July 2009

Experiences of Nutritional Therapy - A Summary of Research Findings
30th July 2009

"Let Food be Thy Medicine" The Experiences of Women Using Nutritional Therapy: A Preliminary Qualitative Study Using Interpretative Phenomenological Analysis (IPA)

Introduction

Nutritional Therapy is a relatively new profession in the UK and whilst there is a small body of research evidence on the use of Complementary and Alternative Medicine (CAM), Nutritional Therapy is rarely included specifically within these studies. In her undergraduate research study, Susan Kelly looked at the experiences of a group of women who had used Nutritional Therapy using Interpretative Phenomenological Analysis (IPA), a qualitative research method which looks at 'the insider's perspective' 

Methodology

The fieldwork for the study took place in Autumn 2008. Five women from Brighton, Hove and West Sussex were interviewed using a semi-structured interview approach exploring their pathways to nutritional therapy, experiences and views. All interviews were audio recorded, transcribed and analysed using Interpretative Phenomenological Analysis, a research method that recognizes the uniqueness of individuals and their ‘lived experiences’. Full details of methodology can be found in the complete study document.

Results

A number of overarching themes were identified in the research because they were either (i) very important to one individual OR (ii) common amongst a number of participants:

Taking Action

(i) Being Responsible for health
It was important to take an active approach to health and take steps to address health conditions or issues - this suggested that participants had an active health management philosophy. Nutritional Therapy was usually taken up in response to a specific health related event which was of major concern rather than for general wellbeing even though most had maintained an interest in food and diet for quite some time
(ii) Listening to internal feelings
Some participants felt it was important to act on their internal feelings or ‘intuition’ as part of their decision to take up Nutritional Therapy. For some ‘it just felt right’
(iii) Listening to others
The views and influences of family, friends and in some cases referring professionals were very important factors in the decision to actually consult a nutritional therapist, even for those that had a considerable pre-existing interest and knowledge about nutrition
(iv) Trying things out
A philosophy of having an open mind and ‘trying things out’ in order to help resolve health issues or conditions was a common experience

Let Food Be Thy Medicine

(i) Food as medicine
For all participants positive nutrition was perceived as central in managing their illness or health conditions. For some this included perceiving some of the more unpalatable food recommendations by Nutritional Therapists as ‘a medicine that had to be taken’. Participants believed food to be most important part of Nutritional Therapy but had a range of views about nutritional supplements – participants generally viewed them as of secondary importance or ‘add-ons’ to the food based approach rather than seeing Nutritional Therapy as giving ‘a pill to cure an ill’
(ii) A holistic approach
Participants appeared to consistently value the holistic approach of nutritional therapy, contrasting it often with a symptom based approach of conventional medicine. Some valued the therapeutic approach and opportunity to ‘tell their story’ as well as the nutritional information
(iii) A scientific approach
Most participants perceived the scientific and evidence informed approach to be important. Participants valued the work of the Nutritional Therapist in helping them understand the rationale for specific recommendations.
(iv) Returning to the natural
Whilst valuing the science based approach , participants also viewed nutrition as ‘natural’ and ‘safe’. Some participants talked of the important of traditional diets and lifestyles and contrasted this with what they saw as the ‘unnaturalness’ and limitations of contemporary Western lifestyles and medication based medicine.

Collaboration and Choice

(i) Choosing a service
Taking an active role in health for some participants also involved taking a ‘customer approach’ to healthcare  - choosing to access a range of services dependent on their needs at any one time. Some  of the participants had reached the ‘end of the line’ with mainstream medicine in some ways but, at the same time, had not completely rejected it,  recognising instead that some health needs could best be met through complementary therapy while more ‘serious’ or acute issues would lead them to return to their GP or mainstream services.
(ii) The need for a specialist
Participants in the study already had significant knowledge or experience in thinking about nutrition prior to seeking a Nutritional Therapist. There was a recognition of the need to apply this knowledge to their particular circumstances .
(iii) A relationship of equals
Whilst valuing the Nutritional Therapist as a ‘specialist’, participants simultaneously viewed the Nutritional Therapy relationship as one of collaboration and partnership rather than a ‘doctor patient’ relationship. Some participants then went on to ‘translate’ the Nutritional Therapist’s recommendations into something they could do ‘in real life’ rather than following a prescriptive approach.
(iv) Education and empowerment
Participants talked about the motivation they gained from their Nutritional Therapist, their increased knowledge about nutrition and valuing a set of recommendations which they could choose how to apply. This was viewed as positive and empowering.

Perceived Barriers

(i) Vulnerability to charlatans
Participants identified a lack of confidence /knowledge about the professional regulation of Nutritional Therapists. There were concerns about the level of training and accreditation that is required to become a a Nutritional Therapist and wary of a potential for financial exploitation . Only one participant who had extensive knowledge of the training and registration requirements through her own research had the confidence to seek a Nutritional Therapist via the Nutritional Therapy Register.Most participants saw a Nutritional Therapists they knew, had a personal recommendation about or approached someone they had opportunity to ‘preview’
(ii) Reluctance to change
Some participants identified that in thinking about going to see a Nutritional Therapist  they recognised that they were likely to need to change their diet/lifestyle as a consequence- some participants thought they may have delayed making an appointment due to this
(iii) Value for money
Costs were seen as a strong potential barrier for some participants – this related to both (i) the affordability of the consultations, subsequent tests and nutritional supplements and (ii) questioning whether Nutritional Therapy was value for money given that they already had a strong knowledge of nutrition and health needs prior to seeking the appointment. There was a perception that Nutritional Therapy is expensive.
(iv) Unrealistic expectations
A final potential barrier which arose in some participants accounts relates to what were perceived as ‘unrealistic’ or ‘difficult to follow’ nutritional programmes. For one participant, these difficulties were overcome by a belief around ‘no pain no gain’. For others participants, they implemented only the parts which they felt were realistic for them and their lifestyle.

Discussion

  • The experiences of nutritional therapy within this particular study were reported as positive by all participants with each demonstrating beliefs in an empowered and action based approach to their health and an open mind about trying alternatives to mainstream healthcare
  • In line with most studies of health behaviours, each individuals decision to seek Nutritional Therapy support was complex and involved a range of factors including ‘push factors’ such as specific health related problems or ‘coming to the end of the line’ in some way with mainstream health services and ‘pull factors’ such as a strong belief in the importance of food and diet
  • Participants saw their relationship with the Nutritional Therapist as intrinsically different to that they may have with a doctor and valued the empowering approach and partnership working
  • Fear of charlatans may be a barrier to individuals taking up Nutritional Therapy. Improvements in regulation , training and stronger publicity about the operation of the professional register may help in the medium to long term
  • The beliefs about the inherent safety and ‘naturalness’ of nutritional therapy indicate a need for Nutritional Therapy professionals to clearly discuss safety issues relating to drug-nutrient interactions or other risk issues in their work
  • Nutritional Therapy appears to be valued for both its ‘natural’ and scientific approach – participants value both the educational information and the therapeutic benefit of a personalised and detailed approach