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Individual Enquiry

Research Paper 2010

Title:

Is There A Need To Promote Osteopathic Awareness Amongst Ethnic Minority Communities?

Author: Jaimini Mistry BSc.(Hons) Supervisor: Robert McCoy D.O., BSc.(Hons)., MSc.

The British School of Osteopathy 275, Borough High Street, London SE1 1JE

ABSTRACT

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Background: The type of complementary and alternative medicine (CAM) used is known

to vary between racial/ethnic groups. Understanding the prevalence and reasons for its

use within ethnic groups could inform Osteopathic practice.

Objective: To identify the prevalence and management of musculoskeletal conditions and

the suitability for the promotion of Osteopathy as a treatment option within the Indian

community.

Method: A 10-minute quantitative paper questionnaire, conducted in English.

Subjects: A convenience sample of 109 participants attending either Shree Prajapati

Association-London (SPA) or Swadhyay community centres/events over the month of

December 2009, in the London borough of Brent.

Main Outcome Measures: Patients self-reported experience and treatment of

musculoskeletal conditions; awareness and use of Osteopathy compared with allied

manual therapies.

Results: A high prevalence of musculoskeletal conditions was reported. No significant

difference was found between socio-demographic factors and health-seeking behaviour,

religiosity or Osteopathic awareness. Combined use of CAM and conventional medicine

was the preferred method of healthcare. A significant proportion of those over 35 were

found to use manual therapies of massage and physiotherapy. Awareness and

perceptions of Osteopathy were comparable to the general UK population however

majority wanted to learn more directly from Osteopaths or through general practitioners

(GPs).

Conclusion: The promotion of Osteopathy may be appropriate within this community.

However, there is a need for further research in developing a culturally sensitive survey

conducted in ethnic-specific languages and using larger population samples.

Keywords:

CAM, Ethnic Minorities, Hindu, Access to healthcare, Pain, Beliefs, Osteopathy.

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INTRODUCTION

Prevalence and Access to Complementary Therapy

CAM encompasses an array of therapies aimed at promoting health and well-being. In

1999 a House of Lords report grouped CAM therapies according to level of statutory or

professional regulation and evidence-based effectiveness. Manipulative therapies

including Osteopathy and Chiropractic were classified as ‘Group 1,’ seen appropriate for

NHS funding (House of Lords, 2000).

Over the past decade, research shows there has been a renewed interest and use of

CAM, including Osteopathy, especially in the treatment of musculoskeletal pain (Harris &

Rees, 2000; Eisenberg et al, 1998; Astin, 1998). A national UK survey conducted in 2001

found 1 in 10 adults had used a practitioner to receive CAM-based treatments in the past

12 months (Thomas & Coleman, 2004). Further, access to Osteopathy and Chiropractic

via the NHS and/or independent referrals was seen to double between 1995-2001

(Thomas et al, 2003).

CAM use within Ethnic Minority Groups

Research shows the type of CAM used varies considerably across racial and ethnic

groups (Greenfell et al 1998; Mackenzie et al 2003; Hsiao et al, 2006; Quan et al, 2008).

Evidence suggests the use of manipulative therapies, amongst ethnic minority groups, is

far less than the use of other CAM therapies when compared to the white population

(Eisenberg et al; 1998; Hsiao et al, 2006; Satow et al, 2008). Reasons for this are unclear;

but given that many CAM therapies stem from healing traditions of specific cultural groups,

often from non-Western society, it is not possible to conclude from these studies that CAM

does not play a role within ethnic minorities (Mackenzie et al, 2003).

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A national UK survey conducted by Thomas & Coleman (2004) found CAM use to be

lower in younger and older age groups, and positively associated with high income level,

non-manual social class and full-time higher education. The main disadvantage of this and

other national surveys is that ethnic minorities are not oversampled and so insufficient data

is available to aid statistical analysis and draw conclusions (Eisenberg et al; 1998;

Licciardone, 2003).

Hsiao et al (2006) found reduced English proficiency lead to greater ethnic-specific CAM

use. In contrast to national surveys on CAM use, this study found factors such as age,

level of education, gender, spirituality and religiosity to be associated with ethnic-specific

CAM use but differed between ethnic groups. This suggests a need for clinicians to

understand ethnic-specific CAM use in order to provide culturally sensitive care.

Ethnic Minorities & Musculoskeletal Prevalence

Indians make-up the largest ethnic minority group in the UK with a population of over 1.1

million (ONS, 2001). Over half (52%) live predominantly in the London boroughs of Brent

and Harrow (ONS, 2001). Hinduism is the most common religion practised by Indians;

however, it is not only a religion but a way-of-life and often religious practices and customs

are closely interwoven. Health beliefs/practices may also be influenced by a rich history of

traditional/folk medicine.

Research suggests there is a prevalence of musculoskeletal conditions within the Indian

ethnic group (Allison et al, 2002; Singh et al, 2004; Palmer et al, 2007). Musculoskeletal

symptoms were found to be more generalised, with pain reported in several sites than the

UK white population (Allison et al, 2004; Palmer et al, 2007).

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A study by Greenfell et al (1998), conducted in the London borough of Brent found 76% of

Asians used CAM (mainly herbal/ayurveda) for the treatment of musculoskeletal pain.

Findings also showed CAM was often the treatment of choice before medical consult was

sought. Half the users failed to disclose CAM use to their GP. Reasons for non-disclosure

were not ascertained. Other studies have found similar levels of non-disclosure with CAM

often being used alongside conventional medicine (Thomas & Coleman, 2004; Singh et al,

2004; Rhodes et al, 2008).

These findings highlight a number of important issues for primary healthcare providers

such as Osteopaths. First, it highlights the possible cultural differences in the way

musculoskeletal pain is experienced and communicated to relatives and practitioners.

Secondly, considerations for ethnic minority health beliefs/practices may directly impact on

the practitioner-patient relationship. Thus greater inquisitiveness may better inform the

practitioner on any CAM use, how best to treat/advise patients and reduce the potential for

side-effects from combining treatments/medication. Thirdly, research suggests that there

maybe limited awareness of the existence and access to complementary therapies

potentially preventing the use of therapies such as Osteopathy within the Indian

community.

Osteopathic Awareness

Osteopathy deals primarily with musculoskeletal conditions. Its prominence and public

awareness has been growing rapidly. The 2001 and 2006 surveys carried out on behalf of

the General Osteopathic Council (GOsC) showed awareness of Osteopathy,

Physiotherapy and Chiropractic to be in excess of 80% since 1996, of which, Osteopathy

saw a 25% increase. However, only a quarter of those who had heard of Osteopathy had

also visited an Osteopath (GOsC, 2001 & 2006). Both surveys highlighted Osteopaths as

specialists treating conditions/injuries of the musculoskeletal system (GOsC, 2001 &

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2006). Osteopathic awareness was found lower amongst the lower socio-economic

classes and the younger age group (18-24yrs). This compared to US research by

Licciardone (2003) and Stamat (2008), who found awareness to be directly associated

with age and education and less with lower socio-economic classes and non-white

population.

