Assessment Tools for Contextual Factors in Interactions in CAM

描述（由申请人提供）：本提案涉及与补充和替代医学（CAM）治疗相关的一个基本主题：我们如何衡量遭遇的背景？接触被定义为患者在到达CAM实践场所和离开时的经历。这种接触可以分为两部分：（a）主要治疗干预的经历（干预）和（B）干预之前、期间和之后的所有其他经历（背景）。背景效应在评估CAM干预措施的功效和有效性方面起着两个关键作用。首先，情境效应可以调节治疗效果（情境作为中介）。第二，背景效应实际上可能直接影响结果（背景即干预）。在一个经典的随机对照试验中，研究者通常希望控制作为中介的背景效应，并测量作为干预的背景效应，以理清结果中哪些部分是由于干预，哪些是由于背景。在CER中，研究人员不太关心控制环境作为中介的影响，但他们想了解遇到的哪一部分占任何积极的结果。在任何一种情况下，调查人员都必须知道如何衡量背景。没有这些措施，就不可能评估任何一种背景效应。该提案有三个具体目标：1。了解在CAM遭遇期间患者暴露于何种背景因素？ 2.确定如何通过观察和/或患者和提供者回忆可靠地测量这些背景因素;以及3.为了评估背景因素在（a）CAM模态内和跨（a）CAM模态（即，整脊疗法与整骨疗法）;（B）实践场所，（c）提供者，和（d）个体患者接触本研究将使用脊椎指压治疗接触作为CAM的范例，并开发一种快速人种学观察方法来研究接触的背景。该项目的目标是开发一种可靠，有效和严格的方法来收集有关上下文的数据。拟议的研究解决了一个基本问题，所有的健康结果研究：如何衡量的健康结果的背景下的效果。 公共卫生相关性：评价补充和替代医学（CAM）干预措施的一个基本问题是如何衡量遭遇的背景及其对结果的贡献的影响。本研究的目的是发展一种快速的民族志观察方法，以脊椎指压治疗作为CAM的范例，研究遭遇的背景。

DESCRIPTION (provided by applicant): This proposal addresses a fundamental topic relative to Complementary and Alternative Medicine (CAM) treatments: How do we measure the context of an encounter? Encounters are defined as what patients experience between when they arrive at a CAM practice site and when they leave. The encounter can be divided into two parts: (a) the experience of the main treatment intervention (the intervention) and (b) all other experiences before, during, and after the intervention itself (the context). Contextual effects play two critical roles in assessing the efficacy and effectiveness of CAM interventions. First, contextual effects may mediate how well a treatment works (context as mediator). Second, context effects may actually contribute to outcomes directly (context-as-intervention). In a classic RCT, investigators typically want to control for context-as-mediator effects and measure context-as-intervention effects to disentangle what portion of the results are due to the intervention and what are due to the context. In CER, investigators are less concerned about controlling for context-as-mediator effects, but they would like to understand what part of the encounter accounts for any positive results. In either case, investigators MUST know how to measure the context. Without such measures, it is impossible to assess either type of context effect. This proposal has 3 specific aims: 1. to understand what kinds of contextual factors patients are exposed to during CAM encounters? 2. To determine how to measure such contextual factors reliably via observation and/or patient and provider recall; and 3. To assess the degree to which contextual factors might vary within and across (a) CAM modalities (i.e., chiropractic versus osteopath); (b) practice sites, (c) providers, and (d) individual patient encounters This study will use the chiropractic encounter as an exemplar for CAM and develop a rapid ethnographic observation method to study the context of the encounter. The objective of this project is to develop a reliable, valid, and rigorous methodology for collecting data about the context. The proposed study addresses a fundamental issue of all outcome studies in health: how to measure the effect of the context on the health outcomes. PUBLIC HEALTH RELEVANCE: A fundamental issue in evaluating complementary and alternative medicine (CAM) interventions is how to measure the effect of the context of an encounter and its contribution to the outcomes. The aim of the proposed study is to develop a rapid ethnographic observation method, using the chiropractic encounter as an exemplar of CAM, to study the context of an encounter.