Consultation on Identity
Quantitative Research Findings
December 7, 2004
Table of Contents
Page
INTRODUCTION
3
Background & Objectives
4
Methodology
5
Definitions
6
Reporting Perspective
7
EXECUTIVE SUMMARY
8
DETAILED FINDINGS
13
APPENDIX – Respondent Profile
49
Page 2
INTRODUCTION
Background & Objectives
Within chiropractic, there has been continuing controversy concerning the identity of the profession,
widespread international growth of chiropractic education and practice, and more diversity of the practice
settings and services offered.
The World Federation of Chiropractic (WFC) has been asked by its Members’ national associations
worldwide, to carry out an international consultation on the most appropriate public
identity for the profession within health care.
The purpose of the study is to understand attitudes and perceptions towards the profession.
The survey will be used as a tool to help define the organization’s positioning strategy.
Page 4
Methodology
Online survey.
A list of Members’ email addresses was provided to Northstar
Members were sent an email notifying them of the survey one week in advance of the survey launch
(September 27th)
29,094 email invitations were sent out on October 4th inviting Members to participate in the survey
A reminder email was sent out on October 11th to Members who had not yet completed the survey
The survey closed on October 24th
3,689 completes were obtained.
Questionnaire was approximately 15 minutes in length.
Data has been weighted to reflect the true distribution of chiropractors in the participating countries.
Page 5
Definitions
For the purposes of this study, the following terms were defined for respondents as follows:
Primary Health Care: Focused Scope
Direct access; focused scope of practice; may have overall responsibility for patient and coordination of
care within scope of practice.
Example: dentist, optometrist.
Primary Health Care: Broad Scope
Direct access; broad scope of practice; overall responsibility for patient and coordination of care.
Example: Family MD/GP, internist.
Specialist Care:
Primary care and specialist training; focused scope of practice; practice on referral.
Example: orthopaedic surgeon, radiologist.
Mainstream:
Services which are part of the core health delivery system.
Complementary & Alternative:
Services accepted by many of the public but that are not part of the core health delivery system.
Page 6
Reporting Perspective
Data has been tested for statistical significance, which is indicated in the report as follows:
= Statistically higher / lower between groups
= Directionally higher / lower between groups
A sample of 3,689 is accurate within a statistical tolerance level of +/- 1.6 percentage points, 19 times out of
20.
Page 7
EXECUTIVE SUMMARY
Executive Summary
There is general consensus among chiropractors that it is important
for a profession to have a
clear public identity.
That said, most agree that the chiropractic profession
suffers from an unclear identity and
position within health care today.
When it comes to communicating with the general public to promote the use of chiropractic services, just over
one-half (54%) of chiropractors believe that the chiropractors’ view of the profession and the
general public’s view of the profession are equally as important to represent.
This underscores the importance of understanding how chiropractors
think the profession should
be viewed and how they think it is actually viewed.
Page 9
Executive Summary (cont’d)
should be
perceived by the general public and medical doctors and the way they think the profession is actually
perceived.
There is
significant discrepancy
in the way chiropractors believe the profession
While the vast majority of chiropractors believe the profession should be considered
health care
primary
with focused (55%) or broad (36%) scope, in actuality, most believe that both the
general public and medical doctors alike, have no
clear perception of the profession or perceive
the profession as offering specialist care.
Similarly, while most chiropractors (88%) believe the profession and its services
should be
perceived as mainstream (or core to the health delivery system), there is agreement that the
profession is not viewed this way by the public at large or by medical doctors, instead it is viewed as
being complementary and alternative.
Further, while the vast majority of chiropractors believe the practice of chiropractic should be perceived
as wellness care and / or non-drug, non-surgical health care, the general sense is that
management of back and neck
pain and to a slightly less extent, the management of spinal problems.
the profession is perceived by the general public as the
Page 10
Executive Summary (cont’d)
Most chiropractors (62%) strongly
agree with the policy statement opposing the use of
prescription drugs in the practice of chiropractic.
In fact, positioning the profession as non-drug, non-surgical heath care is viewed as being
integral to
how the profession should be perceived by the general public.
Page 11
Executive Summary (cont’d)
The lack of clarity surrounding the identity of the profession has also likely been fed by:
1
2
Limited public awareness regarding the education of chiropractors.
Recent newsworthy events that have called into question the ethics
& professional conduct
of some members of the profession.
There is agreement that this has impacted the level of public confidence in
chiropractic health care & that the issues of ethics, professional behaviour and trust is very
important for the profession’s positioning within the heath care system.
Issues of ethics, professional behaviour & trust (along with the ability to
get patients back to their daily routine, patient-centered care and
spinal care expertise) are viewed as being very important in shaping perceptions of
the profession.
safety of
chiropractic care is very important for building greater mutual respect and
cooperation between the two professions.
Furthermore, there is consensus that medical doctors’ perceptions about the
Page 12
DETAILED FINDINGS
Importance for a Profession to Have a Clear Public Identity
There is almost universal agreement that it is important for a profession to have a clear public identity.
“It is Important for a Profession to Have a Clear Public Identity”
(1 to 7 Scale from Strongly Disagree to Strongly Agree)
7
74%
Strongly Agree (6&7)
90%
1 to 2
4%
3 to 5
6%
6
16%
Mean Score: 6.5
Base: Total sample (n=3689)
Q1a. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below where 1 means strongly disagree and 7 means
strongly agree.
