C onsultation on I dentity December 7, 2004 Quantitative Research Findings

CConsultation on onsultation on IIdentitydentity

December 7, 2004December 7, 2004

Quantitative Research FindingsQuantitative Research Findings

Page 2

Table of ContentsTable of Contents

PagePage

INTRODUCTIONINTRODUCTION 3

Background & Objectives 4

Methodology 5

Definitions 6

Reporting Perspective 7

EXECUTIVE SUMMARYEXECUTIVE SUMMARY 8

DETAILED FINDINGSDETAILED FINDINGS 13

APPENDIXAPPENDIX – Respondent Profile 49

INTRODUCTIONINTRODUCTION

Page 4

Background & ObjectivesBackground & Objectives

Within chiropractic, there has been continuing controversy concerning the identity of the profession, widespread international growth of chiropractic education and practice, and more diversity of the practice settings and services offered.

The World Federation of Chiropractic (WFC) has been asked by its Members’ national associations worldwide, to carry out an international consultation on the most appropriate public international consultation on the most appropriate public identity for the professionidentity for the profession within health care.

The purpose of the study is to understand attitudes and perceptions towards the attitudes and perceptions towards the profession.profession.

The survey will be used as a tool to help define the organization’s positioningtool to help define the organization’s positioning strategy.

Page 5

MethodologyMethodology

Online survey.Online survey. A list of Members’ email addresses was provided to NorthstarMembers were sent an email notifying them of the survey one week in advance of the survey launch (September 27th)29,094 email invitations were sent out on October 4 th inviting Members to participate in the surveyA reminder email was sent out on October 11th to Members who had not yet completed the surveyThe survey closed on October 24th

3,689 completes3,689 completes were obtained.

Questionnaire was approximately 15 minutes15 minutes in length.

Data has been weightedData has been weighted to reflect the true distribution of chiropractors in the participating countries.

Page 6

DefinitionsDefinitions

For the purposes of this study, the following terms were defined for respondents as follows:

Primary Health Care: Focused Scope Primary Health Care: Focused Scope Direct access; focused scope of practice; may have overall responsibility for patient and coordination of care within scope of practice.Example: dentist, optometrist.

Primary Health Care: Broad Scope Primary Health Care: Broad Scope Direct access; broad scope of practice; overall responsibility for patient and coordination of care. Example: Family MD/GP, internist.

Specialist Care:Specialist Care:Primary care and specialist training; focused scope of practice; practice on referral.Example: orthopaedic surgeon, radiologist.

Mainstream:Mainstream:Services which are part of the core health delivery system.

Complementary & Alternative:Complementary & Alternative:Services accepted by many of the public but that are not part of the core health delivery system.

Page 7

Reporting PerspectiveReporting Perspective

Data has been tested for statistical significance, which is indicated in the report as follows:

= Statistically higher / lower between groups

= Directionally higher / lower between groups

A sample of 3,689 is accurate within a statistical tolerance level of +/- 1.6 percentage points, 19 times out of 20.

EXECUTIVE SUMMARYEXECUTIVE SUMMARY

Page 9

Executive SummaryExecutive Summary

Page 10

Executive Summary Executive Summary (cont’d)(cont’d)

There is significant discrepancysignificant discrepancy in the way chiropractors believe the profession should beshould be perceived by the general public and medical doctors and the way they think the profession is actually perceived.actually perceived.

While the vast majority of chiropractors believe the profession should be considered primary health careprimary health care with focused (55%) or broad (36%) scope, in actuality, most believe that both the general public and medical doctors alike, have no clear perceptionno clear perception of the profession or perceive the profession as offering specialist care.specialist care.

Similarly, while most chiropractors (88%) believe the profession and its services should be perceived as mainstreamshould be perceived as mainstream (or core to the health delivery system), there is agreement that the profession is not viewed this way by the public at large or by medical doctors, instead it is viewed as being complementary and alternative.complementary and alternative.

Further, while the vast majority of chiropractors believe the practice of chiropractic should be perceived as wellness carewellness care and / or non-drug, non-surgical health care,non-drug, non-surgical health care, the general sense is that the profession is perceived by the general public as the management of back and neck painmanagement of back and neck pain and to a slightly less extent, the management of spinal problems. spinal problems.

Page 11


Most chiropractors (62%) strongly agree with the policy statement opposing the use of prescription drugsstrongly agree with the policy statement opposing the use of prescription drugs in the practice of chiropractic.

In fact, positioning the profession as non-drug, non-surgical heath care is viewed as being integral to how the profession should be perceivedintegral to how the profession should be perceived by the general public.

Page 12


The lack of clarity surrounding the identity of the profession has also likely been fed by:

Limited public awarenessLimited public awareness regarding the educationeducation of chiropractors.

Recent newsworthy events that have called into question the ethics & professional conductethics & professional conduct of some members of the profession. of some members of the profession.

There is agreement that this has impacted the level of public confidenceimpacted the level of public confidence in chiropractic health care & that the issues of ethics, professional behaviour and trust is very important for the profession’s positioning within the heath care system.

Issues of ethics, professional behaviour & trustIssues of ethics, professional behaviour & trust (along with the ability to get patients back to their daily routine, patient-centered care and spinal care expertise)get patients back to their daily routine, patient-centered care and spinal care expertise) are viewed as being very important in shaping perceptions of the profession.

