In Lebanon, estimates of Complementary and Alternative Medicine (CAM) use among college students are not available. CAM practices are not well regulated and some products contain unsafe substances. The purpose of this study was to estimate the prevalence and predictors of CAM use among Lebanese college students using the health belief model. A quantitative cross sectional research design was used. An online survey was administered to 126 Lebanese college students with the aim of determining the most important predictors of CAM use. A majority (89%) of surveyed students reported the use of CAM in the last 12 months. Based on the findings of a multiple logistic regression analysis, perceived susceptibility (OR = 1.781), perceived barriers (OR =.809), and cues to action (OR = 1.650), 95% CIs [1.185, 2.678], [.658, .995], [1.049, 1.821], respectively, significantly predicted CAM use. Results indicate that people who perceive themselves more susceptible to diseases, who do not perceive barriers to CAM use, and who follow more cues to action are more likely to use CAM than others. These factors provide pathways for facilitating positive social change by developing stricter governmental policies to ensure consumer safety and to promote high quality products, and by driving the development of public awareness interventions about CAM use and related health risks.

This thesis will focus on what Mechanic terms "cultural and social aspects of medical care"; more specifically, it is the layman's evaluation of medical practitioners and practices. Medical practices are defined as the behavior directed toward maintenance or improvement of health while medical orientation designates the cognitive and affective attitudes toward health care.

Stroke is the fifth leading cause of death in the U.S. with approximately 795,000 Americans experiencing a stroke each year. In addition to common difficulties with communication and physical impairments following stroke, psychosocial impacts warrant assessment and treatment. Experiencing a stroke can lead to depression, mood disorders, and difficulties with emotion regulation. It is well documented that post-stroke depression (PSD) affects a third of stroke survivors. Higher levels of depression and depressive symptoms are associated with a less efficient use of rehabilitation services, poor functional outcomes, greater odds of hospital readmission, negative impacts on social participation, and increased mortality. The acute phase of stroke recovery may be a key factor in influencing the depression trajectory with early depression predicting poor longitudinal outcomes. The current approach to treating PSD is medication. However, psychotherapy approaches have demonstrated more promise in preventing PSD. Investigations into music-based treatments have shown encouraging results following acquired brain injuries with active music therapy interventions demonstrating large effect sizes for mood improvement. Therefore, the purpose of this three-part dissertation was to examine the effects of active music therapy on mood and describe the clinical decision making process of using music therapy to target mood elevation for hospitalized adults following a first-time acute ischemic stroke. The first study examined the effect of one treatment of active music therapy on mood following a first-time ischemic stroke during acute hospitalization. Active music therapy was defined as music making interventions that elicit and encourage active participation from participants. The Faces Scale was used to assess mood immediately prior to and following treatment. Forty-four adults received at least one treatment. A significant change in mood was found following one treatment. Comment analysis indicated that participants viewed music therapy as a positive experience. The second study investigated the impact of receiving two treatments of active music therapy on mood as compared to one. No significant difference was found between those who received one treatment and those who received two. Both dosing groups demonstrated significant mood improvement; however Group 2 (two treatments) had more severe strokes and did not improve until the second session. The purpose of the third study was to describe the clinical decision-making (CDM) process of a music therapist targeting mood elevation for hospitalized patients following a first-time acute ischemic stroke. The Three Phase Process Model of Collaborative Self-Study was selected as a guiding qualitative methodological framework. Data was collected from four sources: (a) electronic medical records, (b) audio recordings of eight music therapy treatments, (c) a researcher journal, and (d) patient and caregiver/visitor comments. Results indicate that factors influencing CDM included progression through a four-stage treatment process, use of a variety of music-based and therapy-based techniques, and the monitoring and influencing of participant levels of arousal, affect, salience, and engagement. In conclusion, active music therapy during acute hospitalization following a first-time ischemic stroke is effective in significantly improving mood. Components of clinical decision making to elevate mood are illustrated in a provided conceptual framework. Continued investigation is warranted with consideration of stroke severity, dosing amounts, and additional outcomes of interest. Longitudinal investigation is needed to evaluate the impact of treatment on the trajectory of post-stroke depression.

