The following data is from
THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 10, Number 2, 2004, pp. 357-367
© Mary Ann Liebert, Inc.
Wellness Lifestyles II:
Modeling the Dynamic of Wellness
TONYA L. SHUSTER, Ph.D., MARNIE DOBSON, Ph.D. (Cand.) MARITZA JAUREGUI, Ph.D., and ROBERT H.I. BLANKS, Ph.D.
ABSTRACT
Objective: Empirical application of a theoretical framework linking Network Spinal Analysis (NSA) ; a holistic, wellness-oriented form of complementary and alternative medicine [CAM], health lifestyle practices and wellness.
Design: Cross-sectional self-administered survey study.
Respondents: Two thousand five hundred and ninety six (2596) patients from 156 offices who were members of the Association for Network Chiropractic (currently titled Association for Network Care ); estimated response ate was 69%.
Measures: Exogenous variables entered into the structural equation model include gender, age, education, income, marital status, ailments, life change, and trauma. A wellness construct consisted of calculated difference scores between two referents, presently and before Network care, for self-reported items representing wellness domains of physical state, mental-emotional state, stress evaluation, and life enjoyment. Positive reported change in nine items assembled into dietary practices, health practices, and risk dimensions serve as indicators of the construct of changes in healthy lifestyle practices. The NSA care construct consisted of duration of care in months, awareness of breathing since beginning Network care.
Results: Of the exogenous variables only gender, age, and education remain in the final parsimonious structural equation model in these data. Reported wellness benefits accrue to individuals along a direct path from both self-reported positive changes ( 0.22), and from NSA care (0.43), The path (0.65) from NSA care to positive health lifestyle changes that indicates NSA care also has an indirect effect on wellness through changes in health lifestyle practices.
Conclusion: The Structural Equation model tested in these analyses lends support to our theoretical framework linking wellness, health lifestyles, and CAM. The study provides further evidence that our measurements of health and wellness are particularly appropriate for investigating wellness-oriented CAM. There is a positive relationship between the experience of NSA care and self-reported improvements in wellness as well as self-reported changes in lifestyle practices. NSA care users tend toward the practice of a positive health lifestyle which also has a direct effect on reported improvements in wellness. These empirical links are discussed relative to the sociodemographic characteristics of this population and show that use of NSA care is an aspect of a wellness lifestyle.
Reduced final structural equation model.
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Key to Construct and Variable Labels
Ovals = hypothesized constructs
Rectangles = measured/observed variables (sets of variables)
Circles = Measurement error.
Exogenous Variables age cat: age in categories, male = 1.
Postcoll: post college education = 1., rincdol: income in dollars, midpoint of range ($15, $30, $40, $50, $60 thousand)
CARE NSA = Care construct: rcarecat: length of time in care characterized in months
Rbreath: presently more aware of energy =1 raware: presently more aware of breathing =1
LIFESTYLE = Health Lifestyle Change Construct: pchdiet: positive change in dietary practice = 1 pchrisk: positive change in health risky behavior =1 pchprac: positive change in health practice = 1
WELLNESS construct: dfstrs: differences scores in stress evaluation items. Dfphys: differences scores in physical state items Dfemos differences scores in mental/emotional state items. Dfenjs: differences scores in life enjoyment items.
In the final model, reported wellness benefits accrue to individuals along a direct path from both self reported positive changes(0.22), and from NSA care (0.43). Note that NSA care directly contributes more than health lifestyles to self reported improvements in wellness by a factor of 2:1.In addition, the path (0.65) from NSA care to positive health lifestyle changes provides evidence that these individuals are likely to have also effected positive changes in their health-related lifestyles practices (which in turn,impacts wellness) during the time they received NSA care. Thus NSA care contributes both directly and indirectly (through lifestyle) to self reported wellness.
DISCUSSION
This study represents the first empirical application of our theoretical framework which proposes dynamic links among wellness,health lifestyle practices, and an holistic form of CAM (Schuster et al., pp349-356), in this case Network Spinal Analysis. We utilized SEM to investigate relationships among these constructs, and found evidence that health lifestyle practices influence wellness, and NSA impacts wellness both directly and indirectly through influence on health lifestyle practices. These complex interrelationships then indicate that use of NSA as a wellness - oriented CAM modality is an aspect of a wellness lifestyle.
