Provider support in complementary and alternative medicine: Exploring the role of patient empowerment
Background: The quality of the patient–provider relationship is well-recognized as having a key role in therapeutic outcomes irrespective of treatment effects. Yet there is a lack of scales to assess aspects of complementary and alternative medicine (CAM) provider support. Objectives: The objectives of this study were to develop and psychometrically evaluate scales to measure patients' perceptions of provider support, patient-centered care, and empowerment as predictors of health outcomes. Methods: Based on five focus groups with CAM clients, we developed the following three scales: Perceived Provider Support, Patient-Centered Care (PCC), and Empowerment. The scales were cognitively tested with 6 CAM users and then pilot-tested with 216 respondents. Confirmatory factor analyses, item response theory analyses, and Cronbach's alphas were conducted to evaluate their psychometric properties. Bootstrapping techniques and structural equation modeling were used to evaluate Empowerment as a mediator of the relationship of Perceived Provider Support and PCC with symptom relief. Results: All three scales demonstrated high internal consistency with Cronbach's alphas of 0.85 to 0.90 and confirmatory factor analyses supported a one-factor solution for each scale. Controlling for demographics, presenting problem, and main CAM provider used in the past 12 months, each of the scales had a positive and significant relationship with overall symptom relief for the patient's primary presenting problem (p<.01). Bootstrapped Sobel tests were significant (p<.01), supporting the role of empowerment as a mediator of the impact of PCC and provider support on symptom relief. A structural equation model combining PCC and provider support into a single latent variable representing quality of patient–provider interactions and including empowerment as a mediator fit well. Conclusions: From a holistic perspective, CAM treatment effects can arise in part from sources related to the therapeutic relationship, as well as the philosophy of healing and specific techniques designed to reduce symptoms. This analysis provides conceptual support for this perspective, a means to evaluate aspects of the therapeutic relationship and to measure its impact on outcomes of CAM treatment across conditions and therapies.