Overseas Chinese students in the UK: Patterns and correlates of their use of Western and traditional Chinese medicine

Cultural issues and other factors that affect self-management of Type 2 Diabetes Mellitus (T2D) by Chinese immigrants in Australia

AIMS

To investigate the influence of cultural and other factors on diabetes self-management behaviors among Australian Chinese immigrants with T2D.

METHODS

A cross-sectional survey was conducted between June and October 2015. The questionnaire comprised several validated scales examining aspects of self-management practice including medication adherence, acculturation and demographics. Participants were recruited from the community and Diabetes Center of the Royal Prince Alfred Hospital (RPAH), Sydney, Australia.

RESULTS

Of the 139 participants, a majority were female, from mainland China, with high school level education and a mean age of 64 (SD±12) years. Participants were found to have poor self-management practices generally but moderate medication adherence. 13.7% of participants reported incorporating TCM into their diabetes treatment and 24% reported a cultural shame surrounding a diabetes diagnosis. Higher levels of acculturation predicted better medication adherence, whereas stronger beliefs in TCM predicted poorer medication adherence. Gender, education level and duration of diabetes were also predictors of diabetes self-management behaviors.

CONCLUSIONS

This study provided insight into cultural influences on diabetes self-management and medication taking among Chinese immigrants in Australia. Health care providers should take these into account in delivering culturally sensitive care and advice to achieve better health outcomes.

The experiences and perceptions of family planning of female Chinese asylum seekers living in the UK

INTRODUCTION

Chinese family planning policy is unique. There is limited sex education and the state is highly influential. This has resulted in extremely wide coverage of contraception with long-acting methods being favoured. The Chinese constitute a large proportion of asylum applicants to the UK. This study examines how their experiences and decisions about family planning in the UK are shaped by their cultural background.

METHODS

Data were drawn from 10 semi-structured qualitative interviews with female Chinese asylum seekers recruited through a family planning clinic in the UK.

RESULTS

The increased autonomy provided by the UK system was appreciated by the participants. Choice of contraceptive method was influenced by traditional cultural beliefs and values, and the effect of hormonal contraception on menstruation was particularly concerning. Women arrived from China with little knowledge of contraception. Friends from a similar background were the most trusted source of advice. When transitioning from China to the UK unwanted pregnancies had occurred amongst unmarried women who had missed out on sex education while living in China.

CONCLUSIONS

Chinese societal and cultural practices continue to influence family planning decisions made within the UK. Culturally competent health strategies are needed to ensure Chinese immigrant women fully benefit from family planning within the UK.

A systematic literature review of complementary and alternative medicine prevalence in EU

BACKGROUND

Studies suggest that complementary and alternative medicine (CAM) is widely used in the European Union (EU). We systematically reviewed data, reporting research quality and the prevalence of CAM use by citizens in Europe; what it is used for, and why.

METHODS

We searched for general population surveys of CAM use by using Ovid MEDLINE (1948 to September 2010), Cochrane Library (1989 to September 2010), CINAHL (1989 to September 2010), EMBASE (1980 to September 2010), PsychINFO including PsychARTICLES (1989 to September 2010), Web of Science (1989 to September 2010), AMED (1985 to September 2010), and CISCOM (1989 to September 2010). Additional studies were identified through experts and grey literature. Cross-sectional, population-based or cohort studies reporting CAM use in any EU language were included. Data were extracted and reviewed by 2 authors using a pre-designed extraction protocol with quality assessment instrument.

RESULTS

87 studies were included. Inter-rater reliability was good (kappa = 0.8). Study methodology and quality of reporting were poor. The prevalence of CAM use varied widely within and across EU countries (0.3-86%). Prevalence data demonstrated substantial heterogeneity unrelated to report quality; therefore, we were unable to pool data for meta-analysis; our report is narrative and based on descriptive statistics. Herbal medicine was most commonly reported. CAM users were mainly women. The most common reason for use was dissatisfaction with conventional care; CAM was widely used for musculoskeletal problems.

CONCLUSION

CAM prevalence across the EU is problematic to estimate because studies are generally poor and heterogeneous. A consistent definition of CAM, a core set of CAMs with country-specific variations and a standardised reporting strategy to enhance the accuracy of data pooling would improve reporting quality.

The dragon and the snake: health practices among Chinese in the UK from an inter-disciplinary perspective

OBJECTIVES

This paper explores how ethnicity has been represented in research on the health practices of Chinese populations in the UK and suggests ways in which such research might be enriched by adopting an interdisciplinary approach.

DESIGN

A systematic literature review of studies was conducted on research with 'Chinese' in the UK.

RESULTS

The review highlighted that research with Chinese populations is frequently grounded in assumptions about the homogeneity of Chinese ethnic and cultural identities, and health practices, which undermines the generalizability of findings and conclusions.

CONCLUSIONS

There was a lack of clarity surrounding the term 'Chinese' as an ethnic and national label that can lead to racialised constructions of ethnicity. An interdisciplinary approach is a valuable tool for enriching understandings of culturally-specific accounts of health and illness, and to address ways in which Chinese populations negotiate different health care systems and models of health.