Page 14
Importance for a Profession to Have a Clear Public Identity
- Profiled
“It is Important for a Profession to Have a Clear Public Identity”
(1 to 7 Scale from Strongly Disagree to Strongly Agree)
Gender (%)
Rating
Age (%)
School Philosophy (%)
Total
(%) Men Women <35 35 – 59 60+
Group A
Group B
Country of Graduating Institution (%)
US Can. Europe
Aus./
NZ
Rest of
world
1 to 2
4
4
4
5
3
4
4
4
4
2
2
2
4
3 to 5
6
5
7
6
6
4
5
7
5
6
6
7
12
6 to 7
90
91
89
89
91
92
91
89
91
92
92
91
84
Mean score
6.5
6.5
6.4
6.4
6.5
6.5
6.5
6.4
6.5
6.5
6.6
6.5
6.4
Base: Total sample (n=3689)
Q1a. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below where 1 means strongly disagree and 7 means
strongly agree.
Page 15
Clarity of the Profession’s Identity
However, most chiropractors in our sample don’t believe the chiropractic profession has a clear public identity
today.
“The Chiropractic Profession Has a Clear Public Identity”
(1 to 7 Scale from Strongly Disagree to Strongly Agree)
1 to 2
40%
7
2%
6
2%
Strongly Disagree (1&2)
40%
Strongly Agree (6&7)
4%
3 to 5
56%
Mean Score: 3.0
Base: Total sample (n=3689)
Q1b. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means
strongly agree.
Page 16
Clarity of the Profession’s Identity
- Profiled
“The Chiropractic Profession Has a Clear Public Identity”
(1 to 7 Scale from Strongly Disagree to Strongly Agree)
Country of Current Practice (%)
Years in Practice (%)
Importance of a Clear Identity (%)
More
Reg. Unreg. Aus./ Rest of 5 or
than
Can. Eur. Eur.
NZ world less 6 – 10 11 - 20 20
Very
Somewhat
Important Important
(6 or 7)
(3 to 5)
Not
Important
(1 or 2)
Total
(%)
US
1 to 2
40
41
44
25
49
31
34
42
44
38
37
42
30
18
3 to 5
56
55
53
69
49
63
59
55
53
59
57
55
68
59
6 to 7
4
4
3
6
2
6
7
3
3
3
6
3
2
23
3.0
3.0
2.9
3.5
2.8
3.3
3.2
2.9
2.9
3.0
3.1
2.9
3.1
4.1
Rating
Mean score
Base: Total sample (n=3689)
Q1b. To begin, please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means
strongly agree.
Page 17
Area of Central Importance in Practice & Public Identity
While the nervous system is viewed as being fundamental to the practice of chiropractic (more so than the
spine), it is viewed as being less important when it comes to framing the profession’s identity.
% Rating Level of Agreement a 6 – 7
(on a 1-7 scale from Strongly Disagree to Strongly Agree)
The nervous system is of central importance
to the practice of chiropractic
The spine is of central importance to the
practice of chiropractic
The spine is of central importance to the
public identity of chiropractic
The nervous system is of central importance
to the public identity of chiropractic
85%
72%
66%
60%
Base: Total sample (n=3689)
Q9. Please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means strongly agree.
Page 18
Area of Central Importance in Practice & Public Identity
- Profiled
% Rating Level of Agreement a 6 – 7
(on a 1-7 scale from Strongly Disagree to Strongly Agree)
Gender (%)
Age (%)
School Philosophy (%)
Total
(%) Men Women <35 35 – 59 60+ Group A Group B
The nervous system is of central
importance to the practice of
chiropractic
85
84
88
87
85
87
91
77
The spine is of central importance
to the practice of chiropractic
72
73
69
69
73
83
78
67
The spine is of central importance
to the public identity of chiropractic
66
66
66
64
67
73
69
63
The nervous system is of central
importance to the public identity of
chiropractic
60
60
61
64
60
55
67
54
Base: Total sample (n=3689)
Q9. Please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means strongly agree.
Page 19
Area of Central Importance in Practice & Public Identity
- Profiled
% Rating Level of Agreement a 6 – 7
(on a 1-7 scale from Strongly Disagree to Strongly Agree)
Total
(%)
Country of Current Practice (%)
Years in Active Practice (%)
US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world 5 or less 6 – 10 11 - 20 >20
The nervous system is of central
importance to the practice of
chiropractic
85
86
80
85
89
87
88
86
89
84
84
The spine is of central importance
to the practice of chiropractic
72
72
73
73
77
75
84
67
74
72
77
The spine is of central importance
to the public identity of chiropractic
66
66
69
67
73
70
78
63
65
65
72
The nervous system is of central
importance to the public identity of
chiropractic
60
61
56
47
66
60
64
62
63
58
59
Base: Total sample (n=3689)
Q9. Please indicate the extent to which you agree or disagree with the following statements. Please use the 7-point scale below, where 1 means strongly disagree and 7 means strongly agree.
Page 20
Preferred Emphasis When Promoting Use of Services to
the General Public
Most feel that when it comes to promoting the use of chiropractic services to the general public, both the
chiropractic’s and the general public’s views, are equally as important to emphasize. This highlights the
importance of understanding how doctors of chiropractic would like the profession perceived by the public as
well as how they think it is being perceived today.
