Original articleParents’ and practitioners’ differing perspectives on traditional and complementary health approaches (TCAs) for children
Introduction
Traditional and complementary healthcare approach (TCA) is an umbrella term, encompassing complementary and alternative medicine (CAM) and traditional, ‘folk’ or ‘ethno’ medicine [1]. Traditional medicine is often passed down through generations, is relatively informal and non-commercial [2].
Estimates of TCA use for children in primary care or the general population vary from 1.8% to 70% [3], [4], [5], depending on the country of study, ethnic origin of participants and differing definitions of CAM/TCA. The most prevalent types used for children are dietary supplements (vitamins and minerals) [6], [7], [8], homeopathy [9], [10], [11] and herbal medicine [11], [12].
Between 18% and 80% of practitioners report discussing TCA with patients [13], [14], [15], over half of practitioners recommend some form of TCA [16], [17], [18] and up to 95% have referred patients to TCA practitioners [19], [20].
Quantitative surveys have shown that the majority of practitioners have an ‘ambivalent’ or ‘neutral’ attitude to TCA [14], [21], [22], others have shown that few practitioners have overtly negative attitudes to TCA [14], [23] and two surveys have shown predominantly positive attitudes [24], [25]. A qualitative UK study of academic GPs found their beliefs about TCA could be viewed as on a spectrum from enthusiastic to skeptical, with those who were undecided being in the middle. The main influence on their attitude was their professional experience [26].
Studies rarely compare patient and practitioner reported data [27]. Studies have generally found that patients have more positive attitudes and greater expectations regarding TCA than practitioners. A survey comparing physician and patient knowledge of and attitudes to traditional Chinese medicine (TCM) found that knowledge levels were similar but patients were slightly more positive, and patients knew more about practical aspects compared to practitioners’ basic concepts [28]. However, this quantitative survey does not explore the details of these constructs. Two other studies investigated cancer patients, one is ongoing [27], the other found disparities in: definition of ‘unconventional’; reasons for communication; and decision making [29]. Two studies have included the triad of patient, physician and CAM practitioner [27], [30]. Ben-Arye et al. [30] found that patients perceived CAM as safer and more efficacious and had greater expectations of the physician's role in CAM than physicians. Adler emphasise the need to study all the stakeholders in order to gain a realistic view of healthcare communication [27]. Stevenson et al. [48] studied self-treatment in the consultation, using audio-taping of consultations and qualitative interviews with patients and practitioners. Kleinman highlights the significance of patients’ and practitioners’ differing explanatory models of health and illness [31]. These studies highlight potential discrepancies but rarely explore in-depth the beliefs behind these differing behaviours and expectations.
Other studies show that practitioners may underestimate how many of their patients use TCA [17], [32] and many agree they should have greater TCA knowledge [18], [21], [33].
This study aimed to compare parents’ and practitioners’ perspectives on traditional and complementary healthcare approaches (TCAs) used for children in a multi-ethnic community.
Section snippets
Methods
An exploratory qualitative study was conducted within community settings and primary care in Northwest London.
Focus groups were conducted with parents to explore their use of TCA for their children, sources of TCA information, their decision-making processes and whether they communicated with healthcare practitioners about the use of TCA. Sampling was purposive to achieve a broadly representative range of ethnicities. Parents were recruited from community settings such as mother and toddler
Participants
Groups invited to participate in focus groups were as follows: 47 community groups (from lists on community websites); 3 refugee groups; 13 GP practice mother and toddler/baby clinic groups; 4 nurseries; 8 schools; 29 places of worship; 1 parenting website; 1 early years centre and 1 baby massage class. Reasons for non-response or non-participation were lack of time, lack of resources, commitments to other projects and concerns about confidentiality. 11 focus groups were conducted in the
Discussion
This study identified that parents and practitioners have a number of disparate perspectives on TCA, mainly related to definition, categorisation, range, plausibility, efficacy, epistemology (source and nature of knowledge) and evidence.
