The pandemic prompted many changes. So, OCA commissioned an Environics Research survey last fall to learn how it has affected Ontarians’ attitudes, goals and behaviours about their health care, including chiropractic care. In this episode, we speak with Nancy Gale, OCA’s VP, Strategic Communications and Stakeholder Management who led this project to discuss highlights of this research. Nancy outlines how consumers’ priorities have shifted, what they're willing to invest in their health, why they are seeking chiropractic care, and more.
The pandemic prompted many changes. So, OCA commissioned an Environics Research survey last fall to learn how it has affected Ontarians’ attitudes, goals and behaviours about their health care, including chiropractic care. In this episode, we speak with Nancy Gale, OCA’s VP, Strategic Communications and Stakeholder Management who led this project to discuss highlights of this research. Nancy outlines how consumers’ priorities have shifted, what they're willing to invest in their health, why they are seeking chiropractic care, and more.
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Key Links to References/Resources Discussed:
About Nancy Gale:
An award-winning accredited Business Communications (ABC) professional, Nancy is Vice President, Strategic Communications and Stakeholder Management for the Ontario Chiropractic Association (OCA). She has more than 25 years of experience designing and executing measurably successful strategies for public and private sector organizations in Canada.
Nancy joined the OCA after more than a decade of experience in leadership roles for several public sector health care organizations, including Southlake Regional Health Centre, Mississauga Halton Community Care Access Centre and Trillium Health Centre.
Episode 8: Ontarians’ Evolving Attitudes on Health Care
Introduction:
Welcome to ON Spinal Chat, where we explore what O-C-A is doing or supporting to help enhance your patient care, grow your practice or advance the chiropractic profession.
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As the pandemic prompted many changes, we wondered how it's affected Ontario's attitudes, goals, and behaviours about their healthcare. So O-C-A commissioned an Environics Research survey last fall to learn what Ontario consumers feel about their health and care, including chiropractic care. I'm Leslie from the O-C-A.
In this episode, I speak with Nancy Gale, O-C-A's Vice President of Strategic Communications and Stakeholder Management. Nancy led this project and helped developed the questions. She also analyzed the data to discover insights to help you enhance your patient care, as well as inform our member programs, services and initiatives.
In today's episode, Nancy shares the most surprising changes in consumer attitudes. She outlines how consumers' priorities have shifted, what they're willing to invest in their health and what this can mean to you and your practice. Nancy also discusses why Ontarians are seeking chiropractic care, for what issues, the online clinic features they value and more.
We also chat about the gap between chiropractor scope of practice, patients' perceptions, what the O-C-A is doing to close these gaps and what members like you can also do. Listen to discover tips that may help you use this research to meet Ontario's evolving needs.
Main Interview:
Leslie:
Thank you Nancy, for joining me today. First off, why did the O-C-A decide to do an Environics Research survey last fall?
Nancy:
Hi, Leslie. O-C-A commissioned independent research in 2021 because we wanted to gain a better understanding of changes in consumer behaviours, as we collectively, in Ontario, recover from COVID-19. We knew that the goals were different from our 2016 and 2019 Environics surveys because not only were we looking at past behaviour, but we wanted to know what consumer attitudes, trends and goals would be. In other words, what was important to consumers? What were they willing to spend on? And how was that behaviour different because of COVID?
Leslie:
So who did we survey and when?
Nancy:
This is well-conducted research, and it's similar to the demographic profile that we had in our 2019 Environics survey. We had a total of just over 1,500 Ontario residents who participated in this study and they represent individuals from East Central, Southwest, Northwest Northern and East, a good cross-section of Ontarians. So, it was about 50/50, men and women. The household incomes were a range from lower-income to a much, much higher income, so that we would have a breadth of those individuals who would have the money possible to pay for their own care. But also as representation of those who had employee benefits. The age was across the board from age 18, up to 75. And we did that intentionally, spreading it across somewhat evenly, so that we would have a good sense of consumer behaviour, consumers’ intention to spend, and what was mattering most to them that would be representative of all the ages of Ontarians.
Nancy:
It wasn't a single demographic. Some of those demographics, like ages 18 to 44, or women over men, we could separate out and single out where there were larger groups of people who were going to take some action over others. We also looked at the number of people in households, from one person in a household, to a much smaller extent, more than five people in a household. And that's an important determinant of disposable income. Education has continued to be an important determinant of those who will seek out chiropractic care. The larger group is 40% who are university educated, followed by those who have a vocational trade school, community college or C-E-G-E-P designation that represents 67% of the constituents that we asked in this survey. That's important because we see an increase in chiropractic care and chiropractic inclination of trust and use of chiropractic care in that demographic. We were in market in September of 2021, so the information is really current.