General public's view
of the profession
25%
Chiropractics' view of
the profession
21%
Both views are
equally as important
54%
Total
(%)
Gender (%)
Men
School Philosophy (%)
Women Group A
Group B
Country of Current Practice (%)
US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world
Both views are equally important
54
53
60
53
54
54
54
64
65
61
63
General public’s view of the profession
25
26
21
24
28
25
29
19
16
17
14
Chiropractic’s view of the profession
21
21
19
23
18
21
17
17
19
22
23
Base: Total sample (n=3689)
Q8. When communicating with the general public to promote the use of chiropractic services, which view do you think should receive more emphasis…?
Page 21
There is considerable
profession should
discrepancy between how chiropractors feel the
be perceived by the general public and how they think it is
actually being perceived.
Perceptions of How the General Public Perceives the
Chiropractic Profession
Most chiropractors (91%) think the profession should be perceived by the general public as a form of primary
health care with a focused (55%) or broad (36%) scope. However, only four-in-ten (44%) believe this is how
the profession is actually perceived by the general public.
The Chiropractor’s Perspective
How the Profession Should Be Perceived by the Public
Specialist care
9%
Primary health care:
broad scope
36%
Primary health care:
focused scope
55%
How the Profession is Currently Perceived by the Public
Primary health care:
focused scope
41%
Primary health care:
broad scope
3%
Specialist care
30%
No clear perception of
the profession
26%
Base: Total sample (n=3689)
Q2. Using the definitions provided below, do you think the chiropractic profession is currently perceived by the general public in your country as offering primary health care: focused scope,
primary health care: broad scope, or specialist care?
Q3. Again, using the definitions provided, do you think the chiropractic profession should be perceived by the general public in your country as offering primary health care: focused scope,
primary health care: broad scope, or specialist care?
Page 23
Perceptions of How the Public Perceives the Chiropractic
Profession - Profiled
The Chiropractor’s Perspective
How the Profession Should Be Perceived by the Public
Gender (%)
Total Men Women
School Philosophy (%)
Group A
Group B
Country of Current Practice (%)
US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world
Primary heath care: focused scope
55
55
53
58
48
53
59
68
57
56
62
Primary health care: broad scope
36
35
39
33
42
38
33
23
27
36
23
Specialist care
9
10
8
9
10
9
8
9
16
8
15
How the Profession is Currently Perceived by the Public
Gender (%)
Age (%)
School Philosophy (%)
Total Men Women <35 35 – 59 60+ Group A
Group B
Country of Current Practice (%)
US Can.
Reg.
Eur.
Unreg.
Eur.
Aus./
NZ
Rest of
world
Primary heath care: focused scope
41
42
37
44
40
45
42
34
39
59
47
25
68
20
Specialist care
30
30
32
30
31
21
29
37
34
11
21
19
6
18
No clear perception
26
25
28
23
26
30
26
26
24
27
27
53
19
53
Primary health care: broad scope
3
3
3
3
3
4
3
3
3
3
5
3
7
9
Base: Total sample (n=3689)
Q2. Using the definitions provided below, do you think the chiropractic profession is currently perceived by the general public in your country as offering primary health care: focused scope,
primary health care: broad scope, or specialist care?
Q3. Again, using the definitions provided, do you think the chiropractic profession should be perceived by the general public in your country as offering primary health care: focused scope,
Page 24
primary health care: broad scope, or specialist care?
Perceptions of How the General Public Perceives the
Chiropractic Profession
While the vast majority feel that the chiropractic profession and its services should be perceived by the
general public as mainstream, a near equal proportion feel that in actuality, it is being perceived as a form of
complementary & alternative health care.
The Chiropractor’s Perspective
How the Profession & Its Services Should Be
Perceived by the Public
Complementary &
Alternative
12%
Mainstream
88%
How the Profession & Services are Currently
Perceived by the Public
Mainstream
11%
Complementary &
Alternative
89%
Base: Total sample (n=3689)
Q4. Using the definitions appearing below, do you think the chiropractic profession and its services are currently perceived by the general public in your country as mainstream or
complementary and alternative?
Q5. Again, using the definitions provided, do you think the chiropractic profession and its services should be perceived by the general public in your country as mainstream or complementary
and alternative?
Page 25
Perceptions of How the Public Perceives the Chiropractic
Profession - Profiled
The Chiropractor’s Perspective
How the Profession & Its Services Should Be Perceived by the Public
Gender (%)
Age (%)
Country of Current Practice (%)
Total
(%) Men Women <35 35 – 59 60+ US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world
Mainstream
88
87
90
90
87
80
89
88
88
76
82
76
Complementary & Alternative
12
13
10
10
13
20
11
12
12
24
18
24
How the Profession & Services are Currently Perceived by the Public
Gender (%)
Age (%)
Country of Current Practice (%)
Reg.
Total Men Women <35 35 – 59 60+ US Can. Eur.
Years in Active Practice (%)
Unreg. Aus. Rest of
Eur.
/NZ world
5 or
less
6–
10
11 20
>20
Complementary & Alternative
89
87
96
91
88
86
89
91
82
96
91
92
92
92
88
85
Mainstream
11
13
4
9
12
14
11
9
18
4
9
8
8
8
12
15
Base: Total sample (n=3689)
Q4. Using the definitions appearing below, do you think the chiropractic profession and its services are currently perceived by the general public in your country as mainstream or
complementary and alternative?
