Developing and testing a conceptual decision-making model on CAM use for children in a multi-ethnic community

Abstract

Why parents choose CAM is a complex process reflecting diversity of cultures and health beliefs. Explanatory models of decision-making in CAM for children are limited. A multi-ethnic paediatric outpatient questionnaire survey in NW London identified that 36% of parents were using CAM for their children. Traditional medicines and home remedies were popular. Following on from the survey, focus groups with 100 parents from over 20 different countries were carried out. These explored the predisposing, enabling and need factors and influence of healthcare experience on CAM use for children. Themes were identified using Framework Analysis and Atlas.ti software. Traditional home remedies including herbs, spices, foods, prayer and rituals were used by the majority of parents and often used as a first choice of treatment. Many of these treatments were perceived as natural and safe, related to ethnicity and bought from ethnic grocers or brought from their home country. Family knowledge and history of use were predictors of CAM use and discussion of CAM use with doctors was rare. The use of focus groups allowed exploration of cultural beliefs and norms and identified factors influencing parental choice of CAM which could be used to inform the development of a conceptual model. The Andersen Behavioural Model, which has previously been adapted for CAM use, may provide an appropriate framework to conceptualise CAM decision-making for children. Data from the focus group analysis were used to develop and adapt this behavioural model for children, whilst reflecting the influence of diverse cultural backgrounds. This adapted model is currently being empirically tested using a survey instrument within primary care. This will validate the model for wider use and may provide an opportunity to develop a consistent methodological approach for CAM decision-making. Understanding this process is crucial in promoting shared decision-making between primary care practitioners and parents and could help to inform service provision, delivery and policy. We are grateful to the King's Fund for financial support.