Opioid therapy is widely used to treat veterans with chronic noncancer pain (CNCP) despite evidence indicating patient safety concerns with the treatment. Although there is a place for opioid therapy in chronic pain management, opioids are not recommended as the first line of treatment for CNCP because of the risk for accidental overdose and death. The purpose of this project was to examine alternative practices for managing CNCP through a systematic review of the literature guided by the conceptual model of the Joanna Briggs Institute method for systematic reviews (JBIM-SR). A critical appraisal of the literature was conducted, and data were extracted and analyzed to identify evidence-based alternatives to opioids for managing CNCP in veterans. Using Cochrane, CINAHL, Joanna Briggs, and PubMed databases for the search, 116 articles were initially identified and through exclusion of duplicates and those not consistent with the study purpose, the review was narrowed to 16 articles. A 2nd reviewer completed an identical search using the exclusion criteria and databases confirming the search results of the primary reviewer. The 16 peer-reviewed research studies published between 2006 and 2016 selected for the analysis were graded using the JBIM-SR grading chart. Educational programs were seen as positive for improving providers' use of alternative therapies for CNCP. Complementary and alternative therapies such as yoga, peer support, injection therapy, cognitive behavioral therapy and acceptance commitment therapy provided improvement in pain perceptions, and coping abilities. Results of this project can promote positive social change as the findings are shared with providers in the practice site and as Veterans receive safe alternatives to opioid therapy.

Chronic pain affects approximately 100 million adults in the United States annually, and costs exceeding $635 billion. Pain is the most common complaint in primary care, and chronic pain accounts for up to 16% of emergency room visits. Additionally, chronic pain accounts for 25% of missed workdays annually. Veterans are particularly vulnerable to chronic pain and have an increased incidence of chronic non-cancer pain. Chronic pain for veterans cost the Veterans Administration (VA) about $385 billion each year. This project evaluated the Patient Aligned Care Team (PACT) model to manage chronic lower back pain (CLBP) at a VA primary care center. The framework that guided the project was the theory of planned change and the chronic care model. A retrospective electronic chart review of demographic and pain management data was collected from a convenience sample of veterans (20 women, 20 men) with a history of CLBP managed by the primary care center for at least 1 year prior to and one year after the PACT model was implemented. Overall, the paired-samples t-test to was not statistically significant for improvements in veteran reported pain scores over time. However, there was a significant interaction between time and gender that indicates changes over time significantly differed because of gender. In addition, descriptively the mean pain levels were initially higher for men as compared to women, and these levels increased sharply for females over time while the men decreased. This project contributes positively to social change for veterans as the findings indicate an important gender difference in patient reported pain scores over time. There needs to be additional investigation to understand the etiology of the gender difference in the pain outcomes for CLBP.

Improved health indicators, mental and physical health outcomes, and sustainable lifestyle practices have been found among yoga practitioners. The purpose of this study was to examine the impact of mixed styles of yoga practice on the health and behaviors of yoga practitioners. The relationship between yoga and body mass index (BMI), self-reported disease diagnosis, participation in other types of physical activity, adoption of healthy and sustainable lifestyle and dietary behaviors, perceived improvements in medical conditions that yoga was used to treat, quality of life resulting from yoga practice, and the reasons for beginning and continuing yoga were observed and tested in this study. Participants (N = 383) were adult yoga practitioners who were recruited using systematic sampling in Facebook social media. Data were analyzed using multiple linear regression, ANOVA, McNemar Chi square, and Spearman's correlation. Mean BMI for all yoga styles were in the normal range; however, ashtanga yoga was a significant predictor of low BMI. Self-reported disease diagnosis was significantly lower after beginning yoga practice. The majority of participants also engaged in other types of physical activity and adopted many healthy lifestyle practices. However, general/hatha and other styles of yoga were associated with adopting a greater number of other physical activities and general/hatha, ashtanga, and yoga therapy styles were associated with adopting a greater number of healthy and sustainable lifestyle and dietary behaviors. Medical conditions that yoga was used to treat and quality of life were perceived to be improved as a result of yoga practice. Results of this study confirm previous research findings that demonstrate numerous positive health outcomes from yoga practice.

