Amie Steel and Hope Foley
This blog post is based on the Evidence & Policy article, ‘Designing the Contemporary Implementation of Traditional knowledge and Evidence (CITE) framework to guide the application of traditional knowledge in contemporary health contexts: a Delphi study’.
The Contemporary Implementation of Traditional Knowledge and Evidence (CITE) framework is a groundbreaking guide designed to integrate traditional medicine (TM) with modern healthcare systems. Developed through expert consensus, with the results published in Evidence & Policy, this framework provides essential principles and criteria for evaluating and applying traditional knowledge in clinical practice, research, education and policy. As global health initiatives and institutions increasingly recognise the value of Traditional, Complementary and Integrative Healthcare (TCIH), the CITE Framework offers a timely, practical solution for ensuring the quality, safety, and efficacy of these practices in contemporary health contexts.
The 2018 Declaration of Astana and the World Health Assembly have emphasised the importance of integrating traditional medicine (TM) into primary healthcare systems. Such integration is intended to support achievement of the global Sustainable Development Goals, however, it necessitates robust evidence of the safety and effectiveness of TM practices, products and treatments.
Alongside this, the TM community are voicing the need for such evidence to respect the core traditions, philosophies and principles of TM systems, in order to accurately and authentically reflect the approaches from which TM interventions arise. Despite this, there has been a lack of resources to support appropriate implementation of TM knowledge into health practice, policy, research, and education.
The CITE framework
The Contemporary Implementation of Traditional knowledge and Evidence (CITE) framework was developed by researchers from the Australian Research Consortium in Complementary and Integrative Medicine (at University of Technology Sydney) and the National Centre for Naturopathic Medicine (at Southern Cross University) to address this gap.
Using Delphi methodology, the framework was refined through consensus among international experts in various TM systems, including naturopathy, Western herbal medicine, osteopathy, traditional Chinese and Oriental medicine, Ayurveda, and homeopathy. The framework was primarily designed for use with knowledge from TM systems with an established history of written traditional sources.
It is designed to be adaptable to the specific needs and philosophical approaches of different TM systems, while providing guidance on complex ideas that may be implicit in current practices but are not applied consistently and explicitly across all health settings.
The study built on a comprehensive systematic review and stakeholder consultation. The final stage Delphi study involved two rounds of surveys with 19 and 15 participants, respectively. The experts evaluated and refined the framework based on the importance and clarity of its items.
The final framework provides guiding principles to inform all translation and implementation of traditional knowledge, as well as criteria to inform appraisal and application of traditional knowledge in any of the four contexts (see Figure 1).
The CITE Framework aims to facilitate the appropriate use and integration of traditional knowledge with contemporary evidence-based approaches. It includes principles and criteria for evaluating and applying traditional knowledge in clinical practice, research, education, and policy contexts. Each principle includes a header, a statement and an explainer. The appraisal and application criteria comprise a header, guiding question/s, and an explainer.
Conclusion
The CITE Framework provides a practical guide for the rigorous and respectful implementation of traditional knowledge in contemporary health settings. It addresses a critical need for resources that support the integration of TM into mainstream healthcare systems, ensuring the quality, safety, and efficacy of these practices.
Future directions
To maximise its impact, the CITE Framework should be adopted and implemented across various settings, from community practices to global health policy bodies. Further research and development are needed to create supporting tools and training resources for its application. A similar framework is also needed for oral TM systems, but such work should be led by experts in oral traditions, namely First Nations and Indigenous medicine researchers, leaders and practitioners.
Image credit: N. Voitkevitch from pexels.com
Amie Steel
Associate Professor, Australian Research Consortium in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Australia
Hope Foley
Postdoctoral Research Fellow, Australian Research Consortium in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Australia
Read the original research in Evidence & Policy:
Steel, A. Foley, H. Bugarcic, A. Adams, J. Leach, M. & Wardle, J. (2024). Designing the Contemporary Implementation of Traditional knowledge and Evidence (CITE) framework to guide the application of traditional knowledge in contemporary health contexts: a Delphi study. Evidence & Policy, DOI: 10.1332/17442648Y2024D000000037.
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