The main disadvantage of national surveys from both the USA and UK is that they under-

represent ethnic minority groups making it difficult to ascertain whether or not manipulative

therapies are used (GOsC, 2001 & 2006; Mackenzie et al; 2003; Licciardone, 2003;

Stamat et al, 2008). Secondly, US research on the awareness and promotion of

Osteopathy is not directly comparable to Osteopathic awareness in the UK. This is

because Osteopathy in the US parallels conventional allopathic medicine, whereby

Osteopathic physicians are licensed and able to do everything allopathic physicians do

(Licciardone, 2003).

The use of manipulative treatments compared to other CAM therapies among the non-

white population has been reported to be lower than the white population for the treatment

of musculoskeletal conditions (Licciardone, 2003; Hsiao et al, 2006; Stamat, 2008). It is

unclear why manipulative therapies like Osteopathy are not used. It could be due to a lack

of awareness of the profession or barriers to access such as communication, language,

modesty or cultural issues. By focusing efforts on enhancing public awareness of

individual communities/ethnic groups; the Osteopathic profession could gain invaluable

information in providing culturally sensitive care, thus having a competitive advantage on

other allied manual therapies.

There is a gap in knowledge about whether or not Indians are aware of and approach

Osteopaths. This research hopes to add to current knowledge by identifying the

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prevalence and management of musculoskeletal conditions currently employed by Indians.

It also aims to identify the levels of Osteopathic awareness; any potential barriers for

seeking Osteopathic treatment and the suitability for promoting the profession as a viable

treatment option.

Research Questions

1. What are the common musculoskeletal complaints reported and treatments

sought by the Indian community?

2. What percentage of the sample has visited an Osteopath?

3. Are there any barriers/considerations when seeking Osteopathic/CAM

treatments?

4. Is there a difference in demographic variables between people who have

heard of Osteopathy and those who have not?

5. Are people with qualifications more likely to have had Osteopathic

treatment?

6. Are people who are actively practising their religion less likely to seek

treatment from (GPs / CAM therapies) for musculoskeletal complaints?

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METHOD

Subjects

A volunteer convenience sample of 1000 individuals were chosen from two Indian

communities based in North West London: SPA and Swadhyay, (n=109). Both have

activities on a weekly or bi-monthly basis and are open to all individuals.

Inclusion criteria:

Individuals over 18 years attending community centres/events.

Willingness to participate.

Full completion and return of questionnaire.

Exclusion criteria:

Individuals under 18 years.

Those not attending centre/events.

Failure of full completion of questionnaire.

Design

A 10 minute quantitative questionnaire, in English, amongst individuals attending SPA or

Swadhyay community centres in the month of December 2009. The survey design was

adapted from validated surveys by Hsiao et al, (2006); Graham et al, (2005) and the 2001

National GOsC Survey. Twenty-three tick-box style questions explored the type of

musculoskeletal pain experienced, current management, participant’s health beliefs and

the awareness/use of Osteopathy. The survey generated categorical data.

Pilot Study

A pilot was conducted on a convenience sample of 10 Indian individuals (4 male, 6 female)

to evaluate the design and clarity of the survey. Grammatical errors were corrected and

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two questions were amended to record only positive responses. An additional question

was added to provide information on individuals’ perceptions of Osteopathic treatment.

Equipment

Pens x 10

Posters x 4

Copies of: Questionnaire, Participant Information Sheet (PIS), Summary Request

Forms (SRF) x 300

Sealed collection boxes x 2

Procedure

Two posters were displayed in both community centre notice-boards inviting individuals to

participate. A table with 150 surveys, pens and a sealed collection box was set up in each

foyer. Each surveys had a PIS and SRF attached. Surveys were numbered 1-300 which

corresponded to its respective PIS to enable survey identification should participants later

choose to withdraw. Participants could complete the questionnaire in their own time and

return it to the designated collection box by 30-December-2009. The SRF was optional

and not numbered. Personal data (e-mail/address) obtained from the SRF was separated

from the questionnaire on receipt. Both community co-ordinators made up-to two

announcements during events to draw attention to the research.

Ethical issues

Ethical approval was granted by the British School of Osteopathy Research Ethics

Committee (BSOREC). Physical harm was not inherent in this study design. Researcher

absence limited coercion and bias.

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Three research questions regarding ethnicity and religion had the potential to cause

distress. Risk was minimised using standardised structured questions as suggested on the

Office for National Statistics website (ONS, 2008, Accessed 25/08/09). Participants were

informed on how they could withdraw from the study via the PIS. Participants were

assured their decision to participate would not affect their standing within the community.

Research benefits to the communities were stipulated to avoid potential feelings of

victimisation. Anonymity and confidentiality was guaranteed.

Statistical Analysis

Data was analysed using SPSS software (version 17.0). Descriptive statistics were used to

summarise demographic variables while inferential statistics were applied to correlate data

between communities. Hypotheses were tested using non-parametric statistics (chi-

squared or Mann-Whitney), as the questionable data was categorical. The p-value was set

at <0.05.

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RESULTS

Response Rate

A total response rate of 39% (117/300) was achieved. Response was greater from SPA

(70/150, 46.7%) than Swadhyay (47/150, 31.3%). Eight responses could not be used: 5

were incomplete and 3 were received past the deadline. Analysis was conducted on 109

respondents.

Socio-demographic characteristics

The socio-demographic data of the 109 respondents are summarised in Tables 1 and 2.

Data from both communities was pooled together as no significant differences were found

between the socio-demographic characteristics, including religiosity (Table 3). The median

age range in both communities was 35-49 years. All respondents were Indian. All but one

respondent stated their religion as Hindu, while 67% (n=73) considered themselves as

actively practicing their religion.

A high proportion, 66.1% (n=72), had attained a degree level qualification and 41.3%

(n=45) were in managerial or professional occupations. To aid statistical analysis (due to a

small sample size), age categories were re-categorised as 18-34 years and over 35 years.

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Characteristic Respondents

(n= 109)

No. %

Age

18-24 19 17.4

25-34 29 26.6

35-49 28 25.7

50-64 23 21.1

Over 65 10 9.2

Education Level

No Qualifications 2 1.8

G.C.S.E 18 16.5

A-Level 17 15.6

Undergraduate Degree 51 46.8

Postgraduate Degree 21 19.3

Occupation

Manager 13 11.9

Professional 32 29.4

Assoc. Professional 7 6.4

Admin. / Secretarial 7 6.4

Skilled trades 5 4.6

Personal service 2 1.8

Sales/ Customer Service 10 9.2

Process, Plant, Machine 2 1.8

Unemployed/Homemaker 15 13.8

Student 16 14.7

Practicing Religion (Religiosity)

Yes 73 67

No 36 33

Main Language=English

Yes 87 79.8

No 22 20.2

Table 1: Socio-demographic characteristics of respondents.

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Male (n) Female (n) Total n(%)

S.P.A (London) 29 35 64 (58.7%)

Swadhyay 18 27 45 (41.3%)

Total n(%) 47 (43.1%) 62 (56.9%) 109

Characteristic Mann-Whitney U Chi-squared P Value

Age 1411.5 0.857

Gender - 0.304 0.581

Actively Practicing - 0.278 0.598

Main language= English

- 0.198 0.657

Education 1351.5 - 0.562

Occupation n/a n/a n/a

Experience and Management of Musculoskeletal Pain

Table 4 shows reported sites of pain and practitioner consultation sought over the last 12

months. The most common musculoskeletal conditions experienced were back-pain,

headache/migraine and muscle sprain/strain, but few sought treatment. A greater

percentage sought treatment for whiplash, arthritis, joint and pregnancy pain. Treatment

methods are shown in figures 1 and 2, below. Insufficient data prevented analysis on

religiosity and health-seeking behaviour of individuals.

