Integrative Healthcare: An Exploration of Students Who Choose This Undergraduate Major

Introduction

The growing movement to approach healthcare from an integrative perspective is evident internationally. As a multitude of approaches emerge, the question arises: Who will practice and lead integrative healthcare in the future? Academic institutions are providing health education that includes a diverse curriculum that considers different approaches and modalities. Several universities offer bachelor's degrees in CAM, holistic health, and integrative medicine ^{1 –3} and new curricula are being developed. ⁴ Community colleges offer holistic health associates degrees and certificates. ^5,6 Understanding this population of students is increasingly important because undergraduate integrative healthcare students are not adequately described in the literature. Research can be found delineating who decides to enter medicine, ⁷ nursing, ⁸ pharmacy, ⁹ and advanced (CAM) training programs, such as that for chiropractic medicine. ¹⁰ However, there is little knowledge regarding who and why students enter undergraduate integrative health programs.

Extensive research has focused on the use of CAM. Whites, ^{11 –14} women, and people with higher levels of education use CAM more frequently. ¹⁵ Sirois and Gick studied various CAM practitioner patient populations and found that dissatisfaction about conventional medicine and the presence of health-aware behaviors best predicted overall complementary medicine use. ¹⁶ Other researchers have explored the utilization and perceptions of CAM modalities among students. Kanadiya et al. studied osteopathic medical students and found that these students frequently used CAM modalities. ¹⁷ Yildirim et al. examined nursing and medical students and found that nursing students' use of CAM modalities was higher overall than for medical students. ¹⁸

Many researchers have sought to understand what influences a student's choice of a major or what students enter healthcare. Cho et al. looked at whom and what guided the choice of nursing as a career. Employability and aptitude were the two most significant factors for choosing this career. ⁸ Dante et al. found that students who had a relative in the nursing profession were more likely to choose this degree. ¹⁹ Medical school students expressed an interest in people and sought a wide range of job opportunities. ²⁰ Pharmacy school student demographics revealed that whites and Asians were more likely to enter pharmacy school. ⁹ Data summarizing the motivations of chiropractic students found that a desire to help others and holistic approaches were key factors. ²¹ Nedrow et al. focused on the sociodemographic characteristics and attitudes of naturopathic, chiropractic, Oriental medicine, and medical student groups. ²² They found that female students held generally more positive perceptions of CAM than male students. In addition, naturopathic medicine and Oriental medicine students reported the most positive assessments of CAM.

Another study described characteristics of participants in a holistic health class. Those students were more likely to engage in CAM therapies and to identify with holistic cultural values than students who enrolled in a general health education class or a human sexuality course. ²³

In summary, the current literature describes who, how, and why the general populace chooses to use CAM modalities. The current literature also describes the demographic characteristics of students who enroll in nursing, medicine, pharmacy, osteopathic medicine, and chiropractic medicine programs. But the demographic characteristics and motivations of students who choose to study integrative healthcare, including the profile of a typical student, have not yet been explored in the literature. As the interest in CAM continues to grow, this is a vital area of inquiry.

The purpose of the study was to learn who chooses to study integrative healthcare during their undergraduate career and why. This knowledge will allow the academic community to understand these students' backgrounds prior to declaring this major, what influenced their decision and the students' plans after graduation. The results of this study have the potential to guide integrative healthcare, holistic health, and/or CAM undergraduate and community college programs in making academic work relevant to students and connecting curriculum with previous and future personal and work experiences. It can assist integrative health undergraduate, graduate, and advanced study programs in recruiting efforts and in targeting marketing to potential students. This descriptive study also sought to understand the student population demographically and ethnically and identify ways to diversify the pool of graduates to meet community needs for practitioners. A study of undergraduate students entering this field provides knowledge about the population of potential leaders who will take integrative healthcare into the future.

