key: cord-0260715-fmr3hcx7 authors: Steel, A.; Redmond, R.; Schloss, J.; Cramer, H.; Goldenberg, J.; Leach, M.; Harnett, J.; Van de Venter, C.; McLintock, A.; Bradley, R.; Hawrelak, J.; Cooley, K.; Leung, B.; Adams, J.; Wardle, J. title: INTERNATIONAL PREVALENCE OF CONSULTATION WITH A NATUROPATHIC PRACTITIONER: A SYSTEMATIC REVIEW AND META-ANALYSIS date: 2021-08-09 journal: nan DOI: 10.1101/2021.08.08.21261774 sha: f7666f8deb850f5b6516ad2a705aa4ad90f61c2d doc_id: 260715 cord_uid: fmr3hcx7 Objectives: Naturopathy is a traditional medicine system informed by codified philosophies and principles, and an emphasis on non-pharmacologic therapeutic interventions. While naturopathy is practiced by approximately 75 000 to 100 000 naturopathic practitioners in at least 98 countries, little is known about the international prevalence of history of consultation with a naturopathic practitioner. This study reports a systematic review and meta-analysis of studies describing the global prevalence of history of consultation with a naturopathic practitioner by the general population. Setting: The included literature was identified through a systematic search of eight databases between September and October 2019, as well as the grey literature. Participants: Studies were included if they reported the prevalence rate of consultations with a naturopathic practitioner by the general population Interventions: Survey items needed to report consultations with a naturopathic practitioner as defined in the country where data was collected, and not combine naturopathic consultations with other health services or only report consulations for illness populations. Primary and secondary outcome measures: Primary measures used for the analysis was consultations in the previous 12-months. Other prevalence timeframes were reported as secondary measures. Methods: Meta-analysis of prevalence data was conducted using random effects models based on individual countries and World Health Organisation (WHO) world regions. Results: The literature search identified eight manuscripts summarizing 13 studies reporting prevalence for inclusion in the review. All included studies had a low risk of bias. Meta-analysis of the included studies by world region found the 12-month prevalence of history of naturopathy consultations ranged from 1% in the Region of the Americas to 6% in the European and Western Pacific Regions. Conclusions: There are up to 6-fold differences in the prevalence of naturopathy consults over 12-months between and within world regions, which may be driven by a range of policy, legislative and social factors. a . • T h e r e s u l t s a r e l i m i t e d b y t h e p o o r a v a i l a b i l i t y o f d a t a r e p o r t i n g c o n s u l t a t i o n s w i t h a n a t u r o p a t h i I N T R O D U C T I O N N a t u r o p a t h y i s a t r a d i t i o n a l m e d i c i n e s y s t e m u n d e r p i n n e d b y s i x p h i l o s o p h i c a l p r i n c i p l e s ( s e e T a b l e 1 ) , w h i c h w e r e c o d i f i e d b y t h e p r o f e s s i o n i n t h e 2 0 t h c e n t u r y [ 1 ] . T h e s e p h i l o s o p h i c a l p r i n c i p l e s c h a r a c t e r i z e n a t u r o p a t h i c p r a c t i c e a n d a r e g l o b a l l y a c c e p t e d b y t h e p r o f e s s i o n [ 2 ] . O t h e r d e f i n i n g t e n e t s o f n a t u r o p a t h i c p r a c t i c e a r e p a t i e n t -c e n t e r e d n e s s a n d i n d i v i d u a l i z a t i o n , w i t h n a t u r o p a t h s t y p i c a l l y d r a w i n g u p o n a r a n g e o f t h e r a p e u t i c i n t e r v e n t i o n s ( e . g . , d i e t a n d l i f e s t y l e c o u n s e l l i n g , h e r b a l m e d i c i n e , n u t r i t i o n a l s u p p l e m e n t a t i o n , m a n u a l t h e r a p i e s , a n d m i n d -b o d y p r a c t i c e s ) t o b e s t m e e t t h e h e a l t h c a r e n e e d s a n d p r e f e r e n c e s o f t h e p a t i e n t [ 3 ] . G l o b a l l y , n a t u r o p a t h y i s p r a c t i c e d i n a t l e a s t 9 8 c o u n t r i e s w i t h r e p r e s e n t a t i o n i n e v e r y w o r l d r e g i o n [ 4 ] . i t i o n a l m e d i c i n e , h e r b a l m e d i c i n e , l i f e s t y l e m e d i c i n e , d i e t a r