Table 4: Prevalence and proportion consulting a practitioner for musculoskeletal conditions.

Table 2: Gender distribution of respondents across communities.

Table 3: Comparison of demographics between the two communities. No statistical difference found (p<0.05).

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Area of Pain

Musculoskeletal Experience in Past

12 Months Visit to Practitioner

Percentage Seeking Treatment

for each Musculoskeletal

Complaints

(n = 109) (n = 109)

No. % No. % %

Headache/Migraine 67 61.5% 10 9.2% 14.9%

Neck Pain 43 39.4% 12 11.0% 27.9%

Whiplash 5 4.6% 4 3.7% 80.0%

Back Pain 67 61.5% 21 19.3% 31.3%

Hip/Other joint Pain 30 27.5% 12 11.0% 40.0%

Arthritis 12 11.0% 5 4.6% 41.7%

Foot Pain 34 31.2% 8 7.3% 23.5% Muscle Strain/Sprain 53 48.6% 16 14.7% 30.2%

Nerve Pain 22 20.2% 6 5.5% 27.3%

Anxiety/Stress 39 33.9% 4 3.7% 10.3%

Work Strain 24 22.0% 2 1.8% 8.3%

Abdominal Pain 20 18.3% 7 6.4% 35.0%

Menstrual Pain 24 22.0% 4 3.7% 16.7%

Pregnancy Pain 5 4.6% 2 1.8% 40.0%

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49.5%

37.6%

33.0%

25.7%

24.8%

12.8%

8.3%

7.3%

6.4%

6.4%

4.6%

2.8%

2.8%

1.8%

1.8%

0.9%

0.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

None / Eases with time

Non-Prescription drugs/gels

Massage

GP / Medical Professional

Home / Natural Remedies

Acupunture / Acupressure

Osteopathy

Ayurveda

Reflexology

Physiotherapy

Prayer

Aromatherapy

Traditional Chinese Medicine

Reiki

Other

Chiropractic

Spiritual Healers

Tre

atm

en

t M

eth

od

s U

se

d

Percentage of Respondents

Figure 1: Treatments used to manage musculoskeletal conditions.

Half the respondents chose to do nothing. There was a greater use of

massage compared to other CAM therapies (e.g. home/natural remedies or

acupuncture) observed.

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28.4%

10.1%

3.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Pray for own health Ask others to pray Perform ritual/ceremony

Use of Prayer/Ceremony

Pe

rcen

tag

e o

f R

esp

on

de

nts

Figure 2: Use of prayer and ceremonies for health purposes.

A third (n=31) used prayer specifically for their own health. Chi-square tests found no

significant difference between those who pray themselves and those who do not when

compared to active religiosity, (x2 = 3.661, p=0.056). Insufficient data prevented

statistical analysis between religiosity and asking others to pray and use of rituals. No

significant difference was found between active religiosity and the main methods used

to manage musculoskeletal conditions.

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Age vs. Musculoskeletal Conditions and Treatment

Chi-squared tests found no significant difference between binary age categories and

musculoskeletal conditions experienced, p>0.05. Massage was found statistically

significant (x2 =5.766, p=0.016) as a treatment for musculoskeletal conditions between

binary age categories. Over 35’s (42.6%, n=26) were twice as likely to have used

massage in the past 12 months than those under 34 (20.8%, n=10).

Age and Preferred Method of Healthcare

The majority (56% n=61) preferred a combined method of healthcare (Table 5). Mann-

Whitney U test found a statistically significant difference between the preferred healthcare

option and the binary age groups (U=1053.0, p=0.005).

Preferred Method to Improve Health

Age (years)

18-34 Over 35

No. %=n/109 No. %=n/109

Modern Medicine 19 17.4 8 7.3

CAM 8 7.3 13 11.9

Both 21 19.3 40 36.7

Table 5: Preferred method of improving health by recoded binary age

category.

Those aged 18-34 were three times more likely to use “modern medicine”

than the over 35s. CAM use was more prevalent by those over 35 years.

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Disclosure to GP

Only 22.9% (n=25) informed their GP about CAM use but nearly half (45.9%, n=50) did

not. Figure 3 illustrates reasons for non-disclosure. Insufficient data in cells prevented

analysis of CAM disclosure to GP by socio-demographic characteristics.

23.9%

11.9%11.0%

6.4%

2.8%

0.0%0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Not important to

tell GP

GP not ask/care Forgot to tell GP Not seen GP Unwilling to tell

GP

Other

Reasons for Non-disclosure

Perc

en

tag

e o

f R

esp

on

den

ts

Awareness & Use of Osteopathy

Figure 3: Reasons for non-disclosure to GP on CAM use.

Informing GPs on CAM use was not considered important by the majority. Equally,

respondents forgot to tell their GP or did not disclose because the GP failed to ask or

was viewed not to care.

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Figure 4 illustrates second highest levels of awareness for Osteopathy (n=89) when

compared to Physiotherapy and Chiropractic. Of those who had heard of Osteopathy a

majority (57.8%, n=63) were aware of registration requirements for Osteopaths. Statistical

tests found no significance between demographic variables and Osteopathic awareness.

No significant difference was found between gender, education levels and language with

the use of Osteopathy. Table 5 shows the number of respondents receiving manual

therapy treatment and their perceptions of the treatment received.

78.0%

93.6%

81.7%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Chiropractic

Physiotherapy

Osteopathy

Aw

are

ne

ss o

f T

he

rap

ies

Percentage of Respondents

Figure 4: Percentage of all respondents who have heard of the three main manual

therapies.

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14.7%

20.2%

22.0%

18.3%

6.4%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

18-24

25-34

35-49

50-64

65+

Ag

e C

ate

go

ries

Percentage of Respondents

Figure 5: Awareness of Osteopathy by age range.

Greatest awareness among those aged 35-49, while the older and younger age categories

demonstrate the least awareness.

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Use of manual therapy (n=109) Frequency of treatments Effectiveness

Treatment Method Yes (%)

No (%)

Once (%)

Few (%)

Regular (%)

Not Effective

(%) Effective

(%)

Very Effective

(%)

Osteopathy 17 (15.6) 92

(84.4)

3 (17.6)

11 (64.7)

3 (17.6) 1 (5.9)

10 (58.8) 6 (35.3)

Physiotherapy 31 (28.4) 78

(71.6)

8 (25.8)

20 (64.5) 3 (9.7) 6 (19.4)

18 (58.1) 7 (22.6)

Chiropractic 13 (11.9) 96

(88.1)

4 (30.8)

8 (61.5) 1 (7.7) 2 (15.4)

10 (76.9) 1 (7.7)

Massage 36 (33.0) 73

(67.0)

10 (27.8)

16 (44.4)

10 (27.8)

1 (2.8)

23 (63.9)

12 (33.3)

Table 5: Frequency of treatments and effectiveness of each manual treatment

used.