Leslie:
So what did this research tell us about Ontarians’ current attitude towards their health?
Nancy:
It's really interesting, 7 in 10 Ontarians feel that COVID-19 has made them more conscious of their health. In particular, those who are aged between 18 and 24, who are university educated females. And those who are working from home, and we see that throughout the research.
Leslie:
So how are Ontarians now prioritizing their physical and mental health in terms of the time, as well as the money that they're willing to invest in it?
Nancy:
This is the most important difference that we've learned from this research. Spending time and money on physical health is new. And it is a direct result, we think, out of recovery from the COVID world. When we asked consumers, were they planning to spend more time on their physical health? 47% said that they were planning to spend more time to optimize their physical health. This is a significant change from pre-COVID times.
We also asked, were they planning to spend more money on their physical health? It's really interesting as a determinant of what they intend to do versus what they're prepared to support, almost 20% of consumers plan to spend more money on their physical health.
And when we asked them, how would those increased costs be covered? About 35% said it would be through their employee benefits, about 16% said it would be through personal health spending accounts, 16% said it would be through private health insurance. But a whopping 77% of respondents said that they would pay for their increased focus on physical health through their personal out of pocket expenses. This is a significant investment of consumers’ time and money in their health and it creates an incredible opportunity for chiropractors.
Leslie:
Absolutely. Now, what do we know about these consumers? Does this willingness vary between demographics?
Nancy:
We knew that through the demographic research that it was varying between demographic groups. And what we found out was that residents aged 18 to 44 are more likely to say that they'll spend more money on their physical health.
Leslie:
What about their approach to their mental health?
Nancy:
We separated out mental health and physical health so that there would be a clear delineation for our members and to understand what were consumers prepared to do and to spend on their personal physical health.
We also asked the same question on mental health. And a smaller amount, 12% plan to spend more money on their mental health. And 65% were prepared to do that out of pocket, which was less than the 77% of Ontarians who said that they would pay for that additional focus on their physical health out of pocket.
On time, it was also a bit less on mental health, about 27% said that they were willing to spend more time on their mental health. That's a little bit more than the money they're prepared to spend. And those aged 18 to 44 are more likely to say that they'll spend more time on their mental health.
And that's not surprising given the stress that resulted from COVID, both for isolation and changes and separation from family and friends, connecting with people. It is really important for us to realize that in this research it was reported that overall health is considered to be in better state than mental health. And we want to continue to optimize that benefit.
Leslie:
So in terms of physical health, what issues are prompting Ontarians to seek chiropractic care?
Nancy:
Where we're seeing that there is a bit of a combination of patients not knowing what chiropractors can do in the breadth of their expertise. But we also see that Ontarians are seeking support and treatment for conditions that are not just back pain.
Although, back pain is still is the number one reason why patients will go to a chiropractor. Well, followed by back pain is very closely, neck pain. 43% of Ontarians declared that they went to a chiropractor in the last 12 months for neck pain. Followed by stiffness, stress and strains at 33%. And that's not surprising, given that we were working in less than optimal conditions in our living room, on our dining room table during the pandemic. And then it follows very closely with shoulder pain, spinal or joint manipulation or adjustments, muscle pain problems, and problems with joints. And those are really the top list followed after that with headache and migraine. Smaller areas are osteoarthritis, joint order, fibromyalgia, whiplash, myofascial pain.
Only 8% of individuals said that they see a chiropractor for arthritis. Now that's one of the reasons why we launched our comprehensive digital campaign on arthritis, because one in five Ontarians suffers from a form of arthritis. Half of them are under the age of 65. There is a gap in understanding how critical chiropractors are to the diagnosis and treatment of arthritis.
So we see a small group, only 8%, going to chiropractors for arthritis. But we see this as a tremendous opportunity because of the growing prevalence of this chronic disease in Canada and in Ontario. And that there is such an important role for chiropractors to play and not all consumers are aware of it.
Leslie:
So you've talked about the perception gap between what chiropractors are qualified to treat and what Ontarians actually think they treat. You've mentioned the arthritis campaign. What else is O-C-A working on to help close this gap?
