‘Forging a conviction’ – participants’ experiences of a western acupuncture randomised controlled trial

Research into acupuncture has shown that individuals continue to report<br/>favourable clinical effects despite the lack of systematic evidence supporting a<br/>point specific therapeutic effect for real acupuncture treatment. This thesis<br/>presents a qualitative study, nested within a large randomised controlled trial of<br/>acupuncture specifically designed to investigate both specific and non-specific<br/>effects of western acupuncture for osteoarthritis pain. The aim was to explore the<br/>non specific effects of acupuncture in a trial context from the participants’<br/>perspective, in particular the therapeutic relationship and any additional<br/>influences on the patient experience that might lead to non-specific effects on<br/>outcomes.<br/><br/>Participants were recruited from hip or knee joint replacement waiting lists and<br/>randomised to one of three treatments (real acupuncture or 2 placebo controls)<br/>and one of two consultation conditions (empathic or non- empathic). The<br/>qualitative methodology was grounded theory. Data collection combined 27 post<br/>trial audio taped, semi structured interviews with post treatment debriefing,<br/>participant and non participant observation and personal reflections.<br/><br/>The findings of this study identified a core category of ‘forging a conviction’<br/>and a substantive theory of ‘active trial participation’ was developed. Participants<br/>gave reasons for entering the trial and for maintaining their commitment to it,<br/>despite numerous barriers. These experiences helped to forge convictions about<br/>the trial interventions and their effects. As a result a combination of specific and<br/>non specific influences appeared to impact on the participants’ reporting of<br/>outcomes, leading to discrepancies between the quantitative and qualitative data.<br/><br/>This theory of ‘active participation’ in clinical trials challenges some of the<br/>basic assumptions of randomized controlled trials, most notably that participants<br/>are passive recipients of an intervention and report its effects factually.

Name dc:type.qualificationname

Ph.D.

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

University of Southampton

Year dc:date.issued

2009

Author dc:creator

• Hill, Clare Marie

Advisors dc:contributor.advisor

• Walker, Jan
• White, Peter
• Lewith, George