Nineteen percent (17/89) who had heard of Osteopathy had received Osteopathic

treatment. Of those receiving treatment, chi-squared test was significant for

physiotherapy use (x2=10.709, p=0.001) by binary age categories. Over 35s were three

times more likely to have been treated by a physiotherapist than those under 34. No

significant difference was found between the types of manual therapies and the

frequency of treatments received or its effectiveness.

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Perceptions of Osteopathy

Chi-squared tests found no significant difference between socio-demographic

characteristics and perceptions of Osteopathy.

84.4%

75.2%

71.6%

68.8%

60.6%

53.2%

19.3%

14.7%

7.3%

3.7%

3.7%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

Backpain

Neckpain

Sports Injury

Hip/ other joint Pain

Whiplash

Work Strain

Headache

Pregnancy Pain

Colic / Crying Baby

Abdominal Pain

Menstrual Pain

Perc

ep

tio

ns o

f C

on

dit

ion

s T

reata

ble

Percentage of Respondents

Figure 7: Perceptions of conditions treatable by an Osteopath.

Osteopaths are largely perceived as treating conditions of the musculoskeletal system.

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66.1%

58.7%

47.7%

46.8%

21.1%

19.3%

14.7%

5.5%

4.6%

4.6%

1.8%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Effectiveness of treatment

Appropriate treatment

Practitioner competence

Cost

Time constraints

Ease of Access

Previous bad experience

Communication difficuties

Undressing

Gender of Practitioner

Practice aesthetics/brandingC

on

sid

era

tio

ns

wh

en

Se

ek

ing

Tre

atm

ete

nt

Percentage of Respondents

Figure 8: Treatment concerns/considerations.

Effectiveness and receipt of appropriate treatment were found to be the main

considerations/concerns while cultural issues (language, barriers, undressing or

practitioner gender) were less important considerations.

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Source of Information

Initial source of Osteopathic awareness is shown in figure 9 while the preferred method of

obtaining information is shown in figure 10.

67.4%

28.00%

14.70%

12.80%

12.80%

11%

7.30%

5.50%

4.60%

3.70%

3.70%

1.80%

0.90%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

Friend/Relative/colleague

Medical Professional

Television

Magazine

Work

Internet

Books

Neswpaper

Don't Know / Remember

Demonstrations

Radio

Other

School / School Advisor

So

urc

e o

f In

itia

l In

form

ati

on

Percentage of Respondents

Figure 9: How respondents first heard of Osteopathy.

Personal recommendation was the main source of information for over two-thirds of

respondents (n=60). Less than a quarter (n=24) obtained information from the medical

profession. No significance was found between demographics and initial information

source. The main source in the ‘other’ category was through university.

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37.6%

34.9%

24.8%

24.8%

15.6%

11.0%

8.3%

7.3%

5.5%

0.9%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

Demonstrations

Medical Professional

Television

Internet

Neswpaper

Friend/Relative/colleague

Books

Magazine

Radio

OtherP

refe

rre

d S

ou

rce o

f In

form

ati

on

Percentage of Respondents

Figure 10: Preferred information source on Osteopathy.

The preferred method of receiving information about Osteopathy was through live

talks/demonstrations (n=41) and through medical professionals (n=38), while

recommendation from friends/relatives was less preferred (n=12). Interactive media (i.e.

television, internet and newspaper) saw its figures double as a preferred information

source (compared to figure 9). Leaflets made up the ‘other’ category.

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DISCUSSION

The aims of this research were to examine the prevalence and management of

musculoskeletal conditions within the Indian community and to establish the

suitability/need for the promotion of Osteopathy as a treatment option.

Socio-demographic predictors of CAM use among nationally representative samples have

shown greater use amongst females, higher -income levels, -social-economic groups and -

education levels (Eisenberg et al, 1998; Astin, 1998; Thomas & Coleman, 2004). Health-

seeking behaviour between racial/ethnic groups have been shown to be strongly

influenced by culture, religion, and beliefs; thus potentially influencing a preference for one

CAM therapy over another (Mackenzie et al 2003; Singh et al, 2004; Hsiao et al, 2006;

Mehta et al, 2007; Satow et al, 2008). Greater awareness and use of spiritual-healing,

Ayurveda and natural/herbal remedies has been reported amongst Indians especially for

non-serious medical conditions and health promotion (Greenfell et al 1998; Mackenzie et

al 2003; Singh et al, 2004; Rao 2006; Satow et al, 2008). This survey lends support to

previous research as perceptions on the severity of musculoskeletal conditions were found

to directly affect health-seeking behaviour (e.g. more practitioner treatment sought for

whiplash, pregnancy and joint pain than for back, neck, or muscle pain).

In contrast to previous research, this survey found limited use of Ayurveda, home/natural

remedies with no respondents using spiritual healing (Greenfell et al 1998; Mackenzie et al

2003; Singh et al, 2004; Rao, 2006; Satow et al, 2008). Excluding the response “doing

nothing/eases-with-time”; “non-prescription” products, “massage” and “GP/medical care”

were the main methods used to deal with musculoskeletal conditions. Ethnic-specific CAM

therapies identified in previous studies may still be used but perhaps not for the treatment

of musculoskeletal conditions. This could be an avenue for future research. In addition, a

third of respondents considered themselves as religious (i.e. “actively practising” their

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72

religion); however, this was not reflected in treatment methods used. No significance was

found between religiosity and prayer use or for the research hypothesis that religiosity

affected treatment-seeking behaviour. Religiosity, for this sample, may imply more than

just how religious one is per se; but instead take on a broader context within Hinduism of it

being a way-of-life (Jootum, 2002). This may explain the discrepancy observed. Further,

prayer use has been found to be inversely related to educational attainment, which may

explain the preferences seen for some treatments over others (Conboy et al, 2005).

It has been widely reported that CAM therapies are used alongside conventional medicine

for health promotion/disease prevention and not as a substitute to conventional medicine

(Eisenberg et al, 1998; and Astin, 1998; Thomas & Coleman, 2004; Graham et al, 2005;

Hsiao et al, 2006; Rhodes et al, 2008). This survey found an overall preference for a

combined healthcare approach irrespective of age and gender. However, a significant

preference for conventional medicine was identified by those aged under 34, whilst those

over 35 showed preference for CAM. This supports previous findings which found CAM

use to increase with age (Eisenberg et al, 1998; Astin, 1998; Licciardone, 2003; Thomas &

Coleman, 2004; Stamat 2008).

Despite the use of CAM alongside conventional medicine, disclosure rates of CAM usage

to GPs were comparable with both national and ethnic-specific studies conducted

(Eisenberg et al, 1998; Singh et al, 2004; Graham et al, 2005). The majority considered it

“not important to tell GP” followed by “forgot to tell” and “GP not ask/care.” It suggests that

many consider CAM therapies to be a “safe” treatment option with few or no side-effects.

However, there is a need for improved GP/practitioner-patient communication in-order to

ascertain the potential for any adverse medical-CAM interactions; especially for those

suffering chronic illnesses. Reduced awareness of CAM referrals offered by GP’s in the

London borough of Brent may also affect disclosure rates (Greenfell et al, 2008).