Q5. Again, using the definitions provided, do you think the chiropractic profession and its services should be perceived by the general public in your country as mainstream or complementary
and alternative?
Page 26
Agreement with Policy Opposing Use of Prescription Drugs
The majority (62%), strongly support the policy opposing the use of prescription drugs in the practice of
chiropractic.
Agreement with Policy Opposing Use of Prescription Drugs
Strongly agree
Somewhat agree
62%
Somewhat disagree
Strongly disagree
79%
Total
79%
Gender
Men
Women
77%
Country of Current Practice
US
Canada
Regulated Europe
Unregulated Europe
Australia / New Zealand
Rest of world
87%
78%
81%
72%
90%
81%
85%
17%
School Philosophy
Group A
Group B
12%
Years in Practice
5 or less
82%
6 – 10
11 – 20
> 20
83%
79%
74%
9%
86%
70%
Base: Total sample (n=3689)
Q17. Since 1999, the World Federation of Chiropractic has had a policy statement opposing any use of prescription drugs in the practice of chiropractic. In that policy the WFC resolves that “for
reasons of chiropractic principle, patient welfare and interdisciplinary cooperation, the practice of chiropractic does not include the use of prescription drugs”. To what extent do you agree with
this policy? Do you …
Page 27
In fact, the non-drug,
non-surgical mandate of chiropractic is
viewed as being ‘cornerstone’ to the profession’s identity.
However…
While most would
like chiropractic to be perceived as wellness care and
/ or non-drug, non-surgical health care,
many believe chiropractic health care is more commonly perceived by the
general public as the management of neck & back pain and
to a lesser extent, the management of spinal problems.
Perceptions of How the General Public Perceives the
Chiropractic Profession
% Saying 6 – 7 (on a 1-7 scale from Does Not Describe at All to Describes Perfectly)
How Chiropractic Profession…
Should Be Perceived by the General Public is Currently Perceived by the General Public
Wellness care
83%
Non-drug / non-surgical health care
82%
Management of spinal problems & their impact
on general health
Management of neuromusculoskeletal
conditions & their impact on general health
Primary health care
Management of vertebral subluxation & its
impact on general health
75%
37
58
17%
72%
59
13%
67%
65
2%
65%
60%
Management of neuromusculoskeletal
conditions
60%
Management of spinal problems
60%
Management of back & neck pain
77
45%
Management of back & neck pain & their
impact on general health
Management of vertebral subluxation
Gap
6%
60
5%
30
30%
22
38%
-
60%
56%
47%
9%
47
81%
-34
Base: Total sample (n=3689)
Q6. Please indicate how well each of the following statements describes how chiropractic health care is currently perceived by the general public in your country. Please use the 7-point scale below, where 1
means does not describe public perception at all and 7 means describes it perfectly.
Q7. Please indicate how well each of the following statements describes how you would like chiropractic health care to be perceived by the general public in your country. Again, please use the 7-point scale
Page 30
below, where 1 means does not describe what I would like at all and 7 means describes what I would like perfectly.
Perceptions of How the Public Perceives the Chiropractic
Profession - Profiled
% Saying 6 – 7 (on a 1-7 scale from Does Not Describe at All to Describes Perfectly)
Gender (%)
How chiropractic profession
SHOULD BE perceived…
Age (%)
School Philosophy (%)
Total
(%) Men Women <35 35 – 59 60+
Group A
Country of Current Practice (%)
Reg. Unreg. Aus./
Group B US Can. Eur. Eur.
NZ
Rest of
world
Wellness care
83
81
88
84
82
80
87
80
85
76
59
80
69
75
Non-drug / non-surgical health care
82
80
89
86
81
80
84
80
83
79
74
91
78
81
Management of spinal problems & their
impact on general health
75
74
78
73
75
83
74
75
75
73
73
78
75
88
Management of neuromusculoskeletal
conditions & their impact on general health
72
71
77
68
74
78
67
78
72
76
76
71
71
85
Primary health care
67
65
76
67
67
70
68
63
66
76
67
78
73
64
Management of vertebral subluxation & its
impact on general health
65
64
70
68
63
74
76
52
66
55
51
74
69
67
Management of back & neck pain & their
impact on general health
60
59
62
55
61
71
56
64
59
61
66
65
57
78
Management of neuromusculoskeletal
conditions
60
60
59
58
60
70
54
68
59
64
69
54
57
66
Management of spinal problems
60
60
56
58
59
70
57
64
59
60
63
59
57
66
Management of vertebral subluxation
56
55
58
60
54
67
67
46
57
47
40
62
57
55
Management of back & neck pain
47
48
45
44
48
66
42
54
47
48
59
48
45
56
Base: Total sample (n=3689)
Q7. Please indicate how well each of the following statements describes how you would like chiropractic health care to be perceived by the general public in your country. Again, please use
Page 31
the 7-point scale below, where 1 means does not describe what I would like at all and 7 means describes what I would like perfectly.