Furthermore, there is consensus that medical doctors’ perceptions about the safety of chiropractic caresafety of chiropractic care is very important for building greater mutual respect and cooperationgreater mutual respect and cooperation between the two professions.11

22

DETAILED FINDINGSDETAILED FINDINGS

Page 14

Importance for a Profession to Have a Clear Public IdentityImportance for a Profession to Have a Clear Public Identity

There is almost universal agreement that it is important for a profession to have a clear public identity.

774%

616%

3 to 56%

1 to 24%

Strongly Agree (6&7)Strongly Agree (6&7)

90%90%

Mean Score: 6.5Mean Score: 6.5

““IIt is t is IImportant for a mportant for a PProfession to rofession to HHave a ave a CClear lear PPublic ublic IIdentity”dentity”(1 to 7 Scale from Strongly Disagree to Strongly Agree)

Base: Total sample (n=3689)Q1a. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below where 1 means strongly disagree and 7 means strongly agree.

Page 15

Importance for a Profession to Have a Clear Public IdentityImportance for a Profession to Have a Clear Public Identity- Profiled- Profiled

Base: Total sample (n=3689)Q1a. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below where 1 means strongly disagree and 7 means strongly agree.

Total (%)

Gender (%) Age (%) School Philosophy (%) Country of Graduating Institution (%)

Rating Men Women <35 35 – 59 60+ Group A Group B US Can. EuropeAus./NZ

Rest of world

1 to 2 4 4 4 5 3 4 4 4 4 2 2 2 4

3 to 5 6 5 7 6 6 4 5 7 5 6 6 7 12

6 to 7 90 91 89 89 91 92 91 89 91 92 92 91 84

Mean score 6.5 6.5 6.4 6.4 6.5 6.5 6.5 6.4 6.5 6.5 6.6 6.5 6.4

““IIt is t is IImportant for a mportant for a PProfession to rofession to HHave a ave a CClear lear PPublic ublic IIdentity”dentity”(1 to 7 Scale from Strongly Disagree to Strongly Agree)

Page 16

Clarity of the Profession’s IdentityClarity of the Profession’s Identity

However, most chiropractors in our sample don’t believe the chiropractic profession has a clear public identity today.

3 to 556%

1 to 240% 7

2%

62%

““TThe he CChiropractic hiropractic PProfession rofession HHas a as a CClear lear PPublic ublic IIdentity”dentity”(1 to 7 Scale from Strongly Disagree to Strongly Agree)

Mean Score: 3.0Mean Score: 3.0

Base: Total sample (n=3689)Q1b. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means strongly agree.

Strongly Disagree (1&2)Strongly Disagree (1&2)

40%40%

Strongly Agree (6&7)Strongly Agree (6&7)

4%4%

Page 17

Clarity of the Profession’s Identity Clarity of the Profession’s Identity - Profiled- Profiled

Base: Total sample (n=3689)Q1b. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means strongly agree.

Country of Current Practice (%) Years in Practice (%) Importance of a Clear Identity (%)

RatingTotal (%) US Can.

Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

5 or less 6 – 10 11 - 20

More than 20

Very Important (6 or 7)

Somewhat Important (3 to 5)

Not Important (1 or 2)

1 to 2 40 41 44 25 49 31 34 42 44 38 37 42 30 18

3 to 5 56 55 53 69 49 63 59 55 53 59 57 55 68 59

6 to 7 4 4 3 6 2 6 7 3 3 3 6 3 2 23

Mean score 3.0 3.0 2.9 3.5 2.8 3.3 3.2 2.9 2.9 3.0 3.1 2.9 3.1 4.1

““TThe he CChiropractic hiropractic PProfession rofession HHas a as a CClear lear PPublic ublic IIdentity”dentity”(1 to 7 Scale from Strongly Disagree to Strongly Agree)

Page 18

Area of Central Importance in Practice & Public IdentityArea of Central Importance in Practice & Public Identity

While the nervous system is viewed as being fundamental to the practice of chiropractic (more so than the spine), it is viewed as being less important when it comes to framing the profession’s identity.

72%

66%

85%

60%

The nervous system is of central importance to the practice of chiropractic

The spine is of central importance to the practice of chiropractic

The spine is of central importance to the public identity of chiropractic

The nervous system is of central importance to the public identity of chiropractic

% R% Ratingating L Levelevel ofof A Agreementgreement aa 6 – 7 6 – 7 (on a 1-7 scale from Strongly Disagree to Strongly Agree)

Base: Total sample (n=3689)Q9. Please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means strongly agree.

