Complementary and alternative medicine in rural communities: current research and future directions

Contexts: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. Purpose: This article presents the first review and synthesis of research findings on CAM use and practice in rural communities. Methods: A comprehensive search of literature from 1998 to 2010 in CINAHL, MEDLINE, AMED, and CSA Illumina (social sciences) was conducted. The search was confined to peer‐reviewed articles published in English reporting empirical research findings on the use or practice of CAM in rural settings. Findings: Research findings are grouped and examined according to 3 key themes: “prevalence of CAM use and practice,”“user profile and trends of CAM consumption,” and “potential drivers and barriers to CAM use and practice.” Conclusions: Evidence from recent research illustrates the substantial prevalence and complexity of CAM use in rural regions. A number of potential gaps in our understanding of CAM use and practice in rural settings are also identified.     

Acculturation and the use of complementary and alternative medicine

The use of complementary and alternative medicine (CAM) has been growing substantially in the US in recent years. Such a growth in CAM use coincides with an ongoing increase in the proportion of the foreign-born population in the US. The main objective of this study is to examine the relation between acculturation and the use of CAM therapies among immigrants. Data from a CAM supplement to the 2002 National Health Interview Survey were analyzed to estimate the effects of acculturation on the likelihood of using different CAM therapies over the past 12 months prior to the survey. The results suggest that the level of acculturation-as measured by nativity/length of stay in the US and language of interview-is strongly associated with CAM use. As immigrants stay longer in the US or as their use of English becomes more proficient, the likelihood that they use CAM therapies increases as well, and it gradually approaches the level of CAM use by native-born Americans. Moreover, this relation between acculturation and CAM use generally persists even after the effects of socioeconomic status, health insurance coverage, self-reported health status, and other demographic variables have all been taken into consideration. The substantially lower rates of CAM use by recent immigrants and its possible causes warrant further research.     

Complementary and alternative medicine practitioner use prior to pregnancy predicts use during pregnancy

ABSTRACT

The objective of the authors in this study was to determine if prior visits to a complementary and alternative medicine (CAM) practitioner were associated with CAM use during pregnancy. The study sample comprised the Australian Longitudinal Study on Women’s Health. Women were surveyed prior to pregnancy in 2006, and then again in 2010 if they were pregnant or had recently given birth, and asked a range of questions relating to demographic variables, health status, and use of CAM. A multivariable analysis identified significant covariates associated with visits to specific CAM practitioner modalities during pregnancy. Of the 447 women who consulted a CAM practitioner prior to pregnancy, 62.4% (n = 279) continued this use during pregnancy. Prior use of massage therapy, acupuncture, herbalist/naturopath, or chiropractor was related to use of the same service during pregnancy. Higher income and working full-time were associated with the continued use of massage, while continued visits to a chiropractor were associated with having depressive symptoms, a urinary tract infection, and living in a rural community. Prior use of CAM was highly related to continuing use during pregnancy. Further research is required to elucidate the benefits women attain from a CAM-model of care that they do not get from their conventional maternity care providers alone.     

Exclusive versus everyday forms of professional knowledge: legitimacy claims in conventional and alternative medicine

In this paper I present a model of professional knowledge forms that accounts for the different, and sometimes contradictory, ways in which medical doctors (MDs) and various complementary and alternative medicine (CAM) practitioners define their competencies and make legitimacy claims. The first section provides a schema for problematising knowledge and its relationship to legitimacy by distinguishing between the context, form and content of professional knowledge. I draw particularly upon Jamous and Peloille's (1970) distinction between the technical or indeterminate forms of professional knowledge. I argue that their characterisation might be enriched by attending to dimensions of 'exclusive' versus 'everyday' knowledge forms. In particular, I point out that both technical and indeterminate forms are amenable to exclusion, or conversely can be made accessible as everyday knowledge. Both forms can thus be employed in attempts to legitimate professional practice. In the final section, I map the current context of CAM and biomedicine onto this expanded professional knowledge map.     

Complementary Alternative Medicine Practices Used by Religious Professionals

Religious professionals completed an online survey of their use of health related practices currently known as complementary and alternative medicine (CAM). They indicated how often they engaged in these practices and how often they had used these practices when helping other people. The majority of religious professionals used at least one of the practices when alone and when helping other people. The most frequently used practices were meditation and deep breathing exercises used both when alone and when helping others. Female respondents were more likely to use these practices on their own and when helping others than were males, and older respondents were more likely to use multiple CAM practices than their younger counterparts. Other Faith/Humanists used the most CAM practices when alone and Jewish respondents used the fewest. In general, religious professionals used fewer practices when helping others than they used for themselves. Limitations of this study and suggestions for future studies for examining CAM practices among religious professionals are discussed.     

