Dr Tristan Carter

This study examines various factors surrounding the use of Homeopathy in the UK, including characteristics of users, patient experiences of homeopathic care, disclosure of use and other information sharing, and predictors of use. It is part of a larger project exploring the use of traditional, complementary and integrative medicine in the UK. The study methods involved administration of a national survey to a sample proportionally representative of basic demographics in the UK.

Introduction: There is a need to better understand traditional, complementary, and integrative medicine (TCIM) and health literacy (HL) as intersecting fields of research, and to identify the impact of HL on TCIM use and practices. This is best achieved through validated instruments that measure TCIM-specific HL.
Methods: This critical, systematic review aimed to identify the use and features of validated instruments for measuring HL in the general adult population using TCIM, and the degree to which those elements measure TCIM-specific HL. Evaluation of the methodological rigor of instrument testing and grade determination was undertaken using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and an adapted version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-COSMIN manual for the systematic review of patient-reported outcome measures.
Results: A total of 21 validated HL instruments, identified from 29 studies, were included in the review. Ten instruments were specific or partially specific to TCIM. Most instruments assessed two or more HL domains (n = 14), including five that assessed all four domains of the integrated conceptual model of HL. Approximately one quarter of all instruments received an overall assessment rating of "very good" quality (n = 5), with majority of instruments rating as either "doubtful" (n = 9) or "inadequate" (n = 7) quality.
Conclusion: The examination of HL in relation to TCIM use and users will clearly benefit the TCIM research field and the wider health research community. Focused efforts to develop validated TCIM-specific HL instruments will ensure TCIM use and users are not excluded from HL scholarship and advancements.

Preconception health can be optimized through preconception care, which is considered an effective catalyst for behavior change prior to parenthood and is of paramount importance due to the influence that health behaviors can have on pregnancy and offspring outcomes. The preconception health and preconception health behaviors of males before they become fathers for the first time remain underexplored and are an emerging area of interest for public health and reproductive health research. This article is the first report and quantitative cross-sectional analysis of the national dataset pertaining to male health, Ten to Men, reporting data relevant to male health across the life course, during preconception. This report offers research foresight into the health behaviors (e.g., smoking or alcohol), health conditions, health consultations, medications, health information, and health literacy of Australian males prior to becoming a father (n = 572). The findings of this research support an undervalued albeit indispensable research area by providing up-to-date evidence-based information regarding paternal preconception health and health behaviors. This public health research with a focus on paternal preconception health behaviors and health behavior change can only strengthen the call for preventive health and offer preconception health and preventive knowledge about males for the research community and practitioners.

Objectives: To describe the prevalence and characteristics of traditional, complementary and integrative medicine (TCIM) practice and product use by the population of the UK providing up-to-date data on the landscape of TCIM use in the UK.
Design, setting and participants: A cross-sectional online survey, administered using the Qualtrics platform, among adults (aged 18 years and over) residing in the UK (England, Wales, Scotland or Northern Ireland). Data were collected between May and October 2024. The 40-item instrument covered four domains: demographics, health status, use of health products and practices, and use of health services. Descriptive statistics were used to summarise survey responses, and chi(2) tests were applied to assess associations between participant characteristics and TCIM use. Backwards stepwise logistic regression was conducted to identify predictors of TCIM use across four outcome categories (p <= 0.05).
Results: The sample (n=1559) was broadly representative of the UK population. Prevalence of any TCIM use over a 12-month period was 65.9% with 19.1% consulting a TCIM practitioner and 63.3% using any TCIM product or practice. Bodywork therapists (massage therapists 9.4%, chiropractors 7.9%, yoga teachers 5.0%) and homeopaths (4.1%) were the most commonly consulted TCIM practitioners and Anthroposophic doctors were the least commonly consulted (2.1%). Among TCIM products, vitamin and mineral supplements were the most commonly used (37.3%) and relaxation or meditation practices were reported by 19.4% of respondents. TCIM users were more likely to be female, identify as Asian or Black, have a chronic disease diagnosis, report good health, possess private health insurance, have a higher education level, be employed (or seeking employment) and sometimes experience financial management difficulties.
Conclusions: There is substantial use of TCIM across the UK adult population and there is a need for more research on integrating TCIM into mainstream healthcare and the National Health Service. Clear strategies are necessary to enhance communication between TCIM and conventional healthcare providers, ensure patient safety and promote person-centred, coordinated models of care.

