« Describing and Explaining the use of alternative practitioners in France. »
Thesis supervision :
- Benoit ALLENET, Professeur des Universités, Praticien Hospitalier, Université Grenoble Alpes, Director
- Nicolas PINSAULT, Maître de conférences, Université Grenoble Alpes, Co-director
- Bruno FALISSARD, Professeur des Universités, Praticien Hospitalier, Université Paris XI et unité Inserm 1178, Reporter
- Edzard ERNST, Professeur Émérite, Université d'Exeter, Reporter
- Mireille MOUSSEAU, Professeur des Universités, Praticien Hospitalier, Centre Hospitalo-Universitaire Grenoble Alpes, Examiner
- Olivier DESRICHARD, Professeur associé, Université de Genève, Examiner
- Jean-Philippe REGNAUX, Maître de conférences, École des hautes études en santé publique, Examiner
Consulting a therapist using practices without scientific basis (complementary and alternative medicine (CAM) practitioner) involves risks: delaying the diagnosis of a serious disease, turning away from effective treatement, exposing oneself to false information about one's health or illness, or simply paying and spending time for treatment that is at best ineffective but harmless, at worst useless and dangerous. Thus, the use of CAM practitioners questions both from the point of view of public health and the reasons for this behaviour. Yet, in France, data on the subject are scarce and insufficiently detailed to assess the real public health challenge of the phenomenon. In addition, the mechanisms leading patients to use CAM practitioners are poorly understood, which can make it difficult to communicate on the subject for professionals and health institutions. Therefore, our objectives were to describe and explain the use of CAM practitioners in the general French population. After conducting a systematic literature review and developing and validating a questionnaire adapted to our objectives, we performed a cross-sectional survey with a convenience sample of 10,478 adults living in metropolitan France, as well as a case-control study involving 2,056 respondents from this sample. In the latter, we tested whether being dissatisfied with one’s physician can explain the use of a CAM practitioner without medical training. Finally, we proposed an explanatory model of this recourse, accompanied by testable predictions.
52% of respondents reported use of an acupuncturist, chiropractor, homeopath, magnetizer, osteopath or bonesetter in the past 12 months. 68 other types of CAM practitioners were consulted, raising the total recourse rate to 54%. These practitioners, mainly unconventional health practitioners, were consulted mainly for low back pain in addition to medical care. For low back pain, our results showed that being dissatisfied with medical care explains a large part of the complementary use of a CAM practitioner without medical training, except for non-physician osteopaths. Conversely, consulting a CAM practitioner in isolation from any medical care is poorly explained by dissatisfaction with one's general practitioner. In both cases, complementary or isolated recourse, other explanatory factors should be considered, such as the fact that physicians and other conventional health practitioners use or advise themselves scientifically unfounded practices.
complementary and alternative medicine, questionnaire, observational study, decision making, patient satisfaction, logistic regression