Knowledge, utilisation and perceptions of the chiropractic profession by general practitioners in Harare, Zimbabwe

Background: There have been an increased number of patients using complementary alternative medicine (CAM), including chiropractic care. All population age groups are utilising chiropractic treatment for various ailments. Research has shown that general practitioners have limited knowledge and perception about chiropractic in many countries. Their perception towards other health care professionals is important, particularly in their role as gatekeepers in the health care system. The current perception in Zimbabwe is thought to be no referral of patients between general practitioners and chiropractors and a low degree of knowledge amongst general practitioners about chiropractic. Aim: The aim of this study was to determine the knowledge, utilisation and perceptions of general practitioners in Harare, Zimbabwe. Objectives: • To establish the knowledge about chiropractic amongst general practitioners in Harare, Zimbabwe. • To determine perceived role and utilisation of chiropractic by general practitioners in Harare, Zimbabwe. • To determine the relationships, if any, between knowledge, perception, and utilisation of chiropractic by general practitioners in Harare, Zimbabwe. Methods: The study was a descriptive, quantitative, cross-sectional study using a structured questionnaire adapted from similar studies. The questionnaire was validated by means of a focus group discussion. The survey was conducted on a random sample of 72 general practitioners practising in the Avenues area of Harare, Zimbabwe. A single stage sampling techniques was used to select participants from a list of 88 registered general practitioners from the Medical and Dental Practitioners Council of Zimbabwe who met the inclusion criteria. Questionnaires were provided to general practitioners who were in private practice in the Avenues area of Harare, Zimbabwe at the time of the study by the researcher. The data collected was analysed using the Statistical Package for Social Science (SPSS)® 2.4 (IBM, Armonk, NY. USA) software at a statistical significance of p<0.05. Pearson’s correlation was used to assess the relationship between continuous variables, while the t test was used to copmare the mean scores between independent binary variables. Results: Many of the participants had some kind of knowledge regarding chiropractic modalities, areas of chiropractic specialisation but only a few had adequate knowledge and a good perception of it. General practitioners who were knowledgeable about chiropractic tended to have a positive perception and were more likely to refer patients to a chiropractor. A response rate of 54.5 percent was achieved. Most of the respondents tended to be in the age group of 35-54 and most were female (54.2 percent). Over 90 percent of the participants referred patients with musculoskeletal complaints to physiotherapists while only 16.67 percent referred to chiropractors. More than 65 percent of the participants responded that they knew something about chiropractic, and of these almost 50 percent obtained their information from the media. Over 80 percent of the participants who knew something about chiropractic thought that extremities, neuro-musculoskeletal system, rehabilitation and sports injuries were areas chiropractors can specialise in. Almost all the participants who knew something about chiropractic were aware of adjustments or manipluation of joints as modalities of chiropractic treatment. Majority (75.8 percent) of the participants who knew something about chiropractic thought that chiropractic could help selected conditions, while only 3 percent felt it was not effective and 21.2 percent felt they were not informed enough to comment. GP’s surveyed considered chronic back pain (91 percent), sports trauma (85 percent), shoulder/knee problems (79 percent), arthritis (76 percent), back and pelvic problems during pregnancy (70 percent), nerve root entrapment (70 percent) and carpal tunnel syndromme (70 percent) as some of the appropriate conditions for chiropractors to treat. Forty two percent of the GP’s referred patients to chiropractors mostly on both the patient’s request and their own judgment. The main reason for not referring patients to chiropractors cited by most (70 percent) of the GPs was limited knowledge about chiropractic care. There was a statistically significant and moderately high positive correlation between knowledge and perception scores (r=0.668). This study suggests that GP’s who have a higher degree of knowledge about chiropractic tend to have a positive perception of chiropractic. There was a non-significant difference in knowledge between those who refer patients and those who do not (p=0.425). In this study knowlegde about chiropractic did not significantly influence referral to chiropractors. There was however a statistically significant difference in perception between those who refer patients and those who do not (p=0.006). The perceptions were higher in those who refer patients compared to those who do not refer patients. Perceptions were found to determine utilisation rather than knowledge even though there was a correlation between the two.