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Study: Potential Factors Influencing the Use of Massage therapy

Purpose: The objective of this exploratory, cross-sectional, and multi-site study, ethically approved by the University of Toronto, was to ascertain characteristics of chronically-ill, non-institutionalized Toronto (Ontario Canada) area residents (aged 60 and over) who: (1) used, (2) had stopped using or (3) had never used registered massage therapy. Due to space limitations, only a few of the analyzed variables are noted below.

Context: Reasons for the use of complementary/alternative medicine (CAM), such as massage, and the characteristics of its users, remains poorly understood. Increasing use of CAM services has spurred a need for health services research to examine the patterns and correlates of such usage. Although chronic conditions
and disability are frequently cited in the literature as a predictor of CAM usage, to date there is little to no information regarding who among the chronically ill tend to use specific modes of CAM, like massage.

Sample Characteristics: To have been eligible to participate, respondents had to be: (1) aged 60 and
over; (2) willing to complete (and mail) a consent form plus a 15-20 minute postal questionnaire (using a
stamped-addressed envelope provided); (3) be a non-institutionalized (community-dwelling) Toronto area resident; (4) have one or more self-reported chronic health conditions (on-going for 6 or more months) and, (5) be able to understand and communicate in English. Out of 157 postal questionnaires returned, 16 were disqualified as they did not meet the above inclusion criteria.

A total of 141 qualified respondents participated after a pre-test of the postal questionnaire which was developed by this researcher. A web site was also developed by a software engineer, Qing Zhu, to help inform massage therapists and others about the study (http://www3.sympatico.ca/qing.zhu/mtstudy.html). Respondents included 44% Users (n=62); 15% (n=21) Former Users and 41% (n=58) Non-users of (registered) massage therapy (MT).

Age Characteristics: At the time of the data collection, 13% (n=18) were aged 60-64; 25% (n=35) were aged 65-69; 21% (n=30) were aged 70-74 while 41% of the sample (n=58) were aged 75 and over. The minimum age of the total sample was 60 and the maximum age was 94, with
a mean of 73 (Range = 34).

Gender Characteristics: Females represented 78% of the total sample (n=110) while males represented 22% (n=31). Forty-three females (69%) and 19 males (31%) were Users of MT (of n=62). Seventeen females (81%) and 4 males (19%) were Former Users (n=21). Of the Non-Users, 50 were females (86%) and eight (14%) were males.

Educational Background: Thirty per cent of the Users of (MT) reported having a high school education
or less, followed by 60% of the Non-Users and 48% of the Former Users. Sixty-eight per cent of the Users of MT reported having more than a high school education, followed by 40% of the Non-Users and 52% of the Former Users. Missing data in this category only accounted for 1% of the results. Spouses of the Users of MT were also noted as having more formal education than the spouses of both Former and Non-Users of MT.

Marital Status: The majority (38%) reported being widowed, followed by 31% who were legally married (not separated), 16% who were divorced; 12% indicated they were single and never married, and 4% who reported being married and separated. The majority of Non-Users (n= 32, 55%) and Former Users (n=7, 33%) stated that they were widowed. This compared with only 23% (n=14) of the Users.

Income of Respondents: Eight ordinal-level categories were used in the last question of the postal questionnaire to help ascertain the respondent’s total household annual income from all sources. This was then later collapsed into three categories to which 129 respondents (92%) responded. Of these, 47 per cent of the sample (n=66), indicated an annual income of $0-29,999; thirty percent of the sample (n=42) indicated an income of $30,000-$59,999 while 15% of the total sample (n=21) reported receiving
an annual income of $60,000 or more.

Non-Users of massage therapy (MT) indicated a frequency of n=33 in category 1 ($0-$29,999) at 57%, n=20 in category 2 ($30,000-$59,999) at 34%, and an n=4 (7%) in category 3 (at $60,000 or more). One Non-user (2%) did not respond.

Users of massage therapy (27%) were in category 1 ($0-$29,999); n=20 (32%) in category 2 ($30,000-$59,999); and an n=16 (26%) in category 3 ($60,000 or more). Nine MT Users (15%) did not respond to this question.

Former Users of MT show a frequency of n=16 in category 1 at 76%; an n=2 (10%) in category 2; and an
n=1 (5%) in category 3. Two Former Users (~9%) did not respond.