Parents’ perspectives on TCA were in general more pragmatic, including their classification of treatments and decision making, which was informed by effectiveness. Practitioners focussed on more theoretical issues such as theories of how TCA work and the
Conclusions
Practitioners’ professionally guided criteria for assessing TCA are likely to differ greatly from parents’ more pragmatic criteria. This mismatch in perspectives regarding TCA may create communication problems during consultation. Practitioners need to appreciate the range and extent of TCA used for children and understand the reasons behind this use. They can then ask families about TCA use and make judgements with them about whether and how these can be integrated with current medical
Financial support
This study was supported by a grant from the King's Fund, a healthcare charity based in London.
Conflict of interest
No conflict of interest declared.
Acknowledgements
We would like to thank all the parents and practitioners who took part in this study.
References (71)
- et al.
Disclosure of natural product use to primary care physicians: a cross-sectional survey of naturopathic clinic attendees
Mayo Clinic Proceedings
(2005) - et al.
Use of alternative therapies by patients presenting to a pediatric emergency department
Journal of Emergency Medicine
(2005) - et al.
Complementary medicine use in multi-ethnic paediatric outpatients
Complementary Therapies in Clinical Practice
(2008) - et al.
Use of complementary/alternative therapies among children in primary care pediatrics
Ambulatory Pediatrics
(2002) - et al.
Complementary medicine and general practice: an urban perspective
Complementary Therapies in Medicine
(2000) - et al.
Providing complementary and alternative medicine in primary care: the primary care workers’ perspective
Complementary Therapies in Medicine
(2004) - et al.
Attitudes to and use of complementary medicine among physicians in the United Kingdom
Complementary Therapies in Medicine
(2001) - et al.
Differences between family physicians and patients in their knowledge and attitudes regarding traditional Chinese medicine
Integrative Medicine
(2000) - et al.
Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners
Patient Education and Counseling
(2008) - et al.
Developing a decision-making model on traditional and complementary medicine use for children
European Journal of Integrative Medicine
(2009)
Self-treatment and its discussion in medical consultations: how is medical pluralism managed in practice?
Social Science & Medicine
The relationship between health promotion and complementary therapies
Complement Therapy in Nursing Midwifery
A survey of medical students’ opinions about complementary and alternative medicine
American Journal of Obstetrics and Gynecology
Folk medicine and health culture in contemporary society
Primary Care
Varieties of healing. 2. A taxonomy of unconventional healing practices
Annals of Internal Medicine
Cultural diversity, alternative medicine, and folk medicine
New Directions in Folklore
Use of complementary and alternative medicine by children in the United States
Archives of Pediatrics & Adolescent Medicine
Prevalence of complementary/alternative medicine for children: a systematic review
European Journal of Pediatrics
The use of alternative medicine by children
Pediatrics
A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales
BMC Complementary & Alternative Medicine
Use of complementary and alternative medicines by children and adolescents with inflammatory bowel disease
Journal of Paediatrics & Child Health
Complementary medicine use in children: extent and reasons. A population based study
British Journal of General Practice
Surveying physicians’ attitudes about herbal supplements, resources, and pharmacy consultations
Journal of Pharmacy Technology
Communication about complementary and alternative medicine: perspectives of primary care clinicians
Alternative Therapies in Health & Medicine
Alternative therapies and nurse practitioners: knowledge, professional experience, and personal use
Holistic Nursing Practice
Academic physicians and complementary and alternative medicine: an institutional survey
American Journal of Medical Quality
Clinicians’ attitudes and usage of complementary and alternative integrative medicine: a survey at the Johns Hopkins Medical Institute
Journal of Alternative and Complementary Medicine
A comparison of the attitudes shown by general practitioners, hospital doctors and medical students towards alternative medicine
Journal of the Royal Society of Medicine
Physicians want education about complementary and alternative medicine to enhance communication with their patients
Archives of Internal Medicine
Complementary therapies: knowledge and attitudes of health professionals
Paediatric Nursing
Complementary and alternative medical practices: training, experience, and attitudes of a primary care medical school faculty
Journal of American Board in Family Practice
Academic doctors’ views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study
BMC Complementary and Alternative Medicine
Relationships among older patients. CAM practitioners, and physicians: the advantages of qualitative inquiry
Alternative Therapies In Health and Medicine
A comparison of physician and patient perspectives on unconventional cancer therapies
Psychooncology
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