JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

The experiences of persons living with HIV who participate in mind-

body and energy therapies: a systematic review protocol of
qualitative evidence
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX

Marie Bremner1,3
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

Barbara Blake1,3

Cheryl Stiles2,3

1 WellStar School of Nursing, Kennesaw State University, USA

2 Sturgis Library Services, Kennesaw State University, USA
3 Indiana Center for Evidence Based Nursing Practice: a Collaborating Center of the Joanna
Briggs Institute

Corresponding author:

Marie Bremner

mbremner@kennesaw.edu

Review question/objective
The purpose of this systematic review is to explore the experiences and perceptions of persons living
with HIV who participate in mind-body and energy therapies. The review will focus on the use of mind-
body medicine and energy therapies that include meditation, prayer, mental healing, Tai Chi, yoga, art
therapy, music therapy, dance therapy, Qigong, reiki, therapeutic touch, healing touch and
electromagnetic therapy. These mind-body and energy therapies are selected categories because they
do not involve options that might be contraindicated to an individual’s current treatment regime. More
specifically, the review questions are:

 Does the use of mind-body medicine and energy therapies influence psychological well-being?
 Does the use of mind-body medicine and energy therapies influence social well-being?
 Does the use of mind-body medicine and energy therapies influence physical well-being?

Background
Complementary and alternative medicine (CAM) is a popular adjunct to conventional medicine across
global populations. Complementary generally refers to a non-mainstream approach together with
conventional medicine whereas alternative refers to a non-mainstream approach in place of
conventional medicine. Most people use non-mainstream approaches along with conventional
treatments. The World Health Organization [WHO] defines CAM as distinct health-care practices that
have not been assimilated into a country’s mainstream health care system.1

The USA’s National Center for Complementary and Integrative Health (NCCIH), formerly National
Center for Complementary and Alternative Medicine (NCCAM), organizes CAM into five medical system
categories: whole medical systems, mind-body medicine, biologically based practices, manipulative and
body-based practices, and energy therapies.2 Whole medical systems include homeopathy,
naturopathy, traditional Chinese medicine and Ayurveda. Mind-body medicine includes meditation,
prayer, mental healing, Tai Chi, yoga, art therapy, music therapy and dance therapy. Biologically based
practices include dietary supplements, herbal supplements and a few scientifically unproven therapies.
Manipulative and body-based practices include massage and spinal manipulation such as chiropractic

doi: 10.11124/jbisrir-2015-2321 Page 41

 JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

and osteopathic. Energy therapies include Qigong, reiki, therapeutic touch, healing touch and
electromagnetic therapy.

The NCCAM, the Alternative Medicine’s Strategic Plan for 2011-2015 and the Healthy People 2020
envision a society in which all people have the opportunity to live long, healthy lives. In most countries,
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX

life expectancy has increased, but unfortunately, the incidence of chronic illnesses such as
cardiovascular disease, cancer, hypertension, diabetes and depression continues to increase.2-4
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

Research findings indicate that the use of CAM is often greater among people living with a chronic or
life threatening illness compared with the general population,5-7

Until the development of highly active antiretroviral medications (ARVs) in 1996, a diagnosis of human
immunodeficiency virus (HIV) was considered to be a death sentence.8 The human immunodeficiency
virus attacks the immune system and weakens a person’s ability to combat infections and some types
of cancer. Currently, there is no cure for HIV but because of lifesaving medications, the mortality rate
has declined significantly. The disease is now considered a chronic illness and highly manageable.9,10
Effective treatment has resulted in approximately 35 million people worldwide still living with HIV at the
end of 2012.11

Because HIV is no longer a death sentence but a chronic illness, there is a need to evaluate the
experiences and perceptions of people using CAM, considering the prevalence of CAM use within this
population. In the United States and Canada, the rate of CAM use among HIV positive persons is
approximately 50% to 70%, whereas in Africa, rates of CAM use range from 36% to 68%. Popular forms
of CAM among persons living with HIV include herbal or nutritional supplements, mind and body
practices, and spiritual or religious healing.12-14 Worldwide, only a small percentage of persons who
have access to ARVs refuse to take them and utilize CAM exclusively to treat their HIV infection.15,16

People living with HIV often report using CAM because they believe that these therapies will improve
their overall health and well-being and provides them an opportunity to take some responsibility in
managing their personal health, which includes medication side effects.12,17-21 However, the effect of
CAM on an individual’s physical health often cannot be measured physiologically, but may be felt or
experienced.

Understanding CAM use is essential so that health professionals will have the most accurate
information about which integrative therapies may or may not be helpful for people living with HIV. As
recommended by the Institute of Medicine report entitled, ‘Integrative Medicine and Patient Centered
Care’, health professionals have a moral commitment to find innovative ways of obtaining evidence and
expanding knowledge about diverse interpretations of health and healing. 22 Research aimed at
exploring patients’ experiences and perceptions of mind-body and energy therapies is imperative so
asto offer comprehensive care and promote shared decision making regarding complementary
therapeutic options.

