Elsevier

Vaccine

Volume 23, Issue 3, 2 December 2004, Pages 372-379
Vaccine

Beliefs and behaviours: understanding chiropractors and immunization

https://doi.org/10.1016/j.vaccine.2004.05.027Get rights and content

Abstract

Background:

Concerns have been raised about the beliefs and behaviours of chiropractors related to immunization; however, none have systematically examined the relationships between beliefs and behaviours.

Purpose:

We examine the immunization-related behaviours and beliefs of chiropractors in Alberta, Canada, and explore the relationship of beliefs to immunization-related behaviours with patients.

Methods:

Data were collected in 2002 from a postal survey of Alberta chiropractors. The questionnaire inquired about six behaviours of interest in the six months prior to survey (gave information about risks/benefits of vaccination; advised patients in favour/against have self/children immunized; counselled on freedom of choice; directed to sources of information on immunization). It included items addressing beliefs and norms related to immunization.

Results:

The response rate was 78.2% (503/643). Immunization arose with patients at least monthly for 36.5% of respondents, and at least weekly for 9.2%. One quarter advised patients in favour and 27% against having themselves/their children immunized. A parsimonious model of chiropractor pro/anti-vaccination behaviours included beliefs about the efficacy/safety of vaccination, chiropractic philosophy and individual rights.

Conclusions:

Similar proportions of chiropractors advise patients in favour or against immunization. A small minority deals with immunization issues frequently. Behaviours can be understood in the context of beliefs.

Introduction

Chiropractic was the third most popular complementary or alternative modality used in the USA in 1999 [1], [2] and is also commonly used in Canada [3]. Concerns have been raised about the beliefs and behaviours of chiropractors related to immunization; however, published studies have included only relatively small samples [4], studied only beliefs and/or had low response rates and/or were limited to students [5], [6]. We examine the immunization-related beliefs and behaviours of chiropractors and explore the relationship between the beliefs and the behaviours, using data collected in a postal survey of Alberta chiropractors conducted in 2002.

Section snippets

Methods

A listing of all chiropractors registered to practice in Alberta as of August 2001 was obtained from the College of Chiropractors of Alberta. Survey procedures included up to five contacts and followed the principles described by Dillman [7]. The 55-item questionnaire required 15–20 min for completion.

The questionnaire included items on demographics, immunization behaviours (Table 1), the frequency with which immunization issues arose in practice, and immunization behavioural and normative

Response and respondents

Questionnaires were sent to 682 persons and 39 were returned by the post office as not having valid addresses. Completed questionnaires were returned by 503 chiropractors (78.2% of those with a valid address); however, a variable number of these persons responded to each item. Forty-one persons returned the partial-responder questionnaire. The median year of graduation from Chiropractic College was 1992. Nearly 80% had graduated from one of four Colleges of chiropractic: 199 from the Canadian

Discussion

The strengths of this study include being population-based, the high response rate, and collection of data on partial-respondents (considered to be proxies for non-respondents) that included information on the behaviours of interest.

The data shows that for about 10% of chiropractors practicing in Alberta immunization is discussed with patients on a weekly basis while for about 35% on a monthly basis. For most others the issue is raised also, albeit less frequently, suggesting that the

Acknowledgements

This study was funded by the Alberta Children’s Hospital. Dr. Eliasziw is funded by the Alberta Heritage Foundation for Medical Research. We are grateful to the College of Chiropractors of Alberta for releasing to us the nominal listing of registrants for this study, which materially assisted us in doing this work. We thank the anonymous chiropractors who so helpfully participated in questionnaire development and pre-tests, and those who kindly participated in this study.

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