1.11 Researching health beliefs and CAM users' expectations
People's beliefs about health and illness play an important role in determining whether and when they seek medical care and the extent to which they follow advice and treatment regimes. Beliefs can influence the outcome of treatments (Zola, 1973; Stainton-Rogers, 1991). Therefore, it is important to explore whether users of CAM have different beliefs about and different expectations of health care than non-users.
Adrian Furnham and his colleagues conducted several psychological studies designed to examine the extent to which certain beliefs and attitudes influence the use of CAM, and whether beliefs change as a result of using it. These studies use the Health Belief Model (HBM) as a starting point, which, as you may recall from Box 1, suggests that health beliefs can be correlated with behaviour and can differentiate between those who do and those who do not exhibit various health behaviours. Furnham and other researchers have examined whether users of CAM perceive themselves to be more susceptible to disease, whether they have stronger beliefs about self-control, and whether they have different attitudes about the perceived efficacy of biomedical treatment.
The findings vary according to which therapy is studied but they have revealed some statistically significant results. For example, users of homoeopathy were more critical and sceptical of biomedicine (Furnham and Smith, 1988; Furnham and Bragrath, 1992) and were more conscious of their health generally, lending some support for Giddens’ description of the more reflexive and sceptical consumer (Giddens, 1991). A further study by Furnham and Forey (1994) revealed that users of homoeopathy were also more likely to believe that their health could be improved, had more self and ecologically aware lifestyles, were concerned about ensuring a holistic approach to health care, and were generally more knowledgeable about their bodies than users of conventional health care. Furnham and Smith (1988) and Conroy et al. (2000) also showed that users of CAM did not consider themselves to be more susceptible to disease than non-users and were no more anxious about their health.
A study of people who use acupuncture revealed lower levels of confidence in general practitioners than non-users and a reduced faith in biomedical drugs (Furnham et al., 1995). These levels of dissatisfaction were not present among users of homoeopathy, although a study in the USA found that they were more displeased than people who used chiropractors (Yu et al., 1994). A comparison of users of osteopathy, homoeopathy and acupuncture showed that homoeopathy users valued their involvement in the healing process, while acupuncture users were most concerned about the side effects of biomedical drugs (Vincent and Furnham, 1997). Furthermore, Sirious and Gick (2002) showed differences between long-term and new users of CAM in terms of their values and beliefs, although in both groups health-aware behaviour and dissatisfaction with conventional medicine were the best predictors of use. More importantly, there appear to be as many subtle differences between users of CAM as there are between users and non-users. CAM users should not be considered a homogeneous group with similar beliefs, attitudes and expectations. Nevertheless, this work helps to locate some differences in attitudes and beliefs and suggests reasons for the popularity of CAM. However, and perhaps most interestingly, these studies did not ask the users about their reasons for consulting a CAM practitioner.
Sharma (1992) showed that most CAM users are pragmatic and eclectic. They are interested in whether the therapy might work for them, rather than the theory behind the practice, although Sharma notes that they appreciate explanations which make sense of previously unaccountable experiences or symptoms. She concludes from her research that lay convictions about the causes of health and illness may be relatively unstructured and that patients will try any treatment that seems to work or has worked for people they know. This might account for users expressing satisfaction with a variety of CAM therapies based on mutually exclusive models. Sharma also suggests that a therapy could be said to ‘work’ in that the practitioner's discourse provides meanings and interpretations that are more satisfactory to the user than orthodox explanations. One attraction for users is that CAM practitioners can give an explanation of health and illness that is more congruent with their own account:
Complementary practitioners may have explanations that make sense to patients – such as describing illness as a result of environmental factors or as a physical expression of emotional patterns. Conventional medicine may have problems with such explanations if they have no scientific justification, but sociological research shows that patients consider them beneficial when they reinforce their own beliefs and expectations.
(Zollman and Vickers, 1999, pp. 1487–8)
Watts asked what users wanted and found that:
Many people get more out of being told that their inner being is out of balance than they do out of knowing that their haemoglobin level is low. The latter may mean little to them; but even sceptics will recognize the former as a kind of metaphorical description of the feelings that may have driven them to seek help in the first place.
(Watts, 1992, p. 105)
How far will users go along with the therapist if the treatment is strange and unusual and not what they were expecting? Sharma's study suggests that CAM users do not necessarily seek out practitioners who share similar beliefs about health and healing to their own. Users can often be persuaded to try out new ideas:
I suspect that sick people who find the treatments offered altogether too bizarre or counter to their own notions of what will make them better drop out before the treatment has gone too far. Others can be cajoled into accepting unfamiliar, time-consuming or even painful regimes because the therapist is prepared to explain the treatment and provide moral support, for which the orthodox doctor has little time and sometimes no inclination.
(Sharma, 1992, p. 168)
Sharma suggests that, even if some users start out using CAM believing they are no different from non-users, their exposure to therapists’ ideas may affect their health beliefs over time. Sharma speculates that this is more so when the use of one non-orthodox type of medicine leads users to experiment with other forms of CAM, thus increasing their exposure to alternative beliefs:
There is no reason to suppose that therapist and patient always share beliefs about health and illness, but equally there is no reason to suppose that the one may not influence the other as they interact.
(Sharma, 1992, p. 88)
Sharma's study of CAM practitioners researched the extent to which they explicitly and consciously offer alternative explanations of health and illness, and whether the encounter between practitioner and user is used as an opportunity to socialise users into new ways of interpreting what happens to their bodies – an issue that is returned to in Extract 2. Sharma asks whether practitioners treat their special knowledge as a source of dominance: a resource they are not prepared to share. She wonders whether there is an element of control in practitioners trying to bring round users to their way of thinking (Sharma, 1992, p. 168). One homoeopath said it was not so much about getting users to comply with the advice of medical authority (the doctor or practitioner), but rather it was more about getting users to a stage where they take responsibility for their own health (Sharma, 1992).
The practitioners in Sharma's study rejected the notion of professional mystique: that is, that they would give away too much power if they explained too much about the therapy and how it works. None the less, practitioners were not always keen to give detailed explanations of what they did and why. Sharma (1992) also found that practitioners had ways of accounting for therapeutic failures that made sense within their own theories of healing: ‘the patient was clinging to his/her illness, s/he was not the kind of patient who could easily accept homoeopathy, the patient did not give the treatment long enough to work.’
Clearly, researching people's beliefs and expectations about CAM, and their motivation for using it, reveals a variety of findings. While some people are attracted to a specific philosophy or set of beliefs, others seem content to pursue a therapy if they believe it will work for them. Researchers acknowledge the methodological difficulties of trying to analyse individuals’ health choices and behaviours retrospectively.