Page 19

Total (%)

Gender (%) Age (%) School Philosophy (%)

Men Women <35 35 – 59 60+ Group A Group B


85 84 88 87 85 87 91 77

The spine is of central importance to the practice of chiropractic 72 73 69 69 73 83 78 67

The spine is of central importance to the public identity of chiropractic 66 66 66 64 67 73 69 63


60 60 61 64 60 55 67 54

Area of Central Importance in Practice & Public Identity Area of Central Importance in Practice & Public Identity - Profiled- Profiled



Page 20

Total (%)

Country of Current Practice (%) Years in Active Practice (%)

US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world5 or less 6 – 10

11 - 20 >20


85 86 80 85 89 87 88 86 89 84 84

The spine is of central importance to the practice of chiropractic 72 72 73 73 77 75 84 67 74 72 77

The spine is of central importance to the public identity of chiropractic 66 66 69 67 73 70 78 63 65 65 72


60 61 56 47 66 60 64 62 63 58 59

Area of Central Importance in Practice & Public Identity Area of Central Importance in Practice & Public Identity - Profiled- Profiled



Page 21

Total (%)

Gender (%) School Philosophy (%) Country of Current Practice (%)

Men Women Group A

Group B US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world

Both views are equally important 54 53 60 53 54 54 54 64 65 61 63

General public’s view of the profession 25 26 21 24 28 25 29 19 16 17 14

Chiropractic’s view of the profession 21 21 19 23 18 21 17 17 19 22 23

Preferred Emphasis When Promoting Use of Services to Preferred Emphasis When Promoting Use of Services to the General Publicthe General Public

Most feel that when it comes to promoting the use of chiropractic services to the general public, both the chiropractic’s and the general public’s views, are equally as important to emphasize. This highlights the importance of understanding how doctors of chiropractic would like the profession perceived by the public as well as how they think it is being perceived today.

General public's view of the profession

25%

Chiropractics' view of the profession

21%

Both views are equally as important

54%

Base: Total sample (n=3689)Q8. When communicating with the general public to promote the use of chiropractic services, which view do you think should receive more emphasis…?

There is considerable discrepancyconsiderable discrepancy between how chiropractors feel the

profession should beshould be perceived by the general public and how they think it is

actually being perceived.actually being perceived.

Page 23

Perceptions of How the General Public Perceives the Perceptions of How the General Public Perceives the Chiropractic ProfessionChiropractic Profession

Most chiropractors (91%) think the profession should be perceived by the general public as a form of primary health care with a focused (55%) or broad (36%) scope. However, only four-in-ten (44%) believe this is how the profession is actually perceived by the general public.

Primary health care: focused scope

41%

Primary health care: broad scope

3%

Specialist care30%

No clear perception of the profession

26%

Base: Total sample (n=3689)Q2. Using the definitions provided below, do you think the chiropractic profession is currently perceived by the general public in your country as offering primary health care: focused scope, primary health care: broad scope, or specialist care? Q3. Again, using the definitions provided, do you think the chiropractic profession should be perceived by the general public in your country as offering primary health care: focused scope, primary health care: broad scope, or specialist care?


55%Primary health care:

broad scope36%

Specialist care9%

TThehe Chiropractor’s P Chiropractor’s Perspectiveerspective

HHow the ow the PProfession rofession ShouldShould BBe e PPerceived by the erceived by the PPublicublic HHow the ow the PProfession rofession is Currentlyis Currently PPerceived by the erceived by the PPublicublic

Page 24

Perceptions of How the Public Perceives the Chiropractic Perceptions of How the Public Perceives the Chiropractic Profession Profession - Profiled- Profiled

Base: Total sample (n=3689)Q2. Using the definitions provided below, do you think the chiropractic profession is currently perceived by the general public in your country as offering primary health care: focused scope, primary health care: broad scope, or specialist care? Q3. Again, using the definitions provided, do you think the chiropractic profession should be perceived by the general public in your country as offering primary health care: focused scope, primary health care: broad scope, or specialist care?

Gender (%) School Philosophy (%) Country of Current Practice (%)

Total Men Women Group A Group B US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world

Primary heath care: focused scope 55 55 53 58 48 53 59 68 57 56 62

Primary health care: broad scope 36 35 39 33 42 38 33 23 27 36 23

Specialist care 9 10 8 9 10 9 8 9 16 8 15

Gender (%) Age (%) School Philosophy (%) Country of Current Practice (%)

Total Men Women <35 35 – 59 60+Group

A Group B US Can.Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

Primary heath care: focused scope 41 42 37 44 40 45 42 34 39 59 47 25 68 20

Specialist care 30 30 32 30 31 21 29 37 34 11 21 19 6 18

No clear perception 26 25 28 23 26 30 26 26 24 27 27 53 19 53

Primary health care: broad scope 3 3 3 3 3 4 3 3 3 3 5 3 7 9


HHow the ow the PProfession rofession ShouldShould BBe e PPerceived by the erceived by the PPublicublic

HHow the ow the PProfession rofession is Currentlyis Currently PPerceived by the erceived by the PPublicublic

Page 25


While the vast majority feel that the chiropractic profession and its services should be perceived by the general public as mainstream, a near equal proportion feel that in actuality, it is being perceived as a form of complementary & alternative health care.

Mainstream88%

Complementary & Alternative

12% Mainstream11%

Complementary & Alternative

89%

Base: Total sample (n=3689)Q4. Using the definitions appearing below, do you think the chiropractic profession and its services are currently perceived by the general public in your country as mainstream or complementary and alternative? Q5. Again, using the definitions provided, do you think the chiropractic profession and its services should be perceived by the general public in your country as mainstream or complementary and alternative?


