Patterns of conventional and complementary non-pharmacological health practice use by US military veterans: a cross-sectional latent class analysis

Abstract

BackgroundNon-pharmacological therapies and practices are commonly used for both health maintenance and management of chronic disease. Patterns and reasons for use of health practices may identify clinically meaningful subgroups of users. The objectives of this study were to identify classes of self-reported use of conventional and complementary non-pharmacological health practices using latent class analysis and estimate associations of participant characteristics with class membership.MethodsA mailed survey (October 2015 to September 2016) of Minnesota National Guard Veterans from a longitudinal cohort (n = 1850) assessed current pain, self-reported overall health, mental health, substance use, personality traits, and health practice use. We developed the Health Practices Inventory, a self-report instrument assessing use of 19 common conventional and complementary non-pharmacological health-related practices. Latent class analysis was used to identify subgroups of health practice users, based on responses to the HPI. Participants were assigned to their maximum-likelihood class, which was used as the outcome in multinomial logistic regression to examine associations of participant characteristics with latent class membership.ResultsHalf of the sample used non-pharmacological health practices. Six classes of users were identified. “Low use” (50%) had low rates of health practice use. “Exercise” (23%) had high exercise use. “Psychotherapy” (6%) had high use of psychotherapy and support groups. “Manual therapies” (12%) had high use of chiropractic, physical therapy, and massage. “Mindfulness” (5%) had high use of mindfulness and relaxation practice. “Multimodal” (4%) had high use of most practices. Use of manual therapies (chiropractic, acupuncture, physical therapy, massage) was associated with chronic pain and female sex. Characteristics that predict use patterns varied by class. Use of self-directed practices (e.g., aerobic exercise, yoga) was associated with the personality trait of absorption (openness to experience). Use of psychotherapy was associated with higher rates of psychological distress.ConclusionsThese observed patterns of use of non-pharmacological health practices show that functionally similar practices are being used together and suggest a meaningful classification of health practices based on self-directed/active and practitioner-delivered. Notably, there is considerable overlap in users of complementary and conventional practices.Electronic supplementary materialThe online version of this article (10.1186/s12906-018-2313-7) contains supplementary material, which is available to authorized users.

The relationship between capacity and utilization of nonpharmacologic therapies in the US Military Health System

“…Author details 1 The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MA 02453 Waltham, USA. 2 • support for research data, including large and complex data types • gold Open Access which fosters wider collaboration and increased citations maximum visibility for your research: over 100M website views per year…”

“…Patients and healthcare systems alike are increasingly turning to nonpharmacologic therapies (NPTs) to address multiple health conditions including acute and chronic pain [1][2][3]. These approaches include physical therapy, chiropractic care, cognitive behavioral therapy, mindfulness, and acupuncture [4].…”

Evidence-Based Care for Women Veterans: A Burgeoning Effort in the Department of Veterans Affairs Healthcare System

“…Some of these differences may be rooted in the fact that women servicemembers historically have experienced different military exposures than their male counterparts (Sternke et al, 2017). From a health services perspective, women veterans are more likely to use manual therapies (e.g., chiropractic, physical therapy, massage) to manage chronic pain (Donaldson et al, 2018).…”

Clinical yoga program utilization in a large health care system.

“…Published research data suggest usage of complementary and integrative approaches among U.S. military veterans is associated with being female and having chronic musculoskeletal pain (Donaldson et al, 2018). Also, engagement in yoga is higher among younger people, veterans who identify as White, and lower among those who identify as non-Hispanic Black and Hispanic in large surveys of the U.S population (Birdee et al, 2008; Olano et al, 2015; Park, Braun, & Siegel, 2015).…”