Introduction: The preconception period is an opportunity to address health-related behaviours to optimise pregnancy and child health outcomes. However, preconception health research and practice are primarily focused on females while similar attention on males remains underdeveloped. To address evidence gaps and inform effective paternal preconception health support, the aim of this systematic review was to identify the health beliefs, attitudes, and intentions of males toward pregnancy planning and preconception health and care.
Methods: A literature search was conducted in seven databases: Medline, Embase, PubMed, CINAHL, PsycINFO, Scopus, and Web of Science to identify original research regarding pregnancy planning or preconception health beliefs, attitudes, and/or intentions among generally healthy adult males. Methodological rigour of included studies was assessed using the Newcastle Ottawa Scale (NOS) and the Critical Appraisal Skills Programme (CASP) Qualitative Studies checklist.
Results: Nine studies were included; cross sectional studies (n=6); a qualitative exploratory case study (n=1); a mixed method study (n=1) and a study incorporating qualitative and quantitative surveys (n=1). Analysis identified three broad themes: 1) Importance of Preconception Health and Care; 2) Paternal Preconception Behaviours; and 3) Inequalities in Preconception Health and Preconception Care. Findings reveal 1) Many males did not attend a preconception care consultation and believed it was not needed, or they already knew enough about a healthy pregnancy. 2) Males often agreed that smoking and alcohol consumption can affect the quality of their sperm and sometimes agreed it is important to consume a healthy preconception diet and to be physically active to achieve a healthy weight before conception. 3) For many males, there was a tendency to direct a greater level of responsibility to the female than to themselves regarding preconception health. African American males can feel marginalised.
Conclusion: Males do not always opt for a preconception consultation and many believe they are adequately prepared for a healthy pregnancy. Further, many males place a greater level of responsibility for planning and preparing for pregnancy on their partners rather than themselves. Further research focused upon male experiences and perspectives around preconception health is needed to inform targeted preconception health education, policy and care.

Background: Australia's National Preventive Health Strategy (NPHS) explicitly highlights the important role of primary care in screening for and supporting behaviour change to help reach preventive health goals. Given osteopaths' position as primary care providers in Australia, their role in fulfilling the NPHS warrants consideration. In response, this study aims to investigate osteopaths' perceptions regarding their role in preventive health and their practice behaviours regarding the key priority areas outlined in the NPHS.
Methods: This online cross-sectional 63-item survey was completed by registered osteopaths practising in Australia. Data were descriptively analysed. Participants rated each determinant on a 7-point Likert scale ranging from 'no role at all' (1) to 'a very significant role' (7). Participants rated each determinant on a 7-point Likert scale ranging from 'no role at all' (1) to 'a very significant role' (7).
Results: Participants (n = 220) identified all levels of preventive health as highly relevant for osteopathic practice, with the greatest relevance attributed to secondary prevention (Mean [M]: 6.2; Standard deviation [SD]: 1.2) and the lowest to quaternary prevention (M: 5.7; SD 1.6). When considering the seven priority preventive health topics outlined in the NPHS, participants reported most frequently screening for physical activity (M: 4.7; SD: 0.6) and least for immunisation status (M: 2.1; SD: 1.0). Participants rated patients explicitly asking them about changing their behaviour as having the greatest influence on their decision-making regarding discussing 'healthy eating' (M: 4.5; SD: 0.8), 'physical activity' (M: 4.4; SD: 0.9), 'mental health' (M: 4.4; SD: 0.9) and 'immunisation' (M: 3.8; SD: 1.3) with their patients. Participants reported being likely to undertake a range of actions in response to identifying patient need.
Conclusions: This study suggests osteopaths play a role in preventive health that may be broader than previously assumed yet is still not inclusive of the full range of behaviours required of health professionals if the Australian government is to fulfil the goals and objectives outlined in the NPHS.
So What?: Government initiatives to implement the NPHS must ensure they are leveraging health professionals to their fullest potential.

Objective: To explore the global research funding landscape for traditional, complementary and integrative medicine.
Methods: We conducted a three-part study to assess the global research funding landscape. First, we searched the Dimensions database and online sources using Microsoft Copilot and Google between 12 November 2024 and 22 January 2025 for relevant grants. Second, we analysed national research infrastructure using World Health Organization (WHO) data, verified by regional contacts (14 January-28 February 2025). Third, we appraised selected funders across WHO regions, evaluating funding schemes for innovation, capacity-building and alignment with traditional medicine paradigms.
Findings: We identified 39 927 grants in the Dimensions database, with funding data available for 27 019 grants totalling 24.5 billion United States dollars (US$) for the years 1960 to 2024. Most grants (42.6%; 11 548) were valued under US$ 100 000, and half had a duration of 2-4 years. Cancer and cardiovascular diseases accounted for over half (8385/15 273) of topic-categorized grants, receiving US$ 5.8 billion and US$ 2.2 billion, respectively. Funders were concentrated in the Region of the Americas, and European and Western Pacific Regions. Only seven countries had schemes explicitly funding research for traditional, complementary and integrative medicine. Case study analysis of 40 schemes across 12 countries revealed limited support for traditional medicine paradigms, with few schemes meeting criteria for innovation, capacity-building or sensitivity to traditional knowledge systems.
Conclusion: Funding for traditional medicine research remains disproportionately low relative to its global use. Strengthening support from research funding agencies is essential to achieving the goals of the WHO Global traditional medicine strategy 2025–2034.