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National UK surveys conducted on behalf of the GOsC in 2001 and 2006 found only a

quarter of those aware had visited an Osteopath (GOsC, 2001 & 2006). Awareness and

use was directly associated with age suggesting individuals needs change with age

(GOsC, 2001). This survey found comparable levels of awareness and registration

requirements to both GOsC surveys (GOsC, 2001 & 2006). Unlike previous studies, no

significant difference was found between socio-demographic factors and Osteopathic

awareness (Licciardone 2001; GOSC, 2001 & 2006; Stamat, 2008). This finding was

consistent with a few studies that have reported socio-demographic factors not to influence

CAM use among non-whites (Licciardone, 2003; Singh et al, 2004). Educational

attainment did not significantly influence Osteopathic use, perhaps confounded by the

majority of respondents achieving a minimum of G.C.S.E-equivalent education. A better

understanding of respondent’s knowledge of treatable conditions by Osteopaths may have

been possible had multiple response answers not been provided.

A fifth of those aware had been treated by an Osteopath. However, there was a significant

use of other manual therapies, Physiotherapy and Massage, by those over 35. Treatment

effectiveness was comparable between all manual therapies and considered “effective” or

“very effective.” The techniques of massage and manipulation are commonly associated,

by the public, with Osteopathy but are also used within Physiotherapy, Chiropractic and

Massage (GOsC, 2006). Thus, given the prevalence of musculoskeletal conditions and

current use of manual therapy, the promotion of Osteopathy is potentially viable.

The main considerations when seeking treatment were appropriateness/effectiveness of

treatment, practitioner competence and cost; rather than practitioner gender, undressing

and communication difficulties. This suggests limited Osteopathic use maybe due to

reduced knowledge of what treatment involves and how it may help with specific

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74

conditions. Reasons for treatment cost considerations are unclear. Further research may

help establish whether cost considerations reflect views of cost-effectiveness of having a

treatment or the amount people are prepared to spend on their health.

Family and friends play an important role in raising initial awareness. However, the

majority preferred obtaining information via talks/demonstrations or medical professionals.

In addition, the respondents expressed a preference for observable/interactive media (i.e.

television, internet and newspaper) as a future information source. This suggests credible

information sources play an important role in generating new business. Demonstrations

would allow Osteopaths to inform people on the range of conditions treatable and enable

people to observe and ask any questions regarding the treatment process.

Limitations / Future Research

A narrow population of Hindus were sampled based on community centre attendees, thus

making generalisations to the wider Hindu population difficult. Attendance may have been

affected by those who have the resources to attend (e.g. transport) and based on types of

events/gathering held. This may explain the low response rate and a potential source for

bias, which in-turn prevented in-depth analysis. The design and validity of this

questionnaire is unclear. Some terms used were vague and open to interpretation

including ‘actively practicing,’ ‘home/natural remedies’; while ‘Chiropractor’ may have been

mistaken for ‘Chiropody.’ The survey was only conducted in English, not representing

those less proficient in English.

Future research may look at conducting surveys in ethnic-specific languages (e.g. Hindi

and Gujarati) to avoid potential sample bias. There is also a need to develop culturally

sensitive questionnaires to improve the validity and reliability of data. In addition, future

research focused on individual racial/ethnic populations will enable the profession to

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provide culturally sensitive care tailored to meet the needs of their target audience and a

competitive edge for business generation.

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CONCLUSIONS

The results of this small-scale survey found a high prevalence of musculoskeletal

conditions within the Indian community and a preference for a combined healthcare

approach. No significance was found between socio-demographic factors and Osteopathic

awareness. Despite high levels of Osteopathic awareness few sought treatment. However,

a significant proportion of those over 35 years used massage and Physiotherapy, finding it

equally as effective. Results suggest a potential to promote Osteopathy within this group;

however, the credibility of information/referral source may play an important role in

encouraging Osteopathic use.

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ACKNOWLEDGMENTS

The author would like to thank Robert McCoy for his enthusiasm and Melanie Wright for

her invaluable assistance with statistical analysis.

A special thanks to the co-ordinators from Shree Prajapati Association (London) and

Swadhyay Pariwar for allowing the research to take place at their centres and to the

participants for volunteering their time.

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REFERENCES

Allison, T.R., Symmons, D.P., Hayes, P., Rogers, A. Roxby, M. & Urwin, M. (2002).

Musculoskeletal Pain is More Generalised among People from Ethnic Minorities than

Among White People in Greater Manchester. Annals of the Rheumatic Diseases, 61(2),

pp. 151-6.

Astin, JA. (1998). Why Patients use Alternative Medicine: Results of A National Study.

Journal of the American Medical Association, 279, pp.1548-1553.

Chaturvedi, N., Rai, H. & Ben-Shlomo, Y. (1997). Lay Diagnosis and Health-Care-Seeking

Behaviour for Chest Pain in South Asians and Europeans. Lancet, 350(9091), pp. 1578-

83.

Conboy, L., Patel, S., Kaptchuk, T.J., Gottlieb, B.,Eisenberg, D., Acevedo-Garcia, D.

(2005). Socio-demographic Determinants of the Utilisation of Specific Types of

Complementary and Alternative Medicine: Analysis Based on a Nationally Representative

Survey Sample. The Journal of Alternative and Complementary Medicine, 11 (6), pp.977-

994.

Eisenberg, D.M., Davis, R.B., Ettner, S.L., et al. (1998). Trends in alternative medicine use

in the United States, 1990-1997. Journal of the American Medical Association, 280,

pp.1569-1575.

General Osteopathic Council (GOsC), Public Awareness Survey 2001.

http://www.osteopathy.org.uk/resources/surveys-statistics/ (Accessed 20/08/09)

General Osteopathic Council (GOsC), National Osteopathy Report 2006:

http://www.osteopathy.org.uk/uploads/public%20awareness%20survey%20report%20200

6%20-final.pdf (Accessed 28/1/10)

Graham, R.E., Ahn, A.C., Davis, R.B., O’Conner, B.B., Eisenberg, D.M., & Phillips, R.S.

(2005). Use of Complementary and Alternative Medical Therapies among Racial and

Ethnic Minority Adults: Results from the 2002 National Health Interview Survey. Journal of

the National Medical Association, 97(4), pp.535-545.

QIN: ________

79

Greenfell, A., Patel, N., & Robinson, N. (1998) Complementary Therapy: General

Practitioners' Referral and Patients' Use in an Urban Multi-ethnic Area. Complementary

therapies in medicine, 6 (3), pp.127-132.

Harris, P. & Rees, P. (2000). The Prevalence of Complementary and Alternative Medicine

Use Among the General Population: A Systematic Review of the Literature.

Complementary therapies in medicine, 8 (88).

Ho, K., Jones, L. and Gan, T.J. (2009). The Effect of Cultural Background on the Usage of

Complementary and Alternative Medicine for Chronic Pain Management. Pain Physician,

12, pp.685-688.

House of Lords. (2000). Select Committee on Science and Technology: Sixth Report on

Complementary and Alternative Medicine.

http://www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12304.htm#a15

(Accessed 11/2/10).

Hsiao, A., Wong, M.D., Goldstein, M.S., Yu, H., Anderson, R.M., Brown, R.E., Becerra,

L.M. & Wenger, N.S. (2006). Variation in Complementary and Alternative Medicine (CAM)

Use Across Racial/Ethnic Groups and the Development of Ethnic-Specific Measures of

CAM Use. The Journal of Alternative and Complementary Medicine, 12 (3), pp.281-290.

