Survey of Health Care Use and Practice

Dear Participant,

We are conducting a survey of attitudes, awareness, and self-perceived skills in complementary and alternative medicine (CAM) use. Your input will be used to construct future CAM educational programs for students, residents, faculty and allied health professionals. Your responses will be anonymous and confidential and never associated with any information that could identify you personally. Only aggregated data from this survey will be reported. As there are no right or wrong answers to any item, please respond to each item according to how you feel about CAM at this point in time. Participation in this study is voluntary. You may decide not to complete this survey at any time without penalty.

Thank you.

* * * * * Completion of this survey indicates your consent to participate. * * * * *

Use of Non-conventional Therapies: For each of the following 15 CAM modalities, please indicate (a) if you have ever used or currently use this modality; (b) would you recommend the use of this modality, and (c) have you ever recommended or would you consider recommending the use of this modality to patients? If your answer is YES, check the box--an unchecked box indicates an answer of NO. Please check all that apply.

Modality / Have you ever used it or are currently using it? / Would you recommend using it? / Have you ever recommended it to patients or would you consider recommending it?
Biofeedback /  /  / 
Hypnosis /  /  / 
Meditation/Yoga/Relaxation/Imagery /  /  / 
T'ai Chi/Qi Gong /  /  / 
Traditional Oriental (including Acupuncture/ Acupressure) /  /  / 
Ayurveda /  /  / 
Curanderismo /  /  / 
Chiropractic /  /  / 
Massage /  /  / 
Osteopathy /  /  / 
Therapeutic Touch/Reiki /  /  / 
Spirituality/Prayer /  /  / 
Herbal/Botanical/Supplements /  /  / 
Homeopathy /  /  / 

Use of CAM Resources. For each of the following, please check all that apply.

Online CAM Resource / Have you heard of it? / If you have used it, do you find it useful?
PubMed /  / 
Cochrane Library /  / 
German Commission E Monographs: Therapeutic Guide to Herbal Medicine /  / 
Combined Health Information Database /  / 
NCCAM Website /  / 

Where do you obtain information and resources for evidence-based/educational materials on CAM? (Check all that apply.)

 Books  Internet  Journals  Videos  Health Databases

 Other (please specify) ______

Beliefs and Opinions about CAM: Please read and respond to the following statements according to your beliefs, using the numbers 1-7 where 1 is absolutely disagree and 7 is absolutely agree.

(29 items from the IMAQ[16] inserted here)

30.The physical and mental health are maintained by an underlying energy or vital force.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

31. Health and disease are a reflection of balance between positive life-enhancing forces and negative destructive forces.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

32. The body is essentially self-healing and the task of a health care provider is to assist in the healing process.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

33. A patient's symptoms should be regarded as a manifestation of a general imbalance or dysfunction affecting the whole body.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

34. A patient's expectations, health beliefs and values should be integrated into the patient care process.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

35. Complementary therapies are a threat to public health.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

36. Treatments not tested in a scientifically recognized manner should be discouraged.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

37. Effects of complementary therapies are usually the result of a placebo effect.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

38. Complementary therapies include ideas and methods from which conventional medicine could benefit.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

39. Most complementary therapies stimulate the body's natural therapeutic powers.

Absolutely Disagree  1  2  3  4  5  6  7 Absolutely Agree

Background Information

Are you affiliated with UCI?  Yes No

What is your current professional status?

Student: Year 1 Year 2 Year 3 Year 4

Fellow/Resident:

 Fellow 3rd Year Resident

 1st Year Resident  Other (Please specify: ______)

2nd Year Resident

Faculty/Health Care Staff (choose the one that best describes your discipline):

MD/DO Psychologist

Nurse Social Work/Counselor

Nurse Practitioner Other (Please specify: ______)

Physical Therapist

If you are in a specific specialty, please select one from the following:

Anesthesiology Neurology

Emergency Medicine Pediatrics

Family Medicine Psychiatry

Internal Medicine Surgery

Ob/Gyn Other (Please specify: ______)

Years of Practice:

0-5 Years 16-20 Years

6-10 Years more than 20 years

11-15 Years

Gender: Female Male

Ethnicity (Choose the one that most closely describes you):

UCIrvine Survey of Health Care Use and Practice1

African American

Caucasian

American Indian or Alaska native

Chinese

Korean

Japanese

Vietnamese

Other South East Asian

Indian or Pakistani

Native Hawaiian

Filipino

Other Pacific Islander

Other Asian

Mexican American/Chicano

Puerto Rican

Other Hispanic

Other Ethnicity (Please specify: ______)

UCIrvine Survey of Health Care Use and Practice1

Age: 20-29 30-39 40-49 50-59 60 or over

Medical Information:

 How long has it been since you last had a routine medical checkup?

Never2 to 5 years ago

Within the past 12 months More than 5 years ago

1 to 2 years ago

 Has your cholesterol been checked in the last five years?  Yes No

 Do you get your blood pressure checked periodically?  Yes No

 Do you exercise for 30 minutes 3 or more times a week?  Yes No

 Are you currently a cigarette smoker?  Yes No

10/07/18UCIrvine Survey of Health Care Use and Practice1