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Background: This article presents findings from qualitative interviews conducted as part of a research study that trained Acupuncture, Massage, and Chiropractic practitioners' in Arizona, US, to implement evidence-based tobacco cessation brief interventions (BI) in their routine practice. The qualitative phase of the overall study aimed to assess: the impact of tailored training in evidence-based tobacco cessation BI on complementary and alternative medicine (CAM) practitioners' knowledge and willingness to implement BIs in their routine practice; and their patients' responses to cessation intervention in CAM context. Methods: To evaluate the implementation of skills learned from a tailored training program, we conducted semistructured qualitative interviews with 54 CAM practitioners in Southern Arizona and 38 of their patients. Interview questions focused on reactions to the implementation of tobacco cessation BIs in CAM practice. Results: After participating in a tailored BI training, CAM practitioners reported increased confidence, knowledge, and motivation to address tobacco in their routine practice. Patients were open to being approached by CAM practitioners about tobacco use and viewed BIs as an expected part of wellness care. Conclusions: Tailored training motivated CAM practitioners in this study to implement evidence-based tobacco cessation BIs in their routine practice. Results suggest that CAM practitioners can be a valuable point of contact and should be included in tobacco cessation efforts.

The formal recognition of traditional healing has been controversial for some time with traditional healers being labelled by those of conventional medical orientation as a medical hazard and purveyors of superstition. The support for the development of traditional medicine and establishment of co-operation between traditional healers and allopathic heath practitioners was first promoted in the international health arena by the World Health Organisation. Estimating that 80% of the population living in rural areas of many developing countries was using traditional medicine for the primary healthcare needs, this organisation advocated for the establishment of mechanisms that would facilitate strong cooperation between traditional healers, scientists and clinicians. The study was undertaken in the Amathole District Municipality, Province of the Eastern Cape based on Chapter 2, Section 6(2) (a) of the Traditional Health Practitioners Bill 2003, which required regulation and promotion of liaison between traditional health practitioners and other health professionals registered under any law. The purpose of the study was to develop and propose strategies to facilitate collaboration between traditional and allopathic health practitioners to optimise and complement healthcare delivery. The conceptual framework guiding the study was derived from Leininger’s theory of Cultural Care Diversity and Universality chosen because of its appropriateness. The terms used throughout the study were defined to facilitate the reader’s understanding. Ethical principles were adhered to throughout the research process. To ensure trustworthiness of the study, Guba’s model (in Krefting,1991:214-215) was used where the four aspects of trustworthiness namely, truth value, applicability, consistency and neutrality were considered. A qualitative, exploratory, descriptive and contextual research design was used which assisted in articulating the appropriate strategies to develop to facilitate v collaboration between allopathic and traditional health practitioners. The study was done in two phases. Phase one entailed data collection using unstructured interviews, a focus group interview, literature control and modified participant observation. In Phase two strategies to facilitate collaboration between allopathic and traditional health practitioners were developed. The population in this study comprised three groups of participants. Group 1 consisted of allopathic health practitioners, Group 2 comprised traditional healers and Group 3 was composed of participants who were trained as both traditional healers and allopathic health practitioners. All participants had to respond to three research questions which aimed at:  exploring and describing the nature of the relationship between allopathic and traditional health practitioners before legalisation of traditional healing and their experience as role-players in the healthcare delivery landscape in the Amathole District Municipality.  eliciting the viewpoints of allopathic and traditional health practitioners regarding the impact on their practices of legalisation of traditional healing and  developing strategies to facilitate collaboration between allopathic and traditional health practitioners. Data obtained from each group was analysed using Tesch’s method as described by Creswell (2003:192). Themes emerging from data and the corresponding strategies to address the themes were identified for each group. The participants’ responses to the three research questions revealed areas of convergence and divergence. Of significance was the reflection by the participants on their negative attitude towards each other. They also highlighted that there was no formal interaction between traditional and allopathic health practitioners in the Amathole District Municipality. Their working relationship was characterised by a one-sided referral system with traditional healers referring patients to allopathic health practitioners but this seemed not to be reciprocated vi by the latter group. The exception was the case of traditional surgeons whose working relationship with allopathic health practitioners was formally outlined in the Application of Health Standards in the Traditional Circumcision Act, Act No.6 of 2001. Allopathic health practitioners attributed their negative attitude as emanating from the unscientific methods used by traditional healers in treating patients, interference of traditional healers with the efficacy of hospital treatments and delays by traditional healers in referring patients to the hospitals and clinics. Traditional healers stated that they were concerned about failure of allopathic health practitioners to refer patients who talked about “thikoloshe” and “mafufunyana” to the traditional healers. Consequently, these patients presented themselves to the traditional healers when the illness was at an advanced stage. A reciprocal referral system was perceived by the traditional healers as the core element or crux of collaboration. There were ambivalent views regarding the impact of legalisation of traditional healing on the practices of both traditional and allopathic health practitioners. Elimination of unscrupulous healers, economic benefits, and occupational protection were benefits anticipated by traditional healers from the implementation of the Act. The possibility of having to divulge information regarding their traditional medicines, monitoring of their practice resulting in arrests should errors occur were however, cited by traditional healers as threatening elements of the Act. A lack of understanding the activities of each group with an inherent element of mistrust became evident from the participants’ responses. Ways of fostering mutual understanding between them were suggested which included holding meetings together to discuss issues relating to healing of patients, exposing both groups of health practitioners to research, as well as training and development activities. The participants also highlighted areas of collaboration as sharing resources namely, budget, physical facilities, equipment and information and role clarification especially pertaining to disease management. The participants vii strongly suggested that there should be clarity on the type of diseases to be handled by each group. The need for capacity building of traditional and allopathic health practitioners in preparation for facilitating collaboration was advocated by all and the relevant activities to engage into were suggested. Analysis, synthesis and cross referencing of the themes that emerged from the data culminated in the identification of three strategies that were applicable to all groups of participants and which would assist in facilitating collaboration between allopathic and traditional health practitioners. The researcher coined the three strategies “Triple C” strategies abbreviated as the TRIC strategies. The first “C” of the three “Cs” stands for “change attitude”, the second “C” for “communication” and the third “C” for “capacity building.” Each of the proposed three strategies is discussed under the following headings:- Summary of findings informing the strategy  Theory articulating the strategy  Aim of the strategy  Suggested implementation mechanism As the strategies had to be grounded in a theory which would serve as a reference point, the researcher used the Survey List by Dickoff, James and Wiedenbach (1968:423) as a conceptual framework on which to base the proposed three strategies. The results of this study and recommendations that have been made will be disseminated in professional journals, research conferences and seminars.

