Demographic variables Biological Sex Age Relationship Status Ethnicity Educational attainment Belief variables
Health Locus of Control Religiosity/Spirituality Enabling Variables Income Insurance Status Employment Status Educational Funding Need Variables Diagnoses Physical Health Mental Health Physical Functioning Emotional Functioning Role Functioning Social Functioning Mental Health Bodily Pain Vitality General Health Outcome Variables Lifetime CAM use Last 12 month CAM use
Demographic Questionnaire Male/Female
Date of Birth
Single, Married, Separated/Divorced/Widowed Ethnic Background
Current level of education, years in college
Ratings on the MHLC internality, powerful others externality, and chance externality.
Ratings on the BMMRS 12 subscales: Demographic Questionnaire
Household income for the past year
Type of insurance; insurance coverage of CAM Unemployed, part-time, full-time, disability How education is funded
Demographic Questionnaire: ever diagnosed; condition name SF36v2 Physical Health Component Summary Scale T-scores SF 36v2 Mental Health Component Summary Scale T-scores SF 36v2 physical functioning subscale score
SF36v2 role-physical functioning subscale score SF36v2 role-emotional functioning subscale score SF36v2 role-social social functioning subscale score SF36v2 mental health subscale score
SF36v2 bodily pain subscale score SF26v2 vitality subscale score SF36v2 general health subscale score
Total score for number of services used for each domain Total score for number of services used for each domain
Figure 3. A summary of study variables.
CAM Utilization
Because no standardized measure of CAM use exists, a measure of CAM use was designed specifically by the researcher from a comprehensive review of measures used in previous research. Borrowing from Johnson and Blanchard (2006) and the National
Health Interview Survey (NHIS) CAM supplement (NHIS, 2007), the questionnaire consisted of 144 questions that assessed life time and past 12 month use of the 36 types of CAM therapies defined by the National Center for Complementary and Alternative Medicine (NCAAM, 2008) as well as frequency of use and reason for use. The NCAAM groups these products and services into four broad categories including: alternative medical systems, biologically based therapies, manipulative and body based therapies, and mind-body therapies. For purposes of consistency, the questionnaire used in this study presented CAM products and services in the same manner. For ease of
administration and to prevent participant fatigue questions were presented in a format that allowed individuals who never used a type of CAM to skip the associated questions.
Health Status and Quality of Life
Health status was measured using the Short Form Health Survey (SF-36v2; Ware, Snow, Kosinski, & Gandek, 2000). The Short Form Health Survey (SF-36) is a 36-item general health survey that assesses eight dimensions of health-related quality of life: physical functioning, role-physical, bodily pain, general health, vitality, social
functioning, role-emotional, and mental health. These eight subscales are combined to form the Physical Health (PCS) and Mental Health (MCS) Component Summary scales. The Mental Health Component Summary scale will be used to give an indication of levels of psychological distress and psychological well-being. Raw scores on the PCS and MCS scales and transformed into a linear t score giving both scales a mean of 50 and a standard deviation of 10. Numerous studies with various populations in a variety of contexts suggest that the SF-36 has sufficient evidence for its content, criterion (Kagee,
2001), construct (Jenskinson, 1999), and predictive validity (Ware et al., 2000) as well as its test-retest reliability (PCS, α = .92; MCS, α =.91) and internal consistency (Alonso et al., 2004).
Health Locus of Control
Health locus of control was measured by the Multidimensional Health Locus of Control scale (MHLC; Wallston et al., 1976b). This measure asks participants to rate their level of agreement with 18 items on a 6-point Likert scale ranging from strongly disagree (1) to strongly agree (6). Ratings on the MHLC provide scores ranging from 6 to 36 for three 6 item subscales; internality, powerful others externality, and chance
externality. Higher ratings on a subscale indicated a higher orientation towards that locus of control. The MHLC has good internal consistency (α = .60-.75) and test-retest
reliability (.60-.70; Wallston, 2005).
Religious and Spiritual Beliefs
Empirical research suggests that religiosity and spirituality (R/S) are
multidimensional constructs. For the purposes of this study, R/S was measured using the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS; Fetzer Institute/ National Institute on Aging Working Group, 1999). The BMMRS was developed as an assessment tool suitable for use in health research (Fetzer Institute/National Institute on Aging Working Group, 1999). It has been used in numerous studies of adults and adolescents and has established psychometrics among adults (Idler et al., 2003; Shahabi et al., 2002). The BMMRS has 12 subscales: daily spiritual experiences, meaning, values/
beliefs, forgiveness, private religious practices, religious and spiritual coping, religious support, religious/spiritual history, commitment, organizational religiousness, religious preference, and overall self-ranking. The scale and number of items on each subscale differ. Scales are scored on either a 2-point scale (yes/no), a 4-point scale (strongly agree –strongly disagree), a 6-point scale (never-more than once a week), or an 8-point scale (never-more than once a day). The number of items for each subscale range from two to seven with lower scores indicating higher ratings on that domain. The BMMRS subscales have been used in clinical research on adults and have well established reliability and validity (Fetzer Institute & Nation Institute on Aging Working Group, 1999; Stewart & Koeke, 2006). Several studies have provided limited support for the validity and
reliability of the BMMRS and substantial support for the measures multidimensionality (Piedmont, Mapa, & Williams, 2007; Stewart & Koeske, 2006). In a recent examination of the psychometric properties of the BMMRS among college student Masters and colleagues (2009) provided preliminary support for the psychometric properties of the BMMRS and revealed a seven factor model that may provide a better fit for a
multidimensional measure of R/S.
Data Analysis
Data was analyzed using the Statistical Packages for Social Sciences version 20 (SPSS 20.0). Descriptive statistics including percentages, means, and standard deviation were used to characterize the sample in relation to the study variables. Intercorrelations between the variables were assessed using Pearson correlation coefficients. The first and
second research objectives were addressed by calculating the descriptive statistics and the intercorrelations among the predictor variables of interest and multiple measures
associated with CAM utilization. The third objective was addressed by using a series of multiple linear regression analyses to test the strength of a multivariate predictive model of CAM utilization. Specific research questions and their corresponding data analyses are summarized in Figure 4.
OBJECTIVE 1: Research Questions OBJECTIVE 1: Data Analyses