HHow the ow the PProfession & rofession & IIts ts SServices ervices ShouldShould BBe e

PPerceived by the erceived by the PPublicublic

HHow the ow the PProfession & rofession & SServices ervices are Currentlyare Currently PPerceived by the erceived by the PPublicublic

Page 26


Base: Total sample (n=3689)Q4. Using the definitions appearing below, do you think the chiropractic profession and its services are currently perceived by the general public in your country as mainstream or complementary and alternative? Q5. Again, using the definitions provided, do you think the chiropractic profession and its services should be perceived by the general public in your country as mainstream or complementary and alternative?

Total(%)

Gender (%) Age (%) Country of Current Practice (%)

Men Women <35 35 – 59 60+ US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world

Mainstream 88 87 90 90 87 80 89 88 88 76 82 76

Complementary & Alternative 12 13 10 10 13 20 11 12 12 24 18 24

Gender (%) Age (%) Country of Current Practice (%) Years in Active Practice (%)

Total Men Women <35 35 – 59 60+ US Can.Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

5 or less

6 – 10

11 - 20 >20

Complementary & Alternative 89 87 96 91 88 86 89 91 82 96 91 92 92 92 88 85

Mainstream 11 13 4 9 12 14 11 9 18 4 9 8 8 8 12 15


HHow the ow the PProfession & rofession & IIts ts SServices ervices ShouldShould BBe e PPerceived by the erceived by the PPublicublic

HHow the ow the PProfession & rofession & SServices ervices are Currentlyare Currently P Perceived by the erceived by the PPublicublic

Page 27

Agreement with Policy Opposing Use of Prescription DrugsAgreement with Policy Opposing Use of Prescription Drugs

The majority (62%), strongly support the policy opposing the use of prescription drugs in the practice of chiropractic.

12%

17%

62%

9%

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

Base: Total sample (n=3689)Q17. Since 1999, the World Federation of Chiropractic has had a policy statement opposing any use of prescription drugs in the practice of chiropractic. In that policy the WFC resolves that “for reasons of chiropractic principle, patient welfare and interdisciplinary cooperation, the practice of chiropractic does not include the use of prescription drugs”. To what extent do you agree with this policy? Do you …

AAgreement withgreement with P Policy olicy OOpposing pposing UUse of se of PPrescription rescription DDrugsrugs

79%79%

79%

81%

81%

85%

86%

74%

82%

90%

83%

79%

72%

87%

78%

77%

70%

Total

Gender

Rest of world

Australia / New Zealand

Unregulated Europe

CanadaUS

Country of Current Practice

WomenMen

School Philosophy

Group BGroup A

11 – 206 – 10

5 or lessYears in Practice

> 20

Regulated Europe

In fact, the non-drug, non-surgical mandate of chiropractic is non-drug, non-surgical mandate of chiropractic is viewed as being ‘cornerstone’viewed as being ‘cornerstone’ to the profession’s identity.

However…

While most would likewould like chiropractic to be perceived as wellness care and wellness care and / or non-drug, non-surgical health care,/ or non-drug, non-surgical health care,

many believe chiropractic health care is more commonly perceived by the general general public as the management of neck & back painpublic as the management of neck & back pain and to a lesser

extent, the management of spinal problemsmanagement of spinal problems.

Page 30

6%

45%

17%

13%

2%

5%

30%

38%

60%

9%

81%

83%

82%

75%

72%

67%

65%

60%

60%

60%

56%

47%


% S% Sayingaying 6 – 7 6 – 7 (on a 1-7 scale from Does Not Describe at All to Describes Perfectly)

Wellness care

Non-drug / non-surgical health care

Management of spinal problems & their impact on general health

Management of neuromusculoskeletal conditions & their impact on general health

Primary health care

Management of vertebral subluxation & its impact on general health

Management of back & neck pain & their impact on general health

Management of neuromusculoskeletal conditions

Management of spinal problems

Management of vertebral subluxation

Management of back & neck painBase: Total sample (n=3689)Q6. Please indicate how well each of the following statements describes how chiropractic health care is currently perceived by the general public in your country. Please use the 7-point scale below, where 1 means does not describe public perception at all and 7 means describes it perfectly. Q7. Please indicate how well each of the following statements describes how you would like chiropractic health care to be perceived by the general public in your country. Again, please use the 7-point scale below, where 1 means does not describe what I would like at all and 7 means describes what I would like perfectly.

Should BeShould Be Perceived by the General Public is CurrentlyCurrently Perceived by the General Public

How Chiropractic Profession…How Chiropractic Profession…

7777

3737

5858

5959

6565

6060

3030

2222

--

4747

-34-34

GapGap

Page 31


Base: Total sample (n=3689)Q7. Please indicate how well each of the following statements describes how you would like chiropractic health care to be perceived by the general public in your country. Again, please use the 7-point scale below, where 1 means does not describe what I would like at all and 7 means describes what I would like perfectly.