The increasing popularity of integrative medicine requires that we understand the meaning that patients attribute to their treatment experience. This project was a phenomenological study that sought to understand how nine chronically ill patients perceived their experience of living with illnesses and the treatment process at the integrative clinic. My findings reveal that their illnesses disrupted their life and were a threat to their self. An impetus combined with the influence of the social sphere led patients to join the clinic. The relationship with caregivers at the clinic was an important component of the treatment process and provided participants with the knowledge necessary to manage their illnesses. The positive interaction with caregivers enhanced patient empowerment and improved patient participation. Following treatments at the clinic, the majority of participants felt that their health had improved and that they had returned to their old self. Many had set future goals.

The field study took place in Dzodze, Ghana, over a period of 4 months in 2009. The data was collected through semi directed interviews and ethnography. The aim of this study was to investigate how localized practices provide a lens to gain larger insights into national and transnational politics of healing and knowledge. Precisely, how are current relationships between informal healers and biomedical practitioners performed in the everyday life of Dzodze, Ghana? The results of the study indicate no direct or institutionalized collaboration between biomedical practitioners and healers, however there is some form of relationships between informal birth attendants and public midwives. It is also apparent that the power relations linked with formal practices decrease possibilities for collaboration with informal medicine and also have a negative influence on any possible medium of innovation. The study also shows that people continue to use informal medicine because it works for them yet government reaction towards integration of informal medicine into national health system remains slow. Keywords: informal medicine, biomedicine, relationships

Integrative healthcare (IHC), the combination of biomedical disciplines and expertise in various forms of complementary and alternative medicine (CAM), is an example of interdisciplinary collaboration that has emerged over the last two decades. Little has been written so far to gain an understanding of how the healthcare practitioners in such setting collaborate. The main goal of this doctoral dissertation was to better understand what is inside the "black box" of interdisciplinary collaboration within IHC clinics so that appropriate links related to clinic effectiveness and cost-effectiveness as well as patient outcomes could be tested in future research. This thesis explored the concept of interprofessional collaboration in IHC using three theoretical and conceptual models: Input Process Output, Relationship-Centered Care, and Models of Team Healthcare Practice. Inductive and deductive inquiries were conducted through sequential mixed methods and methodological triangulation techniques. Four objectives were proposed to better understand how collaboration was experienced and conceptualized within these clinics and how the related factors interacted with each others. Finally, assumptions of a conceptual model of classification of IHC clinics were tested. Constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration consisted in communication, patient referral and power relationships. These determinants of collaboration resulted in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. The quantitative inquiry revealed that interpersonal relationships were shown to be central to the collaborative practice of IHC delivery. Additionally, beliefs in the benefits of collaboration were found to play an important role in an IHC collaborative enterprise. Finally, clinic model comparisons confirmed that interprofessional collaboration is modulated by the practice model. Suggestions to improve the conceptual model of classification were made. This multi-method study was the first to summarize systematically the factors that impact and ensue from interprofessional collaboration in the context of Canadian IHC. The framework lay down by this dissertation represents an important step to investigate further the impact of IHC on patients and the Canadian healthcare system and to guide the development of more effective IHC clinics.