General Public’s Perceptions of Chiropractic Health Care
- Profiled
% Saying 6 – 7 (on a 1-7 scale from Does Not Describe at All to Describes Perfectly)
How chiropractic profession
IS CURRENTLY perceived…
Gender (%)
Age (%)
School Philosophy (%)
Total
(%) Men Women <35 35 – 59 60+ Group A
Group B
Country of Current Practice (%)
Reg. Unreg. Aus./ Rest of
US Can. Eur. Eur.
NZ
world
Management of back & neck pain
81
81
84
86
81
67
80
84
82
80
85
66
84
61
Management of spinal problems
60
59
64
60
61
53
55
65
60
56
71
57
71
48
Non-drug / non-surgical health care
45
43
49
47
44
45
44
44
45
44
46
53
44
38
Management
conditions
38
37
42
37
39
37
38
41
40
29
35
35
29
34
Management of back & neck pain & their
impact on general health
30
30
27
38
27
26
28
33
31
26
25
16
27
22
Management of spinal problems & their
impact on general health
17
18
16
19
17
22
14
23
18
13
17
11
17
12
Management of neuromusculoskeletal
conditions & their impact on general health
13
13
14
15
12
22
12
16
14
9
10
12
8
9
Management of vertebral subluxation
9
8
14
8
10
17
9
11
10
7
9
11
6
13
Wellness care
6
6
6
6
6
7
6
7
6
5
3
6
2
4
Management of vertebral subluxation & its
impact on general health
5
5
6
4
5
9
5
7
6
3
3
6
2
5
Primary health care
2
3
1
1
2
6
3
1
2
3
6
5
6
3
of
neuromusculoskeletal
Base: Total sample (n=3689)
Q6. Please indicate how well each of the following statements describes how chiropractic health care is currently perceived by the general public in your country. Please use the 7-point scale
below, where 1 means does not describe public perception at all and 7 means describes it perfectly.
Page 32
From the chiropractor’s perspective, the ability
to get a patient back to
their regular routine and the fact that chiropractic health care delivers
patient-centered care and spinal care expertise are key in helping
shape the general public’s perceptions of the profession.
Additionally, issues of ethics, behaviour & trust play an important role in
influencing public opinion.
Influencing Factors on Public Perceptions
% Saying 6 – 7
(on a 1-7 scale from Not at all Important to Very Important)
Ability to get the patient back to work / daily activities
84%
Patient-centered care
84%
Spinal care expertise
77%
Issues of ethics, professional behaviour & trust
77%
Hands-on care
76%
Quick recovery from pain & disability
75%
Ability to manage pain
72%
Ability to manage back pain
71%
Ability to diagnose the cause of symptoms
68%
Level of education / training
68%
65%
A practice model that does not involve drugs or surgery
Attitudes of the media
62%
Preventative care
59%
The profession's different model of health
59%
Attitudes of government & health authorities
58%
Third party funding for care
55%
Attitudes of other health care professionals
54%
Base: Total sample (n=3689)
Q11. In your opinion, how important are each of the following in shaping the general public’s perception of the chiropractic profession? Please use the 7-point scale below, where 1 means not at
Page 34
all important and 7 means very important.
Influencing Factors on Public Perceptions
- Profiled
% Saying 6 – 7 (on a 1-7 scale from Not at all Important to Very Important)
Gender (%)
Total
(%)
Age (%)
School
Philosophy (%)
Group
Men Women <35 35 – 59 60+
A
Country of Current Practice (%)
Group
Reg. Unreg. Aus./ Rest of
B
US Can. Eur. Eur.
NZ world
Ability to get patient back to work / daily activities
84
83
88
80
85
91
82
85
84
86
89
84
79
92
Patient-centered care
84
84
87
85
84
88
83
85
85
84
83
77
82
77
Spinal care expertise
77
77
77
74
78
81
77
75
76
79
83
82
82
86
Issues of ethics, professional behaviour & trust
77
77
78
75
77
87
76
80
78
74
71
71
76
79
Hands-on care
76
75
77
75
76
82
77
75
76
73
78
79
77
78
Quick recovery from pain & disability
75
74
78
68
78
85
72
78
75
77
78
76
71
84
Ability to manage pain
72
71
75
65
74
83
66
76
71
72
76
68
70
82
Ability to manage back pain
71
70
72
63
73
85
65
75
69
72
82
75
72
89
Ability to diagnose the cause of symptoms
68
67
72
64
69
84
62
73
67
73
76
70
69
81
Level of education / training
68
68
71
69
67
78
66
71
67
71
72
73
73
79
Practice model that does not involve drugs /
surgery
65
64
69
67
63
68
68
62
66
61
55
66
58
68
Attitudes of the media
62
62
62
64
61
64
62
65
63
67
51
59
53
63
Preventative care
59
58
62
64
56
64
62
57
60
53
49
59
54
65
The profession's different model of health
59
59
61
63
57
61
65
54
61
52
42
61
52
61
Attitudes of government & health authorities
58
58
57
59
57
63
57
61
59
60
48
53
46
69
Third party funding for care
55
55
52
48
57
64
53
63
59
52
23
29
28
32
Attitudes of other health care professionals
54
54
55
60
52
50
51
58
54
57
51
49
48
61
Base: Total sample (n=3689)
Q11. In your opinion, how important are each of the following in shaping the general public’s perception of the chiropractic profession? Please use the 7-point scale below, where 1 means not at
Page 35
all important and 7 means very important.
