Designing the Contemporary Implementation of Traditional knowledge and Evidence (CITE) framework to guide the application of traditional knowledge in contemporary health contexts: a Delphi study

Abstract

Background: The 2018 Declaration of Astana acknowledges the need to include traditional, complementary and integrative health care (TCIH) knowledge and technologies within primary health care. The World Health Assembly has also called member states to integrate TCIH into national healthcare systems. However, little attention has been given to developing supportive resources for this process in practice, policy, research and education. Methods: This study employed Delphi methodology to refine a framework for the evaluation and implementation of text-based traditional knowledge in contemporary health contexts. An international sample was recruited of expert participants with experience in a diversity of settings and disciplines. Framework items were retained, removed or modified based on participant consensus agreement on the importance of each item (consensus set at ≥75 per cent agreement), and mapped for comprehensiveness against an implementation framework. Findings: The initial survey round was completed by 19 participants and the second round by 15 participants. Most participants (n=15) held TCIH qualifications, representing six TCIH professions in total (naturopathy, Western herbal medicine, osteopathy, traditional Chinese and Oriental medicine, Ayurveda, and homeopathy). Participants typically had experience in multiple contexts across clinical practice, research, education and policy development. Consensus was achieved after two rounds and the resulting framework included three sections comprising guiding principles (five items), critical appraisal criteria (three items) and application criteria (eight items). Conclusions: As the international health community increasingly recognised the potential value and importance of TCIH knowledge and technologies, this Contemporary Implementation of Traditional knowledge and Evidence (CITE) Framework provides a timely and much-needed practical guide to rigorous and respectful traditional knowledge implementation.