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Emotionless holism: Factor and rasch analysis of the Chinese Integrative Medicine Attitude Questionnaire

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Abstract

Objective

To examine the Eastern-Western difference in the interpretation of Integrative Medicine Attitude Questionnaire (IMAQ) by assessing the psychometric properties of a revised Chinese medicine (CM)-specific version of IMAQ (CM-IMAQ).

Methods

Factor and Rasch analysis were performed with data collected from a mail survey of 165 Hong Kong Western medical doctors (WMD) randomly sampled from the official registry. The structural validity, unidimensionality, item fit, and differential item functioning (DIF) of the Hong Kong CM-IMAQ were evaluated.

Results

Confirmatory factor analysis (CFA) demonstrated that the original IMAQ factor structure was not concordant with our data on Chinese WMD, and subsequent explanatory factor analysis (EFA) validated a new three-factor model for CM-IMAQ: (1) attitude towards “tonification”, (2) attitude towards the effectiveness of CM, and (3) attitude towards CM knowledge. The original IMAQ factor on holism and doctor-patient relationship disappeared. Rasch analysis confirmed the unidimensionality of “tonification” and the effectiveness domains, but further refinement of the knowledge domain is needed.

Conclusions

Cultural adaptation of the IMAQ has demonstrated differences between Eastern and Western doctors trained in allopathic medicine in their interpretations of holism in healthcare. For Chinese WMD, the emphasis of holistic care is placed on “tonifying” the body rather than on nurturing the mind and spirit. Confucian and Taoist conceptualizations of mental health as well as the persistent stigma towards mental illness within modern Chinese culture may explain why Chinese WMD do not regard mental health promotion as part of routine healthcare.

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References

  1. WHO Congress on Traditional Medicine 2008: Beijing Declaration. Available at: http://www.who.int/medicines/areas/traditional/congress/beijing_declaration/en/index.html. Accessed December 11, 2009.

  2. Ernst E, Resch KL, White AR. Complementary medicine. What physicians think of it: a meta-analysis. Arch Intern Med 1995;155:2405–2408.

    Article  PubMed  CAS  Google Scholar 

  3. Astin JA, Marie A, Pelletier KR, Hansen E, Haskell WL. A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med 1998;158:2303–2010.

    Article  PubMed  CAS  Google Scholar 

  4. Hirschkorn KA, Bourgeault IL. Conceptualizing mainstream health care providers’ behaviours in relation to complementary and alternative medicine. Soc Sci Med 2005; 61:157–170.

    Article  PubMed  CAS  Google Scholar 

  5. Schneider CD, Meek PM, Bell IR. Development and validation of IMAQ: integrative medicine attitude questionnaire. BMC Med Educ 2003;28:5.

    Article  Google Scholar 

  6. Schmidt K, Rees C, Greenfield S, Wearn AM, Dennis I, Patil NG, et al. Multischool, international survey of medical students’ attitudes toward “holism”. Acad Med 2005;80:955–963.

    Article  PubMed  Google Scholar 

  7. Rees CE, Wearn AM, Dennis I, Amri H, Greenfield SM. Medical students’ attitudes to complementary and alternative medicine: further validation of the IMAQ and findings from an international longitudinal study. Med Teach 2009;31:125–132.

    Article  PubMed  Google Scholar 

  8. Griffiths S, Chung V. Development and regulation of traditional Chinese medicine practitioners in Hong Kong. Pespect Public Health 2009;129(2):3–5.

    Google Scholar 

  9. Chung V, Wong E, Griffiths S. Content validity of the integrative medicine attitude questionnaire: perspectives of a Hong Kong Chinese expert panel. J Altern Compl Med 2007;13:563–570.

    Article  Google Scholar 

  10. Hays RD, Morales LS, Reise SP. Item response theory and health outcomes measurement in the 21st century. Med Care 2000;38(9 Suppl):1128–1142.

