Astin J A
Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif 94304-1583, USA.
JAMA. 1998 May 20;279(19):1548-53. doi: 10.1001/jama.279.19.1548.
Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood.
To investigate possible predictors of alternative health care use.
Three primary hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness. Additional predictor variables explored included demographics and health status.
A written survey examining use of alternative health care, health status, values, and attitudes toward conventional medicine. Multiple logistic regression analyses were used in an effort to identify predictors of alternative health care use.
A total of 1035 individuals randomly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States.
Use of alternative medicine within the previous year.
The response rate was 69%. The following variables emerged as predictors of alternative health care use: more education (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI, 1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having had a transformational experience that changed the person's worldview (OR, 1 .8; 95% CI, 1 .3-2.5); any of the following health problems: anxiety (OR, 3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1 .7-3.2); chronic pain (OR, 2.0; 95% CI, 1.1 -3.5); urinarytract problems (OR, 2.2; 95% CI, 1.3-3.5); and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies.
Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.
美国国内外的研究表明,有相当数量的人使用各种形式的替代医学。然而,目前对于使用替代医学的原因了解甚少。
调查使用替代医疗保健的可能预测因素。
测试了三个主要假设。人们寻求这些替代方法是因为:(1)他们在某种程度上对传统治疗不满意;(2)他们认为替代治疗在医疗保健决策方面能提供更多的个人自主权和控制权;(3)他们认为替代方法与患者关于健康和疾病的本质及意义的价值观、世界观或信念更相符。探索的其他预测变量包括人口统计学特征和健康状况。
一项书面调查,考察替代医疗保健的使用情况、健康状况、价值观以及对传统医学的态度。使用多元逻辑回归分析来确定替代医疗保健使用的预测因素。
从一个同意参与邮寄调查且居住在美国各地的小组中随机选取的1035个人。
过去一年中替代医学的使用情况。
回复率为69%。以下变量成为替代医疗保健使用的预测因素:受教育程度更高(优势比[OR],1.2;95%置信区间[CI],1.1 - 1.3);健康状况较差(OR,1.3;95%CI,1.1 - 1.5);对健康持整体观念(OR,1.4;95%CI,1.1 - 1.9);有过改变个人世界观的转变经历(OR,1.8;95%CI,1.3 - 2.5);以下任何一种健康问题:焦虑(OR,3.1;95%CI,1.6 - 6.0);背部问题(OR,2.3;95%CI,1.7 - 3.2);慢性疼痛(OR,2.0;95%CI,1.1 - 3.5);泌尿系统问题(OR,2.2;95%CI,1.3 - 3.5);以及属于一个通过对环保主义的认同、对女权主义的认同以及对灵性和个人成长心理学的兴趣来确定的文化群体(OR,2.0;95%CI,1.4 - 2.7)。对传统医学的不满并不能预测替代医学的使用。在接受调查的人中,只有4.4%的人报告主要依赖替代疗法。
除了受教育程度更高和健康状况较差外,大多数使用替代医学的人这样做似乎并非主要因为对传统医学不满意,而是很大程度上因为他们发现这些医疗保健替代方法与他们自己对健康和生活的价值观、信念及哲学取向更一致。