Consultation on Identity

1
Consultation on Identity
Quantitative Research Findings
December 7, 2004
2
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
3
INTRODUCTION
4
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 organizations positioning strategy.

5
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.

6
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.
7
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.

8
EXECUTIVE SUMMARY
9
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 publics
  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.

10
Executive Summary (contd)

• There is significant discrepancy in the way
  chiropractors believe the profession should be
  perceived by the general public and medical
  doctors and the way they think the profession is
  actually perceived.
• While the vast majority of chiropractors believe
  the profession should be considered primary
  health care 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 the profession is perceived by the general
  public as the management of back and neck pain
  and to a slightly less extent, the management of
  spinal problems.

11
Executive Summary (contd)

• 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.

12
Executive Summary (contd)

• The lack of clarity surrounding the identity of
  the profession has also likely been fed by
• 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
  professions 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.
• Furthermore, there is consensus that medical
  doctors perceptions about the safety of
  chiropractic care is very important for building
  greater mutual respect and cooperation between
  the two professions.

13
DETAILED FINDINGS
14
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)
Strongly Agree (67) 90
Mean Score 6.5
Base Total sample (n3689) 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.
15
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)
Total () Gender () Gender () Age () Age () Age () School Philosophy () School Philosophy () Country of Graduating Institution () Country of Graduating Institution () Country of Graduating Institution () Country of Graduating Institution () Country of Graduating Institution ()
Rating Total () Men Women lt35 35 59 60 Group A Group B 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 (n3689) 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.
16
Clarity of the Professions Identity

• However, most chiropractors in our sample dont
  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)
Strongly Disagree (12) 40
Strongly Agree (67) 4
Mean Score 3.0
Base Total sample (n3689) 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.
17
Clarity of the Professions Identity - Profiled
The Chiropractic Profession Has a Clear Public
Identity (1 to 7 Scale from Strongly Disagree to
Strongly Agree)
Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Years in Practice () Years in Practice () Years in Practice () Years in Practice () Importance of a Clear Identity () Importance of a Clear Identity () Importance of a Clear Identity ()
Rating Total () US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world 5 or less 6 10 11 - 20 More than 20 Very Important (6 or 7) Somewhat Important (3 to 5) Not Important (1 or 2)
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
Mean score 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
Base Total sample (n3689) 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.
18
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
  professions 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
Base Total sample (n3689) 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.
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 () Gender () Gender () Age () Age () Age () School Philosophy () School Philosophy ()
Total () Men Women lt35 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 (n3689) 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.
20
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 () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Years in Active Practice () Years in Active Practice () Years in Active Practice () Years in Active Practice ()
Total () US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world 5 or less 6 10 11 - 20 gt20
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 (n3689) 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.
21
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 chiropractics and the general publics
  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.

Total () Gender () Gender () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
Total () Men Women Group A Group B 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 publics view of the profession 25 26 21 24 28 25 29 19 16 17 14
Chiropractics view of the profession 21 21 19 23 18 21 17 17 19 22 23
Base Total sample (n3689) Q8. When
communicating with the general public to promote
the use of chiropractic services, which view do
you think should receive more emphasis?
22
There is considerable discrepancy between how
chiropractors feel the profession should be
perceived by the general public and how they
think it is actually being perceived.
23
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 Chiropractors Perspective
How the Profession is Currently Perceived by the
Public
How the Profession Should Be Perceived by the
Public
Base Total sample (n3689) 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?
24
Perceptions of How the Public Perceives the
Chiropractic Profession - Profiled
The Chiropractors Perspective
How the Profession Should Be Perceived by the
Public
Gender () Gender () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
Total Men Women Group A Group B 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 () Gender () Age () Age () Age () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
Total Men Women lt35 35 59 60 Group A Group B 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 (n3689) 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?
25
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 Chiropractors Perspective
How the Profession Services are Currently
Perceived by the Public
How the Profession Its Services Should Be
Perceived by the Public
Base Total sample (n3689) 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?
26
Perceptions of How the Public Perceives the
Chiropractic Profession - Profiled
The Chiropractors Perspective
How the Profession Its Services Should Be
Perceived by the Public
Total () Gender () Gender () Age () Age () Age () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
Total () Men Women lt35 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 () Gender () Age () Age () Age () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Years in Active Practice () Years in Active Practice () Years in Active Practice () Years in Active Practice ()
Total Men Women lt35 35 59 60 US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world 5 or less 6 10 11 - 20 gt20
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 (n3689) 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?
27
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
Total
Gender
Men
Women
Country of Current Practice
US
Canada
Regulated Europe
Unregulated Europe
79
Australia / New Zealand
Rest of world
School Philosophy
Group A
Group B
Years in Practice
5 or less
6 10
11 20
gt 20
Base Total sample (n3689) 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
28

