Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Perceptions of Chiropractors in Mississippi Regarding Obesity Phelesia Nakita Foster Walden University Follow this and additional works at: https://scholarworks.edu/dissertations Part of the Public Health Education and Promotion Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact ScholarWorks@waldenu. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Phelesia Foster has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.
Review Committee Dr. Jeanne Connors, Committee Chairperson, Public Health Faculty Dr. Earla White, Committee Member, Public Health Faculty Dr. Vasileios Margaritis, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.
Walden University 2018 Abstract Perceptions of Chiropractors in Mississippi Regarding Obesity by Phelesia Nakita Foster MSNS, Delta State University, 1998 BS, Delta State University, 1996 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2018 Abstract Obesity continues to be a growing problem across the United States. Chiropractors have made claims of providing health promotion services within their treatment protocol; however, there is a lack of empirical research regarding a need for the chiropractic profession to train chiropractors to address Healthy People 2020 public health initiatives. The purpose of this qualitative study was to examine the perceptions of Mississippi Delta Region chiropractors regarding their role in obesity management as nonmedical practitioners that implement public health objectives in their practice. The research questions aimed at addressing possible barriers and limitations that influenced chiropractors’ perceptions regarding their role in obesity prevention.
The health promotion model which recognizes the vital role of the practitioner to the patient relationship in health outcomes, guided this study. Purposeful sampling was used to recruit 11 eligible board-certified chiropractors in the Mississippi Delta. The participants encountered a 1-time session with open-ended interview questions influenced by the hermeneutic tradition. Interview data were analyzed using thematic analysis.
The findings indicated that chiropractors could treat obese patients and provide some services that are mostly provided and billed by other health care practitioners. Chiropractors, however, encounter legislative and insurance challenges. Outreach programs and collaboration with other health care practitioners would improve chiropractors’ role in obesity management. The study can contribute to social change by increasing understanding of the chiropractic profession and how they may offer health promotion services to improve patient management of obesity and obesity-related illnesses.
Perceptions of Chiropractors in Mississippi Regarding Obesity by Phelesia Nakita Foster MSNS, Delta State University, 1998 BS, Delta State University, 1996 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2018 Dedication This dissertation is dedicated to my family whose support and encouragement facilitated my educational growth, my professors whose patience and dedication made this dissertation possible, and to the memory of my deceased grandparents, Woodrow W. and Charlie and Arecia Calhoune. Acknowledgments I would like to thank my dissertation supervisory committee, Dr. Jeanne Connors, Dr.
Earla White, and Dr. Vasileios Margaritis, for their unwavering support and patience, providing guidance through the dissertation process and for their ever optimistic attitudes when the journey became frustrating and challenging. I would also like to thank my boss, Mrs. Carlean Horton, for being so patient during the time I have spent fulfilling my degree obligations.
I am immensely grateful to each chiropractor that participated in this research study. I could not have accomplished this study without them taking time out of their busy schedule to participate and contribute to the public understanding of their profession. Lastly, I acknowledge my Heavenly Father. It is by faith that I am finishing this journey along with many divinely orchestrated blessings.
Table of Contents List of Tables. vi List of Figures. vii Chapter 1: Introduction to the Study.17 Background of the Problem .4 Purpose of the Study .7 Nature of the Study .10 Assumptions, Limitations, Scope, and Delimitations. 10 Scope and Delimitations.
12 Significance of the Study .15 Chapter 2: Literature Review .17 Literature Search Strategy.19 i Health Promotion Model. 19 Applicability of the Model. 22 Causes of Obesity. 26 Multidisciplinary Teams Approach in Obesity Management.
29 Primary Care Physician. 32 Psycho-emotional Functioning and Adoption of Positive Self-care Behaviors. 33 Professional Attitudes and Beliefs about Obesity. 36 Challenges and Barriers in Obesity Management.
39 Role of Chiropractors. 40 Professional Responsibility of Chiropractors in Obesity Management. 43 Aptitude of Chiropractors. 45 Self-Perceptions of Chiropractors.
46 Attitudes of Chiropractors in Obesity Management. 48 ii Summary and Conclusion .52 Chapter 3: Research Method .55 Research Design and Rationale .55 Role of the Researcher .60 Participant Selection Logic .65 Procedure for Recruitment, Participation, and Data Collection .67 Data Analysis Plan .68 Issues of Trustworthiness .81 Evidence of Trustworthiness.82 iii Presentation of Emerging Themes .93 Chapter 5: Discussion, Conclusions, and Recommendations .95 Interpretations of the Findings. 103 Limitations of the Study.106 Significance of Findings and Social Change Implicationa .109 Recommendations for Future Research. 110 Recommendations for Policy .116 Appendix A: Confidentiality Agreement .134 Appendix B: Interview Protocol .136 Appendix C: Interview Questions .137 iv Appendix D: Participant Demographic Survey .139 Appendix E: Participant Interview Log .140 Appendix F: Recruitment Email .141 Appendix G: Recruitment Flyer.142 v List of Tables Table 1.142 vi List of Figures Figure 1.
The relationship between variables. Map illustrating the Mississippi Delta counties where the participants reside and practice .142 vii 1 Chapter 1: Introduction to the Study According to a 2014 Gallup-Healthways Well-Being Index poll, interviews of more than 167,000 individuals indicated that the number of obesity cases continues to rise in the United States; obesity rates reached 27.7% in 2014—more than a 2% increase since 2008 (Jenna, 2015). Walden, Salsbury, and Lawrence (2014) indicated that chiropractic students provided health advice to less than 7% of their overweight and obese patients. The study revealed that little is known about chiropractors’ perceptions on obesity management.