Measuring what Medical Students Think about Complementary and Alternative Medicine (CAM): A Pilot Study of the Complementary and Alternative Medicine Survey

With increasing national and international support for the development of Complementary and Alternative Medicine (CAM) curricula in American medical schools, it is essential to measure what learners know and believe about CAM in order to assess outcomes of new teaching efforts. This paper describes the development and initial results of a survey designed for those purposes. The survey is constructed so that earlier single-institution studies of students’ attitudes toward CAM topics, preferred ways of learning about CAM, and students’ use of CAM therapies for self-care might be replicated and extended. A pilot test of the Complementary and Alternative Medicine ( CAM) Survey was conducted with third-year medical students at the University of Texas Medical Branch. Validity and reliability studies of the survey were conducted. Findings were compared to those of previously published studies. Interpretable subscales were constructed from survey questions. Students’ attitudes toward CAM-related topics were generally favorable. More students were familiar with biological-based therapies than with other CAM therapies. The majority of respondents listed lectures as their preferred way to learn about CAM. Respondents’ own CAM use varied; minority and economically-disadvantaged students were more likely to use CAM therapies than other students. The survey is a promising assessment of student attitudes toward and knowledge of CAM therapies.     

Determinants of Women Consulting with a Complementary and Alternative Medicine Practitioner for Pregnancy-Related Health Conditions

The objective of this study was to explore the determinants that are related to women’s likelihood to consult with a complementary and alternative medicine (CAM) practitioner during pregnancy. Primary data were collected as a sub-study of the Australian Longitudinal Study on Women’s Health (ALSWH) in 2010. We completed a cross-sectional survey of 2,445 women from the ALSWH “younger” cohort (n = 8,012), who had identified as being pregnant or had recently given birth in 2009. Independent Poisson backwards stepwise regression models were applied to four CAM practitioner outcome categories: acupuncturist, chiropractor, massage therapist, and naturopath. The survey was completed by 1,835 women (79.2%). The factors associated with women’s consultation with a CAM practitioner differed by practitioner groups. A range of demographic factors were related, including employment status, financial status, and level of education. Women’s health insurance coverage, health status, and perceptions toward both conventional maternity care and CAM were also associated with their likelihood of consultations with all practitioner groups, but in diverse ways. Determinants for women’s consultations with a CAM practitioner varied across practitioner groups. Stakeholders and researchers would benefit from giving attention to specific individual modalities when considering CAM use in maternity care.     

The prevalence of dietary-related complementary and alternative therapies and their perceived usefulness among cancer patients

Background:  The present study aimed to directly assess and compare the usage, benefits and side-effects of dietary-related complementary and alternative medicine (CAM) use among adult cancer patients and non-cancer adults in Norwich, UK.
Methods:  Self-administered questionnaires were completed by 98 cancer patients and 92 non-cancer adults to compare demographics, types of CAM usage with reasons, benefits, side-effects and CAM information sources. The groups were matched for gender, age, marital status, education and household income. The mean ages were 62.7 and 59.7 years, respectively, with slightly more female than male participants.
Results:  CAM use was high in both groups (47% in cancer and 53% in non-cancer respondents, P  > 0.05). The most widely-used diet-related CAM among both groups was the large intake of fruit, vegetables and juice, multivitamins, fish oils and glucosamine. Fish oil intake was significantly higher in the non-cancer group ( P  < 0.05), whereas selenium and β-carotene supplements were significantly higher in the cancer group ( P  < 0.01 and P  = 0.02, respectively). The main reasons for using CAM were to boost the immune system and to improve quality of life ( P  > 0.05). Reported benefits included increased optimism and hope for the cancer group and increased optimism and pain relief for the non-cancer group.
Conclusions:  Diet-related CAM is used frequently by both cancer patients and non-cancer adults, with many reported benefits and few reported side-effects. Significant differences between the groups included a higher prevalence of fish oil used by the non-cancer group, and a higher use of selenium and β-carotene supplements in the cancer group.     