How chiropractic profession

SHOULD BESHOULD BE perceived…Total (%)


Men Women <35 35 – 59 60+ Group A Group B US Can.Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

Wellness care 83 81 88 84 82 80 87 80 85 76 59 80 69 75

Non-drug / non-surgical health care 82 80 89 86 81 80 84 80 83 79 74 91 78 81

Management of spinal problems & their impact on general health 75 74 78 73 75 83 74 75 75 73 73 78 75 88

Management of neuromusculoskeletal conditions & their impact on general health 72 71 77 68 74 78 67 78 72 76 76 71 71 85

Primary health care 67 65 76 67 67 70 68 63 66 76 67 78 73 64

Management of vertebral subluxation & its impact on general health 65 64 70 68 63 74 76 52 66 55 51 74 69 67

Management of back & neck pain & their impact on general health 60 59 62 55 61 71 56 64 59 61 66 65 57 78

Management of neuromusculoskeletal conditions 60 60 59 58 60 70 54 68 59 64 69 54 57 66

Management of spinal problems 60 60 56 58 59 70 57 64 59 60 63 59 57 66

Management of vertebral subluxation 56 55 58 60 54 67 67 46 57 47 40 62 57 55

Management of back & neck pain 47 48 45 44 48 66 42 54 47 48 59 48 45 56


Page 32

General Public’s Perceptions of Chiropractic Health CareGeneral Public’s Perceptions of Chiropractic Health Care- Profiled- Profiled

Base: Total sample (n=3689)Q6. Please indicate how well each of the following statements describes how chiropractic health care is currently perceived by the general public in your country. Please use the 7-point scale below, where 1 means does not describe public perception at all and 7 means describes it perfectly.

How chiropractic profession

IS CURRENTLYIS CURRENTLY perceived…Total(%)


Men Women <35 35 – 59 60+Group


Unreg. Eur.

Aus./NZ

Rest of world

Management of back & neck pain 81 81 84 86 81 67 80 84 82 80 85 66 84 61

Management of spinal problems 60 59 64 60 61 53 55 65 60 56 71 57 71 48

Non-drug / non-surgical health care 45 43 49 47 44 45 44 44 45 44 46 53 44 38

Management of neuromusculoskeletal conditions 38 37 42 37 39 37 38 41 40 29 35 35 29 34

Management of back & neck pain & their impact on general health 30 30 27 38 27 26 28 33 31 26 25 16 27 22

Management of spinal problems & their impact on general health 17 18 16 19 17 22 14 23 18 13 17 11 17 12

Management of neuromusculoskeletal conditions & their impact on general health 13 13 14 15 12 22 12 16 14 9 10 12 8 9

Management of vertebral subluxation 9 8 14 8 10 17 9 11 10 7 9 11 6 13

Wellness care 6 6 6 6 6 7 6 7 6 5 3 6 2 4

Management of vertebral subluxation & its impact on general health 5 5 6 4 5 9 5 7 6 3 3 6 2 5

Primary health care 2 3 1 1 2 6 3 1 2 3 6 5 6 3


From the chiropractor’s perspective, the ability to get a patient back to ability to get a patient back to their regular routine their regular routine and the fact that chiropractic health care delivers

patient-centered care patient-centered care and spinal care expertisespinal care expertise are key in helping shape the general public’s perceptions of the profession.

Additionally, issues of ethics, behaviourethics, behaviour & trusttrust play an important role in influencing public opinion.

Page 34

84%

84%

77%

77%

76%

75%

72%

71%

68%

68%

65%

62%

59%

59%

58%

55%

54%

Influencing Factors on Public PerceptionsInfluencing Factors on Public Perceptions

Base: Total sample (n=3689)Q11. In your opinion, how important are each of the following in shaping the general public’s perception of the chiropractic profession? Please use the 7-point scale below, where 1 means not at all important and 7 means very important.

% S% Sayingaying 6 – 7 6 – 7 (on a 1-7 scale from Not at all Important to Very Important)

Ability to get the patient back to work / daily activities

Patient-centered care

Spinal care expertise

Issues of ethics, professional behaviour & trust

Hands-on care

Quick recovery from pain & disability

Ability to manage pain

Ability to manage back pain

Ability to diagnose the cause of symptoms

Level of education / training

A practice model that does not involve drugs or surgery

Attitudes of the media

Preventative care

The profession's different model of health

Attitudes of government & health authorities

Third party funding for care

Attitudes of other health care professionals

Page 35


Total (%)

Gender (%) Age (%) School Philosophy (%)

Country of Current Practice (%)


AGroup

B US Can.Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

Ability to get patient back to work / daily activities 84 83 88 80 85 91 82 85 84 86 89 84 79 92

Patient-centered care 84 84 87 85 84 88 83 85 85 84 83 77 82 77

Spinal care expertise 77 77 77 74 78 81 77 75 76 79 83 82 82 86

Issues of ethics, professional behaviour & trust 77 77 78 75 77 87 76 80 78 74 71 71 76 79

Hands-on care 76 75 77 75 76 82 77 75 76 73 78 79 77 78

Quick recovery from pain & disability 75 74 78 68 78 85 72 78 75 77 78 76 71 84

Ability to manage pain 72 71 75 65 74 83 66 76 71 72 76 68 70 82

Ability to manage back pain 71 70 72 63 73 85 65 75 69 72 82 75 72 89

Ability to diagnose the cause of symptoms 68 67 72 64 69 84 62 73 67 73 76 70 69 81

Level of education / training 68 68 71 69 67 78 66 71 67 71 72 73 73 79

Practice model that does not involve drugs / surgery 65 64 69 67 63 68 68 62 66 61 55 66 58 68

Attitudes of the media 62 62 62 64 61 64 62 65 63 67 51 59 53 63

Preventative care 59 58 62 64 56 64 62 57 60 53 49 59 54 65

The profession's different model of health 59 59 61 63 57 61 65 54 61 52 42 61 52 61

