Complementary and Alternative Medicine (CAM)

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Chapter 3 Methodology

Qualitative Research Methodology

This study was explorative in nature as insufficient research had been undertaken in the area of Reiki therapy and the impact it has on the quality of life of PLWH. Due to the nature of the study objectives qualitative research methods were used. Specific research objectives are (1) The perceptions and experiences of PLWH of Reiki therapy as a complementary and alternative treatment. (2) The perceived benefits of Reiki therapy for PLWH who received Reiki therapy as a complementary and alternative treatment. (3) The perceived obstacles to the general use of Reiki therapy for PLWH who received Reiki therapy as complementary and alternative treatment.
Whereas there have been a number of studies exploring the reasons why people opt to use CAM ( Ernst & White 2000; Vincent & Furnham 1996; Zollman & Vickers 1999) few studies were done in which people were actively recruited into the use of CAM and asked to describe their first-hand experiences (Cartwright & Torr 2005). Due to the fact that the field of people’s first-hand experiences with CAM is relatively unknown, and due to the personal nature of the involvement of the researcher with the research participants, a qualitative approach was chosen for this study.
According to Creswell (1994:94-96) “Qualitative research is an inquiry with the goal of understanding a social or human problem from multiple perspectives; conducted in a natural setting with a goal of building a complex and holistic picture of the phenomena of interest.” Qualitative methods can be used to obtain the details about phenomena such as feelings, thought processes, and emotions that are difficult to extract or learn about through more conventional methods.
In this chapter, the study design and the chosen idiographic approach are discussed. Further, the role of the researcher and the volunteer participants, the recruiting of participants, the interviews and the problems experienced recruiting volunteer participants for the research are discussed. The method of data collections, data analysis and ethics follows thereafter.

Study Design

Using a qualitative approach, seven persons living with HIV were recruited as volunteer participants in the study. Because the aim was not to measure the research participants’ responses to Reiki by means of objective behavioural indicators, but rather to give an account of their first-hand experiences with Reiki as naturally occurring data, an idiographic qualitative approach was chosen. With the notion “naturally occurring data” it is implied that respondents were recruited among people living with HIV and choosing voluntarily to be exposed to Reiki as a CAM-intervention for the first time in their lives. The aim was to capture these research participants’ initial expectations of Reiki as CAM, their first-hand experiences of Reiki and of the training and their self-reported experiences of the benefits or disadvantages of Reiki a few days after practicing self-healing. Following the cognitive appraisal model of stress and coping, the intention was to see to what extent (if any) Reiki therapy was able to help the research participants cope with the appraisal of their illness and with their symptom experiences to help them adjust to living with HIV. Since very little research was undertaken on the experiences of PLWH with Reiki treatments, the researcher felt the need to research and document a complementary medical support system for people living with HIV. Initially PLWH were recruited via the voluntary counselling and testing (VCT) Clinic at the RK Khans Hospital. This proved to be difficult for various reasons. The reasons for non-participation are discussed further on in this chapter. Recruiting, training and self-healing were undertaken over a 6 month-period. Interviews were conducted before and after Reiki attunement and Reiki self-healing. Semi-structured interviews were employed.
Reiki attunements and training were undertaken by the researcher who is a qualified Reiki Master/Teacher. Participants were then requested to perform self-healing in the privacy of their own homes. Their self-healing was in no way manipulated by the researcher. They were asked to monitor and record changes independently. Reiki sessions were not controlled by the researcher. The researcher however had telephonic contact with the research participants to provide supportive services and to ensure healing was being undertaken regularly.

An idiographic approach

In this study an idiographic approach was used because of the exploratory nature of the study. In this respect Mason (1996), mentions that in such an approach human experiences are examined through the detailed description of the people being studied – the goal is to understand the “lived experience” of the individuals being studied. This approach involves researching a small group of people intensively over a long period of time. According to Creswell (1994), investigating a particular phenomenon occurs over three major phases. This is intuiting, analysing and describing. The first process is to understand and know the phenomenon, which is Reiki therapy. In this study the idiographic approach led to data collected from the PLWH who described their experiences with Reiki therapy. In the analysis, the different elements of the Reiki experience were examined.