y m o d i f i c a t i o n , h o m e o p a t h y , a n d m a n u a l t h e r a p i e s ) [ 4 ] . D e s p i t e s i m i l a r i t i e s i n t h e c o n t e n t o f t h e s e t r a i n i n g p r o g r a m s , n a t u r o p a t h i c s c o p e o f p r a c t i c e v a r i e s c o n s i d e r a b l y a c r o s s j u r i s d i c t i o n s d u e t o d i f f e r e n c e s i n r e g u l a t i o n a n d l e g i s l a t i v e r e q u i r e m e n t s [ 6 ] . I n r e s p o n s e t o a n i n c r e a s e i n t h e u s e o f t r a d i t i o n a l a n d c o m p l e m e n t a r y m e d i c i n e ( i n c l u d i n g t h e u t i l i z a t i o n o f n a t u r o p a t h i c h e a l t h s e r v i c e s ) , t h e W o r l d H e a l t h O r g a n i s a t i o n h a s d e v e l o p e d g l o b a l s t r a t e g i e s t o e n s u r e a c c e s s t o s a f e a n d e f f e c t i v e h e a l t h c a r e , w h i c h i n c l u d e p r o m o t i n g t h e i n t e g r a t i o n o f t r a d i t i o n a l a n d c o m p l e m e n t a r y t h e r a p i e s ( i n c l u d i n g n a t u r o p a t h y ) i n t o h e a l t h c a r e s y s t e m s [ 7 ] . S e v e r a l i n t e r n a t i o n a l r e s e a r c h s t u d i e s s u g g e s t t h e d e m a n d f o r n a t u r o p a t h i c s e r v i c e s m a y b e a t t r i b u t e d t o p e r s o n a l h e a l t h c a r e b e l i e f s , d i s s a t i s f a c t i o n w i t h b i o m e d i c a l c a r e , i n c r e a s e d d i s e a s e s e v e r i t y , a n d u n m e t h e a l t h c a r e n e e d s [ 8 -1 5 ] . N e v e r t h e l e s s , t h e g l o b a l u s e o f n a t u r o p a t h i c s e r v i c e s i s n o t w e l l u n d e r s t o o d . T h e r e f o r e t h e a i m o f t h i s s t u d y w a s t o d e s c r i b e t h e p r e v a l a n c e o f a h i s t o r y o f c o n s u l t a t i o n s w i t h n a t u r o p a t h i c p r a c t i t i o n e r s g l o b a l l y , i n c l u d i n g p o t e n t i a l d i f f e r e n c e s a c r o s s w o r l d r e g i o n s . M E T H O D S A I M T h i s s t u d y a i m s t o d e s c r i b e t h e g l o b a l p r e v a l e n c e o f a h i s t o r y o f c o n s u l t a t i o n w i t h a n a t u r o p a t h i c p r a c t i t i o n e r b y t h e g e n e r a l p o p u l a t i o n . S T U D Y D E S I G N . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 9, 2021. ; A s y s t e m a t i c r e v i e w a n d m e t a -a n a l y s i s o f p is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; a d d i t i o n a l 1 9 a r t i c l e s ( 3 r e f e r e n c e s a n d 1 6 c i t a t i o n s ) , o f w h i c h o n e r e p o r t w a s f o u n d t o m e e t t h e i n c l u s i o n c r i t e r i a f o r t h i s r e v i e w . T h i s y i e l d e d a t o t a l o f e i g h t i n c l u d e d s t u d i e s , o n e o f w h i c h w a s p u b l i s h e d i n a r e p o r t . S T U D Y C H A R A C T E R I S T I C ] . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; T w o s t u d i e s r e p o r t e d p r e v a l e n c e o f n a t u r o p a t h y u s e o v e r o t h e r t i m e p e r i o d s . O n e s t u d y f r o m t h e R e g i o n o f t h e A m e r i c a s ( C a n a d a ) i n d i c a t e d 6 % o f t h e g e n e r a l p o p u l a t i o n i n 1 9 9 7 , 9 % i n 2 0 0 6 , a n d 1 1 % i n 2 0 1 6 u s e d n a t u r o p a t h y a t s o m e p o i n t i n t h e u s e r ' s l i f e t i m e [ 3 0 ] . A s t u d y f r o m t h e S o u t h -E a s t A s i a n w o r l d r e g i o n i n d i c a t e d 1 0 % o f t h e p o p u l a t i o n h a d u s e d n a t u r o p a t h y a n d y o g a , b u t t h e t i m e f r a m e o f u s e w a s n o t s p e c i f i e d [ 2 1 ] . is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; I n s u r a n c e c o v e r a g e i s a l s o k n o w n t o b e a s i g n i f i c a n t d r i v e r o f n a t u r o p a t h i c u s e [ 3 2 ] , a n d v a r i a b l e i n s u r a n c e c o v e r a g e a r r a n g e m e n t s f o r n a t u r o p a t h y -a s o b s e r v e d i n t h e U S A [ 3 5 ] -m a y a l s o r e s u l t i n r e g i o n a l d i f f e r e n c e s . F u r t h e r a t t e n t i o n t o w a r d s r e g i o n a l v a r i a t i o n s a n d h e t e r o g e n e i t y , p a r t i c u l a r l y a s i t r e l a t e s t o s p e c i f i c b a r r i e r