Background and purpose: The Practitioner Research and Collaboration Initiative (PRACI), established in 2014, recruited the largest range of complementary medicine (CM) professions in a practice-based research network (PBRN) worldwide. The ongoing success of PRACI and its ability to accurately reflect current CM practice and use requires an updated practitioner membership. This paper aims to report the demographic and practice characteristics of the recently refreshed PRACI membership.
Materials and methods: A cross-sectional survey was administered to those currently in clinical practice within one of nine CM professions: acupuncture, Bowen therapy, Chinese herbal medicine, kinesiology, massage therapy, myotherapy, naturopathy, nutrition, and Western herbal medicine. Responders provided consent to join membership of the PRACI PBRN. The survey covered practitioner demographics, clinical identity and qualifications, clinical career and practice, and practice characteristics.
Results: A total of 922 practitioners across all nine targeted CM professions were recruited with the majority identifying as female and reported practicing in an urban locality. Most common areas of clinical interest were general health and wellbeing, musculoskeletal health, pain management, and women's health.
Conclusion: The refreshed PRACI membership provides world-leading infrastructure to facilitate urgently needed research activity and capacity-building focused upon issues and challenges grounded in CM clinical practice. Such value will build upon and extend the numerous PRACI sub-studies successfully completed, and collaborations successfully undertaken to date.

Adequate folate is essential to prevent neural tube defects; therefore, supplementation with folic acid is widely recommended for women during preconception and early pregnancy. However, the potential risks associated with excessive intake of folic acid and/or an elevated blood folate concentration are not well recognized. The aim of this review was to evaluate the potential adverse health outcomes associated with excessive intake of folic acid and/or an elevated blood folate concentration during preconception and pregnancy. The review included studies that measured intake of folic acid via dietary sources and supplements, and/or quantified serum/plasma and red blood cell folate concentrations. Excessive intake of folic acid and an elevated blood folate concentration were associated with several adverse outcomes. The most notable association was with gestational diabetes mellitus, where elevated intake of folic acid and a high blood folate concentration were found to increase the risk. Excessive intake of folic acid supplements and a high blood folate concentration were associated with gestational diabetes mellitus, and adverse neurodevelopmental issues in offspring, as well as large-for-gestational-age infants and higher birth weight. Clear definitions of safe upper limits for intake of folic acid and blood folate concentration are needed urgently to prevent potential adverse outcomes.

Background: The preconception period allows couples to plan and prepare for pregnancy. However, males can often consider this integral public health topic as a female domain. To better understand and support behaviour change for males before conception, this study aimed to identify and explore the preconception and pregnancy planning health beliefs and intentions of expectant male reproductive partners of pregnant women in Australia.
Methods: An online cross-sectional survey [2020-2021] among males aged 18-49 years who were the reproductive partner (expectant partner) of a pregnant female. Recruitment occurred via social media. The 80-item survey consisted of five sections. Survey items regarding beliefs and intentions were formulated using the Theory of Planned Behaviour. Associations between participants' beliefs, subjective norms, perceived behavioural control, and intentions related to three outcomes (regular exercise, healthy diet, and alcohol avoidance) were estimated using Structural Equation Modelling.
Results: Expectant partners' (n = 136) had a mean age of 31 years. Their beliefs toward regular exercise and their perceived behavioural control to exercise regularly were associated with a greater intention to exercise regularly (Standardised estimate β = 0.54; p = 0.0087 and β = 0.43; p = 0.02, respectively). The beliefs of expectant partners toward alcohol avoidance and their perceived behavioural control toward alcohol avoidance were associated with a greater intention to avoid alcohol (β = 0.43; p < 0.001 and β = 0.36; p < 0.001, respectively). For the healthy diet outcome, subjective norms of expectant partners, and perceived behavioural control to adopt a healthy diet were associated with an intention to adopt a healthy diet (β = 0.23; p = 0.04 and β = 0.47; p < 0.001, respectively). Intention was in turn associated with behaviour for all three outcomes.
Conclusion: Our study demonstrated that the preconception intentions of expectant partners were associated with their preconception behaviours; especially for the intention to exercise regularly or to avoid alcohol. Further studies examining paternal preconception health beliefs, and intentions and the motivations behind health behaviours for males are needed to help develop targeted preconception health promotion messages and interventions that support males to optimise their preconception health.