Influencing Factors on Public Perceptions
- Profiled
% Saying 6 – 7
(on a 1-7 scale from Not at all Important to Very Important)
Desired Perception of Profession (%) Desired Perception of Profession & Services (%)
Total
(%) Focused scope Broad scope Specialist Mainstream
Complementary & Alternative
Ability to get the patient back to work/ daily activities
84
82
86
89
86
73
Patient-centered care
84
84
86
81
85
81
Spinal care expertise
77
78
74
85
78
68
Issues of ethics, professional behaviour & trust
77
77
76
81
78
71
Hands-on care
76
75
77
77
76
76
Quick recovery from pain & disability
75
73
77
81
77
63
Ability to manage pain
72
69
74
78
74
56
Ability to manage back pain
71
70
69
82
73
57
Ability to diagnose the cause of symptoms
68
64
73
75
70
52
Level of education / training
68
66
71
73
70
58
A practice model that does not involve drugs or surgery
65
65
65
62
64
68
Attitudes of the media
62
62
62
63
64
50
Preventative care
59
55
65
53
59
57
The profession's different model of health
59
58
63
56
59
61
Attitudes of government & health authorities
58
57
59
62
60
43
Third party funding for care
55
53
56
59
57
37
Attitudes of other health care professionals
54
52
55
59
56
38
Base: Total sample (n=3689)
Q11. In your opinion, how important are each of the following in shaping the general public’s perception of the chiropractic profession? Please use the 7-point scale below, where 1 means not at
Page 36
all important and 7 means very important.
Professional Conduct & Standards
In fact, there is consensus among chiropractors that public confidence has been impacted by newsworthy
events that have called into question the conduct of some members of the profession.
Most also believe that the public at large is not aware of the level of education of chiropractors.
% Saying Strongly or Somewhat Agree
Concerns with respect to the ethics and
professional conduct of some members of the
profession have a significant impact on the
level of public confidence in chiropractic
health care
Higher among…
48%
The general public has confidence in the 7%
quality of care provided by chiropractors
The general public is aware of the level of
1% 19%
education of chiropractors
Strongly agree
38%
58%
86%
65%
•Those practicing in regulated Europe –
84%; 60+ years – 72%
•Those practicing in a school outside of the
US – 28%; Those who have been practicing
for 11+ years – 24%; 35+ years – 22%
20%
Somewhat agree
Base: Total sample (n=3689)
Q12. Please indicate whether you strongly agree, somewhat agree, somewhat disagree or strongly disagree with the following statements:
Page 37
Factor Influence When Seeking Chiropractic Care
From a chiropractor’s perspective, reputation for effectiveness, manual procedures and specialized
knowledge and education are most important to patients seeking chiropractic health care.
% Saying 6 – 7
(on a 1-7 scale from Not at all Important to Very Important)
Reputation for effectiveness
87%
Manual procedures (adjusting, mobilization, manipulation, soft tissue, etc.)
74%
Specialized knowledge & education
67%
Non-drug / non-surgical approach
62%
Availability of third party funding
58%
Diagnostic ability
55%
Exercise/ rehabilitation
Lifestyle counseling / advice
Nutritional support / advice
38%
36%
27%
Base: Total sample (n=3689)
Q10. Patients seek chiropractic care for different reasons. In your opinion, how important are each of the following attributes of chiropractic health care to patients? Please use the 7-point
scale below, where this time, 1 means not at all important and 7 means very important.
Page 38
Factor Influence When Seeking Chiropractic Care
- Profiled
% Saying 6 – 7
(on a 1-7 scale from Not at all Important to Very Important)
Gender (%)
Age (%)
School Philosophy (%)
Total
(%) Men Women <35 35 – 59 60+ Group A
Group B
Country of Current Practice (%)
Reg.
US Can. Eur.
Unreg. Aus./
Eur.
NZ
Rest of
world
Reputation for effectiveness
87
87
87
86
88
90
88
86
87
89
89
85
89
88
Manual procedures (adjusting,
mobilization, manipulation, soft
tissue, etc.)
74
74
77
75
74
74
73
76
74
76
79
76
73
87
Specialized knowledge & education
67
68
64
62
69
74
66
68
65
73
75
75
73
73
Non-drug / non-surgical approach
62
61
68
63
62
64
63
64
63
59
55
72
55
59
Availability of third party funding
58
59
56
54
60
64
58
64
63
55
22
27
30
31
Diagnostic ability
55
54
58
51
55
68
49
59
53
62
69
63
61
66
Exercise / rehabilitation
38
38
40
39
38
45
33
47
38
41
40
30
34
49
Lifestyle counseling / advice
36
35
39
33
37
43
35
41
36
33
32
46
22
54
Nutritional support / advice
27
27
31
25
27
41
24
36
29
22
14
20
14
29
Base: Total sample (n=3689)
Q10. Patients seek chiropractic care for different reasons. In your opinion, how important are each of the following attributes of chiropractic health care to patients? Please use the 7-point
scale below, where this time, 1 means not at all important and 7 means very important.
Page 39
Factor Influence When Seeking Chiropractic Care
- Profiled
% Saying 6 – 7
(on a 1-7 scale from Not at all Important to Very Important)
Desired Perception of Profession (%)
Perception of Profession & Services (%)
Total
(%)
Focused
scope
Reputation for effectiveness
87
90
90
86
84
89
87
Manual procedures (adjusting,
mobilization, manipulation, soft
tissue, etc.)
