority (62.9%; n = 39) of respondents perceived there to be a growing acceptance of chiropractic within the medical community, whilst 98.4% (n = 61) stated that they are currently part of an active referral system between various other medical practitioners. 46% (n = 23) listed DUT as their preferred choice of chiropractic institution. Conclusion and Recommendations: The majority of respondents’ indicated DUT as the preferred choice of chiropractic institution due to its location and the system of chiropractic taught (diversified). However, shortcomings in the education were highlighted to be a lack of practically applicable knowledge taught at undergraduate level, most especially business skills and speciality areas and that respondents’ perceived the qualification not to be as versatile and widely accepted as other international chiropractic qualifications. Factors responsible for positively affecting the career paths of chiropractic graduates were indicated to be the personality type of the graduate, the means to finance a practice, support from parents and spouse or partner and the level of acceptance graduates received from the public and other professions within the medical sector. A recommendation for future studies is that a longer time period be given for questionnaires to be returned and a larger sample group be established in order to ensure that the sample group and total population is homogenous.Item The knowledge and perceptions of the medical staff about chiropractic at the Kimberly [i.e. Kimberley] Hospital Complex(2009) Meyer, Julia; De Busser, Nikki LaurenBackground: In order to develop a balanced healthcare system, healthcare integration and inter-professional communication is important and allows for optimum healthcare benefits for a patient and improves cost-effectiveness. The chiropractic profession has been trying to improve inter-professional communication with the medical profession. Kimberly Hospital Complex (KHC) is a tertiary provincial hospital situated in the Northern Cape and since 1998, a permanent chiropractic post exists at this hospital, making it the only state hospital in South Africa with a full-time chiropractic clinic and post. Purpose: To determine the knowledge and perceptions of the medical staff about chiropractic at KHC. Method: This study was achieved by means of a questionnaire, which was modified to suit a South African context by means of a focus group. The questionnaire was personally delivered to 975 medical staff members at KHC. A response rate of 30% (n = 292) was achieved and the data was analysed using SPSS version 15 (SPSS Inc., Chicago, III, USA). Results: The mean age of the respondents was 37.3 years and most were female (78.9%, n = 289). Doctors (62.5%, n = 54) and therapists (61.6%, n = 10) had a higher knowledge percentage score than nurses (48%, n = 213) or other healthcare professions (56.8%, n = 15). Doctors (77.8%, n = 42), therapists (100%, n = 10) and other healthcare professions (69.2%, n = 9) were more inclined to think that chiropractic is an alternative healthcare service, while nurses perceived chiropractic as a primary healthcare service (43.3%, n = 91). Many respondents were unaware of the fact that Diagnostics, Emergency Medical Care, Pharmacology and Radiology are included in the chiropractic curriculum and that chiropractic leads to a Master’s degree. Seventy five percent (n = 203) believed that chiropractors are competent in the general medical iv management of patients, but they would still rather refer patients to physiotherapists and orthopaedic surgeons. Despite the poor level of knowledge of chiropractic, 79.2% (n = 224) believed that it is sufficiently different from physiotherapy to warrant two separate professions and few (24%, n = 69) perceived it as unscientific. A large proportion of the respondents (80.3%, n = 228) believe that chiropractic is not well promoted in South Africa and only 20.8% (n = 59) felt that they know enough about the profession to advise a patient. The majority wanted to learn more about the chiropractic profession (95.8%, n = 277), especially pertaining to the scope and the treatment employed by chiropractors. Seventy-nine percent (n = 212) believed that patients benefit from chiropractic at KHC and 95.4% (n = 268) felt that South African hospitals would benefit from chiropractic care. Conclusion: Due to the poor level of knowledge at KHC, an educational drive should be employed to educate the medical staff in order to increase their understanding of chiropractic and to aid chiropractic integration into the state hospital system of South Africa.Item The knowledge and perceptions of paediatricians in South Africa with respect to chiropractic(2008) Heslop, Sarah JaneObjectives: To investigate the knowledge and perceptions of Paediatricians in South Africa with respect to Chiropractic, and to determine if any correlation exists between the two. Methods: A posted quantitative questionnaire was used to collect data from Paediatricians in South Africa. Follow up telephonic calls were made to encourage response from participants. After a 12-week period, returned questionnaires were collected and data analysed. Results: The results obtained (25% response rate), indicated that there are relatively low levels of knowledge and poor perceptions amongst Paediatricians, which was supported by the low referral rate from Paediatricians for Chiropractic treatment. With regard to perception, Paediatricians seem to have a better perception of Chiropractic for the general compared to the paediatric population. Paediatricians felt that they do not have enough knowledge to discuss Chiropractic with their patients and would like to be further informed. This was reflected in the statistically significant correlation between knowledge and perception, and it would seem that better knowledge allowed for more positive perceptions. The study also found that Paediatricians agreed that they would like to receive treatment feedback after referring a patient for Chiropractic treatment and they were more likely to refer to a Chiropractor if they had a post-registration paediatric specialisation. Conclusions: A correlation exists between knowledge and perceptions of Paediatricians in South Africa with respect to Chiropractic, with both being relatively, although better perceptions of Chiropractic for the general than for the paediatric population exist.Item A study to determine the perceptions, attitudes and knowledge of selected South African pharmacists on the chiropractic profession(2008) Palmer, David CraigPharmacists are seen as a trustworthy source of advice and information to many people. Their accessibility, approachability and availability enable them numerous opportunities to offer health education and advice in an informal environment. Patient use of and demand for complementary and alternative practitioners including chiropractors, continues to increase, however there have been no studies to determine the extent of the pharmacists knowledge and perceptions/attitudes towards these alternative practitioners. Thus the purpose of this study was to determine the current perceptions, attitudes and knowledge of selected South African pharmacists with respect to the chiropractic profession. This will provide a basis for future studies, as well as a knowledge base to facilitate greater understanding and co-operation between pharmacists and chiropractors.Item An exploratory mixed-methods study to determine factors which may affect satisfaction levels of patients outside of a clinical setting(2007) Talmage, Grant L.; Korporaal, Charmaine MariaIt has been shown that patient satisfaction evaluation is an excellent tool that may be used to determine whether practitioner services are meeting the needs of the general public. Furthermore, it has been observed that patients who were satisfied with their treatment behave differently to those who were dissatisfied with their levels of care, as patient’s who were satisfied with their levels of treatment are more likely to be compliant with their treatment regime and more likely to seek out similar care for the same condition in the future. With satisfaction having such an affect on patient’s behaviour toward practitioners and the treatment experience outcomes, it is imperative to understand the underlying factors that may affect the levels of satisfaction.