Jootum, D. (2002). Nursing with dignity–Part 7–Hinduism. Nursing Times, 98(15), 38-40.

Kinsley, D. (1993) Hinduism: A cultural perspective. Englewood Cliffs: Prentice Hall.

Licciardone JC. (2003). Validity and reliability of the Osteopathic Survey of Health Care in

America. Journal of the American Osteopath Association, 103(2), pp.89-101.

Mackenzie, E.R., Taylor, L., Bloom, B. S., Hufford, D. J. & Johnson, J.C. (2003). Ethnic

Minority use of Complementary and Alternative Medicine (CAM): A National Probability

Survey of CAM utilisers. Alternative Therapies, 9 (4), pp. 50-56

QIN: ________

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Mehta, D.H., Phillips, M.D., Davis, R.B. & McCarthy, E.P. (2007). Use of Complementary

and Alternative Therapies by Asian Americans. Results from the National Health Interview

Survey. Journal of General Internal Medicine, 22, pp. 762-767.

Neal, R.D., Ali, N., Atkin, K., Allgar, V.L., Ali, S. & Coleman, T. (2006). Communication

Between South Asian Patients and GPs: Comparative Study Using the Roter Interactional

Analysis System. British Journal of General Practice, 56(532), pp.869-75.

Office of National Statistics (ONS). (2001). Focus on Religion.

http://www.statistics.gov.uk/focuson/religion/. (Accessed 25/8/09).

Office for National Statistics (ONS). (April 2008). Harmonised Concepts for Social Data

Sources. Primary Standards. Ethnic Group.

http://www.statistics.gov.uk/about/data/harmonisation/downloads/P3.pdf. (Accessed

25/8/09).

Palmer, B., Macfarlane, G., Afzal, C., Esmail, A., Silman, A. & Lunt, M. (2007).

Acculturation and the Prevalence of Pain amongst South Asian Minority Ethnic Groups in

the UK. Rheumatology (Oxford), 46(6), pp. 1009-14.

Patel, S., Peacock, S., McKinley, R., Carter, D.C. & Watson, P.J. (2008). GPs Experience

of Managing Chronic Pain in a South Asian Community: A Qualitative Study of the

Consultation Process. Family Practice, 25(2), pp. 71-77.

Quan, H., Lai, D., Johnson, D., Verhoef, M. & Musto, R., (2008). Complementary and

Alternative Medicine Use Among Chinese and White Canadians. Canadian Family

Physician, 54, pp.1563-9.

Rao, D. (2006). Choice of Medicine and Hierarchy of Resort to Different Health

Alternatives Among Asian Indian Migrants in a Metropolitan City in the USA. Ethnic Health,

11 (2), pp.153-67.

Rhodes, P.J., Small, N., Ismail, H., & Wright, J.P. (2008). The Use of Biomedicine,

Complementary and Alternative Medicine and Ethnomedicine For The Treatment of

QIN: ________

81

Epilepsy Among People of South Asian origin in the UK. BMC Complementary and

Alternative Medicine, 8(7).

Satow, Y. E., Kumar, P.D., Burke, A. & Inciadi, J. F. (2008) Exploring the prevalence of

Ayurveda use Among Asian Indians. The Journal of Alternative and Complementary

Medicine, 14 (10), pp. 1249-1253.

Singh, V., Raidoo, D.M. & Harries, C.S. (2004). The Prevalence, Patterns of Usage and

Peoples Attitude Towards Complementary and Alternative Aedicine (CAM) Among the

Indian community in Chatsworth, South Africa. BMC Complementary and Alternative

Medicine, 4(3).

Stamat, H.M., Injety, R.K., Liechty, D.K., Pohlod, C.A. & Aguwa, M.I. (2008). Osteopathic

Medicine and Community Health Fairs: Increasing Public Awareness While Improving

Public Health. Journal of the American Osteopath Association, 108(8), pp. 397-403.

Sun, C., Desai, G.J., Pucci, D.S., Sherman Jew, J.D. (2004). Musculoskeletal Disorders:

Does the Osteopathic Medical Profession Demonstrate Its Unique and Distinctive

Characteristics? Journal of the American Osteopath Association, 104(4), pp. 149-155.

Thomas, K. & Coleman, P. (2004). Use of Complementary or Alternative Medicine in a

General Population in Great Britain. Results from the National Omnibus Survey. Journal of

Public Health, 26 (2), pp.152-157.

Thomas, K., Coleman, P., & Fall, M. (2001). Access to Complementary Medicine via

General Practice. British Journal of General Practice, 51, pp.25-30.

Thomas, K., Coleman, P., & Nicholl, J.P. (2003). Access to Complementary Therapies via

Primary Care in England: Changes Since 1995-2001. Results from a Follow-up National

Survey. Family Practice, 20 (5), pp.575-577.

Wachholtz, A.B., Pearce, M.J. & Koenig, H. (2007). Exploring the Relationship Between

Spirituality, Coping and Pain. Behavioural Medicine, 30(4), pp.311-8.

Whitman, S.M. (2007). Pain and Suffering as Viewed by the Hindu Religion. Journal of

Pain, 8(8), pp.607-13.

QIN: ________

82

Wachholtz, A.B. & Pearce, M.J. (2009). Does Spirituality as a Coping Mechanism Help or

Hinder Coping With Chronic Pain? Current Pain and Headache Reports, 13(2), pp.127-32.

Zaman, T., Agarwal, S. & Handa, R. (2007). Complementary and Alternative Medicine in

Rheumatoid Arthritis: An Audit of Patients Visiting a Tertiary Care Centre. National Medical

Journal of India, 20(5), pp.236-9.

QIN: ________

83

APPENDIX 1 – AWARENESS POSTER

Are You Aged Over 18 Years?

Would you like to help a final year Osteopathic student in

her research project?

It involves completing ONE survey and should only take 10

minutes of your time.

The research is looking at whether or not more should be done to

promote the awareness of Osteopathy amongst ethnic minority

communities.

Researcher: Jaimini Mistry

For further information please contact the researcher by

Email:J.Mistry@bso.ac.uk or

Telephone: 07956 166 227

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APPENDIX 2 - PARTICIPANT IMFORMATION SHEET (SPA)

Participant Information Sheet

Is There A Need to Promote Osteopathic Awareness Amongst Ethnic Minority

Communities?

Invitation Paragraph

You are invited to take part in the following research study. Before you decide on taking part it is important

for you to understand why the research is being undertaken and what it will involve. Please take your time to

read the following information carefully and feel free to discuss it with others if you wish. Ask us if there is

anything that is not clear or if you would like further information. This research is looking at whether there is

a need to promote Osteopathic awareness amongst ethnic minority communities and how best to do so.

Thank you for reading this.

What is the purpose of the study?