74
78
86
72
70
79
74
Specialized knowledge & education
67
67
72
68
64
74
66
Non-drug / non-surgical approach
62
63
68
61
62
64
62
Availability of third party funding
58
58
56
61
56
61
58
Diagnostic ability
55
55
62
57
51
59
54
Exercise / rehabilitation
38
38
49
41
35
42
38
Lifestyle counseling / advice
36
34
58
36
36
42
35
Nutritional support / advice
27
24
49
30
26
30
27
Broad scope Specialist No clear perception Mainstream Complementary & Alternative
Base: Total sample (n=3689)
Q10. Patients seek chiropractic care for different reasons. In your opinion, how important are each of the following attributes of chiropractic health care to patients? Please use the 7-point
scale below, where this time 1 means not at all important and 7 means very important.
Page 40
Up until now, we have focused on perceived perceptions of the general public. We will
now turn our attention to how chiropractors believe the profession
by medical doctors.
is perceived
Perceptions of How Chiropractic is Perceived by Medical
Doctors
It appears that chiropractors believe the fuzziness surrounding the identity of their profession is even greater
among medical doctors than the public at large, with one-half of chiropractors believing medical doctors have
no clear perception of the profession.
Primary health care:
focused scope
20%
For comparison:
No clear perception of
the profession
49%
Chiropractors believe 26% of
the general public does not
have a clear perception of
the profession.
Age (%)
Specialist care
31%
School Philosophy (%)
Total
(%) <35 35 – 59 60+
Country of Current Practice (%)
Group A
Group B
US
Can.
Reg. Unreg Aus./
Eur. . Eur. NZ
Years in Active Practice (%)
Rest of
world
5 or
less
6 – 10
11 - 20 >20
No clear perception
49
46
49
64
49
45
46
58
48
77
56
72
47
49
46
54
Specialist care
31
33
32
20
31
41
36
10
19
13
5
15
32
34
35
26
Primary heath care:
focused scope
20
21
19
16
19
14
18
31
32
10
39
12
21
18
19
20
Primary heath care:
broad scope
*
*
*
-
*
*
*
1%
1%
-
*
1%
*
-
*
*
* Less than 0.5%
Base: Total sample (n=3689)
Q14. Using the definitions provided below, do you think the chiropractic profession is currently perceived by medical doctors as offering primary health care: focused scope, primary health care:
Page 42
broad scope, or specialist care?
Perceptions of How Chiropractic is Perceived by Medical
Doctors
Consistent with how chiropractors think the general public perceives the profession, most chiropractors
believe medical doctors perceive chiropractic care as complementary & alternative rather than mainstream.
Mainstream
2%
Complementary &
alternative
98%
Base: Total sample (n=3689)
Q15. Again, using the definitions provided below, do you think the chiropractic profession and its services are currently perceived by medical doctors as mainstream or complementary and
alternative?
Page 43
Perceptions of How Chiropractic is Perceived by Medical
Doctors
The general perspective among chiropractors is that medical doctors perceive chiropractic care as the
management of back and neck pain first and foremost. There is also a perception that some medical doctors
(55%) see chiropractic as a competitor within the health care system.
% Saying 6 – 7
(on a 1-7 scale from Does Not Describe Their Perception at All to Describes It Perfectly)
67%
The management of back & neck pain
55%
A competitor within health care delivery
47%
Non-drug / non-surgical health care
42%
The management of spinal problems
32%
The management of neuromusculoskeletal conditions
14%
The management of back & neck pain & their impact on general health
The management of neuromusculoskeletal conditions & their impact on general health
7%
The management of spinal problems & their impact on general health
7%
The management of vertebral subluxation
7%
Wellness care
3%
The management of vertebral subluxation & its impact on general health
3%
Primary health care 1%
Base: Total sample (n=3689)
Q13. Please indicate how well each of the following statements describes how you believe chiropractic health care is currently perceived by medical doctors. Please use the 7-point scale below,
where 1 means does not describe their perception at all and 7 means describes it perfectly.
Page 44
Perceptions of How Chiropractic is Perceived by MDs
- Profiled
% Saying 6 – 7
(on a 1-7 scale from Does Not Describe Their Perception at All to Describes It Perfectly)
Age (%)
Country of Current Practice (%)
Total
(%) <35 35 – 59 60+
US Can.
Reg.
Eur.
Unreg Aus./ Rest of
. Eur. NZ world
The management of back & neck pain
67
72
66
42
67
66
78
69
68
47
A competitor within health care delivery
55
53
56
49
57
50
32
53
55
39
Non-drug / non-surgical health care
47
50
47
36
48
46
44
55
37
43
The management of spinal problems
42
44
42
30
40
41
57
54
49
42
The management of neuromusculoskeletal conditions
32
33
32
23
33
22
31
35
25
27
The management of back & neck pain & their impact
on general health
14
21
12
6
14
14
19
16
12
9
The management of neuromusculoskeletal conditions
& their impact on general health
7
10
7
4
8
5
7
7
3
5
The management of spinal problems & their impact on
general health
7
10
6
3
7
5
12
9
8
5
The management of vertebral subluxation
7
7
7
6
7
5
11
10
3
7
Wellness care
3
3
3
3
3
2
3
3
1
6
The management of vertebral subluxation & its impact
on general health
3
3
3
3
3
3
3
2
1
5
Primary health care
1
1
1
1
1
3
5
2
5
2
Base: Total sample (n=3689)
Q13. Please indicate how well each of the following statements describes how you believe chiropractic health care is currently perceived by medical doctors. Please use the 7-point scale below,
Page 45
where 1 means does not describe their perception at all and 7 means describes it perfectly.