Nancy:
There's a really good example of this, with our opioid and pain reduction collaborative. We created the collaborative because it is an important collaboration with physicians and nurse practitioners. And it creates a tremendous opportunity for chiropractors to be very much a part of the solution of this national crisis. We worked with the Centre for Effective Practice to create an evidence-based clinical tool for physicians and nurse practitioners. And this clinical tool identified the first line of treatment for neck, shoulder, and back pain is chiropractic treatment. In collaborating with the patient and their prescribing physicians, chiropractors are able to help avoid, reduce, or even eliminate opioid dependency with patients. What we've also done is to launch with C-M-C-C an unprecedented opioid course that provides the skills, confidence, and resources to begin a crucial conversation with patients and their prescribing physicians or nurse practitioners. We just found out that some of the feedback from our members who have taken the course are scoring at five out of five.
Leslie:
And what about our members? What can they do to help close this gap?
Nancy:
I think part of it is that if we recognize that patients really are at the center of their care and that chiropractors are a key part of that patient circle of care, that it is through excellent patient care that we actually make a difference. And part of that is engaging with or collaborating with those in the broader health ecosystem. Our members already do that.
For example, the rapid access clinics, 7 of 13 R-A-Cs are led by chiropractors. 58 chiropractors work as practitioners and more are being recruited. That program is where physicians refer their patients to the R-A-C. It is a chiropractor who then does an assessment and diagnosis and determines whether that patient is a surgical candidate. Surgeons trust that chiropractors and other practitioners in the R-A-Cs can do that triage and effectively assess and diagnose the patient. That's an example of what exists today, that is a great example of collaboration.
The more we collaborate with others in the publicly-funded system, the greater the benefit to our patients and the greater the likelihood that patients will come and see a chiropractor. Because one of the things that has stayed the same between our 2019 and 2021 research is the number one reason a patient will visit a chiropractor is if it's recommended by a doctor or a nurse practitioner.
And that is one of the reasons why, even with our arthritis campaign, we took the time to also speak directly to the medical community around arthritis. And it is in our health profession section of our website that members of the medical community could come learn, watch videos, and understand the value of chiropractic care.
Leslie:
Let's loop back to paying for care. What about extended healthcare plans or employee benefit plans? What does the data tell us about consumers' attitudes towards these plans and how well they're addressing their musculoskeletal or neuromusculoskeletal needs?
Nancy:
So when we asked if the respondents to the research had employee benefits, it was 62% who had access to employee benefits or an insurance plan. And they had similar access to a number of manual therapy services. And in this case, about 85% had coverage for chiropractic care.
Although, we do know that many of them think that's insufficient care and they want actually more coverage. And for those who have access to various services within their employee benefits package, 36% of those respondents want more coverage for chiropractic care. So there is a demand for more coverage for chiropractic treatments. And this is a very effective tool for us to advocate for more coverage, particularly around conditions. So this is what we are sharing with extended healthcare providers and employers so that they know what's important to retain and recruit their employees.
Leslie:
Indeed. Now, what about online services? When a consumer is looking for a chiropractor or another healthcare professional, what kind of online services or other features do they value to help them through this process?
Nancy:
This was really interesting because we assume that the traditional ways that a patient would call, make an appointment, maybe call and reschedule again, depending on work. That's not how it works anymore.
And so we did ask about what was important to consumers when they were seeking a healthcare provider. So it was generic and across the board, we listed some of the key features that other professions have for helping their patients in booking a visit, a whopping 95% of respondents said, if they can schedule the appointments online, then that is what they really care about. If they can reschedule or cancel their appointments online, 95% said that was really valuable.
When we talked about, is it important for you to get a text reminder or an email reminder, again, 91% of consumers said, yes, this is what they want. And then we also asked about eClaims and how important is that.
And 86% of respondents said eClaims are important. So their providers can submit their claims directly. For our chiropractors to have the ability for patients to schedule an appointment online, to reschedule or cancel that appointment online, to receive a text or email reminder were key differentiators in their likelihood to book an appointment.
So I think that's really important for our members to know that's what consumers are expecting.
Leslie:
And how is O-C-A helping members meet this need?
Nancy:
Well, it is in our O-C-A Aspire practice management and electronic health heard business solution, which is as good or better than anything on the market right now.
We do have scheduling appointments online. We do have rescheduling, cancelling appointments online, text reminders, or email reminders, depending on which the patient wants. And we do have eClaim by TELUS Health. So we do have a solution for our members that gives all of that functionality for consumers for their choice, but also just a terrific solution for chiropractors in their overall practice.