Understanding chiropractor’s perceptions on obesity management is information that could help improve intervention methods. Obesity is associated with other risks such as hypertension, diabetes, stroke, coronary heart disease, and respiratory problems among chronic illnesses (Jensen et al. According to Scharff (2009), obesity can be linked to situational influences such as when an obese person consumes too much food immediately available even though it will have long-term adverse consequences. Choosing unhealthy foods can lead an obese person to seek medical attention, which encompasses many challenges.
Health provisions usually involve psychotherapy and exercise sessions along with dietary advice from a health practitioner (Vine, Hargreaves, Briefel, & Orfield, 2013). Obesity is a complex disease, and to understand the root causes along with treatment challenges among chiropractic providers, researchers need to examine chiropractors’ perceptions of their profession’s role in obesity management. Some health care providers may have negative attitudes toward obese patients, which are associated with provider specialty, competency, training, and other personal perceptions (Jay et al. My aim was to evaluate the perceptions of Mississippi Delta chiropractors as health care providers who interact with obese and overweight patients.
Chiropractic professionals seek to help patients with musculoskeletal disorders and other related ailments (Korpela, & Jones, 2013). Obesity is currently a health issue in the United States, and understanding the chiropractors’ perceptions about their roles with obesity management may provide insight to create better treatment protocols. In this chapter, I discuss the background of the problem, the problem statement, the purpose of the study, the research questions, and the conceptual framework. Additionally, I discuss the operational definitions, the assumptions in the study, and the significance of the study.
Background of the Problem Chiropractors are known for spinal manipulations; however, they encounter diseases outside of musculoskeletal disorders in their daily clinical practice. But chiropractors usually do not address obesity with their patients (Walden et al. This study is dedicated to interpreting the perceptions of Mississippi chiropractors regarding their ability to address the rising obesity problem. Obesity is an important health problem, especially in the United States where 78.6 million adult citizens are obese (Centers for Disease Control and Prevention [CDC], 2015a).
Health practices in the 21st century include integrative health approaches toward treating obesity (Zinn, Schofield, & Hopkins, 2013). An integrated treatment model is one of the most effective approaches to treatment (Collins, Hewson, Munger, & Wade, 2010). Most of the integrated treatment approaches involve cognitive-behavioral psychotherapy and physical reconditioning as well as nutrition intervention (Vine et al. Researchers using 3 integrative treatment approaches suggested that like all medical practitioners, chiropractors might have an important role in treating obesity.
The integrated approach in obesity treatment has seen an increased involvement of chiropractors addressing obesity (Erwin et al. Since chiropractic is not widely known as an option for weight loss or nutritional counseling, exploring chiropractors’ perceptions about their ability to treat obesity offered valuable insight into the chiropractic profession. Chiropractors’ perceptions may be reflective of their personal experiences, but this knowledge could enhance the health care model for more incorporation of chiropractors in the treatment of obesity (Erwin et al. A chiropractic practitioner’s perception about his or her capability may be an indicator of the potential held by chiropractors and their ability to treat obesity (Erwin et al.
Attitudes of the chiropractors indicate the will and optimistic approaches needed to develop effective treatment protocols (Hannon, 2014). Roles have to be defined, especially in the treatment of such major illness to avoid errors (Sinfield, Baker, Pollard, & Mei Yee, 2013). Obtaining more knowledge on chiropractors’ perceptions in their clinical practice setting may aid in the identification of any impending clinical implementation problems and enhance the effectiveness of chiropractic treatment. This study was significant because it provides perceptions of Mississippi chiropractors regarding obesity.
Chiropractic is the most used alternative medicine in the United States and its effectiveness depends on the capability of the chiropractors (Erwin et al. The Mississippi Chiropractic Association recognized the lack of knowledge and practice application that exists among Mississippi chiropractors in reference to 4 Healthy People 2010 (Leach, Cossman, & Yates, 2011), which led to the inquiry concerning their knowledge of Healthy People 2020. Self-perceptions can be one significant factor (among others) that could impact the participation role of chiropractors in the mainstream initiatives. This study was also significant because I explored Mississippi chiropractors’ perceptions about their ability to play a role in treating obesity, a well-known problem in the region.
Problem Statement The general problem in the chiropractic profession is that there is no precise model of care delivery aligned with public health initiatives such as obesity; therefore, a need exists for understanding chiropractors’ perceptions regarding obesity management (Leach et al. This gap may be due to a misaligned self-perception among chiropractic practitioners, hindering their ability to treat obesity. Chiropractors play a vital role in minimizing obesity, which is a disease that increases the risk of comorbidities and other complications such as diabetes, hypertension as well as cardiovascular diseases (CDC, 2015b).1% of adults aged 20 years and above in the United States were overweight with the CDC estimating that more than one- third of the adult population was obese (CDC, 2015a). In 2014, the prevalence rate of obesity had increased by 27.7% since 2008, a fact that has led to the declaration of obesity as a disease (Jenna, 2015).
Obesity has also emerged as possibly the leading cause of death in the United States. The treatment and management of obesity have raised much concern because of the rising cost of treatment that was at $147 billion in 2008 compared to $78 billion in 1998 (CDC, 2015b).