In recent years there has been a call for greater mutual cooperation and respect between
chiropractic and medical doctors in the interest of patients.
Earlier we discussed the importance of ethics, professional conduct & trust in shaping the
identity of the profession. Medical doctors’ perceptions surrounding the safety of
chiropractic care and the standards
for education & practice are also key
in building stronger inter-professional relations.
Importance for Building Inter-Professional Relations
% Saying 6 – 7
(on a 1-7 scale from Not at all Important to Very Important)
Medical doctors' perceptions about the safety of chiropractic health care
89%
Medical doctors' perceptions about the effectiveness of chiropractic health care
86%
Medical doctors' knowledge & understanding of the standards for chiropractic
education & practice
85%
83%
Attitudes & behaviours of chiropractors
79%
Attitudes & behaviours of medical doctors
Chiropractors' perceptions about the safety of medical health care
64%
Chiropractors' perceptions about the effectiveness of medical health care
60%
Influence, attitudes & behaviours of third party payers
60%
Financial barriers to referring patients for chiropractic health care
60%
Chiropractors' knowledge & understanding of the standards for medical
education and practice
56%
Base: Total sample (n=3689)
Q16. ….In your opinion, how important are each of the following with respect to inter-professional relations? Please use the 7-point scale below, where 1 means not at all important and 7 means
Page 47
very important.
Importance for Building Inter-Professional Relations
% Saying 6 – 7 (on a 1-7 scale from Not at all Important to Very Important)
Gender (%)
School Philosophy
Country of Current Practice (%)
Total
Ca
(%) Men Women Group A Group B US n.
Years in Practice (%)
Reg. Unreg. Aus./ Rest of 5 or 6 – 11 Eur.
Eur.
NZ
world less 10 20 >20
Medical doctors' perceptions about the safety of
chiropractic health care
89
88
95
88
91
89 93
88
88
93
86
90
89
90
88
Medical doctors' perceptions about the
effectiveness of chiropractic health care
86
84
91
85
88
86 86
84
84
86
83
88
86
87
83
Medical doctors' knowledge & understanding of
the standards for chiropractic education &
practice
85
83
92
83
87
84 84
87
84
88
88
87
82
85
84
Attitudes & behaviours of chiropractors
83
82
87
82
83
83 83
88
83
82
94
85
83
83
82
Attitudes & behaviours of medical doctors
79
77
84
77
79
78 81
84
77
77
78
82
78
80
74
Chiropractors' perceptions about the safety of
medical health care
64
63
66
63
66
65 59
60
58
63
60
66
64
64
62
Chiropractors' perceptions about the
effectiveness of medical health care
60
59
65
59
62
60 57
58
56
58
67
64
59
59
58
Influence, attitudes and behaviours of third party
payers
60
60
60
59
65
62 55
41
38
49
56
56
58
60
64
Financial barriers to referring patients for
chiropractic health care
60
61
58
59
62
62 61
52
45
48
50
58
59
60
64
Chiropractors' knowledge and understanding of
the standards for medical education and practice
56
54
62
54
60
56 46
60
53
52
72
60
55
56
51
Base: Total sample (n=3689)
Q16. Independent studies in various countries have called for greater mutual cooperation and respect between chiropractic and medical doctors in the interest of patients. In your opinion, how
important are each of the following with respect to inter-professional relations? Please use the 7-point scale below where 1 means not at all important and 7 means very important.
Page 48
APPENDIX: Respondent Profile
Respondent Profile
Total
(%)
Gender
Age
Country of Graduating Institution
Years Since Graduation
Base: Total sample (n=3689)
Male
79
Female
21
Under 35
27
35 – 59
68
60+
5
Average
40
US
86
Canada
6
Europe
3
Australia / New Zealand
3
Rest of the world
2
5 or less
26
6 – 10
18
11 – 20
28
More than 20
28
Average
13
Page 50
Respondent Profile (cont’d)
Total
(%)
Country of Current Practice
Years in Active Practice
Current Role in Chiropractic
Base: Total sample (n=3689)
US
82
Canada
7
Europe
6
Australia / New Zealand
3
Rest of the world
2
5 or less
29
6 – 10
17
11 – 20
28
More than 20
26
Average
13
Clinical practice
91
Administration / Education / Research
6
Retired
1
Other
2
Page 51
Respondent Profile (cont’d)
Country of Current Practice
Country of Graduating Institution
% saying…
US
Canada
Europe
Australia / New Zealand
Rest of the world
US
94
4
2
1
22
Canada
2
89
1
1
1
Regulated Europe
1
2
65
7
42
Unregulated Europe
1
1
24
4
5
Australia / New Zealand
1
3
2
83
9
Rest of the world
1
1
6
4
21
Base: Total sample (n=3689)
Q20. Which institution did you graduate from?
Q23. What country do you currently practice in?
Page 52