Leslie:
Great. So in looking at this current research, what do you see as the top three opportunities for Ontario chiropractors?
Nancy:
I think there's lots of opportunities for chiropractors. The first is that dealing with physical pain and being free of pain, that's a really important aspect for consumers and it's important for them around having good health. I think for chiropractors who can position their clinics as part of holistic healthcare, as part of optimal health, not just the treatment of pain, I think there's some tremendous opportunities there. And we also saw that in what I talked about a moment ago, and that was for the 20% who were prepared to spend more money, 77% of them are going to pay for it out of pocket and not just rely on their employee benefits or health spending accounts. That's a big change.
The second is, I talked a little bit before about the change of focusing on physical health, separate from mental health, but there is a focus on the impact of mental health during COVID. Physical pain, migraines and headaches have worsened for some Ontarians. The burden of physical pain can also contribute as our members know to the stress anxiety of their patients. And it does suggest in this research that chiropractors have a role to play in helping Ontarians manage their worsening physical pain, better than their self-care. More can be done, and there's an interest in consumers to get that additional care.
And third, partnering with and educating physicians and nurse practitioners on the benefits of chiropractic care using clinical data can really help provide a path as another option for patients who are seeking pain relief, optimal health, and ongoing physical strength, as many Ontarians report that they will follow the recommendations of those physicians and nurse practitioners.
In fact, we have already started that through our opioid and pain reduction collaborative where one of our chiropractors and a leading nurse practitioner co-presented on that program to the Nurse Practitioners Association of Ontario. Further now, thanks to you, Leslie, that program will also be adapted and will be part of the very prestigious E-C-H-O Conference that's being held March 31st, 2022. The collaboration, when we're speaking about patient benefit, has a great impact on those other medical professionals and recognizing the expertise, the skill, and value of chiropractic care to patients.
Leslie:
And how does this link with how Ontarians assess their health?
Nancy:
There was startling research that revealed what was important to consumers. The number one at 99%, was that Ontarians want to be free from disease. And 98% of respondents said that good mental health was the second most important criteria of what is important to maintain good health. The third, 98% of respondents said that being free from physical pain was important to them in maintaining good health.
When you think about that, that's a tremendously high number. And that free from disease, good mental health and from physical pain are 98-99% rated in importance for the respondents.
Also, in answering that question, respondents said that regular visits to other healthcare providers like chiropractors ranked an importance of 64%. So, 64% of Ontarians see regular visits to other healthcare providers like chiropractors, important in maintaining their good health.
What has been so impressive is that with the exception of a very short period of time in 2020, when many clinics and health professions offices were temporarily closed, chiropractors have been the constant source for diagnosis and treatment for Ontarians throughout the pandemic. They have maintained such tremendous standards of P-P-E and safety and have been lifelines to their patients. And I think that contributes to a really positive view that chiropractors are trusted professionals and are valued by Ontarians.
Leslie:
Are there any additional takeaways from this research that you think members should know about?
Nancy:
Yes, this research represents some future thinking for how we position and promote chiropractic care in Ontario.
First, we can present chiropractic care as a means of pain relief, but also as an alternative to prescription or pain medication, particularly among those who are using prescription opioids or who are addicted to opioids. This is really important because it is a national crisis.
Secondly, Ontarians' use of chiropractic service, their trust and satisfaction with chiropractors that remains high, and the likelihood of Ontarians to recommend a chiropractor also remain high. And we need to build on that trust in the expertise of chiropractors so that we can draw more Ontarians to chiropractors to receive the appropriate treatment for pain relief and optimal physical health.
So it's the ability to be really focused on your local clinic and your local market and to help to change the types of services that you are offering. And we do see that when it is condition-based. So in this arthritis campaign, we move from back pain, into chronic disease management. That it really opened the eyes of a lot of Ontarians.
So in your practices, what are the services that would really help in the conditions that patients are suffering, that they may not think instantly of chiropractic care? I think it's a very positive time, what chiropractors can do is what Ontarians want.
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Outro:
Thank you, Nancy, for telling us about Ontarians' increased focus on their health, how much time and money they're willing to invest to optimize it and where chiropractic care fits in. Thanks also for sharing your thoughts on what this data highlights as key opportunities for our members.
We'll be off in April, but back in May with another episode of pragmatic insights and tips to help you and your practice. I hope you'll join us.
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