This ethnography explores the varied contours of a national health care system and how it is used in conjunction with traditional forms of health care in Toledo District, Belize, focused on the largest town of Punta Gorda (P.G.), In a medically plural environment, a variety of health care options are used based on a wide range of social, economic, and structural factors that shape people's choices and decisions. The convenience of and experience with low-cost home- and self-care options make these the most common first choice during an illness event in P.G., however a deeper exploration of health behavior reveals that people will exhaust all options in their quest for health. In an era when neoliberal trends have a direct effect on people's lives, including a negative impact on health and well-being, Belize stands out as an interesting case. The small Central American/Caribbean nation has taken actions that appear to be contradictory to broader neoliberal policies that encourage privatization of government services, by implementing a national health care system that provides low-cost and free health services to its citizens. While new health facilities have been opened, and health services have become more widely available throughout Belize, an analysis of how and why the health care system functions shows that such programs may actually function as mechanisms of control and surveillance, thus aligning with neoliberal aims such as decentralization and privatization of services. As it has been implemented in southern Belize, the national health care system also replicates and extends an historic trend of marginalization and neglect to the region, showing that from the perspective of the State, and by extension, the powerful and elite of the nation, the citizens of P.G. are seen as less deserving of the quality of health care services that are necessary to lead healthy and productive lives.

This thesis is about the contemporary challenges facing herbal medicine. Specifically it concerns the difficulties faced by Australian herbalists in their attempts to maintain authority over the knowledge base of their craft and a connection with traditional understandings of the uses of plant medicines, while at the same time engaging with biomedicine and the broader Australian healthcare system. It contributes to the study of the nascent field of qualitative studies in contemporary western herbal medicine by making three main arguments.Firstly, Australian herbal medicine is characterised by its origins as a European colonial practice and its history of professional marginalisation during most of the 20th century. Secondly herbal practitioners have been unable to capitalise significantly on a surge of public popularity in the closing years of the 20th century which brought with it the interest of industry, the scrutiny of regulators and the renewed attention of biomedicine. Herbalists continue to struggle for recognition in the face of these more powerful interests. Thirdly it is argued that herbalists are attempting to gain legitimacy and acceptance as a healthcare profession through a process of underpinning their knowledge base with science, which is replacing their traditional philosophical basis. This has the effect of weakening the ability of herbalists to maintain their identity as an independent profession and makes its knowledge base vulnerable to appropriation by other healthcare professions.Gross’ model of the cultural location of traditions in contemporary societies is used to clarify the situation of herbalists and to identify problems consequent to the political choices they have made or which have been forced upon them. Gross suggests that traditions which place themselves close to power have difficulty in maintaining their own character and integrity, but that other cultural locations are also problematic and limit full participation in society. vi It is argued that there are compelling reasons to move beyond Gross’ analysis and to find ways to strengthen the independence of the herbal profession. Given the financial problems facing the current healthcare system in Australia and the looming ecological challenges, radical changes to the current system are required. The central concepts of herbal practice, in particular vitalism and holism, lead to approaches to healthcare which are potentially both costeffective and ecologically sustainable. A robust and independent profession of western herbalists, with their philosophy articulated and restored, could provide a valuable and sustainable contribution to Australian healthcare.

This research investigated the transformative and extraordinary experiences of nurse healers. The broad aim of the research was to promote the role of the healer in nursing by providing data on the experiences specific to nurse healers’ evolution as healers. The research was theoretically informed by van Manen (1990, 1984) and utilised hermeneutic phenomenology. Van Manen’s emphasis on writing as the key element of phenomenology in lived experience research was employed to bring forth a sense of lived immediacy and aesthetic colour essential to phenomenological understanding. The thesis was also theoretically aligned with the conceptual model of nursing as a caring-healing profession, developed by Jean Watson (1999, 1990a, 1988, 1985a). In particular, this research drew on Watson’s explicit connection of nursing with healing and nursing practice with transformational, transpersonal and esoteric insights. There were eleven nurse (nine women and two men) participants in the study. All participants identified strongly as healers. Selection was based on how long, and important to the individual was their commitment to being a healer. The data collection method used was semi structured interview with a predominant focus on storytelling. The overarching theme of ‘Walking Two Worlds’ was identified, and within that five essential themes were uncovered: (1) Belonging & Connecting; (2) Opening to Spirit; (3) Summoning; (4) Wounding & Healing Journey; and (5) Living as a Healer. Implications for nursing discussed include the need for the profession to provide support to nurse healers as they encounter challenging experiences and to allow for ontological flexibility regarding the esoteric aspects of human/spiritual experience revealed by this research. Further the need to extend the understanding invoked by healing beyond the obvious and opening vistas into experience which have been previously repudiated by domineering, narrow and spirit-denying powers in our society is also discussed.

Éste ensayo se trata de medicina indígena en communidades Mayas, principalmente en Guatemala, y las maneras en que biomedicina ha infiltrado el país. Los sistemas de salud estan analyizado por lentes feministas, antiracistas, anticlassistas.