The results of our investigation also provide evidence that positive health and wellness can be operational zed and utilized to comprehensively investigate the benefits associated with holistic CAM modalities. The confirmatory factor analysis strengthen the conclusions from our earlier reliability studies that these survey items meaningfully capture four coherent wellness themes as well as an overall wellness integrated wellness construct. The retrospective recall approach taps into explicitly referenced individual self- perceptions; the breadth of these items taps into multiple domains of health, and the statistical strategy integrates the domains into an unconstrained generalized self-perception of health we have termed wellness (Schuster et al., pp.349-356). With this we were able to detect positive change in an already well population. We anticipate that the current revision of our SRHW instrument will more fully address each of the domains of health (physical, mental, social, and spiritual) as well as other known precursors to health ( e.g., positive and negative aspects of the immediate social environment of interpersonal relationships) to yield yet more informative results.
This study demonstrates several major findings. A positive relationship between NSA experience and self-reported wellness was supported by these analysis. Self reported positive changes in health lifestyle practices also influenced wellness. NSA experience had a direct impact on positive changes in healthy lifestyle practices. Finally our results illustrate the relative importance of the sociodemographic factors of age, gender, and education, on thee interrelationships.
The substantial path coefficient linking NSA care and wellness represents the independent influence of NSA care while statistically controlling for other known contributors to wellness, and thus increases confidence that the relationship is not caused by some extraneous associated influence. These results augment the findings of our earlier investigation (Blanks et al.,1997), which showed a significant bivariate association between length of time in care and a summated scale of self-perceived differences in wellness items during NSA care.
Another noteworthy finding is that self reported positive changes in health lifestlye practices influence wellness. While popular wisdom may suggest this, few empirical studies have provided evidence of such a linkage. While the magnitude of the effect is only half of the impact of NSA on wellness. This result may be unique to this population currently participating in NSA, but is further evidence that use of CAM may be part of a wellness lifestlyle.
Particularly important is the impact of NSA experience on positive changes in lifestyle practices. NSA care itself is not administered with this objective in mind (see Epstein 1996), and most practitioners are not trained or practicing as lifestyle or nutrition experts during individual sessions. The mechanism by which NSA care promotes a greater sense of wellness and healthy lifestyle choices is unknown. Individuals may be making positive lifestyle choices based on common health beliefs or values that likewise may self-select them to this type of care. The value of health and wellness as an end to itself (see Schuster, et al pp.349-356) may be part of our cultures growing focus on individual responsibility for health, which may influence the use of CAM modalities. Nevertheless, the significance of NSA (and perhaps other CAM) users engaging in health promoting practices and avoiding health risks without specific patient education programs or urging by the practitioner represents a potential milestone to public health/lifestyle research. Regardless of the specific causal relationships between health lifestyles and CAM use, our findings support the concept of a wellness lifestyle.
Our theoretical framework (Schuster, et al.,pp.349-356) proposed several variables affecting the dynamics among the constructs that were dropped in the final model because they made statistically inconsequential contributions and were not central to the overall framework. Nevertheless, their exclusion in the final model is informative. Changes in marital status, job and residence have been shown to be intense life stressors, so it is notable that significant life changes, as well as degree of trauma, did not affect wellness in the final reduced model, perhaps suggesting that NSA care has stress- buffering effects. That is NSA care is associated with higher levels of wellness in which individuals perceive themselves able to meet life challenges and thus do not perceive them as stressful. Similarly, although we predicted that persistent ailments would impact changes in health lifestyles and wellness, neither of these paths remained in our final model for this population. This is an important finding, lending evidence to our conceptualization of wellness lifestyles, and of wellness as a different and perhaps independent construct than the absence of physical ailments.
The above data was summarized for the purposes of this website. Areas of the original publication were omitted due to the constraints of space available Although all of the above information was extrapolated verbatim from the original publication. Synergy Wellness Center encourages those interested in a more complete study of this extraordinary research to send address reprint request to: Tonya L. Schuster, Ph.D. Department of sociology school of social sciences University of California Irvine 3151 Social Science Plaza Irvine, CA 92697-5100.