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Chiropractic Journal of Australia : CJA September 2013
86 Chiropractic Journal of Australia Volume 43 Number 3 September 2013 has happened in spite of some strongly constraining factors. For example, chiropractic is not covered by the Australian health insurance scheme (Medicare), although it is partially covered by most private health care schemes. Furthermore, chiropractic in Australia has received some negative publicity in recent years with the validity and effcacy of some aspects of chiropractic (and other CAM disciplines) and its place in the government funded universities having been vigorously called into question, by some interest groups such as the Friends of Science in Medicine.6 The reasons for the increase in demand for CAM, which have not yet been satisfactorily researched, seem to be many and different in nature. They are to be sought not only within changes in modern medicine and developments in CAM but also in the broader social, economic and political dynamics within a particular society in recent decades.7 Therefore, understanding the broader context and complex, multidimensional network of phenomena and relationships within which health systems operate is necessary to understand the position and signifcance of CAM in general and chiropractic in particular. As this complex network constantly changes and evolves there is a need to regularly evaluate the status and position of the particular health professions within it. As part of this process, we investigated the Australian general public and its relation to chiropractic. The aims of this study were to ascertain the lifetime prevalence of the use of chiropractic in Australia and to investigate the perceptions and attitudes of the Australian general public about several issues: their health status (as related to chiropractic), the chiropractic profession, as well as chiropractic and health services in general. In the last two decades there have only been a few studies carried out, on samples that would be considered representative with appropriate methodological rigour,8 that investigated the attitudes of the general population towards CAM and chiropractic in Australia.2,3,6 The current study was a part of a broader project entitled the Work Force Study, which focused on the current state of chiropractic in Australia.9,10 This project was carried out through three large scale surveys: frst focusing on the practitioners,11 second on the chiropractic patients and third, the results of which are presented here, on the Australian general public. METHODS The research was carried out using a novel 21-item survey questionnaire. The questionnaire (Appendix 1) consisted of two parts. Basic demographic data of the respondents was recorded in the frst section of the survey: age, gender, country of origin, language spoken at home, level of education, occupation, average annual household income and the place (suburb) of residence. In the second part, questions relating to chiropractic and chiropractic services were asked, including questions on respondents health status (presence of discomfort or pain, particularly in the spine and limbs), health practitioners consulted with regards to therapy and relief of the symptoms, expectations of health practitioners, and motivation to seek health care as well as more specifc questions on chiropractic such as previous usage and satisfaction with the service provided. The questionnaire combined open-ended and closed questions; the latter were with dichotomous and nominal-polytomous options as well as scaled questions with Likert-scale options. The questionnaire was administered in an electronic format via SurveyMonkeyTM. The data were collected between the 10th and 15th of January 2012. Sampling was carried out by an independent party -- MyOpinions, a professional market research agency specialising in on-line surveys. The services of MyOpinions were employed in order to utilise their extensive databases and to minimise potential bias. Using the data from the Australian Bureau of Statistics12 as a reference, stratifed sampling was used to obtain representative samples of different strata of the Australian society with regards to age, gender and geographical distribution. Invitation to participate in this survey was sent to adults (18 years of age or over) who were Australian residents. Descriptive statistics (tables and histograms) were used to summarise the fndings and the chi-squared test and logistic regression were used to examine relationships between variables. The ethics approval for this project was granted by the Macquarie University Human Research Ethics Committee. RESULTS Sample For this survey, 842 adult members of the Australian public, sourced from the MyOpinions national database, accessed an electronic survey link. From these, a total of 757 respondents completed the survey. As noted earlier to obtain a sample of respondents whose opinions would be representative of the Australian general population with a 95% level of signifcance and 4% margin of error, a sample of at least 600 respondents was needed. Because a higher number of respondents were actually surveyed this implies a smaller margin of error (greater precision) was obtained. Not surprisingly (because of the design of the study), respondents for this survey closely resembled the demographic distribution reported in the 2011 Australian census12 for the variables stratifed for i.e. age, sex and geographical location (Table 1). Differences were observed for other census variables (see also Table 1) such as education, where lower percentages were obtained for the lowest age categories compared to the census, and a higher percentage of sample respondents had Year 12 education. Also the lowest and highest income groups were under-represented, though these may be the people who chose to not state their income. These differences however are not expected to impact on the validity of the responses. Symptoms Apart from assisting patients with the management of their health and well-being, chiropractors devote most of their energies to the care of patients with pain syndromes, focusing on the musculoskeletal system -- particularly the spine and extremities. Thus, the respondents were asked whether or not they experienced discomfort or pain in various regions of the body. In this sample, 89.4% of respondents stated that they had suffered pain in at least one of the regions of interest, 31% had suffered pain in one or two of the specifed areas, and nearly 60% in three or more areas. The most commonly reported pain was from the lower back (71.1% of the respondents) and neck (55.6%), followed by headaches (45.5%) and pain from the shoulder (45.2%) (Figure 1). SURVEY OF GENERAL PUBLIC BROWN et al
CJA June 2013
CJA December 2013