Prof Amie Steel, Dr Iva Lloyd, Prof Matthew Leach and Dr Vicky Ward
This blog post is based on the Evidence & Policy article, ‘Naturopaths’ behaviours, attitudes and perceptions towards the use of knowledge and information sources’.
The modern health landscape is dominated by the evidence-based practice paradigm which asks health professionals to prefer research evidence over other forms of knowledge and information when providing care to their patients. However, clinicians from most areas of health – including general practice and allied health – have argued that the realities of practice are not so simple. While this ‘messiness’ of clinical practice is documented for many mainstream health professions, there has been little to no research examining how clinicians from traditional medicine systems use knowledge and information in their practice, until now.
An international survey of naturopaths was recently published in Evidence and Policy which found they used a diverse range of knowledge and information sources when making clinical decisions. The survey respondents practice naturopathy, a traditional medicine system originating from Europe but now practiced in 108 countries across all world regions. Naturopathy uses a highly patient-centred and holistic clinical approach that prioritises preventive health and wellness, and patient education and empowerment.
The naturopaths in the study reported relying on a wide range of sources when making clinical decisions including their own clinical experience, their training, scientific journals, conferences, textbooks, laboratory or radiology tests, and their patient’s personal experience of living with their health condition. While the naturopaths reported using these varied knowledge and information sources, they placed the greatest amount of importance and trust on the patient’s experience living with their health condition and the patient’s health history.
The naturopaths considered the knowledge they gained from the patient’s story more important and more trustworthy to their clinical decision-making process than published research from journals, medical examinations or tests, and input from other health professionals providing care to the same patient. They placed the least importance and trust on knowledge and information from government agencies, patient support groups, general internet sources and broadcast media. Overall, the results suggest naturopaths view knowledge and information through a hierarchy which places a greater importance and trust on information that is more directly connected to and shared by the patient (see Figure 1).
This preference for information shared by the patient, about the patient, suggests naturopaths truly do employ a very patient-centred approach to care that emphasizes addressing a patient’s unique needs. Such a preference may also be, in part, linked to naturopaths’ structural isolation in health systems commonly seen around the world.
These study findings suggest naturopaths may have a complex clinical decision-making process as they navigate a mix of research and non-research information sources. Such complexity likely requires naturopaths to draw heavily on critical thinking skills to navigate between the information derived from the different, and potentially contradictory, sources.
This is not a challenge unique to naturopathy and has been reported by other health professionals. The complexity arising from such a challenge may be amplified in a traditional medicine system such as naturopathy, as clinicians are forced to resolve disparities between their traditional knowledge sources, principles and philosophies, the patient’s personal experience and health presentation, and the knowledge derived from other external sources directly (e.g., blood tests, other health professionals’ diagnoses) and indirectly (e.g. research published in journal articles, government agencies) related to the patient in front of them.
Ultimately, clinicians commonly face complex challenges that requires them to draw upon diverse knowledge types to inform their clinical reasoning and decision-making. Given the additional layers of complexity unique to traditional medicine and the patient-centred principles required for naturopathic practice, naturopathy may offer an opportunity to better understand and explore how various forms of knowledge and information can be integrated. Further understanding of the clinical reasoning and decision-making skills used by naturopaths could be adapted and applied to other health professions to better accommodate appropriate use of non-research information sources critical to delivering patient-centred care.
* Figure 1 is not covered by the CC-BY license and is not to be reproduced without prior permission from the publisher, Policy Press.
Image credit: Photo from Canva.com
Amie Steel is Associate Professor in Public Health and Co-director of the Australian Research Consortium in Complementary and Integrative Medicine in the School of Public Health at the University of Technology Sydney, Australia. Twitter: @naturopathamie
Iva Lloyd is Chief Executive Officer of the World Naturopathic Federation and is a naturopathic doctor in private practice in Toronto, Canada. Twitter: @DrIvaLloydND
Matthew Leach is Associate Professor and Deputy Director of Education for the National Centre of Naturopathic Medicine at Southern Cross University, Australia. Twitter: @DrMatthewLeach
Vicky Ward is a Reader in Management, Director of Impact, and Co-Director of the Research Unit for Research Utilisation at the School of Management at University of St Andrews, United Kingdom. Twitter: @VLWard
Read the original research in Evidence & Policy:
Steel, A. Ward, V. Leach, M. and Lloyd, I. (2023). Naturopaths’ behaviours, attitudes and perceptions towards the use of knowledge and information sources. Evidence & Policy, DOI: 10.1332/174426421X16843219978173.
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