s a n d f a c i l i t a t o r s t o a p p r o p r i a t e u t i l i z a t i o n o f n a t u r o p a t h i c s e r v i c e s -i s w a r r a n t e is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; t h a t a r e l i a b l e v a l i d a t e d i n s t r u m e n t i s d e v e l o p e d f o r c o l l e c t i n g m o r e s p e c i f i c d a t a a b o u t n a t u r o p a t h i c s e r v i c e u t i l i z a t i o n w i t h i n a n d a c r o s s c o u n t r i e s t o e s t a b l i s h ' t r u e ' p r e v a l e n c e o f u s e i n f o r m a t i o n . W h i l e p r e v a l e n c e d a t a p r o v i d e s a s n a p s h o t o f a g i v e n p o p u l a t i o n s ' u s e o f n a t u r o p a t h y , l e s s i s k n o w n a b o u t t . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; . N e y e l o f f , J . L . , S . C . F u c h s , a n d L . B . M o r e i r a , M e t a -a n a l y s e s a n d F o r e s t p l o t s u s i n g a m i c r o s o f t e x c e l s p r e a d s h e e t : s t e p -b y -s t e p g u i d e f o c u s i n g o n d e s c r i p t i v e d a t a a n a l y s i s . B M C r e s e a r c h n o t e s , 2 0 1 2 . 5 ( 1 ) : p . 1 -6 . 2 3 . H i g g i n s , J . P . , e t a l . , M e a s u r i n g i n c o n s i s t e n c y i n m e t a -a n a l y s e s . B m j , 2 0 0 3 . 3 2 7 ( 7 4 1 4 ) : p . 5 5 7 -5 6 0 . 2 4 . H i g g i n s , J . P . , e t a l . , C o c h r a n e h a n d b o o k f o r s y s t e m a t i c r e v i e w s o f i n t e r v e n t i o n . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; A U T H O R C O N T R I B U T I O N S A S d e v i s e d t h e p r o j e c t , t h e m a i n c o n c e p t u a l i d e a a n d d r a f t e d t h e r e v i e w p r o t o c o l . A l l a u t h o r s r e v i e w e d a n d e d i t e d t h e p r o t o c o l p r i o r t o r e g i s t r a t i o n . L i t e r a t u r e s e a r c h i n g , r e m o v a l o f d u p l i c a t e s a n d f i l t e r i n g o f c i t a t i o n s b y t i t l e a n d a b s t r a c t w a s u n d e r t a k e n b y A M . F u l l t e x t r e t r i e v a l a n d a s s e s s m e n t o f a r t i c l e s a g a i n s t e l i g i b i l i t y c r i t e r i . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; T a b l e 1 . P h i l o s o p h i c a l p r i n c i p l e s o f n a t u r o p a t h F i g u r e 1 : F l o w c h a r t r e p r e s e n t i n g a r t i c l e s e l e c t i o n m e t h o d i n l i n e w i t h P R I S M A p r o t o c o l A T T A C H E D . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. ; https://doi.org/10.1101/2021.08.08.21261774 doi: medRxiv preprint T A B L E 3 : S U M M A R Y I N F O R M A T I O N O F I N C L U D E D S T U D I E S R E P O R T I N G P R E V A L E N C E O F U S E O F N A T U R O P A T H Y I N T H E P R E V I O U S 1 2 M O N T H is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. T A B L E 4 : S U M M A R Y I N F O R M A T I O N O F I N C L U D E D S T U D I E S R E P O R T I N G P R E V A L E N C E O F U S E O F N A T U R O P A T H Y O V E R O T H E R T I M E P E R I O D . It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. T A B L E 5 : A S S E S S M E N T O F R I S K O F B I A S A N D R E P O R T I N G Q U A L I T Y F O R I N C L U D E D S T U D I E is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted August 9, 2021. F i g u r e 2 : 1 2 -m o n t h p r e v a l e n c e o f n a t u r o p a t h y u s e i n d i f f e r e n t c o u n t r i e s . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 9, 2021. ; https://doi.org/10.1101/2021.08.08.21261774 doi: medRxiv preprint F i g u r e 3 : 1 2 -m o n t h p r e v a l e n c e o f n a t u r o p a t h y u s e i n d i f f e r e n t W H O w o r l d r e g i o n s . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted August 9, 2021. ; Records identified from*: Databases (n = 13 968) Records removed before screening: Duplicate records removed (n = 2509) Records screened (n = 11459) Records excluded** (n = 11 374) Reports sought for retrieval (n = 85) Reports not retrieved (n = 0) Reports assessed for eligibility (n = 85) Reports sought for retrieval (n = 19) Reports not retrieved (n = 0) EXP COMPLEMENTARY THERAPIES/ 2.((ALTERNATIVE OR COMPLEMENTARY OR INTEGRATIVE) ADJ (MEDICINE OR THERAPY OR THERAPIES)).TW,KW. 3. NATUROPATHY