Accessing cancer services in North West England: the Chinese population

Relatively few Chinese patients access tertiary cancer services in North West England. We investigated the reasons behind this using a culturally sensitive questionnaire. The questionnaire, completed by 214 Chinese people in English, Cantonese or Mandarin, evaluated the Chinese population's access and satisfaction with primary care, understanding of cancer and awareness of local cancer services. Ninety-five per cent of respondents were registered with a general practitioner (GP) and 75% had accessed primary care in the last year. Satisfaction with GP consultations was high but a third of respondents reported a lack of confidence in local National Health Service (NHS) services. Only 57% of eligible women had attended cervical screening programmes. The overall understanding of the causes and treatment of cancer and cancer services in the North West was poor. Despite registration with primary healthcare, the Chinese population under-utilise cancer prevention programmes and tertiary cancer services because of a lack of awareness and understanding of cancer services in the North West. A significant proportion of the population is dissatisfied with the perceived slow service and lack confidence in services, with 41% considering using healthcare abroad. These data highlight the critical need to engage with, educate and support the Chinese population if they are to access NHS cancer services.

Views on traditional Chinese medicine amongst Chinese population: a systematic review of qualitative and quantitative studies

BACKGROUND

Health-care professionals worldwide have started to appreciate patients' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east.

OBJECTIVE

This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations.

SEARCH STRATEGY

Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out.

INCLUSION CRITERIA

Quantitative, qualitative or mixed-method research that aimed to investigate Chinese patients' perception of, and perspectives on, TCM was included.

DATA EXTRACTION AND SYNTHESIS

For each study included, texts under the headings of 'results' or 'findings' were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies.

MAIN RESULTS

Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed-method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations.

DISCUSSION AND CONCLUSIONS

Future research should explore how variation in health systems may influence patients' perception of CAM in different countries.

Predictors for adolescent visits to practitioners of complementary and alternative medicine in a total population (the Young-HUNT Studies)

Aim

To investigate the factors predicting adolescent visits to practitioners of complementary and alternative medicine (CAM).

Methods

A longitudinal cohort study conducted in an adolescent total population in Central Norway (The Nord-Trøndelag Health Studies (HUNT)). In Young-HUNT 1, all inhabitants aged 13 to 19 years (N = 8944, 89% response rate) were invited to participate, and the youngest group (13 to 15 year olds) was surveyed again 4 years later (Young-HUNT 2, N = 2429, 82% response rate). The participants completed a comprehensive questionnaire on health and life style which included a question regarding visits to a CAM practitioner in the last 12 months.

Results

One in eleven (8.7%, 95%CI 7.6-9.8%) had visited a CAM practitioner, an increase of 26% in 4 years (1.8% points). The final multivariable analysis predicted increased odds of an adolescent becoming a CAM visitor four years later (p<0.05) if she or he had previously visited a CAM practitioner (adjOR 3.4), had musculoskeletal pain (adjOR 1.5), had migraine (adjOR 2.3), used asthma medicines (adjOR 1.8) or suffered from another disease lasting more than three months (adjOR 2.1). Being male predicted reduced odds of visiting a CAM practitioner in the future (adjOR 0.6).

Conclusion

We can conclude from this study that future visits to a CAM practitioner are predicted by both predisposing factors (being female, having visited a CAM practitioner previously) and medical need factors (having had musculoskeletal pain, migraine, used asthma medicines or experienced another disease lasting more than three months). None of the specific variables associated with CAM visits were predictive for CAM visits four years later.

Comparative use of biomedicine and Chinese medicine in Taiwan: using the NHI Research Database

OBJECTIVES

Users of Traditional Chinese Medicine (CM) and biomedicine (BM) are commonly assumed to belong to two different groups in most of the related literature. The purpose of this article is to compare the characteristics of those who use both CM and BM for the same illness (CBMS) with those who solely use BM (BMS).

METHODS

Starting with a systematic sampling of 200,000 patients from a database of the Taiwan National Health Insurance program for the year 1999, the data were organized so that those who visited hospitals and clinics more than twice for the same illness were selected. In total, there were 96,872 (60%) BM users and 30,099 (19%) CBM users. The χ(2) test and mean test were applied to compare the differences in use between the above two subgroups. Logistic regression was used to calculate odds ratios of demographic variables and disease types.

RESULTS

Compared to the group using BM for the same illness (BMS), there were more females in the group using both CM and BM for the same illness (CBMS) (p < 0.0001). Most of the subjects in the CBMS group were aged 25-49 years (p < 0.0001). The mean number of total visits was higher for CBMS (16.33) than for BMS (13.71) (p < 0.0001). For both groups, the mean number of visits for females was higher than for males (p < 0.0001). Furthermore, the mean cost per visit was significantly lower for CBMS (519.58 New Taiwan Dollar [NTD]) than for BMS (582.37 NTD). Among the top eight major disease categories of patients in the two subgroups, disease of the respiratory system was the most common primary indication in both CBMS and BMS. However, diseases of the musculoskeletal system and injury showed the highest incidences in CBMS when compared with BMS.

CONCLUSIONS

Alternative medicinal treatment has become increasingly popular in recent years. Providing integrated CM and BM service in one medical facility might greatly benefit patients.