    Google Scholar 

  11. List of Registered Hong Kong Doctors. Available at: http://www.mchk.org.hk/doctor/index.htm. Accessed December 11, 2009.

  12. Hair JF, Anderson RE, Tatham RL, Black WC. Multivariate data analysis. 5th ed. New Jersey: Prentice Hall;1998:781–785.

    Google Scholar 

  13. Steiger J. Changing causal relationships without changing the fit: some rules for generating equivalent LISREL models. Multivariate Behav Res 1990;21:309–331.

    Google Scholar 

  14. Tucker LR, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika 1973;38:1–10.

    Article  Google Scholar 

  15. Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull 1980;88:588–606.

    Article  Google Scholar 

  16. MacCallum RC, Hong S. Power analysis in covariance structure modeling using GFI and AGFI. Multivariate Behav Res 1997;32:193–210.

    Article  Google Scholar 

  17. Marsh HW, Balla JR, Hau KT. An evaluation of incremental fit indices: a clarification of mathematical and empirical properties. In: Marcoulides GA, Schumacker RE, eds. Advanced structural equation modelling: issues and techniques. 1st ed. Mahwah, NJ.: Erlbaum; 1996:315–353.

    Google Scholar 

  18. Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, eds. Testing structural equation models. 1st ed. Newbury Park: Sage; 1993:136–162.

    Google Scholar 

  19. Wright BD, Mok M. Rasch models overview. J Appl Measurem 2000;1:83–106.

    CAS  Google Scholar 

  20. Wright BD, Panchapakesan N. A procedure for sample-free item analysis. Educ Psychol Meas 1969;29:23–48.

    Article  Google Scholar 

  21. Wright BD, Masters GN. Rating scale analysis. Rasch measurement. Chicago: MESA Press; 1982:201–210.

    Google Scholar 

  22. Wright BD, Linacre JM. Reasonable mean-square fit values. Rasch Meas Transact 1994;8:370.

    Google Scholar 

  23. Holland PW, Wainer H, eds. Differential item functioning. 1st ed. Hillsdale, NJ: Lawrence Erlbaum; 1993:451–453.

    Google Scholar 

  24. McHorney CA, Monahan PO. Postscript: applications of Rasch analysis in health care. Med Care 2004;42(1 Suppl):173–178.

    Google Scholar 

  25. Hardigan PC, Carvajal MJ. Application of Rasch rating scale model to analysis of job satisfaction among practicing pharmacists. J Am Pharm Assoc 2008;48:522–529.

    Article  Google Scholar 

  26. Block JP, DeSalvo KB, Fisher WP. Are physicians equipped to address the obesity epidemic? Knowledge and attitudes of internal medicine residents. Prev Med 2003; 36:669–675.

    Article  PubMed  Google Scholar 

  27. Scheuneman J. A method of assessing bias in test items. J Educat Meas 1979;16:143–152.

    Article  Google Scholar 

  28. Wang WC. Assessment of differential item functioning. J Appl Meas 2008;9:387–408.

    PubMed  Google Scholar 

  29. Scott NW, Fayers PM, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, et al. The use of differential item functioning analyses to identify cultural differences in responses to the EORTC QLQ-C30. Qual Life Res 2007;16:115–129.

    Article  PubMed  CAS  Google Scholar 

  30. Breslau J, Javaras KN, Blacker D, Murphy JM, Normand SL. Differential item functioning between ethnic groups in the epidemiological assessment of depression. J Nerv Ment Dis 2008;196:297–306.

    Article  PubMed  Google Scholar 

  31. Cheung Y, Chiu W, Lee P. Health: perceptions and practices. In: Lau S, Lee M, Wan P, Wong S, eds. Indicators of social development: Hong Kong 2004, 1st ed. Hong Kong: Hong Kong Institute of Asia Pacific Studies, Chinese University of Hong Kong; 2005:57–97.

    Google Scholar 

  32. Critchley LA, Chen DQ, Lee A, Thomas GN, Tomlinson B. A survey of Chinese herbal medicine intake amongst preoperative patients in Hong Kong. Anaesth Intens Care 2005; 33:506–513.