Occupational Background: Respondents were grouped into one of three categories. Those who fit the profile of “category 1” included the self-employed, professionals, managers, semi-professionals and technicians. Sample occupations in this study included: accountants, professors, social workers, teachers, a storeowner and an executive. Representatives of “category 2” included supervisors, foreman/women, trades people and skilled clerical, sales and service personnel. Example occupations included: carpenters, social service worker, medical secretary and truck drivers. And, within “category 3” occupations included semi and unskilled clerical, sales and service personnel, and manual workers. Example occupations represented in this study included: home makers, factory workers, sales clerks, a laundry worker and data entry clerks. 

The total overall sample yielded 48 individuals who were in category 1 of which 58% (n=28) of these were Users of MT followed by 33% (n=16) of Non-Users and 8% (n=4) of Former Users. Of the 41 respondents placed into category two, 44% (n=18) were Users of MT followed by 34% (n=14) of Non-Users and 22% (n=9) of Former Users. Lastly, those in category three (n=49), represented 57% (n=28) of Non-Users, 29% (n=14) of Users and 14% (n=7) of Former Users. Data missing in this category included three respondents, or 2% of the total sample.

A measure of the respondent’s self-reported last held or current position, found that 34% were located within category one, 29% in category two and 35% within category three. Of the total of 48 individuals found in category 1, 58% (n=28) were Users of MT followed by 33% (n=16) of Non-Users and 8% (n=4) of Former Users. Of the 41 respondents placed into category 2, 44% (n=18) were Users of MT followed by 34% (n=14) of Non-Users and 22% (n=9) of Former Users. Lastly, those in category 3 (n=49), represented  57% (n=28) of Non-Users, 29% (n=14) of Users and 14% (n=7) of Former Users.

In terms of the respondent’s self-reported position held most of his or her life, 40 individuals found in category 1, 55% (n=22) were Users of MT followed by 38% (n=15) of Non-Users and 8% (n=3) of Former Users. Of the 29 respondents placed into category 2, 45% (n=13) were Users of MT followed by 38% (n=11) of Non-Users and 17% (n=5) of Former Users. Lastly, those in category 3 (n=59), represented  47% (n=28) of Non-Users, 39% (n=23) of Users and 14% (n=8) of Former Users.

Usual Method of Payment to Use MT:  Of the Users and Former Users of MT, the primary means of payment came out of pocket at 72.6% and 71% respectively. Of Former Users, 4.8% indicated they paid via private insurance, and 4.8% through other means. Five percent of the Former User sample did not indicate how they paid.  Users on the other hand showed more diversity in the manner they paid for massage therapy (e.g. paid by a family member, friend or relative). Eighteen percent of Users paid via private insurance.

Added Health Insurance Status: Respondents were asked to answer either yes of no to the question: “do you have added health insurance (beyond OHIP – the Ontario Hospital Insurance Plan). Table 1 (at right) provides a summary of participant’s responses.

Study Limitations
This researcher acknowledges that, as a cross-sectional study using a purposive sampling technique, respondents may not be representative of the Toronto population. Further, it is possible that, given the subjects for this study were volunteers, they may have been more interested in the area studied than non-volunteers, therefore, further reducing generalizability. This refers to the notion that the individuals who did participate may possess characteristics apart from non-respondents thereby limiting the generalizability of the findings. Nevertheless, as an exploratory study, findings can provide important information for future (e.g. longitudinal) studies. This study was also limited to the extent that self-reported behavior may not mirror actual behaviors. However, the nature of the postal questionnaire items used in this study does not suggest that unusually strong bias or distortion would be expected as might be in the case with more sensitive topics.

Summary
Findings of this study is indicative of the literature regarding CAM users in general whereby such users tend to have more formal education as well as higher class occupational backgrounds. spouses of Users of MT were also found to have more formal education than those of Non-Users and Former Users. Subsequently, most of the Users of MT were found to have higher incomes and were more apt to have and use added health insurance (beyond OHIP) to pay for their massage. Interestingly, of face-to-face interviews (qualitative data) collected as well (n=28, data not shown), Users of MT with low incomes were reported as saying they were willing to go without food to have a massage as it was that important to them. More research and funding on this topic is warranted.

Acknowledgements
Special thanks goes to Mr. Douglas E. Aboud (RMT) of Toronto who was a tremendous help. Thank you as well to all of the randomized massage therapists who participated in this study and, of course, to all of the informed and consenting (purposively sampled) respondents who took part. I am also very grateful to present and former members of ICT™ Kikkawa College (Toronto), like Brad McCutcheon, for their encouragement and inspiration in getting me started. The efforts of my Dissertation Committee and supervisor, Dr. Victor Marshall, is also appreciated.