• In fact, the non-drug, non-surgical mandate of
  chiropractic is viewed as being cornerstone to
  the professions identity.
• However

29

• 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.

30
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
Gap
Wellness care
Non-drug / non-surgical health care
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
Management of back neck pain their impact on general health
Management of neuromusculoskeletal conditions
Management of spinal problems
Management of vertebral subluxation
Management of back neck pain
77 37 58 59 65 60 30 22 - 47 -34
Base Total sample (n3689) 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 below, where 1 means does
not describe what I would like at all and 7 means
describes what I would like perfectly.
31
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)
How chiropractic profession SHOULD BE perceived Total () Gender () Gender () Age () Age () Age () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
How chiropractic profession SHOULD BE perceived Total () Men Women lt35 35 59 60 Group A Group B US Can. Reg. Eur. Unreg. Eur. Aus./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 (n3689) 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 below, where 1 means does not describe what
I would like at all and 7 means describes what I
would like perfectly.
32
General Publics 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 Total () Gender () Gender () Age () Age () Age () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
How chiropractic profession IS CURRENTLY perceived Total () Men Women lt35 35 59 60 Group A Group B US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of 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 of neuromusculoskeletal 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
Base Total sample (n3689) 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.
33

• From the chiropractors 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
  publics perceptions of the profession.
• Additionally, issues of ethics, behaviour trust
  play an important role in influencing public
  opinion.

34
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
Patient-centered care
Spinal care expertise
Issues of ethics, professional behaviour trust
Hands-on care
Quick recovery from pain disability
Ability to manage pain
Ability to manage back pain
Ability to diagnose the cause of symptoms
Level of education / training
A practice model that does not involve drugs or surgery
Attitudes of the media
Preventative care
The profession's different model of health
Attitudes of government health authorities
Third party funding for care
Attitudes of other health care professionals
Base Total sample (n3689) Q11. In your
opinion, how important are each of the following
in shaping the general publics perception of the
chiropractic profession? Please use the 7-point
scale below, where 1 means not at all important
and 7 means very important.
35
Influencing Factors on Public Perceptions-
Profiled
Saying 6 7 (on a 1-7 scale from Not at all
Important to Very Important)
Total () Gender () Gender () Age () Age () Age () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
Total () Men Women lt35 35 59 60 Group A Group B US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of 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 (n3689) Q11. In your
opinion, how important are each of the following
in shaping the general publics perception of the
chiropractic profession? Please use the 7-point
scale below, where 1 means not at all important
and 7 means very important.
36
Influencing Factors on Public Perceptions-
Profiled
Saying 6 7 (on a 1-7 scale from Not at all
Important to Very Important)
Total () Desired Perception of Profession () Desired Perception of Profession () Desired Perception of Profession () Desired Perception of Profession Services () 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 (n3689) Q11. In your
opinion, how important are each of the following
in shaping the general publics perception of the
chiropractic profession? Please use the 7-point
scale below, where 1 means not at all important
and 7 means very important.
37
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
The general public has confidence in the quality of care provided by chiropractors
The general public is aware of the level of education of chiropractors
Higher among

• 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

Base Total sample (n3689) Q12. Please indicate
whether you strongly agree, somewhat agree,
somewhat disagree or strongly disagree with the
following statements
38
Factor Influence When Seeking Chiropractic Care