To investigate whether there is a need to promote Osteopathic awareness amongst ethnic minority

communities. The research originated following the experience of many Osteopathic students at the British

School of Osteopathy (BSO) who found there was still a need to explain to a majority of friends and family

about what Osteopathy is and what osteopaths do. Musculoskeletal pain is experienced by many people at

some point in their life. This research aims to investigate whether or not musculoskeletal pain is prevalent

amongst ethnic minority communities and how musculoskeletal pain is managed and treated. This research

also looks at the awareness of Osteopathy and whether it is a suitable form of treatment for musculoskeletal

pain amongst ethnic minority communities. The research will require you to fill out a questionnaire on a

single occasion and take no longer than 10 minutes of your time. The research will benefit the Shree

Prajapati Association (SPA) providing it with information on the types of musculoskeletal pain the

community is affected by and how it can best to educate its members in the future. Please note information

on individual participants will not be disclosed. It will also provide the Osteopathic profession information

on whether there is a need to promote Osteopathic awareness amongst ethnic minority communities and how

best to do this.

Why have I been chosen?

This questionnaire is being distributed to two community sites. Permission has been granted by those

responsible for the sites. You have been chosen because you have volunteered to do so; are aged over 18

years and can complete the questionnaire with little help from others.

Do I have to take part?

No. Your decision on whether or not to take part will have no bearing on your standing within the

community.

What does it involve?

The research involves the completion of a questionnaire on a single occasion and takes no longer than 10

minutes of your time. It is up to you whether or not to take part. If you do decide to take part you will be

given this information sheet to keep. Full completion and return of the questionnaire will be taken as an

indication of voluntary consent to participate in this research. If you do decide to take part you are still free

to withdraw at any time without giving any reason until the 30th of December 2009, after which results will

be collated and analysed. Your decision to take part or not will have no bearing on your standing within the

community. If you choose to withdraw from the study please contact us and provide the Questionnaire

Identification Number provided on the front top right of this information sheet. You will not be required to

give your name or reason for withdrawal and this will have no negative consequences.

What do I have to do?

If you decide to take part, you will be required to fully complete the attached questionnaire on a single

occasion and return it to the collection box provided where the questionnaire was obtained. You may take the

questionnaire home to complete and return to the collection box provided or by post to the address provided

below by the 30th December 2009.

Will my taking part in the study remain confidential?

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85

All information collected will remain strictly confidential and not be passed onto a third party. Only the

student researcher and supervisor will have access to the data for research and analysis purposes only. Your

anonymity is assured; your name WILL NOT appear on the questionnaire and any other identifiable

information will be omitted from the final written paper. Data will be stored securely and destroyed 6 years

following the completion of the study.

What will happen to the results of the study?

The results of the research will be used in the researcher’s final dissertation project. You can obtain a copy of

the published results by requesting it on the attached form or later by contacting the researcher. A summary

of the results will also be provided to the Shree Prajapati Association executive committee by the researcher

as a thank you for allowing the research to be conducted within this community. The published results will

also be available in the British School of Osteopathy’s library from July 2010. You will not be identified in

any report/publication.

Who is organising the research?

I am currently a 4th year student at the British School of Osteopathy. This research is being undertaken for

my final year project. My supervisor for this project is Mr Robert Mc Coy.

Thank you for taking the time to read the information sheet.

Our contact details are given below should you have any questions or require further information.

Researcher: Supervisor: Miss Jaimini Mistry Mr Robert McCoy

275 Borough High Street 275 Borough High Street

London SE1 1JE London SE1 1JE

Email: J.Mistry@bso.ac.ukl.com Email: R.McCoy@bso.ac.uk

Telephone: 07956 166 227 Telephone: 0207 089 5345

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APPENDIX 3 - PARTICIPANT IMFORMATION SHEET (Swadhyay)

Participant Information Sheet

Is There A Need to Promote Osteopathic Awareness Amongst Ethnic Minority

Communities?

Invitation Paragraph

You are invited to take part in the following research study. Before you decide on taking part it is important

for you to understand why the research is being undertaken and what it will involve. Please take your time to

read the following information carefully and feel free to discuss it with others if you wish. Ask us if there is

anything that is not clear or if you would like further information. This research is looking at whether there is

a need to promote Osteopathic awareness amongst ethnic minority communities and how best to do so.

Thank you for reading this.

What is the purpose of the study?

To investigate whether there is a need to promote osteopathic awareness amongst ethnic minority

communities. The research originated following the experience of many Osteopathic students at the British

School of Osteopathy (BSO) who found there was still a need to explain to a majority of friends and family

about what Osteopathy is and what osteopaths do. Musculoskeletal pain is experienced by many people at

some point in their life. This research aims to investigate whether or not musculoskeletal pain is prevalent

amongst ethnic minority communities and how musculoskeletal pain is managed and treated. This research

also looks at the awareness of Osteopathy and whether it is a suitable form of treatment for musculoskeletal

pain amongst ethnic minority communities. The research will require you to fill out a questionnaire on a

single occasion and take no longer than 10 minutes of your time. The research will benefit the Swadhyay

community providing it with information on the types of musculoskeletal pain its community are affected by

and how it can best educate its members in the future. Please note information on individual participants will

not be disclosed. It will also provide the Osteopathic profession information on whether there is a need to

promote Osteopathic awareness amongst ethnic minority communities and how best to do this.

Why have I been chosen?

This questionnaire is being distributed to two community sites. Permission has been granted by those

responsible for the sites. You have been chosen because you have volunteered to do so; are aged over 18

years and can complete the questionnaire with little help from others.

Do I have to take part?

No. Your decision on whether or not to take part will have no bearing on your standing within the

community.

What does it involve?

The research involves the completion of a questionnaire on a single occasion and takes no longer than 10

minutes of your time. It is up to you whether or not to take part. If you do decide to take part you will be

given this information sheet to keep. Full completion and return of the questionnaire will be taken as an

indication of voluntary consent to participate in this research. If you do decide to take part you are still free

to withdraw at any time without giving any reason until the 30th of December 2009, after which results will

be collated and analysed. Your decision to take part or not will have no bearing on your standing within the

community. If you do choose to withdraw from the study please contact us and provide the Questionnaire

Identification Number provided on the front top right of this information sheet. . You will not be required to

give your name or reason for withdrawal and this will have no negative consequences.

What do I have to do?

If you decide to take part, you will be required to fully complete the attached questionnaire on a single

occasion and return it to the collection box provided where the questionnaire was obtained. You may take the

questionnaire home to complete and return to the collection box provided or by post to the address provided

below by the 30th December 2009.

Will my taking part in the study remain confidential?

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87

All information collected will remain strictly confidential and not be passed onto a third party. Only the

student researcher and supervisor will have access to the data for research and analysis purposes only. Your

anonymity is assured; your name WILL NOT appear on the questionnaire and any other identifiable

information will be omitted from the final written paper. Data will be stored securely and destroyed 6 years

following the completion of the study.

What will happen to the results of the study?

The results of the research will be used in the researcher’s final dissertation project. You can obtain a copy of

the published results by requesting it on the attached form or later by contacting the researcher. A summary

of the results will also be provided to the Swadhyay executive committee by the researcher as a thank you for

allowing the research to be conducted within this community. The published results will also be available in

the British School of Osteopathy’s library from July 2010. You will not be identified in any

report/publication.

Who is organising the research?

I am currently a 4th year student at the British School of Osteopathy. This research is being undertaken for

my final year project. My supervisor for this project is Mr Robert Mc Coy.

Thank you for taking the time to read the information sheet.

Our contact details are given below should you have any questions or require further information.

