BACKGROUND: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. METHODS: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. RESULTS: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. CONCLUSIONS: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway.

Syftet med denna studie är att undersöka hur upplevd stressnivå påverkas av hand mot hudkontakt vid och efter massage hos massageterapeuter. Studien avgränsas till att endast undersöka massage där massageterapeutens händer har kontakt mot klientens hud, av diplomerade massageterapeuter inom svensk klassisk massage. En enkät utformades specifikt för att undersöka massageterapeuternas upplevelse av stressnivå i samband med och efter massagebehandling. Enkäten besvarades av 78 diplomerade massageterapeuter inom svensk klassisk massage från hela Sverige. Resultatet visar att skattning av upplevd stressnivå var lägre i samband med massagebehandling och direkt efter massagebehandling än 12 och 24 timmar efter utförd massagebehandling. En majoritet (73 procent) angav att de upplevde stressreducering och känsla av lugn under och efter utförd massagebehandling. Ett en-vägs ANOVA test visade att desto längre tid som passerade efter massagebehandlingen, desto högre upplevelse av stressnivå rapporterade respondenterna. Skattningen direkt efter massage jämfört med 24 timmar efter massage visade på en signifikant skillnad. Medan skattning under massage och direkt efter massage visade på en mindre signifikant skillnad. Ett tvåsvansat T-test visade att det fanns en statistiskt signifikant skillnad direkt efter massage och 24 timmar efter. Alltså är det mindre än en chans på 1000 att den upplevda stressnivån (upplevt lugn) beror på slumpen. / The aim of this study is to examine how perceived levels of stress are affected by skin on skin contact during and after giving massage. The study is limited to licensed massage therapists within Swedish massage, where the therapists’ hands are in contact with the clients’ skin during the entire massage. A questionnaire was specifically designed to investigate with the objective to measure the experienced levels of stress during and after giving massage. The questionnaire was answered by 78 certified massage therapists across Sweden. The results show that the perceived level of stress was lower during and shortly after having given massage, than after 12 and 24 hours respectively. With more time passing since the massage was administered, the level of stress increased. A majority (73 percent) of the massage therapists stated that they experienced reduced levels of stress and increased level of calmness during and after giving the massage treatment. A one-way ANOVA test showed that the longer time that passed after giving the massage, the higher levels of stress was reported. The reported level of stress directly after giving massage compared to 24 hours later showed significant difference. While the reported level of stress during and directly after giving massage did not show a significant difference. An independent two-tailed T-test demonstrates that there was a statistically significant difference immediately after giving massage and 24 hours after. Meaning that there is a 0,1 percent risk that the perceived levels of stress (sense of calmness) is a result of random factors.