Pregnancy,risk perception and use of complementary and alternative medicine

Pregnancy and childbirth are events of major significance in women’s lives. In western countries women are increasingly using complementary and alternative medicine during this time. However, there is little research exploring the factors that are influential in women’s motivations to use complementary and alternative medicine during pregnancy and childbirth. This article draws on data from a narrative-based study designed to explore women’s experiences of complementary and alternative medicine use during pregnancy and childbirth. The study involved 14 women living in the South-west of England, who had used complementary and alternative medicine during pregnancy and childbirth. We elicited narratives by interviewing women two to three times. The women in our study used complementary and alternative medicine both as a response to the uncertainty of pregnancy and childbirth and as a defence against manufactured risk, and in doing so indicated their desire to transform an unpredictable and unmanageable future into one which is more predictable and manageable. It was a means of dealing with the stress and anxiety associated with uncertainty which has to be dealt with. Their consciousness of the risks of biomedicine developed though the practice of complementary and alternative medicine, and their high educational status and relative affluence facilitated their choices. There was a tension evident in their narratives between a need to ‘be in control’ versus a desire for a natural childbirth without medical intervention. Women in the study showed their autonomy by actively pursuing complementary and alternative medicine while at the same time selectively using expert medical knowledge.     

Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs

OBJECTIVES: The purpose of our study was to determine the prevalence of complementary and alternative medicine (CAM) use and its clinical and psycho-social correlates, including perceived satisfaction with care and cultural health beliefs. METHODS: A cross-sectional study was carried out in public sector primary care clinics in Singapore using a random sample of 488 adult patients with chronic diseases. The measures were CAM use, satisfaction with care and traditional health beliefs. RESULTS: The 1 year prevalence of CAM use was 22.7%. In univariate analyses, factors associated with CAM use included: middle age, arthritis, musculoskeletal disorders and stroke, multiple conditions, poor perceived health, family use of CAM, recommendation by close social contacts, strong adherence to traditional health beliefs and perceived satisfaction with care. Patients who were dissatisfied/very dissatisfied with the cost of treatment [odds ratio (OR) = 1.79, 95% confidence interval (CI) 1.15-2.82] and waiting time (OR = 1.96, 95% CI 1.20-3.19) were more likely to use CAM. Patients who were very satisfied with the benefit from treatment were much less likely to use CAM (OR = 0.49, 95% CI 0.29-0.83). Satisfaction with doctor-patient interaction was not associated with CAM use. Being 'very satisfied' on overall care satisfaction was significantly associated with much less CAM use (OR = 0.30, 95% CI 0.14-0.68). Multivariate analyses confirmed that CAM use was significantly and independently predicted by the 'chronic disease triad' (arthritis/musculoskeletal disorders/stroke) (OR = 4.08, 95% CI 2.45-6.83), overall satisfaction with care (OR = 0.32, 95% CI 0.14-0.74) and strong adherence to traditional health beliefs (OR = 1.88, 95% CI 1.07-3.31). CONCLUSION: CAM use in Asian patients is prevalent and associated with the 'chronic disease triad' (of arthritis, musculoskeletal disorders and stroke), satisfaction with care and cultural beliefs. In particular, CAM use is not associated with the quality of doctor-patient interaction.     

The dynamic interplay between Western medicine and the complementary and alternative medicine movement: how activists perceive a range of responses from physicians and hospitals

Scholars must examine the dynamic relationship between activists and organisational actors, because all social movements interact in some way with the institutions they seek to change, and because activists engage in ongoing attempts to shape these interactions. Using data from the complementary and alternative medicine (CAM) movement in California and hospitals in New York and Massachusetts, I identify how physicians and hospitals respond to the CAM movement, and how activists perceive each response. Using social movement and institutional theories, this study illustrates that social movements can penetrate and reshape formal organisations, because established organisations have permeable boundaries. Organisational responses to activism can take the form of avoidance, compromise, acquiescence, manipulation or defiance. Activists vary in their response to these outcomes, because activists are not unanimous in their goals. These outcomes result from continual negotiation between CAM activists and organisational actors, and within each group. Thus, the outcomes are constantly evolving.     