Objective: This pilot study sets out to discover the consumer's attitudes and perceptions about herbal therapy-both before and after viewing student pharmacists' posters that included information on various supplements and herbal therapies. Methods: An eleven-question survey was distributed among 61 attendees. In addition to demographic information, questions were asked about opinions of safety and efficacy of natural supplements and herbal therapies. Additionally, respondents were asked about their intended future use of herbal therapies. Results: Twenty-four percent of the survey respondents changed their perception regarding the safety of natural and herbal therapies, (p = 0.23), while 45fc changed their perception of efficacy (p = 0.012). Overall, there was not an anticipated change in the use of natural and herbal therapies among the respondents. Prior use of or familiarity with natural or herbal products did not influence future anticipated use. Conclusion: Student pharmacists' poster presentations significantly changed the perception regarding the efficacy of dietary supplements, but not the perception of safety.

Objective: This pilot study sets out to discover the consumer's attitudes and perceptions about herbal therapy-both before and after viewing student pharmacists' posters that included information on various supplements and herbal therapies. Methods: An eleven-question survey was distributed among 61 attendees. In addition to demographic information, questions were asked about opinions of safety and efficacy of natural supplements and herbal therapies. Additionally, respondents were asked about their intended future use of herbal therapies. Results: Twenty-four percent of the survey respondents changed their perception regarding the safety of natural and herbal therapies, (p = 0.23), while 45fc changed their perception of efficacy (p = 0.012). Overall, there was not an anticipated change in the use of natural and herbal therapies among the respondents. Prior use of or familiarity with natural or herbal products did not influence future anticipated use. Conclusion: Student pharmacists' poster presentations significantly changed the perception regarding the efficacy of dietary supplements, but not the perception of safety.

This thesis investigated the phytochemistry and pharmacology of boreal plant species used traditionally as treatments for symptoms and complications of diabetes and was completed in collaboration with the Team in Aboriginal Anti-Diabetic Medicine and the Cree of Eeyou Istchee in northern Quebec. Using a novel metabolomic-based approach, we first developed methods of phytochemical analysis to characterize Vaccinium angustifolium extracts and then other medicinal Ericaceae, identifying and quantifying an abundance of phenolic compounds. These methods were then employed to profile the phenolics in anti-diabetic species identified by Cree Elders. Pharmacological assays of extracts focused primarily on in vitro inhibition of mechanisms involved in the pathophysiology of diabetic neuropathy, associated diabetic complications and neurodegenerative conditions. Upon testing for cytoprotective effects in two models of diabetic neuropathy, few extracts prevented cell loss mediated by serum/glucose deprivation but 10 of 18 significantly reduced glucotoxic cell death. The activities of Picea glauca needles, which was cytoprotective in both models, and Sarracenia purpurea leaves were of particular interest as observed organ-specific effects correlated with medicinal uses identified by Cree Elders. Cytoprotection, however, did not correlate with extract phenolic content or anti-oxidant activity. Active principles were therefore sought through assay-guided fractionation of S. purpurea extract, identifying quercetin-3- O-galactoside, which inhibited glucotoxicity at low micromolar concentrations. Extracts were then tested for effects on formation of advanced glycation endproducts. Most displayed concentration-dependent inhibition with IC50 values ranging from 0.4-38.6 mug/ml. Anti-glycation activity was significantly correlated with extract phenolic content and anti-oxidant capacity. The bioactivities of individual phenolic metabolites were then evaluated at physiologically relevant concentrations using molecular tools to determine cell proliferation, survival and death. A wealth of anti-apoptotic and mitogenic effects were observed and structure-activity relationships were separately identified among benzoic acid derivatives and flavonoids. To explore the neuroprotective potential of these two phenolic classes, collections of each were tested for the ability to inhibit platelet-activating factor (PAF) neurotoxicity. Three novel PAF inhibitors were identified, orsellinic acid, hesperetin and quercetin, and all prevented PAF-mediated executioner caspase activation. Together, these results validate the traditional knowledge shared by our Cree collaborators and highlight the multidimensional therapeutic potential of boreal plants as culturally appropriate complementary anti-diabetic therapies.

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