Attitudes of government & health authorities 58 58 57 59 57 63 57 61 59 60 48 53 46 69

Third party funding for care 55 55 52 48 57 64 53 63 59 52 23 29 28 32

Attitudes of other health care professionals 54 54 55 60 52 50 51 58 54 57 51 49 48 61


Influencing Factors on Public PerceptionsInfluencing Factors on Public Perceptions- Profiled- Profiled

Page 36


Total (%)

Desired Perception of Profession (%) Desired Perception of Profession & Services (%)

Focused scope

Broad scope

Specialist Mainstream Complementary & Alternative

Ability to get the patient back to work/ daily activities 84 82 86 89 86 73

Patient-centered care 84 84 86 81 85 81

Spinal care expertise 77 78 74 85 78 68

Issues of ethics, professional behaviour & trust 77 77 76 81 78 71

Hands-on care 76 75 77 77 76 76

Quick recovery from pain & disability 75 73 77 81 77 63

Ability to manage pain 72 69 74 78 74 56

Ability to manage back pain 71 70 69 82 73 57

Ability to diagnose the cause of symptoms 68 64 73 75 70 52

Level of education / training 68 66 71 73 70 58

A practice model that does not involve drugs or surgery 65 65 65 62 64 68

Attitudes of the media 62 62 62 63 64 50

Preventative care 59 55 65 53 59 57

The profession's different model of health 59 58 63 56 59 61

Attitudes of government & health authorities 58 57 59 62 60 43

Third party funding for care 55 53 56 59 57 37

Attitudes of other health care professionals 54 52 55 59 56 38


Influencing Factors on Public PerceptionsInfluencing Factors on Public Perceptions- Profiled- Profiled

Page 37

Professional Conduct & StandardsProfessional Conduct & Standards

In fact, there is consensus among chiropractors that public confidence has been impacted by newsworthy events that have called into question the conduct of some members of the profession. Most also believe that the public at large is not aware of the level of education of chiropractors.

48%

7%

38%

58%

19%

86%

65%

20%1%

Strongly agree Somewhat agree

Concerns with respect to the ethics and professional conduct of some members of the

profession have a significant impact on the level of public confidence in chiropractic

health care

The general public has confidence in the quality of care provided by chiropractors

The general public is aware of the level of education of chiropractors

% S% Saying aying SStrongly or trongly or SSomewhat omewhat AAgreegree

Base: Total sample (n=3689)Q12. Please indicate whether you strongly agree, somewhat agree, somewhat disagree or strongly disagree with the following statements:

Higher among…Higher among…

•Those practicing in a school outside of the US – 28%; Those who have been practicing for 11+ years – 24%; 35+ years – 22%

•Those practicing in regulated Europe – 84%; 60+ years – 72%

Page 38

Factor Influence When Seeking Chiropractic CareFactor Influence When Seeking Chiropractic Care

From a chiropractor’s perspective, reputation for effectiveness, manual procedures and specialized knowledge and education are most important to patients seeking chiropractic health care.

87%

74%

67%

62%

58%

55%

38%

36%

27%


Reputation for effectiveness

Manual procedures (adjusting, mobilization, manipulation, soft tissue, etc.)

Specialized knowledge & education

Non-drug / non-surgical approach

Availability of third party funding

Diagnostic ability

Exercise/ rehabilitation

Lifestyle counseling / advice

Nutritional support / advice

Base: Total sample (n=3689)Q10. Patients seek chiropractic care for different reasons. In your opinion, how important are each of the following attributes of chiropractic health care to patients? Please use the 7-point scale below, where this time, 1 means not at all important and 7 means very important.

Page 39

Base: Total sample (n=3689)Q10. Patients seek chiropractic care for different reasons. In your opinion, how important are each of the following attributes of chiropractic health care to patients? Please use the 7-point scale below, where this time, 1 means not at all important and 7 means very important.

Total (%)




Unreg. Eur.

Aus./NZ

Rest of world

Reputation for effectiveness 87 87 87 86 88 90 88 86 87 89 89 85 89 88


74 74 77 75 74 74 73 76 74 76 79 76 73 87

Specialized knowledge & education 67 68 64 62 69 74 66 68 65 73 75 75 73 73

Non-drug / non-surgical approach 62 61 68 63 62 64 63 64 63 59 55 72 55 59

Availability of third party funding 58 59 56 54 60 64 58 64 63 55 22 27 30 31

Diagnostic ability 55 54 58 51 55 68 49 59 53 62 69 63 61 66

Exercise / rehabilitation 38 38 40 39 38 45 33 47 38 41 40 30 34 49

Lifestyle counseling / advice 36 35 39 33 37 43 35 41 36 33 32 46 22 54

Nutritional support / advice 27 27 31 25 27 41 24 36 29 22 14 20 14 29

Factor Influence When Seeking Chiropractic CareFactor Influence When Seeking Chiropractic Care- Profiled- Profiled


Page 40

Base: Total sample (n=3689)Q10. Patients seek chiropractic care for different reasons. In your opinion, how important are each of the following attributes of chiropractic health care to patients? Please use the 7-point scale below, where this time 1 means not at all important and 7 means very important.