The Role of the Researcher

It is important for the reader to understand the background of the researcher in order to better comprehend the analysis and conclusions made by the researcher. The researcher was an Asian female with an Honours degree in Social Sciences, a counsellor for 20 years and a Reiki Master/Teacher for 10 years who has gained extensive experience in counselling and using the different methods of Natural Healing techniques. The researcher’s belief systems acknowledge the existence of energy, spirits and a higher power. By working with clients who have been healed for many ailments through Reiki therapy and other forms of CAM therapies, the researcher felt the need to research and document the benefits of Reiki therapy as a complementary medical support system for people living with HIV. The researchers’ role was to recruit participants for the study, to attune and train research participants to the level of First Degree Reiki. Participants were then requested to continue with self-healing and record their experiences. Researcher conducted two in-depth interviews, one before Reiki attunement and one after Reiki attunement and self-healing. The researcher was also available to participants for counselling and supportive services.
3.5 The Research Participants
The researcher’s initial plan was to recruit research participants at the VCT Clinic at the RK Khans hospital. Pragmatic decisions had to be made in the field to accommodate fears, reservations and obstacles in finding people willing to participate in all aspects of the study. The relative unfamiliarity of medical and supportive staff and of PLWH as service recipients in the public health sector with CAM proved to be one of these obstacles in the field. For this purpose, the researcher spent three months at the hospital, informing the staff and attending support groups for PLWH. The researcher subsequently had individual discussions with interested participants after the support group sessions and made arrangements for the first interview and signing of informed consent forms. During the initial recruitment phase, it was found that many participants would promise to attend a scheduled appointment, but then failed to turn up on the day. Numerous calls were made to follow up, but all proved unsuccessful.
The researcher addressed the staff at the VCT clinic on Reiki therapy and answered their queries about the research. The staff promised to assist with recruiting participants for the study. The researcher thereafter attended support group sessions for PLWH at the hospital. In the course of these sessions, the researcher explained the concept of Reiki therapy and the goals of the research in an attempt to recruit volunteers for the study. Flyers, explaining Reiki therapy, the research and including the contact details of the researcher were distributed to people living with HIV who attended the clinic and the researcher was available on the premises should there be any queries. Many people living with HIV came to the researcher for basic counselling and queries about their social grant applications. As a social worker, the researcher was able to assist with their queries and to act as a resource person in the support group sessions.
Many PLWH attending these group sessions showed interest and arranged to meet the researcher for an initial interview. However, out of the 20 people living with HIV attending the support group sessions, only 3 people living with HIV were prepared to become participants in the study. Reasons given by the people living with HIV for not participating in the study were:
1. That it was too far and too costly to travel to the hospital 3 times (that is for the initial interview, the training and the final interview)
2. That they had no bus fare
3. That they did not understand the concept of Reiki healing because it was foreign and new to them
4. That their partners prevented them from coming back to the hospital.
Language turned out to be another problem. Although an interpreter was available, it soon became apparent to the researcher that many concepts in Reiki could not be translated with ease and explained adequately via a translator. The participants who eventually participated in the research spoke and understood English. There was no need for an interpreter. The researcher does not speak or understand isiZulu. The majority of the people living with HIV at the clinic were from the lower socioeconomic group, were unemployed and spoke very little or no English. The staff at the VCT Clinic at RK Khans Hospital however, were very helpful and assisted wherever possible. They allowed participation in the support groups, helped interpret in isiZulu when necessary and also referred PLWH for the research. The staff also allowed the researcher to use their premises for interviews and Reiki training.
Because of these difficulties in recruiting, potential research participants were invited to approach the researcher via articles placed in the community newspapers and the Sunday Tribune. Again few people responded. Finally four people living with HIV were recruited via the newspaper articles. All four of these participants reported that they were comfortable about their HIV-positive status and that they did not mind being in a group with other people who were HIVpositive. Although the researcher offered to perform individual training to protect their identities, all of the participants were willing to become part of a group. Interestingly, many people claiming to be HIV-negative responded to the newspaper articles. In this respect, forty-five people were interested in obtaining Reiki training or Reiki treatment for other (non-HIV) ailments.
The initial arrangement to conduct two half-day workshops to train and attune participants also had to be changed in the field to accommodate the needs of the research participants. Instead, a full day training session was conducted with the participants. This helped overcome problems with travelling and time constraints for those in employment. The researcher conducted the training alone, as the number of attendees (seven in total) was small and manageable. The seven research participants were trained in three separate groups: one group of three participants at RK Khans Hospital and two groups with two participants per session at the researcher’s clinic.
The participants were issued with a comprehensive training manual and an audio tape on Reiki therapy. The course covered the history of Reiki therapy; the principles of Reiki therapy; the benefits of Reiki therapy and how to heal oneself and others. Participants were also awarded with a certificate acknowledging completion of First Degree Reiki.
Prior to the Reiki attunement and training, all the research participants were asked to sign an informed consent form (see copy in Appendix A) and the first interview was conducted. Final interviews were conducted after 21 – 30 days of self treatment, depending on the availability of the participants.

Data Collection

Data were collected through interviews using semi-structured interviews. Additional information was collected during discussions during training sessions and during telephonic conversations with the research participants to monitor their progress. Each participant was exposed to two in-depth, face-to-face interviews with the researcher, one after the initial agreement to participate and one interview after 21-30 days of self-healing.
At the first interview, each research participant was familiarised with the goals of the study and initial data were gathered on each participant’s views, attitudes and expectations of Reiki therapy. Moreover, research participants were prompted to talk about their quality of life at that time. In the final interview each participant’s overall experiences of Reiki therapy was assessed in terms of symptom experiences, feelings of well-being, appraisal of illness and adjustment to living with HIV.
The questions in the semi-structured interviews were open-ended to help capture what participants felt before and after treatment, in their own words. All interviews were audio taped with the participants’ consent. Notes were also made of all interviews to supplement the transcripts. All information regarding the participants and notes were stored securely by the researcher.

