Table Of ContentThe
Perceptions
and
Experiences
of
Acupuncture
users
A
New
Zealand
Perspective
A
thesis
submitted
in
partial
fulfillment
of
the
requirements
for
the
Degree
Master
of
Health
Sciences
University
of
Canterbury
Dan
Jakes
2014
Table
of
Contents
LIST
OF
TABLES
AND
FIGURES
v
ACKNOWLEDGEMENTS
vi
DEDICATION
vii
LIST
OF
ABBREVIATIONS
viii
NOTES
TO
THE
READER
ix
ABSTRACT
x
1.
THE
PROBLEM
1
1.1
Introduction
1
1.2
Research
question
3
1.3
Purpose
3
1.4
My
interest
in
the
topic
and
pre-‐understandings
3
1.5
Chapter
summary
4
2.
REVIEW
OF
RELATED
LITERATURE
AND
RESEARCH
5
2.1
Introduction
5
2.2
Situating
acupuncture
as
a
CAM
5
2.3
Acupuncture
in
New
Zealand
7
2.4
Safety
and
efficacy
of
acupuncture
8
2.5
Qualitative
systematic
review
of
acupuncture
patients’
experiences
19
2.6
Chapter
summary
41
3
METHODS
AND
PROCEDURES
43
3.1
Introduction
43
i
3.2
Ethics
49
3.3
Sampling
and
recruitment
52
3.4
Participants
53
3.5
Data
collection
54
3.6
Transcription
56
3.7
Data
management
56
3.8
Rigour
56
3.9
Chapter
summary
60
4
ANALYSIS
AND
INTERPRETATION
OF
THE
DATA
61
4.1
Introduction
61
4.2
Usage
61
4.3
Components
of
therapy
70
4.4
Effects
of
treatment
78
4.5
Health
system
and
integration
83
4.6
Health
beliefs
94
4.7
Chapter
summary
102
5
DISCUSSION
103
5.1
Introduction
103
5.2
Usage
103
ii
5.3
Components
of
therapy
110
5.4
Effects
of
treatment
114
5.5
Health
system
and
integration
121
5.6
Health
beliefs
127
5.7
Chapter
summary
131
6
STRENGTHS
AND
LIMITATIONS
OF
THE
STUDY
133
6.1
Strengths
of
the
Study
133
6.2
Limitations
of
the
Study
133
7
CONCLUSIONS
AND
IMPLICATIONS
136
7.1
Conclusions
136
7.2
Implications
for
practice
and
IM
137
7.3
Implications
for
research
140
8
REFERENCES
143
9
APPENDICES
180
Appendix
A
–
Medical
Subject
Heading
(MeSH)
scope
notes
180
Appendix
B
–
Ethics
approval
letter
182
Appendix
C
–
Ethics
approval
amendment
183
iii
Appendix
D
–
Letter
to
practitioners
184
Appendix
E
–
Poster
to
advertise
study
185
Appendix
F
–
Patient
information
sheet
186
Appendix
G
–
Health
and
Disability
Ethics
Committees
(HDEC
)
flowchart
188
Appendix
H
–
Informed
consent
sheet
189
Appendix
I
–
Pages
from
ACC
acupuncture
treatment
profiles
190
Appendix
J
–
Transcription
confidentiality
agreement
193
Appendix
K
-‐
Interview
questions
prompt
sheet
194
Appendix
L
–
Scenarios
of
possible
integration
195
iv
List
of
Tables
Table
Title
Chapter
Page
1
Types
of
CAM
2.2
6
2
Classification
of
Risk
in
Acupuncture
Practice
2.4
9
3
Cochrane
Reviews
of
Acupuncture
Interventions
2.4
11
4
Search
Strategy
2.5
20
5
Search
Outcome
2.5
21
6
Summary
of
Qualitative
Studies
Examining
Patients'
2.5
23
Experiences
of
Acupuncture
7
Quality
Appraisal
of
Studies
2.5
26
8
Examples
of
Reporting
Bias
2.5
41
9
Study
Participants
3.4
54
10
Data
Collection
Timeline
3.5
55
11
Rigour
in
Qualitative
Research
3.8
58
12
What
Respondents
Said
Chinese
Medicine
Care
Does
and
5.4
116
Why
They
Liked
It
v
Acknowledgements
Completing
this
thesis
would
not
have
been
possible
without
the
support
and
participation
of
many
colleagues,
friends
and
family
members.