Materials and Methods

Metropolitan State University of Denver in Colorado offers the United States' first bachelor of science in integrative healthcare. This program was approved by the Colorado Department of Higher Education in 2006. With a foundation in the basic sciences, including general biology, chemistry, anatomy and physiology, and pathophysiology, students progress into the core curriculum, composed of complementary and alternative medicine, holistic health, healthcare ethics, stress and sleep, and healthcare research methods. The students learn about various complementary medicine modalities and gain a holistic approach to the lifespan through their coursework.

Participants eligible for the study included all current integrative healthcare majors enrolled at Metropolitan State University of Denver (203 majors) who were 18 years of age or older. The 25-question survey instrument was designed by the principal investigator after an exploration of surveys used in previous similar studies. For face validity, several non–integrative healthcare majors at Metropolitan State University of Denver and faculty members completed the pilot survey to address areas of possible confusion or design flaws before implementation. Modifications were made on the basis of their input. Categories of CAM modalities from the National Center for Complementary and Integrative Health were modified. The Survey Monkey web application was used to collect responses.

Students' responses were anonymous, and the participants were not identified in the study dataset. The questionnaire obtained basic demographic characteristics, such as sex, ethnicity, current age, full- or part-time academic status, current academic year in school, and academic year when the student declared the integrative healthcare major. Data on employment, current or past Pell grant recipient status, and identification of first-generation college attendees was collected. Students were asked whether they first chose the university and then the integrative healthcare major or had first discovered the major and then enrolled in the university. The survey asked about plans to pursue further academic training after graduation and, if so, in what area.

Questions identified which CAM modalities they had used before declaring their integrative health major and whether they had any prior training in a CAM-related field. The survey asked about their satisfaction or dissatisfaction with complementary and conventional medicine. Lastly, participants were asked what influenced their decision to declare an integrative healthcare major and what most attracted them to the program.

The Metropolitan State University of Denver Institutional Review Board deemed the study exempt. Participants were recruited via an email that was sent to all current majors asking them to consider voluntary participation. The email contained a link to the online survey and consent form. A flyer was also distributed to all current integrative healthcare faculty members to distribute in their classes, and an announcement was posted in online courses, notifying program majors about the study. Data were collected between March and May 2015. Analyses were completed using Stata software, version 13 (Stata Corp., College Station, TX).

Results

One hundred and five of 203 declared integrative healthcare majors (51.7%) completed the survey. Demographic characteristics of survey respondents are summarized in Table 1. Many of the integrative healthcare majors (43%) discovered the integrative healthcare major and then decided to enroll at the university because this major exists at this university. Most integrative healthcare majors are employed (88% of the respondents), and 32% of employed respondents work in a CAM setting.

Ninety-seven percent of respondents (n = 98) plan to pursue postgraduate training/education in an integrative healthcare-related field. Anticipated future areas of study are summarized in Table 2. After graduation, the respondents want to work in a variety of health related fields. Twenty-five percent plan to work within conventional medicine and 36% aim to use wellness coaching in some capacity after graduation. Fifty-five percent of the respondents would like to be entrepreneurs and start their own business after graduation.

Most of the students completing the survey had previously used or received a variety of CAM modalities before declaring their major. These responses are summarized in Table 3. Twenty-five percent of the majors had previous formal training in a CAM-related field before declaring their major, whereas 69% had previously worked in the field. Forty-four percent of those who had previous training had training in reiki, 32% had training as a yoga instructor, and 16% were massage therapists.

Sixty-eight percent of students responding to the survey were raised in families that predominantly used conventional medicine. Twenty-five percent blended complementary and alternative and conventional medical care, and 7% of families favored the use of CAM modalities. Many factors influenced the respondents to declare a major in integrative healthcare. These influences are summarized in Table 4.