Total (%)

Desired Perception of Profession (%) Perception of Profession & Services (%)

Focused scope Broad scope

Specialist No clear perception Mainstream Complementary & Alternative

Reputation for effectiveness 87 90 90 86 84 89 87


74 78 86 72 70 79 74

Specialized knowledge & education 67 67 72 68 64 74 66

Non-drug / non-surgical approach 62 63 68 61 62 64 62

Availability of third party funding 58 58 56 61 56 61 58

Diagnostic ability 55 55 62 57 51 59 54

Exercise / rehabilitation 38 38 49 41 35 42 38

Lifestyle counseling / advice 36 34 58 36 36 42 35

Nutritional support / advice 27 24 49 30 26 30 27

Factor Influence When Seeking Chiropractic CareFactor Influence When Seeking Chiropractic Care- Profiled- Profiled

% S% Sayingaying 6 – 7 6 – 7(on a 1-7 scale from Not at all Important to Very Important)

Up until now, we have focused on perceived perceptions of the general public. We will

now turn our attention to how chiropractors believe the profession is perceived profession is perceived by medical doctors.by medical doctors.

Page 42

Perceptions of How Chiropractic is Perceived by Medical Perceptions of How Chiropractic is Perceived by Medical DoctorsDoctors

It appears that chiropractors believe the fuzziness surrounding the identity of their profession is even greater among medical doctors than the public at large, with one-half of chiropractors believing medical doctors have no clear perception of the profession.

* Less than 0.5%Base: Total sample (n=3689)Q14. Using the definitions provided below, do you think the chiropractic profession is currently perceived by medical doctors as offering primary health care: focused scope, primary health care: broad scope, or specialist care?


20%

Specialist care31%

No clear perception of the profession

49%

Total (%)

Age (%) School Philosophy (%) Country of Current Practice (%) Years in Active Practice (%)

<35 35 – 59 60+ Group A Group B US Can.Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

5 or less 6 – 10 11 - 20 >20

No clear perception 49 46 49 64 49 45 46 58 48 77 56 72 47 49 46 54

Specialist care 31 33 32 20 31 41 36 10 19 13 5 15 32 34 35 26

Primary heath care: focused scope 20 21 19 16 19 14 18 31 32 10 39 12 21 18 19 20

Primary heath care: broad scope * * * - * * * 1% 1% - * 1% * - * *

For comparison:For comparison:

Chiropractors believe 26% of the general public does not have a clear perception of the profession.

Page 43


Consistent with how chiropractors think the general public perceives the profession, most chiropractors believe medical doctors perceive chiropractic care as complementary & alternative rather than mainstream.

Mainstream2%

Complementary & alternative

98%

Base: Total sample (n=3689)Q15. Again, using the definitions provided below, do you think the chiropractic profession and its services are currently perceived by medical doctors as mainstream or complementary and alternative?

Page 44

67%

55%

47%

42%

32%

14%

7%

7%

7%

3%

3%

1%


The general perspective among chiropractors is that medical doctors perceive chiropractic care as the management of back and neck pain first and foremost. There is also a perception that some medical doctors (55%) see chiropractic as a competitor within the health care system.

%% SSaying aying 6 – 7 6 – 7 (on a 1-7 scale from Does Not Describe Their Perception at All to Describes It Perfectly)

The management of back & neck pain

A competitor within health care delivery

Non-drug / non-surgical health care

The management of spinal problems

The management of neuromusculoskeletal conditions

The management of back & neck pain & their impact on general health

The management of neuromusculoskeletal conditions & their impact on general health

The management of spinal problems & their impact on general health

The management of vertebral subluxation

Wellness care

The management of vertebral subluxation & its impact on general health

Primary health careBase: Total sample (n=3689)Q13. Please indicate how well each of the following statements describes how you believe chiropractic health care is currently perceived by medical doctors. Please use the 7-point scale below, where 1 means does not describe their perception at all and 7 means describes it perfectly.

Page 45

Perceptions of How Chiropractic is Perceived by MDsPerceptions of How Chiropractic is Perceived by MDs- Profiled- Profiled

Base: Total sample (n=3689)Q13. Please indicate how well each of the following statements describes how you believe chiropractic health care is currently perceived by medical doctors. Please use the 7-point scale below, where 1 means does not describe their perception at all and 7 means describes it perfectly.

Total (%)

Age (%) Country of Current Practice (%)

<3535 – 59 60+ US Can.

Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

The management of back & neck pain 67 72 66 42 67 66 78 69 68 47

A competitor within health care delivery 55 53 56 49 57 50 32 53 55 39

Non-drug / non-surgical health care 47 50 47 36 48 46 44 55 37 43

The management of spinal problems 42 44 42 30 40 41 57 54 49 42

The management of neuromusculoskeletal conditions 32 33 32 23 33 22 31 35 25 27

The management of back & neck pain & their impact on general health 14 21 12 6 14 14 19 16 12 9

The management of neuromusculoskeletal conditions & their impact on general health 7 10 7 4 8 5 7 7 3 5

The management of spinal problems & their impact on general health 7 10 6 3 7 5 12 9 8 5

The management of vertebral subluxation 7 7 7 6 7 5 11 10 3 7

Wellness care 3 3 3 3 3 2 3 3 1 6

The management of vertebral subluxation & its impact on general health 3 3 3 3 3 3 3 2 1 5

Primary health care 1 1 1 1 1 3 5 2 5 2

%% SSaying aying 6 – 7 6 – 7 (on a 1-7 scale from Does Not Describe Their Perception at All to Describes It Perfectly)

In recent years there has been a call for greater mutual cooperation and respect between chiropractic and medical doctors in the interest of patients.

