There are a variety of ways to achieve health promotion's goal of increasing 'people's control over their health and its determinants' [1, 2]. Within a population health approach, interventions would target not just strategies to enable healthier living and treatment of presenting symptoms, but also factors 'upstream', the primary causes of ill-health, within the wider socio-politico-economic environment in which people live [3, 4]. In contrast, within routine health and medical care, interventions target individual patients, looking towards optimum strategies to promote and support individuals to modify their behaviour. Examples include use of motivational interviewing , applications of the stages of change model  and the notion of 'readiness to change' . Other literature examines the manner in which treatment and care is provided, in particular, for example, shared decision making [8, 9] and patient-centred care . While (individual) patient empowerment  and self-efficacy  may be the ultimate goal, discussions focus on adherence to prescribed programmes and ways to support persons to manage their own ill-health. Left implicit, and thus outside the clinical gaze is the need to move beyond the individual, to consider the individual within their family and wider social network and socio-economic circumstances.
A central concept within health promotion is health literacy. Nutbeam's influential framework  differentiates three levels: functional health literacy (sufficient basic skills in reading and writing to function effectively); communicative/interactive health literacy (ability to extract information and to apply the information); and critical health literacy (ability to critically analyse information and to use it to exert greater control over life events). From a behavioural change perspective, critical health literacy is akin to a person heeding and acting on the advice given (after implicit or explicit reflection) and modifying their behaviour. Health literacy becomes an asset  and the intervention aims at enhancing individuals' control. The clinical or health promotion intention would be to move from providing information on, for example, healthy eating or healthier lifestyles (with an outcome focus on adherence with expert prescribed behaviour) to developing personal skills within a supportive (individual, family, community) environment (with an outcome focus on self-care in partnership with health care professionals) and onto individuals (and communities) taking control for self-care, with the self as the expert and manager [13, 14]. Taking this a stage further, public health literacy embraces critical health literacy needed to make public health decisions that benefit the community  and effective actions at a political and social level to prevent ill-health or support health [13, 16].
The potential contribution of complementary and alternative medicine (CAM) modalities to promote and support critical health literacy has not received substantial attention within either health promotion, CAM or the sociology of CAM literatures. Indeed, Hill  commented that UK health promotion texts rarely include reference to CAM and contain little in-depth discussion over their potential role in collaborative alliances to promote health. This is despite the increasing consumer user of CAM [18–20].
Core features of the philosophy and practice-based commitments of CAM and reasons for its use suggest a prima facie case for consideration of its role. Firstly, CAM modalities centre attention on health and healing. As Fulder  valuably enumerates, characteristics of alternative medicine include: restoring vital forces and self-healing energy (to awaken the immune system/response); working with, and not against, symptoms; seeking out the root of the problem ; exploring individualised paths for treatment; and, adopting a holistic approach to diagnosis and treatment. Secondly, characteristics of the practitioner-client encounter include: a more egalitarian relationship between client and practitioner in order to sustain and strengthen the client's commitment to taking (some) responsibility for health, well-being and self-care [23, 24]; the practitioner listening  and providing a safe, 'protected' space ; and, seeing the presenting reasons/symptoms within the person's wider life and lifestyle [18, 27]. The practitioner may act as teacher and consultant, as well as healer. Thirdly, while some access CAM to help to resolve a long standing condition [28, 29], others talk explicitly about wanting to be proactive in order to prevent further ill health , engaging in active health maintenance and avoiding health-risk behaviours [29, 31, 32]. As Sointu  concludes from her analysis of interviews with practitioners and users of a variety of CAM practices, people may turn to CAM to 'seek a subjective sense of well-being rather than mere health .... The concept of well-being encapsulates a demand for being recognised as an active, empowered and knowledgeable agent' (pp. 345–346).
Such philosophical commitments find representation within the practice of CAM therapies. Energy medicine works 'more with what is felt than measured' . Touching clients enables diagnosis, the delivery of the treatment and feedback as to how the treatment is received; it also creates a relationship between the practitioner and client. Classical (TCM) acupuncture's attempts to treat the 'root' (the underlying central disharmony) and 'branch' (the specific presenting symptoms) of the patient [22, 35]. Some of the 'active ingredients' in homoeopathy, drawn out from case studies of individual packages of care by Thompson and Weiss  include the role of patient expectations (the expectation of potential benefit/belief in the treatment), openness to the mind-body connection, the expression of empathy within the consultation and the co-construction of the homoeopathic care, all apart from the remedy itself. More generally, in a study of CAM use, personality and coping strategies, Jacobson and Honda  suggest that 'openness to experience' may be a personality trait of persons who use body-mind, energy and other biologically-based CAM therapies. Finally, in the context of CAM education provision, Rakel et al  revisit the notion of salutogenesis, arguing for the necessity of health education to include a core understanding of healing and prevention. They illustrate their discussion through a review of evidence of CAM therapies for low-back pain. Areas of influence include mind-body, nutrition (sustaining food choices), spirituality (helping the patient to connect with things that give their life meaning) and the bio-energetic dimension.
Against this background, this paper seeks to explore the role of one CAM modality, shiatsu, to enhance critical health literacy and thus wider population health. Shiatsu, a body-based life-energy therapy, is a holistic health care method developed in Japan and influenced by Western knowledge. It is also inherently a safe modality . Shiatsu uses Oriental energetic diagnosis and body energy techniques to correct imbalances in the body and focuses on the whole person, mind, body and spirit, as an interconnected whole, together with the environment in which the person lives . All aspects of the client's life-energy system are addressed in understanding the condition, making an energetic diagnosis and giving a treatment. A highly developed sensitivity of touch enables the practitioner to feel and interpret the quality and flow of ki, the body's life-force. Treatment thus embraces both the application of gentle pressure to the energy channels on the body surface and commonly includes advice-giving, centred on raising self-awareness, modes of living and lifestyle to sustain good health. While there are many different styles of shiatsu, variations in theoretical content  and cultural dimensions surrounding its delivery , shiatsu training in Europe is grounded most commonly in the fundamentals of Traditional Chinese Medicine (TCM) philosophy and theory and by the approach of Shizuto Masunaga (Zen shiatsu).