First at the National Center for Health Statistics/Centers for Disease Control and Prevention and now at NCCAM, I have been heavily involved with developing three large complementary medicine questionnaires fielded on the National Health Interview Survey (NHIS). Data from the most recent survey, which was fielded in 2012, were publicly released in July 2013.
These surveys have filled the void for large-scale, nationally representative, publicly available datasets on the out-of-pocket costs, prevalence, and reasons for using complementary medicine in the United States. Analyses of the 2002 and 2007 surveys have resulted in more than 100 publications in peer-reviewed journals, and the 2012 survey promises to have the same substantial impact on researchers and policymakers.
A detailed description of the processes we used to develop the three surveys was recently published in BMC Complementary and Alternative Medicine. In brief, we used a series of qualitative approaches including literature reviews, expert panel input, participant interviews, focus groups, and feedback from previous surveys.
In order to keep with NCCAM’s current strategic plan, which emphasizes symptom management and the promotion of optimal health, the 2012 complementary medicine survey includes an extensive list of wellness-related reasons, motivations, and outcomes related to using complementary therapies.
A 2010 “Think Tank” or panel of experts in health services research, minority health, economics, psychometrics, and complementary therapies carefully reviewed the previous two NHIS surveys and helped us decide which questions were most important to retain for the 2012 survey. They also identified key research areas that were not covered previously, such as more details on health insurance coverage and where people go to obtain information about complementary therapies.
In addition to expert input, we also used participant interviews and focus groups to develop the 2012 survey.
Ultimately, this detailed development process resulted in a number of revisions to the 2012 survey compared with the two previous ones. A few examples include:
- Classifying meditation into three categories (mantra, mindfulness, and spiritual)
- Adding questions about having a “personal health care provider”
- Expanding the child survey so that it is almost identical to the adult survey
- Restricting followup questions on yoga, tai chi, and qi gong to only those who use meditation and/or deep breathing as a component of these techniques.
This chart in the BMC Complementary and Alternative Medicine article lists all of the changes between surveys.
In the future, we hope to further leverage lessons learned by past, present, and future data users to help build a common understanding of, and methods to ensure, valid and meaningful analyses of the NHIS complementary medicine surveys.