Earlier we discussed the importance of ethics, professional conduct & trust in shaping the

identity of the profession. Medical doctors’ perceptions surrounding the safetysafety of

chiropractic care and the standards for education & practicestandards for education & practice are also key key in building stronger inter-professional relations.in building stronger inter-professional relations.

Page 47

89%

86%

85%

83%

79%

64%

60%

60%

60%

56%

Importance for Building Inter-Professional RelationsImportance for Building Inter-Professional Relations


Medical doctors' perceptions about the safety of chiropractic health care

Medical doctors' perceptions about the effectiveness of chiropractic health care

Medical doctors' knowledge & understanding of the standards for chiropractic education & practice

Attitudes & behaviours of chiropractors

Attitudes & behaviours of medical doctors

Chiropractors' perceptions about the safety of medical health care

Chiropractors' perceptions about the effectiveness of medical health care

Influence, attitudes & behaviours of third party payers

Financial barriers to referring patients for chiropractic health care

Chiropractors' knowledge & understanding of the standards for medical education and practice

Base: Total sample (n=3689)Q16. ….In your opinion, how important are each of the following with respect to inter-professional relations? Please use the 7-point scale below, where 1 means not at all important and 7 means very important.

Page 48

Importance for Building Inter-Professional RelationsImportance for Building Inter-Professional Relations

Base: Total sample (n=3689)Q16. Independent studies in various countries have called for greater mutual cooperation and respect between chiropractic and medical doctors in the interest of patients. In your opinion, how important are each of the following with respect to inter-professional relations? Please use the 7-point scale below where 1 means not at all important and 7 means very important.

Gender (%) School Philosophy Country of Current Practice (%) Years in Practice (%)

Total (%) Men Women

Group A Group B US

Can.

Reg. Eur.

Unreg. Eur.

Aus./NZ

Rest of world

5 or less

6 – 10

11 - 20 >20

Medical doctors' perceptions about the safety of chiropractic health care 89 88 95 88 91 89 93 88 88 93 86 90 89 90 88

Medical doctors' perceptions about the effectiveness of chiropractic health care 86 84 91 85 88 86 86 84 84 86 83 88 86 87 83

Medical doctors' knowledge & understanding of the standards for chiropractic education & practice

85 83 92 83 87 84 84 87 84 88 88 87 82 85 84

Attitudes & behaviours of chiropractors 83 82 87 82 83 83 83 88 83 82 94 85 83 83 82

Attitudes & behaviours of medical doctors 79 77 84 77 79 78 81 84 77 77 78 82 78 80 74

Chiropractors' perceptions about the safety of medical health care 64 63 66 63 66 65 59 60 58 63 60 66 64 64 62

Chiropractors' perceptions about the effectiveness of medical health care 60 59 65 59 62 60 57 58 56 58 67 64 59 59 58

Influence, attitudes and behaviours of third party payers 60 60 60 59 65 62 55 41 38 49 56 56 58 60 64

Financial barriers to referring patients for chiropractic health care 60 61 58 59 62 62 61 52 45 48 50 58 59 60 64

Chiropractors' knowledge and understanding of the standards for medical education and practice 56 54 62 54 60 56 46 60 53 52 72 60 55 56 51


APPENDIX: Respondent ProfileAPPENDIX: Respondent Profile

Page 50

Respondent ProfileRespondent Profile

Total (%)

GenderGenderMale 79Female 21

AgeAgeUnder 35 2735 – 59 6860+ 5

Average 40

Country of Graduating InstitutionCountry of Graduating Institution

US 86Canada 6Europe 3Australia / New Zealand 3Rest of the world 2

Years Since GraduationYears Since Graduation

5 or less 266 – 10 1811 – 20 28More than 20 28Average 13

Base: Total sample (n=3689)

Page 51

Respondent Profile Respondent Profile (cont’d)(cont’d)

Total(%)

Country of Current PracticeCountry of Current Practice

US 82Canada 7Europe 6Australia / New Zealand 3Rest of the world 2

Years in Active PracticeYears in Active Practice

5 or less 296 – 10 1711 – 20 28More than 20 26Average 13

Current Role in ChiropracticCurrent Role in Chiropractic

Clinical practice 91Administration / Education / Research 6Retired 1Other 2

Base: Total sample (n=3689)

Page 52

Respondent Profile Respondent Profile (cont’d)(cont’d)

% saying… US Canada Europe Australia / New Zealand Rest of the world

US 94 4 2 1 22

Canada 2 89 1 1 1

Regulated Europe 1 2 65 7 42

Unregulated Europe 1 1 24 4 5

Australia / New Zealand 1 3 2 83 9

Rest of the world 1 1 6 4 21CCou

ntry

of

ount

ry o

f CCur

rent

ur

rent

PPra

ctic

era

ctic

e

CCountry of ountry of GGraduating raduating IInstitutionnstitution

Base: Total sample (n=3689)Q20. Which institution did you graduate from? Q23. What country do you currently practice in?

Documents

C onsultation on I dentity December 7, 2004 Quantitative Research Findings