Evaluation On The Use Of Complementary And Alternative Medicine Among Hypertensive Patients In Baghdad, Iraq: A Mixed Methods Approach
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Date
2018-08
Authors
Inas Rifaat Ibrahim
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
The growing interest with complementary and alternative medicine (CAM) is evident among patients with hypertension (HTN). This study aimed to investigate the use and seeking behavior of CAM by hypertensive patients; attitudes towards CAM and towards disclosing it to the doctors before and after an education program; the effect of hypertension-related knowledge (HTN-RK) and health-related quality of life (HRQoL) on patients’ use of CAM. A mixed methodological technique was adopted. The first was a qualitative technique through interviews with 20 patients using semi-structured interview guide. A purposive sampling method was used for patient’s recruitment. The second was a quantitative design where a cross-sectional study was conducted at two major teaching hospitals in Baghdad. A convenience sampling method was used to recruit 400 patients and a validated questionnaire was used for gathering of data. Further, an educative program about CAM was implemented. Results of the qualitative phase detected that 14 patients were using CAM to control the blood pressure. Three major themes were identified familiarity with CAM; perceived benefits; and communication with the physicians. This practice was supportive to the pharmacological treatment and underpinned by the social effect, low cost treatment; religious effects, and cultural perspectives. The quantitative analysis showed that 65.5% of respondents used CAM in the management of HTN. This use was significantly associated with the education level (P< 0.001); marital status (P= 0.007), and the duration of HTN (P= 0.045). The most reported reason of using CAM was to support the standard treatment and this practice was recommended by other hypertensive patients. The mean annual expenditure on CAM was US $ 319. Some perceived adverse effects were reported due to this practice. CAM users were noticed to have a higher favorable attitude than their counterparts (P< 0.001). This attitude was associated with the gender (P< 0.001) and the education level (P<0.001). Patient’s communication with the doctor was very poor (11.5), and poor attitude towards disclosing CAM to the health professionals was noted. Significant improvements in attitudes towards CAM (P< 0.001) and attitudes towards disclosing it to the health professionals (P< 0.001) were detected after the educative intervention. The most reported health status on EQ-5D measure was 12233. CAM-users reported a lower health status than non-users (P< 0.001). Furthermore, the level of hypertension-related knowledge (HTN-RK) was inadequate among the respondents, and it was the lowest among users of CAM (P< 0.001). A prediction model detected that the education level (OR=26.8, P< 0.001) and HTN-RK (OR=0.29, P< 0.001) were the only predictors of using CAM by hypertensive patients. In conclusion, CAM was prevalent among Iraqi hypertensive patients due to favorable attitudes towards it and lack of disclosing this practice to the doctors. Some of patient’s characteristics; as well as, HTN-RK were associated with patient’s use of CAM. Health professionals must be aware of this practice and counsel their patients regarding the concomitant use of CAM with the prescribed treatment. The educative intervention about CAM is important to improve patients’ attitudes towards CAM; as well as, prevent the unnecessary risk associated with it.
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Medicine