    CAS  Google Scholar 

  33. Green G, Bradby H, Chan A, Lee M. “We are not completely Westernised”: dual medical systems and pathways to health care among Chinese migrant women in England. Soc Sci Med 2006;62:1498–1509.

    Article  PubMed  Google Scholar 

  34. Wu APW, Burke A, LeBaron S. Use of traditional medicine by immigrant Chinese patients. Fam Med 2007;39:195.

    PubMed  Google Scholar 

  35. Wu LC, Ginsberg R, eds. Fundamentals of Chinese philosophy. 1st ed. New York: University Press of America; 1986:311–314.

    Google Scholar 

  36. Yip K. Chinese concepts of mental health: cultural implications for social work practice. Int Soc Work 2005;48:391.

    Article  Google Scholar 

  37. Veith I, Rose K. The Yellow Emperor’s classic of internal medicine. California: University of California Press; 2002:1–260.

    Google Scholar 

  38. Yip KS. Taoism and its impact on mental health of the Chinese communities. Int J Soc Psychiatry 2004;50:25.

    Article  PubMed  Google Scholar 

  39. Lauber C, Rössler W. Stigma towards people with mental illness in developing countries in Asia. Int Rev Psychiat 2007;19:157–178.

    Article  Google Scholar 

  40. King B, ed. The conceptual structure of emotional experience in Chinese. Toronto: Global Language Press; 2007:201–240.

    Google Scholar 

  41. Patel MX. Attitudes to psychosis: health professionals. Epidemiol Psichiatr Soc 2004;13:213–218.

    Article  PubMed  Google Scholar 

  42. Wahl O, Aroesty-Cohen E. Attitudes of mental health professionals about mental illness: a review of the recent literature. J Commun Psychol 2009;38:49–62.

    Article  Google Scholar 

  43. Pearson V, Phillips MR. The social context of psychiatric rehabilitation in China. Br J Psychiat Suppl 1994;24:11–18.

    Google Scholar 

  44. Sevigny R, Yang W, Zhang P, Marleau JD, Yang Z, Su L, et al. Attitudes toward the mentally ill in a sample of professionals working in a psychiatric hospital in Beijing. Int J Soc Psychiat 1999;45(1):41–55.

    Article  PubMed  CAS  Google Scholar 

  45. Baum M. Concepts of holism in orthodox and alternative medicine. Clin Med 2010;10:37–40.

    PubMed  Google Scholar 

  46. Korngold E, Beinfield H. Chinese medicine and the mind. Explore 2006;2:321–333.

    Article  PubMed  Google Scholar 

  47. Rathbone J, Zhang L, Zhang M, Xia J, Liu X, Yang Y. Chinese herbal medicine for schizophrenia. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No: CD003444. DOI: 10.1002/14651858.CD003444.pub2

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Authors and Affiliations

  1. School of Public and Primary Care, Chinese University of Hong Kong, Hong Kong, China

    Vincent C. H. Chung, Marc Chong, Lau Chun Hong, Polly H. X. Ma, Samuel Y. S. Wong & Sian M. Griffiths

Authors
  1. Vincent C. H. Chung
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  2. Marc Chong
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  3. Lau Chun Hong
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  4. Polly H. X. Ma
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  5. Samuel Y. S. Wong
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  6. Sian M. Griffiths
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Corresponding author

Correspondence to Vincent C. H. Chung.

Additional information

Supported by the Health Services Research Fund, Health and Food Bureau, Hong Kong, China (No. 05060521)

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Chung, V.C.H., Chong, M., Hong, L.C. et al. Emotionless holism: Factor and rasch analysis of the Chinese Integrative Medicine Attitude Questionnaire. Chin. J. Integr. Med. 18, 457–465 (2012). https://doi.org/10.1007/s11655-012-1117-8

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  • DOI: https://doi.org/10.1007/s11655-012-1117-8

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