Researcher: Supervisor: Miss Jaimini Mistry Mr Robert McCoy

275 Borough High Street 275 Borough High Street

London SE1 1JE London SE1 1JE

Email: J.Mistry@bso.ac.uk Email: R.McCoy@bso.ac.uk

Telephone: 07956 166 227 Telephone: 0207 089 5345

QIN: ________

88

APPENDIX 4 - SURVEY

Is There A Need To Promote Osteopathic Awareness Within Ethnic Minority

Communities?

1. Have you experienced any of

the following in the last 12

months? (Tick ALL that apply)

2. During the past 12 months

did you see a healthcare

practitioner for any of the

following for YOUR OWN

health? (Tick ALL that apply)

Headache / Migraine □ □

Neck Pain □ □

Whiplash Injury □ □

Back pain □ □

Hip / Joint Pain □ □

Arthritis □ □

Foot Pain □ □

Muscle Strain/Sprain □ □

Nerve Pain □ □

Anxiety / Stress □ □

Work strain □ □

Abdominal Pain □ □

Menstrual Pain □ □

Pregnancy Pain □ □

3. During the past 12 months HOW have you dealt with the musculoskeletal complaints

experienced above? (Tick ALL that apply)

Done nothing /Eases with time □

Seen GP/ Nurse /

Other medical professionals □

Non-prescription drugs/creams/gels □

Home / Natural remedies □

Spiritual healers □

Prayer □

Ayurvedic Medicine □ (includes yoga/meditation)

Acupuncture / Acupressure □

Aromatherapy □

Reflexology □

Reiki □

Massage □

Traditional Chinese medicine □

Chiropractic □

Osteopathy □

Physiotherapy □

Other (please specify) □

______________________________

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Yes No

4a. During the past 12 months did you pray specifically

for the purpose of YOUR OWN health? (Please Tick) □ □

4b. Did you ask or have others pray for YOUR OWN health? (Tick) □ □

4c. Did you have a healing ritual/ ceremony performed

for YOUR OWN health? (Please Tick) □ □

5. What is your preferred method to improving your health? (Please tick ONE only)

Modern Medicine

(i.e. GPs/ Nurse/ other medical professional) □

Complementary/Alternative Medicine (CAM)

(e.g. natural/herbal remedies, massage, prayer) □

Using BOTH of the above □

6. Have you EVER told your GP that you are using or have used alternative treatments

(excluding prayer)? (Please Tick)

Yes □ (go to Question 7)

No □ (go to Question 6)

N/A □ (go to Question 7) (i.e. not using alternative treatments)

7. Why have you NOT told your GP about using other treatments? (Tick ALL that apply)

Forgot to tell GP □

GP did not ask /not care □

Not important to tell GP □

Frightened/Unwilling to tell GP □

Not seen GP since using alternative

treatments □

Other Reasons (please specify) □

______________________________

8. Which of the following would you consider when seeking help? (Tick the THREE MOST important).

Cost of treatment □

Qualifications/ Competence of practitioner □

Receiving appropriate treatment □

Having to undress □

Effectiveness of treatment □

Ease of access □

Time Constraints □

Gender of practitioner □

Previous experience □

Practice aesthetics / branding □ Communication difficulties between you and the

practitioner □

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9. Which of the following have you heard of? (Tick ALL that apply)

Yes No

Osteopathy □ □ (If No, go to Question 12)

Physiotherapy □ □

Chiropractic □ □

10. How did you first hear about Osteopathy? (Tick ALL that apply)

Through live talks/demonstrations □

GP/ Nurse / Other Medical professional □

Friend / Relative / Colleague □

Television □

Radio □

Newspaper □

Magazine □

Books □

Internet □

Work □

School Careers Advisor □

Don’t know / Remember □

Other (please specify) □

_________________________

11. Are you aware that osteopaths have to be registered before they can practice? (Please Tick)

Yes □

No □

12. Would you be interested in learning more about Osteopathy? (Please Tick)

Yes □ (go to Question 13)

No □ (go to Question 14 )

13. How would you prefer to learn more about Osteopathy? (Tick maximum of 3).

Through live talks/ demonstrations □

GP/ Nurse/ Other Medical professional □

Friend/ Relative/ Colleague □

Television □

Radio □

Newspaper □

Magazine □

Books □

Internet □

Other (please specify) □

_____________________________

_____________________________

14a. Have you ever been treated by: b. How often? c. How effective was it?

(Please Tick) Y N Once Few times Regularly Not Effective Very Effective Effective

Osteopath? □ □ □ □ □ □ □ □

Physiotherapist? □ □ □ □ □ □ □ □

Chiropractor? □ □ □ □ □ □ □ □

Massage therapist? □ □ □ □ □ □ □ □

QIN: ________

91

15. For which of the following do you think someone might go to see an Osteopath? (Tick ALL

that apply)

Back pain □

Neck pain □

Whiplash □

Headache □

Work Strain □

Hip/Joint pain □

Menstrual pain □

Abdominal pain □

Pregnancy pain □

Colic/crying baby □

Thank you for your time. Please complete the GENERAL INFORMATION SHEET before

returning BOTH questionnaires to the collection box provided.

QIN: ________

46

General Information: Please note ALL information will be handled in the strictest of confidence and will not be used for any

unauthorised purpose.

1. Gender: Male □ 2. Age: 18-24 □ 25-34 □ 35-49 □

Female □ 50-64 □ 65+ □

3. What is your ethnic group? Choose ONE section from A to E, then the appropriate box to indicate your ethnic group.

A. White B. Black/ Black

British

C. Asian/British

Asian

D. Mixed E. Chinese or

other ethnic group

□ British □ Caribbean □ Indian □ White and Black

Caribbean

□ Chinese

□ Irish □ African □ Pakistani □ White and Black

African

□ Any other

□ Any other White

background

□ Any other Black

background

□ Bangladeshi □ White and Asian

□ Any other Asian

background

□ Any other Mixed

background

4. What is your religion even if you are not currently practising? (Tick ONE only)

Christian □

Buddhist □

Hindu □

Jewish □

Muslim □

Sikh □

Any other religion □

Or no religion at all □

5. Do you consider that you are actively practising your religion? Yes □ No □

6. Is English your MAIN method of communication? Yes □ No □

If not, please state your main method of communication: _____________________________

7. What is the HIGHEST level of education you have attained? (Tick ONE only)

No-qualifications □

G.C.S.E or equivalent □

A-level or equivalent □

Undergraduate degree or equivalent □

Post-graduate degree or equivalent □

8. What is your occupation? (If retired, please tick category best describing what you use to do. If Self-

employed, please tick category best describing your profession.) (Tick ONE only)

Manager and senior official □

Professional occupations □

Associate Professional/technical occupations □

Administrative and secretarial occupations □

Skilled trades occupation □

Personal service occupations □

Sales and Customer Service occupations □

Process, Plant and Machine Operatives □

Unemployed / Homemaker □

Student □

Thank you for your time. Please return BOTH questionnaires to the collection box.

Please note: return of the questionnaire will be taken as consent to take part in the research

QIN: ________

47

APPENDIX 5: SUMMARY RESULTS FORM

Summary Results Request Form

If you would like to receive a summary of results on completion of the research please complete the

following form.

Details provided will be strictly confidential and will NOT be used for any unauthorised use or

passed onto a third party.

Email: ___________________________________

OR

Address: _________________________

_________________________

_________________________

_________________________