Keywords
CAM; energy therapies; HIV/AIDS; mind-body medicine; qualitative synthesis

doi: 10.11124/jbisrir-2015-2321 Page 42

 JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

Inclusion criteria
Types of participants

This review will include primary studies that report qualitative evidence about the experiences and
perceptions of persons living with HIV/Acquired Immune Deficiency Syndrome (AIDS) in relation to
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX

participation in mind-body and energy therapies. The decision to include a study based on dosage
(number of therapy sessions) will be deferred to the researchers conducting the study. In other words,
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

the minimum number of therapy sessions will be determined by the authors. Studies which include male
and/or female adult (18 years and above) participants will be considered.

Types of intervention(s)/phenomena of interest

This review will consider studies that investigate the experiences and perceptions of persons living with
HIV/AIDS who participate in mind-body medicine and energy therapies.

Types of studies

This review will focus on qualitative data, including, but not limited to, designs such as phenomenology,
grounded theory, ethnography, and action research. Qualitative elements within a mixed method study
will be included if they are reported clearly and independently from the quantitative findings.

Context

This review will include studies conducted globally in a hospital, home or community setting, but only
those written in the English language.

Search strategy
The goal of the search strategy is to locate both published and unpublished studies including gray
literature. This search strategy will employ a three-tier methodology. The initial search will include
Medline (MeSH 2015 headings), CINAHL and Web of Science, and will include a subsequent textual
analysis of the words contained in the title, abstract, index and descriptor terms. The second and more
comprehensive search will use all identified keywords, index terms and descriptors, and will be
executed across all databases included in this proposal. At the third tier, the citations lists/works cited
will be searched for further studies.

Studies published in English from the year 1996, the year antiretroviral medications became available,
will be included.

The databases to be searched include: Medline (four interfaces available), CINAHL, OVID Journals,
ProQuest Nursing and Allied Health, EBSCO AltHealth Watch, Health Source Nursing Academic
Edition, AAP Psynet, Papers First, PsychArticles, Science Direct, Web of Science, DOAJ: Directory of
Open Access Journals, Scopus, PubMed, and AMED.

The search for unpublished studies will include: Dissertation Abstracts International, Worldcat
Dissertations and Theses, Article First, Google Scholar, and PAIS International.

Keywords to be used will be: Human immunodeficiency virus/ HIV (and its variants…MeSH headings),
Acquired Immune Deficiency Syndrome/ AIDS (and its MeSH headings), Complementary and
alternative medicine/ CAM (and its variants), mind-body medicine, energy therapies, complementary
therapies, integrative care, experience, experiential, qualitative, ethnography, oral history, narrative and
personal narrative, perceptions, feeling/s, emotions, quality of life and well-being.

doi: 10.11124/jbisrir-2015-2321 Page 43

 JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

Secondary keywords to be used will be specific mind-body medicine and energy therapies such as:
meditation, prayer, mental healing, Tai Chi, yoga, art therapy, music therapy, dance therapy, Qigong,
reiki, therapeutic touch, healing touch and electromagnetic therapy.

Assessment of methodological quality

Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX

Qualitative papers selected for retrieval will be assessed by two independent reviewers for
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

methodological validity prior to inclusion in the review using standardized critical appraisal instruments
from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix
1). Any disagreements that arise between the reviewers will be resolved through discussion and with a
third reviewer.

Data extraction
Qualitative data will be extracted from papers included in the review using the standardized data
extraction tool from JBI-QARI. The data extracted will include specific details about the phenomena of
interest, populations, study methods and outcomes of significance to the review question and specific
objectives.

Data synthesis
Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the
aggregation or synthesis of findings to generate a set of statements that represent that aggregation,
through assembling the findings (Level 1 findings), rated according to their quality, and categorizing
these findings on the basis of similarity in meaning (Level 2 findings). These categories are then
subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings
(Level 3 findings) that can be used as a basis for evidence-based practice. Where textual pooling is not
possible the findings will be presented in narrative form.

Conflicts of interest
The reviewers declare that there are no conflicts of interest.

doi: 10.11124/jbisrir-2015-2321 Page 44

 JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

References
1. World Health Organization. WHO traditional medicine strategy: 2014 - 2013; 2013. [Internet].
[Cited on Sept 9, 2014] Available from:
http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf
2. U.S. Department of Health and Human Services. National Center for Complementary and
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX

Integrative Health. Third strategic plan: 2011 - 2015. Exploring the science of complementary
and alternative medicine; 2011. [Internet]. [Cited on May 5, 2015] Available from:
https://nccih.nih.gov/sites/nccam.nih.gov/files/about/plans/2011/NCCAM_SP_508.pdf
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