Data Analysis

All interviews were transcripted and augmented with notes taken as back-up. Prior to data analysis the transcripted interviews were read several times. Participant’s responses were written up as detailed narratives. Each session was carefully described using the verbatim transcripts from the interviews and supported from the researcher’s notes. The descriptions of the participants’ experiences were grouped according to the original study objectives. The study objectives were then transformed into categories based on how the participants described their experiences with Reiki.

Ethical considerations

Ethical approval was obtained from the University of South Africa, through the Department of Sociology’s Ethics Committee. Ethical approval was also obtained from the Kwa-Zulu-Natal Department of Health through its Health Research and Knowledge Management Sub- Component. These different layers of ethical approval were required for approval to work with people living with HIV at the RK Khans Hospital.
Consent letters were given to and signed by all participants. All identifying information of each participant was treated as highly confidential. Pseudonyms were used for the research and for presenting data. Attunement and training were undertaken in groups with the consent of the participants.

Concluding remarks

This study was a qualitative exploratory study. The volunteer participants were recruited in and around the Durban area. Recruiting volunteer participants seemed difficult due to various reasons, however those that participated in the research enjoyed and benefited greatly from the experiences (refer to findings in Chapter 4). The researcher strongly recommends further research in this area.

Chapter 4 Analysis and findings

Introduction

Seven people living with HIV who have never before used CAM took part in the study. In this chapter, the results of the interviews and conversations are discussed according to the following sub-themes: the profiles of the seven research participants who were HIV-positive; a table with the demographic characteristics of the research participants followed by detailed description of the research participants and their responses before and after Reiki attunements and self-healing. Verbatim transcripts from the interview are added to support the researcher’s comments.

Profiles of the seven research participants who were HIVpositive

Seven participants residing in the Durban and surrounding areas who were HIV-positive were recruited for the study. Three of the research participants were attending the VCT clinic at the RK Khans hospital, the other four research participants were recruited via newspaper articles. The ages of the research participants ranged from 25 to 52 years. The majority of the participants were female and only one male was willing to participate. Three of the participants described themselves as black African, three as Asian and one as Coloured. Only one of the research participants, Peter, was employed at the time of recruitment. Three participants, Jane, Alice and Carol secured employment near the end of the fieldwork period.
All research participants except for Peter presented with some or all of the following symptoms which are symptoms experienced by PLWH as discussed in Chapter 2, namely depression and suicidal behaviour, emotional distress, anxiety, fear, feelings of helplessness, feelings of loss of control, a diminished sense of coherence, lowered self-esteem and internalised stigma resulting in self-blame and guilt. The research participants also reported depleted energy levels, sleeplessness and self-imposed isolation. Further, all research participants except Peter reported to be experiencing severe pain in different parts of their bodies and to be self-medicating themselves with over-the-counter pain killers to ease the pain.

TABLE OF CONTENTS
Acknowledgements
Declaration
Summary
Table of Contents
List of Tables
List of Figures
List of Abbreviations
Chapter 1:  Statement of the problem  
1.1   Introduction
1.2   Purpose of Study
1.3  Research Questions
1.4  Complementary and Alternative Medicine (CAM)
1.5  Rationale for the study
1.6  Research Approach
1.7  Significance of the study
1.8  Structure of the Dissertation
1.9  Concluding Remarks
Chapter 2:  Review of Literature   
2.1     Introduction
2.2  Reiki Therapy
2.3  Scientific studies on the effectiveness of Reiki  Therapy
2.4  Conclusion
Chapter 3:  Methodology 
3.1  Qualitative Research Methodology
3.2  Study Design
3.3  An Idiographic Approach
3.4  Role of the Researcher
3.5  The Research Participants
3.6  Data Collection
3.7  Data Analysis
3.8  Ethical Considerations
3.9  Concluding Remarks
Chapter 4:  Analysis and Findings  
4.1  Introduction
4.2  Profiles of the research participants who  were HIV-positive
4.3  Discussion of the research participants’ adjustment to   living with HIV prior to and after their introduction to   to Reiki therapy
4.4.  Conclusion
Chapter 5: Conclusion 
5.1  Introduction
5.2  Reiki as CAM
5.3  Reiki Research
5.4  Effects of Reiki Therapy
5.5  CD4 Count
5.6  Perceived Barriers to using Reiki as a form of CAM
5.7  Limitations
5.8  Further research
5.9  Conclusion
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