• From a chiropractors 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
Manual procedures (adjusting, mobilization, manipulation, soft tissue, etc.)
Specialized knowledge education
Non-drug / non-surgical approach
Availability of third party funding
Diagnostic ability
Exercise/ rehabilitation
Lifestyle counseling / advice
Nutritional support / advice
Base Total sample (n3689) 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.
39
Factor Influence When Seeking Chiropractic Care-
Profiled
Saying 6 7 (on a 1-7 scale from Not at all
Important to Very Important)
Total () Gender () Gender () Age () Age () Age () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
Total () Men Women lt35 35 59 60 Group A Group B US Can. Reg. Eur. Unreg. Eur. Aus./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 (n3689) 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.
40
Factor Influence When Seeking Chiropractic Care-
Profiled
Saying 6 7 (on a 1-7 scale from Not at all
Important to Very Important)
Total () Desired Perception of Profession () Desired Perception of Profession () Desired Perception of Profession () Desired Perception of Profession () Perception of Profession Services () Perception of Profession Services ()
Total () Focused scope Broad scope Specialist No clear perception Mainstream Complementary Alternative
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
Base Total sample (n3689) 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.
41

• 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 is perceived by medical doctors.

42
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.

For comparison Chiropractors believe 26 of the
general public does not have a clear perception
of the profession.
Total () Age () Age () Age () School Philosophy () School Philosophy () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Years in Active Practice () Years in Active Practice () Years in Active Practice () Years in Active Practice ()
Total () lt35 35 59 60 Group A Group B US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world 5 or less 6 10 11 - 20 gt20
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
(n3689) 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 broad scope, or specialist
care?
43
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.

Base Total sample (n3689) 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?
44
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)
The management of back neck pain
A competitor within health care delivery
Non-drug / non-surgical health care
The management of spinal problems
The management of neuromusculoskeletal conditions
The management of back neck pain their impact on general health
The management of neuromusculoskeletal conditions their impact on general health
The management of spinal problems their impact on general health
The management of vertebral subluxation
Wellness care
The management of vertebral subluxation its impact on general health
Primary health care
Base Total sample (n3689) 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.
45
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)
Total () Age () Age () Age () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice ()
Total () lt35 35 59 60 US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of 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 (n3689) 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.
46

• 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.

47
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
Medical doctors' perceptions about the effectiveness of chiropractic health care
Medical doctors' knowledge understanding of the standards for chiropractic education practice
Attitudes behaviours of chiropractors
Attitudes behaviours of medical doctors
Chiropractors' perceptions about the safety of medical health care
Chiropractors' perceptions about the effectiveness of medical health care
Influence, attitudes behaviours of third party payers
Financial barriers to referring patients for chiropractic health care
Chiropractors' knowledge understanding of the standards for medical education and practice
Base Total sample (n3689) 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 very important.
48
Importance for Building Inter-Professional
Relations
Saying 6 7 (on a 1-7 scale from Not at all
Important to Very Important)
Gender () Gender () School Philosophy School Philosophy Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Country of Current Practice () Years in Practice () Years in Practice () Years in Practice () Years in Practice ()
Total () Men Women Group A Group B US Can. Reg. Eur. Unreg. Eur. Aus./NZ Rest of world 5 or less 6 10 11 - 20 gt20
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 (n3689) 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.
49
APPENDIX Respondent Profile
50
Respondent Profile
Total ()
Gender Male 79
Gender Female 21
Age Under 35 27
Age 35 59 68
Age 60 5
Average 40
Country of Graduating Institution US 86
Country of Graduating Institution Canada 6
Country of Graduating Institution Europe 3
Country of Graduating Institution Australia / New Zealand 3
Country of Graduating Institution Rest of the world 2
Years Since Graduation 5 or less 26
Years Since Graduation 6 10 18
Years Since Graduation 11 20 28
Years Since Graduation More than 20 28
Years Since Graduation Average 13
Base Total sample (n3689)
51
Respondent Profile (contd)
Total ()
Country of Current Practice US 82
Country of Current Practice Canada 7
Country of Current Practice Europe 6
Country of Current Practice Australia / New Zealand 3
Country of Current Practice Rest of the world 2
Years in Active Practice 5 or less 29
Years in Active Practice 6 10 17
Years in Active Practice 11 20 28
Years in Active Practice More than 20 26
Years in Active Practice Average 13
Current Role in Chiropractic Clinical practice 91
Current Role in Chiropractic Administration / Education / Research 6
Current Role in Chiropractic Retired 1
Current Role in Chiropractic Other 2
Base Total sample (n3689)
52
Respondent Profile (contd)
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
Country of Current Practice
Base Total sample (n3689) Q20. Which
institution did you graduate from? Q23. What
country do you currently practice in?