3. U.S. Department of Health and Human Services. Healthy people 2020: Health related quality of
life and well-being; 2010. [Internet]. [Cited on Dec 10,2014 ] Available from:
http://www.healthypeople.gov/2020/about/foundation-health-measures/Health-Related-Quality-of-
Life-and-Well-Being
4. World Health Organization. Global health observatory data: Life expectancy. [Internet]. [Cited on
Jan 16, 2015 ] Available from:
http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/
5. Liao GS, Apaya MK, Shyur LF. Herbal medicine and acupuncture for breast cancer palliative
care and adjuvant therapy. Evid Based Complementary Alternat Med. 2013
6. Metcalfe A, Williams J, McChesney J, Patten SB, Jette N. Use of complementary and alternative
medicine by those with a chronic disease and the general population - results of a national
population based survey. BMC Complement Altern Med. 2010;10: 58.
7. Okoro CA, Zhao G, Li C, Bulluz LS. Has the use of complementary medicine therapies by U.S.
adults with chronic disease-related functional limitations changed from 2002 - 2007? J Altern
Complement Med. 2013;10(3): 217 - 223.
8. Cahill S, Valadez R. Growing older with HIV/AIDS: new public health challenge. Am J Public
Health. 2013;103(3): e7 - e15.
9. Cardoso SW, Torres TS, Santini-Oliveira M, Marins LM, Veloso VG, Grinsztejn B. Aging with
HIV: a practical review. Braz J Infect Dis. 2013;17(4): 464-479.
10. Costagliola D. Demographics of HIV and aging. Curr Opin HIV AIDS. 2014;9(4): 294-30.
11. Joint United Nations Programme on HIV.AIDS (UNAIDS). Global report: UNAIDS report on the
global epidemic. 2013 [Internet]. [Cited on June 6, 2014]. Available from
http://www.unaids.org/sites/default/files/media_asset/UNAIDS_Global_Report_2013_en_1.pdf
12. Littlewood RA, Vanable PA. Complementary and alternative medicine use among HIV positive
people: research synthesis and implications for HIV care. AIDS Care. 2008; 20(8): 1002 - 1018.
13. Ontario HIV Treatment Network. Complementary, alternative, and traditional medicine in HIV
care.2013 [Internet]. [Cited on Feb 18, 2015] Available from:
http://www.academia.edu/3216341/Complementary_Alternative_and_Traditional_Medicine_in_HI
V_Care
14. Thorpe R. Integrating biomedical and CAM approaches: the experiences of people living with
HIV/AIDS. Health Sociol Rev. 2008;17(4): 410-418.
15. Fairfield KM, Eisenberg DM, Davis RB, Libman H, Phillip RS. Patterns of use, expenditures, and
perceived efficacy of complementary and alternative therapies in HIV-infected patients. Arch
Intern Med. 1998;158(20): 2257-64.
16. Peltzer K, du Preez NF, Ramlagan S, Fomundam H. Use of traditional complementary and
alternative medicine for HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2008;8:
255.
17. Foote-Ardah CE. The meaning of complementary and alternative medicine practices among
people with HIV in the United States: strategies for managing everyday life. Sociol Health Illn.
2003;25(5): 481-500.
18. Hassan SS, See CK, Choong CLK, Ahmed SI, Ahnadi K, Anwar M. Reasons, perceived efficacy
and factors associated with complementary and alternative medicine use among Malaysian
patients with HIV/AIDS. J Altern Complement Med. 2010;16(11): 1171 - 1176.

doi: 10.11124/jbisrir-2015-2321 Page 45

 JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

19. McDonald K, Slavin S. My body, my life, my choice: practices and meanings of complementary
and alternative medicine among a sample of Australian people living with HIV/AIDS and their
practitioners. AIDS Care. 2010;22(10): 1229 - 1235
20. Thorpe R. Integrating biomedical and CAM approaches: the experiences of people living with
HIV/AIDS. Health Sociol Rev.2008;17(4): 410-418.
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX

21. Thomas SL, Lam K, Piterman L, Mijcha A, Komesaroff PA. Complementary medicine use among
people living with HIV/AIDS in Victoria, Australia: practices, attitudes and perceptions. Int J STD
AIDS. 2007;18(7): 453-457.
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

22. Maizes V, Rakel D, Niemied, C. Integrative medicine and patient-centered care. 2009. [Internet].
[Cited on Feb 15, 2013 ] Available from:
http://www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Integrative%20Medicin
e%20and%20Patient%20Centered%20Care.pdf

doi: 10.11124/jbisrir-2015-2321 Page 46

 JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

Appendix I: Appraisal instruments

QARI appraisal instrument
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

doi: 10.11124/jbisrir-2015-2321 Page 47

 JBI Database of Systematic Reviews & Implementation Reports 2015;13(10) 41 - 49

Appendix II: Data extraction instruments

QARI data extraction instrument
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024

doi: 10.11124/jbisrir-2015-2321 Page 48

 Page 49
2015;13(10) 41 - 49
JBI Database of Systematic Reviews & Implementation Reports

doi: 10.11124/jbisrir-2015-2321
Downloaded from http://journals.lww.com/jbisrir by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 02/07/2024