Developmental issues in chiropractic: a South African practitioner and patient perspective.

OBJECTIVE: This study explores pertinent aspects of chiropractic practice in contemporary South Africa in terms of the domains of beliefs, philosophy, professional matters, and education.

METHODS: Ten practitioners were purposively sampled. From these, 3 were used as gatekeepers to access 6 patients. Semistructured interviews were conducted with the 16 respondents, and computer-assisted thematic analysis was used to interpret data.

RESULTS: The practitioners in this study distinguish between 2 main views of the chiropractic identity--the "technician" and "physician." The patients interviewed responded that the strengths of the chiropractic profession lie in its social desirability and its health care utility. Two factors seem important in endorsing chiropractic, namely, on the grounds of patient beliefs and philosophical views with respect to health care and the model of practice encountered in the chiropractor's office. However, some patients seem confused by the lack of health care system integration and consequently display uncertainty of the status the chiropractor can claim professionally and educationally. Practitioners portrayed a view, indicating that chiropractic cannot claim coherence in any of the 3 domains investigated. Issues such as the apparent lack of conceptual identity of chiropractic; the absence of a coherent, marketable model of chiropractic practice; and poor interprofessional relationships with mainstream health care stakeholders were observed. The issue of integrated public health care practices as part of the education process and the concomitant perceived lack of exposure especially to black South Africans emerged as interesting and pertinent developmental themes in the local context.

CONCLUSIONS: The international discourse related to issues in the domains of philosophy, professionalism, and education and their effect on the practice of chiropractic seem reflected locally. The notion that an increased presence in the public sector might simultaneously increase social awareness and facilitate health care system integration requires further investigation.