In open-ended responses to attractive program attributes, repeating themes emerged. Approximately 23% of the respondents commented on the community of students and faculty and/or the warmth, kindness, and compassionate nature of this community as a reason for choosing their major. Some students mentioned increased respect for a bachelor of science versus a certificate in integrative health. Other students identified a desire to be part of a new movement in healthcare. In addition, some students referenced feeling connected to learning and a curriculum that they could immediately apply to their own life, such as in their holistic health class.

Discussion

The integrative healthcare program appears to attract many prospective students to the Metropolitan State University of Denver. Although most students choose a college because of its academic reputation and the belief that its graduates secure satisfying employment, ²⁴ a substantial proportion of the study respondents stated that they discovered the integrative healthcare major and then decided to attend the university. Despite the ubiquity of CAM practitioners across the United States, this is a unique program with few comparable options. Other academic institutions may be encouraged to increase enrollment through expanding their health professions offerings to include integrative healthcare courses or majors.

More integrative healthcare students are female, correlating with research showing that more women than men use CAM modalities. ¹⁵ In addition, fewer nonwhite students choose this major. These findings demonstrate the importance of the academic and professional community's need to institute practices aimed at increasing diversity in this field. Most integrative healthcare majors plan to pursue training or education after graduation in an integrative healthcare-related field. This finding may guide conventional and complementary postgraduate training programs in student recruitment. These data also suggest that these students will become the integrative healthcare practitioners and entrepreneurs of the future.

Integrative healthcare majors used a variety of CAM modalities before declaring their major, especially massage, yoga, and meditation. Aligning with their personal interest, this may have influenced their decision to choose their major. Several students in the integrative healthcare program have previous training in yoga, massage, and reiki. This information may be useful in marketing undergraduate integrative healthcare academic programs to those practitioners or schools.

The level of dissatisfaction with conventional medicine was fairly high among survey respondents. This finding corresponds with the literature suggesting that dissatisfaction with conventional medicine is often associated with CAM use. ¹⁶ Academic faculty should address why students are dissatisfied with conventional medicine and let students express and discuss these feelings and perceptions. Giving students the opportunity to express their concerns with the healthcare system and to discover how this connects with their personal health garners higher academic commitment. Students take what they learn in the classroom, relate it to personal experience, and discover potential applications in their personal health and the health of others.

Researchers such as Jeffreys have conducted important research on nursing student attributes. ²⁵ This body of research has led to the implementation of multidimensional strategies for nursing school retention that address more than academics in the training of nurses. ²⁶ Through studies such as this, it is hoped that integrative healthcare programs increase enrollment of diverse students, improve their retention and success, and better assist them with their postgraduate plans.

The general profile of an integrative healthcare major appears to be a white woman who has some experience with a CAM modality, some dissatisfaction with conventional Western medicine, and plans for graduate study in the field. The prevalence of white students appears consistent with work by Bausell et al., ¹² and experience with integrative health modalities seems to align with observations for other health disciplines by Kanadiya et al. ¹⁷ and Yildirim et al. ¹⁸ This finding can guide other integrative healthcare programs in addressing the needs of this population as well as identify opportunities to increase diversity in the field.

Although the response rate was good, nonresponse bias is a concern because nonresponders may differ from those who responded. For example, it may be that students who did not respond were more satisfied with conventional medicine. Other variables could have been examined, such as characteristics of online versus classroom students or whether responses varied by year in school. In addition, social desirability bias may have occurred because the students who took the survey knew that this was a faculty study and so students may have responded to please their instructors. Further longitudinal examination of the attitudes of students as they progress could illuminate opportunities to refine program and service offerings. Also, repeating this study at multiple sites that offer a similar integrative healthcare major or minor would assist in generalizing these findings more broadly. Continued collaboration and dialogue on a national level should be an area that integrative healthcare faculty continue and expand as this discipline grows. Faculty members within this integrative healthcare program have a passion for educating students who will be leaders in the future. Research such as this helps to provide a deeper understanding of this student population and may assist faculty and students in other integrative healthcare undergraduate or graduate programs.