Patterns of conventional and complementary non-pharmacological health practice use by US military veterans: A cross-sectional latent class analysis

Melvin T. Donaldson, Melissa A Polusny, Richard F Maclehose, Elizabeth S. Goldsmith, Emily M. Hagel Campbell, Lynsey R. Miron, Paul D. Thuras, Erin E Krebs

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Non-pharmacological therapies and practices are commonly used for both health maintenance and management of chronic disease. Patterns and reasons for use of health practices may identify clinically meaningful subgroups of users. The objectives of this study were to identify classes of self-reported use of conventional and complementary non-pharmacological health practices using latent class analysis and estimate associations of participant characteristics with class membership. Methods: A mailed survey (October 2015 to September 2016) of Minnesota National Guard Veterans from a longitudinal cohort (n = 1850) assessed current pain, self-reported overall health, mental health, substance use, personality traits, and health practice use. We developed the Health Practices Inventory, a self-report instrument assessing use of 19 common conventional and complementary non-pharmacological health-related practices. Latent class analysis was used to identify subgroups of health practice users, based on responses to the HPI. Participants were assigned to their maximum-likelihood class, which was used as the outcome in multinomial logistic regression to examine associations of participant characteristics with latent class membership. Results: Half of the sample used non-pharmacological health practices. Six classes of users were identified. "Low use" (50%) had low rates of health practice use. "Exercise" (23%) had high exercise use. "Psychotherapy" (6%) had high use of psychotherapy and support groups. "Manual therapies" (12%) had high use of chiropractic, physical therapy, and massage. "Mindfulness" (5%) had high use of mindfulness and relaxation practice. "Multimodal" (4%) had high use of most practices. Use of manual therapies (chiropractic, acupuncture, physical therapy, massage) was associated with chronic pain and female sex. Characteristics that predict use patterns varied by class. Use of self-directed practices (e.g., aerobic exercise, yoga) was associated with the personality trait of absorption (openness to experience). Use of psychotherapy was associated with higher rates of psychological distress. Conclusions: These observed patterns of use of non-pharmacological health practices show that functionally similar practices are being used together and suggest a meaningful classification of health practices based on self-directed/active and practitioner-delivered. Notably, there is considerable overlap in users of complementary and conventional practices.

Original languageEnglish (US)
Article number246
JournalBMC Complementary and Alternative Medicine
Issue number1
StatePublished - Sep 5 2018

Bibliographical note

Funding Information:
This research was supported by the National Institutes of Health National Center for Complementary Integrative Health (R01AT008387; Polusny & Krebs, Co-PIs). M. Donaldson was supported by an individual fellowship from National Center for Complementary and Integrative Health (F30AT009162), and the University of Minnesota Medical Scientist Training Program (T32GM00824). This material is the result of work supported with resources and the use of facilities at the Minneapolis VA Health Care System, Minneapolis, MN.

Publisher Copyright:
© 2018 The Author(s).


  • Alternative medicine
  • Complementary integrative health
  • Latent class analysis
  • Non-pharmacological therapies
  • Veterans


Dive into the research topics of 'Patterns of conventional and complementary non-pharmacological health practice use by US military veterans: A cross-sectional latent class analysis'. Together they form a unique fingerprint.

Cite this