title: Intervention development for integration of conventional tobacco cessation interventions into routine CAM practice.
abstract: BACKGROUND
  Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal.
  
  
  METHODS
  Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation.
  
  
  RESULTS
  CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention.
  
  
  CONCLUSIONS
  The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway.
authors.affiliation: Department of Family and Community Medicine, University of Arizona College of Medicine, P.O. Box 245052, Tucson, AZ, 85724, USA. myram@email.arizona.edu.
authors.forename: Myra L
authors.initials: ML
authors.lastname: Muramoto
authors.affiliation: Department of Family and Community Medicine, University of Arizona College of Medicine, P.O. Box 245052, Tucson, AZ, 85724, USA. evam@email.arizona.edu.
authors.forename: Eva
authors.initials: E
authors.lastname: Matthews
authors.affiliation: Department of Family and Community Medicine, University of Arizona College of Medicine, P.O. Box 245052, Tucson, AZ, 85724, USA. ritenbau@email.arizona.edu.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Ritenbaugh
authors.affiliation: University of Arizona, School of Anthropology, 1009 E. South Campus Drive, Tucson, AZ, 85721, USA. mnichter@email.arizona.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Nichter
mesh_terms: D026881:Acupuncture; D015670:Acupuncture Therapy; D002684:Chiropractic; D000529:Complementary Therapies; D003479:Curriculum; D003695:Delivery of Health Care; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D008297:Male; D008405:Massage; D026761:Physical Therapy Specialty; D000074606:Smoking Prevention; D020340:Tobacco Use Cessation; D014029:Tobacco Use Disorder / Q000628:therapy*; D014481:United States