The role of complementary and alternative medicine practitioners in the information-seeking pathway of vaccine-hesitant parents in the Blue Mountains area,Australia

While immunisation rates were 94.63% for the whole Nepean Blue Mountains region of New South Wales in 2017, coverage for 1 year olds in the upper Blue Mountains was under 80%. There is a known relationship between vaccine-hesitant parents and complementary and alternative medicine (CAM) use; however, little is known about how CAM practitioners fit within the information-seeking pathway of parents. This exploratory study sought to address this knowledge gap. Qualitative semi-structured interviews with vaccine-hesitant and vaccine rejecting parents and CAM practitioners purposively sampled from the Blue Mountains area revealed three sets of themes: 1) Parents’ search for further information about immunisation; 2) Parents’ use of CAM practitioners as an immunisation information source; and 3) CAM practitioners’ engagement with parents about immunisation. CAM practitioners form a definite, if complex, part of vaccine-hesitant and vaccine-rejecting parents decision-making pathway in the Blue Mountains area. The notion of patient choice is crucial to vaccine discussions. Development of support materials, such as decision resources which give impartial and detailed information while acknowledging and supporting patient choice, are needed to support both CAM practitioners and parents in making informed vaccination decisions.     

Complementary and alternative medicine (CAM) use among children with current asthma

Objective

To estimate the prevalence of complementary and alternative medicine (CAM) use among children with current asthma.

Design

We analyzed data from the Asthma Call Back Survey (ACBS) 2006-2008. ACBS is a follow-up to the state-based Behavioral Risk Factor Surveillance System (BRFSS) survey that collects information on asthma and related factors including CAM use for asthma. The survey is administered to the parents who report in a subset of BRFSS states that their children have asthma. 5435 children had current asthma and were included in this analysis.

Results

Overall, 26.7% (95% confidence interval [CI] = 24.5-29.0) of children with current asthma reported CAM use in the previous 12 months. Among them, the three most commonly used therapies were breathing techniques (58.5%; 95% CI = 53.6-63.5), vitamins (27.3%; 95% CI = 23.0-31.5), and herbal products (12.8%; 95% CI = 9.2-16.4). Multivariate analysis of CAM use revealed higher adjusted odds ratios (aOR) among children who experienced cost barriers to conventional health care compared with children with no cost barrier (aOR = 1.8; 95% CI = 1.2-2.8). Children with poorly controlled asthma were most likely to use all types of CAM when compared to their counterpart with well-controlled asthma: aOR = 2.3 (95% CI = 1.6-3.3) for any CAM; aOR = 1.7 (95% CI = 1.2-2.6) for self-care based CAM; and aOR = 4.4 (95% CI = 1.6-9.3) for practitioner-based CAM.

Conclusions

Children with poorly controlled asthma are more likely to use CAM; this likelihood persists after controlling for other factors (including parent's education, barriers to conventional health care, and controller medication use). CAM is also more commonly used by children who experienced cost barriers to conventional asthma care. CAM use could be a marker to identify patients who need patient/family education and support thus facilitate improved asthma control.     

The meaning of complementary and alternative medicine practices among people with HIV in the United States: strategies for managing everyday life

The meanings of complementary and alternative medicine (CAM) practices in the everyday lives of people with HIV in the United States were investigated. Interviews of people with HIV revealed that two out of three interviewees (N = 62) used some form of CAM over the course of their ongoing HIV infection. Management of their everyday lives as ill persons was improved to the extent that CAM meanings addressed self-regulation of treatment practices and strategies to cope with uncertainty. Four main strategies are dealt with: managing symptoms, medications and emotions; self experimenting to evaluate disease progression; gaining freedom from medical regimens; and managing AIDS stigma. It was shown that CAM practices are one way people with HIV can increase control over their illness and attempt to normalise health status. CAM practices were discussed in the context of self-regulation in relation to other illnesses.     

Health behaviors and utilization among users of complementary and alternative medicine for treatment versus health promotion

Objective. To compare the characteristics, health behaviors, and health services utilization of U.S. adults who use complementary and alternative medicine (CAM) to treat illness to those who use CAM for health promotion. Data Source. The 2007 National Health Interview Survey (NHIS). Study Design. We compared adult (age ≥18 years) NHIS respondents based on whether they used CAM in the prior year to treat an illness (n=973), for health promotion (n=3,281), or for both purposes (n=3,031). We used complex survey design methods to make national estimates and examine respondents' self‐reported health status, health behaviors, and conventional health services utilization. Principal Findings. Adults who used CAM for health promotion reported significantly better health status and healthier behaviors overall (higher rates of physical activity and lower rates of obesity) than those who used CAM as treatment. While CAM Users in general had higher rates of conventional health services utilization than those who did not use CAM; adults who used CAM as treatment consumed considerably more conventional health services than those who used it for health promotion. Conclusion. This study suggests that there are two distinct types of CAM User that must be considered in future health services research and policy decisions.     