Firstly,
I
would
like
to
thank
the
participants
of
this
study
for
their
insightful
observations
and
willingness
to
contribute
to
this
piece
of
research.
I
must
also
acknowledge
my
supervisors,
Assoc.
Prof
Ray
Kirk
and
Dr
Lauretta
Muir,
who
have
both
offered
their
support
and
guidance
and
contributed
uniquely
to
different
aspects
of
this
study.
I
am
grateful
to
Amy
Collings,
whose
advice,
help
with
transcription,
and
friendship
made
the
writing
process
so
much
less
daunting,
and
to
Katie
Collucio
for
her
meticulous
editing
and
assistance
with
formatting.
The
financial
support
from
the
University
of
Canterbury
Master’s
Scholarship
is
also
gratefully
acknowledged.
Lastly,
I
am
immeasurably
grateful
to
my
wife
Anna,
whose
support,
patience,
insight
and
love
continuously
inspires
me.
vi
Dedication
To
my
Parents
‘The
philosophies
of
one
age
have
become
the
absurdities
of
the
next,
and
the
foolishness
of
yesterday
has
become
the
wisdom
of
tomorrow.’
-‐
William
Osler,
Canadian
physician
vii
List
of
Abbreviations
ACC:
Accident
Compensation
Corporation
CAM:
Complementary
and
Alternative
Medicine
CER:
Comparative
Effectiveness
Research
EBP:
Evidence
Based
Practice
EHR:
Electronic
Health
Record
GPs:
General
Practitioners
IM:
Integrative/Integrated
Medicine
NZRA:
New
Zealand
Register
of
Acupuncturists
NZASA:
New
Zealand
Acupuncture
Standards
Authority
OPP:
Out
of
Pocket
Payment
QARI:
Qualitative
Assessment
and
Review
Instrument
RA:
Rheumatoid
Arthritis
RCTs:
Randomised
Controlled
Trials
TCM:
Traditional
Chinese
Medicine
WHO:
World
Health
Organisation
viii
Notes
to
the
reader
While
there
are
many
different
styles
of
acupuncture
(TCM,
five
element,
Japanese,
etc.)
and
it
is
widely
debated
whether
“Chinese
medicine”
can
be
accurately
conceptualised
as
a
singular
discipline,
it
is
generally
agreed
that
the
various
schools
of
acupuncture
adhere
to
a
common
unifying
conceptual
framework
(yīn/yáng,
qì,
meridians,
etc.).
Throughout
this
thesis
the
terms
“traditional”
and
“Chinese
medicine”
are
thus
used
somewhat
interchangeably.
I
have
chosen,
for
the
sake
of
consistency,
to
use
pinyin
Romanisation
of
all
Chinese
terms,
so
while
some
commonly
used
Chinese
words
such
as
Taoism,
or
Ch’I,
are
often
rendered
in
their
historic
Wade-‐Giles
form,
I
have
used
Daoism,
and
qì,
etc.
To
facilitate
the
fluidity
of
reading,
I
have
tried
to
keep
capitalisation
to
a
minimum.
It
is
conventional
however,
that
English
transliterations
of
Chinese
medicine
terms
are
capitalised
where
they
do
not
correspond
directly
to
biomedical
meanings.
Spleen
for
example
is
used
when
it
refers
to
the
Chinese
medicine
notion
of
the
Spleen
system.
In
the
analysis
of
results
my
explanations
and
interpretations
within
participants’
quotes
are
parenthesised
in
square
brackets
and
intentionally
omitted
phrases
are
depicted
by
ellipses.
ix
Description:Appendix I – Pages from ACC acupuncture treatment profiles. 190. Appendix J – Transcription confidentiality agreement. 193. Appendix K -‐ Interview
