Abstract
Complementary and alternative medicine (CAM) is widely used especially in Asia including for childhood asthma. The use of CAM could influence adherence to evidence-based (E-B) medicine. We explored the views of carers of Malaysian children with asthma regarding the use of CAM for childhood asthma, and its relationship with self-reported adherence to E-B medicine. We used a screening questionnaire to identify children diagnosed with asthma from seven suburban primary schools in Malaysia. Informed consent was obtained prior to the interviews. We conducted the interviews using a semi-structured topic guide in participants’ preferred language (Malay, Mandarin, or Tamil). All interviews were audio-recorded, transcribed verbatim and coded using Nvivo. Analysis was performed thematically, informed by the Necessity-Concerns Framework. A total of 46 carers (16 Malays, 21 Indians, 9 Chinese) contributed to 12 focus groups and one individual interview. We categorised participants’ as ‘Non-CAM’; ‘CAM’; or ‘combination’ user. Cultural practices and beliefs in the efficacy of CAM resulted in widespread use of CAM. Most carers used CAM as ‘complementary’ to E-B medicine. Concerns about dependence on or side effects of E-B treatment influenced carers’ decisions to rely on CAM as an ‘alternative’, with an important minority of accounts describing potentially harmful CAM-use. Healthcare professionals should discuss beliefs about the necessity for and concerns about use of both E-B medicine and CAM, and provide balanced information about effectiveness and safety. The aim is to improve adherence to regular E-B preventer medication and prevent delays in seeking medical advice and harmful practices associated with CAM.
Highlights
Childhood asthma is one of the most common chronic diseases among children.[1]
Some of the Complementary and alternative medicine (CAM) choices were culturally specific warranted further clarification as they were deviant from others in e.g. Chinese preferred Chinese traditional medication, Indians the group) for better understanding about their beliefs and CAM preferred ayurvedic treatment, and Malay preferred Malay and practices
Our findings demonstrate how carers balance their beliefs about E-B medicine and CAM to decide on management strategies for their children
Summary
Childhood asthma is one of the most common chronic diseases among children.[1]. It poses a significant healthcare burden worldwide and is one of the top ten causes of disability-adjusted life years among children aged 5–14 years.[2]. Evidence-based medicine (E-B medicine) as recommended by global guidelines for asthma management can substantially reduce this burden.[3] Good control of asthma symptoms and prevention of attacks is achievable for most children with regular inhaled corticosteroids, and bronchodilators for relief of acute symptoms.[3,4,5] These treatments, only work if they are taken, and adherence to regular E-B medicine is notoriously poor.[6,7] A widely accepted model that helps understand key reasons for poor adherence is the necessity-concerns framework which holds that patients’/carers’ use common-sense judgement when they decide to use treatment (or not).
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