Alternative and Complementary Medicine Web Resources for Autoimmune Diseases

Abstract

Autoimmune diseases affect over 14 million Americans, who may frequently search for alternative or complementary treatment methods aimed at reducing the debilitation associated with chronic disease. Included in this column is a select list of Web-based resources that explore the use of alternative and complementary medicine for autoimmune diseases.     

Use of alternative folk medicine by Mexican American women

Nontraditional health care resources available to Mexican Americans are many. The Mexican culture is rich with alternative health and illness beliefs and remedies which have their origins in ancient Mestizo/Indian folklore which viewed the causes of illness to include social, spiritual, and physical forces. This perception calls for culturally relevant folk practitioners who can treat all aspects of the perceived illness. This study of 70-Mexican American women explored their knowledge of and use of alternative Mexican folk medical practitioners in their own health maintenance. Results provided some evidence that, even among highly assimilated Mexican American women, there persist traditional, indigenous beliefs, and practices.     

Over-the-counter advice seeking about complementary and alternative medicines (CAM) in community pharmacies and health shops: an ethnographic study

In many ways, consumers of complementary and alternative medicine (CAM) embody the values that current policies aim to encourage such as self-caring and private consumption. For example, the British Government's choice agenda suggests patient choice and self-management are key government priorities and state that good information should be at the heart of all services. However, research on community pharmacies suggests that there is a continued lack of knowledge about CAM, especially herbal medicines and the limited research on health shops indicates that advice about CAM products is varied and inconsistent. Recognising the underlying tension of community pharmacies and health shops which combine both retail roles and promotion of patient wellbeing, we set out to examine customer advice seeking about CAM. The settings included independent and chain stores, selling varying amounts and types of CAM products. Data collection was ethnographic involving observation of staff–customer interactions, and semi-structured interviews with counter staff and people who purchased CAM products. The findings identified six main types of staff–customer interactions regarding over-the-counter CAM products. This typology ranged from needing significant amounts of help to needing very little including: help with diagnosis; help finding a general remedy; help with a specific product; free advice; pastoral care; and 'just buying'. The implications of these findings are discussed in the light of ongoing debates about the place of CAM in UK mainstream medicine and the evidence base for CAM. Potentially a highly valuable community resource, there is a lack of support for community pharmacies and health shops despite the government's choice agenda.     

Use of complementary or alternative medicine in a general population in Great Britain. Results from the National Omnibus survey

BACKGROUND: A representative sample of the adults in England, Scotland and Wales was interviewed to estimate levels of use of complementary or alternative medicines (CAMs) and their socio-economic correlates. METHODS: The Omnibus survey is a multi-purpose survey carried out in the United Kingdom by the Office for National Statistics on behalf of non-profit making organizations. The survey is carried out in 2 out of 3 months each quarter using a stratified random, probability sample of households. An eight-question module was added to the interview schedule of the survey in March 2001. Topics included practitioner-based use of 23 named CAM therapies in the past 12 months. The resulting data were analysed in conjunction with socio-economic and demographic variables. RESULTS: A response rate of 65 per cent (1794/2761) was achieved. An estimated 10.0 per cent of the population [95 per cent confidence interval (CI) 8.7-11.5 per cent] had received any CAM therapy from a practitioner in the past year. No individual therapy was used by more than 2 per cent of the sample. An estimated 6.5 per cent (95 per cent CI 5.4-7.6) had used one of the five main therapies: acupuncture, homeopathy, chiropractic, osteopathy or herbal medicine. Estimates of CAM use were similar in England, Scotland and Wales. There was a significant positive association between CAM use and non-manual social class (p < 0.002), age left full-time education (p < 0.001), and gross income over pounds sterling 15,600 (p < 0.001). More than half (52 per cent) of the respondents that had used CAM in the past year had not told their general practitioner. CONCLUSIONS: Strong correlations between the use of CAM and gross socio-economic indicators are demonstrated in the survey. Repeated national surveys of this type could provide a useful vehicle for collecting information about changing patterns of CAM use on a routine basis.