Use of Folk Therapy in Taiwan: A Nationwide Cross-Sectional Survey of Prevalence and Associated Factors

The long-term trend in utilization of traditional Chinese medicine and associated factors among older people in Taiwan

BACKGROUND

Both the size of the older population and the use of complementary and alternative medicine are increasing worldwide. This study evaluated the long-term trend in utilization of traditional Chinese medicine (TCM) and associated factors among older people in Taiwan.

METHODS

Using the database of population-based interview surveys, we evaluated the one-month prevalence of TCM use among 13,945 older people aged over 65 years from 2001-2017. The sociodemographic status and medical comorbidities of older people who did and did not use TCM were compared by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in the multiple logistic regressions.

RESULTS

The one-month prevalence of TCM use increased from 5.5% in 2001 to 9.1% in 2017 among older people in Taiwan. Overall, 7.3% of older people had used TCM within the previous month. People with a history of heart disease (OR 1.62, 95% CI 1.24-2.12), use of folk therapy (OR 3.16, 95% CI 2.00-4.99), and purchase of non-prescribed Chinese herbal medicine (OR 2.08, 95% CI 1.48-2.91) were more likely to use TCM than the comparison group. However, age ≥80 years (OR 0.48, 95% CI 0.31-0.72) and previous hospitalization (OR 0.59, 95% CI 0.41-0.85) were associated with the reduced use of TCM.

CONCLUSION

From 2001-2017, the use of TCM increased in the older population in Taiwan. The use of folk medicine and purchase of non-prescribed Chinese herbal medicine were significant predictors for the use of TCM.

Social determinants of health that impact the time to diagnosis and treatment of infertility in Taiwan

BACKGROUND/PURPOSE

Taiwan is one of the countries with the lowest birth rate in the world. We investigated factors associated with the time to diagnosis and treatment of infertility in Taiwan.

METHODS

The study was conducted through an online questionnaire in December 2021. The questionnaire was adapted from a previously published multinational survey, and culture-specific questions were added. 91 infertile patients and 89 partners of patients in Taiwan, aged 20- to 45- year-old, were included.

RESULTS

The average duration before diagnosis was 2.9 years, followed by 1.5 years before treatment. Older age at marriage (p = 0.0024), higher education level (P = 0.0001), and a higher gender equality score (p = 0.0031) were associated with earlier diagnosis. Conversely, folk therapy use was linked to later diagnosis (p < 0.0001) and treatment (p < 0.0001). Notably, in the female (p = 0.039) and patient (p = 0.0377) subgroups, a higher gender equality score was associated with a shorter duration of folk therapy. Subjectively, the most frequent factor influencing treatment decision was affordability or lack thereof. The government subsidy for in vitro fertilization led to increased treatment willingness for 46.3% of respondents, and 47.3% reported more likely to pursue earlier treatment.

CONCLUSIONS

This study highlights the influence of education, gender equality, folk therapy, and government subsidy on fertility care decisions. To improve the timeliness of infertility healthcare in Taiwan, potential strategies include promoting education, fostering gender equality, providing financial support, and raising awareness on the association between folk therapy and delayed medical care.

Use of integrative and complementary health practices by Brazilian population: results from the 2019 National Health Survey

BACKGROUND

In 2006, Brazil implemented the National Policy on Integrative and Complementary Practices of the SUS. and in 2015, the Brazilian Ministry of Health issued a reinforcement to this policy to increase access to integrative and complementary health practices (ICHP). In this study, we described the prevalence of ICHP in Brazilian adults according to their sociodemographic characteristics, self-perceived health, and chronic diseases.

METHODS

This is a nationally representative cross-sectional survey including 64,194 participants from the 2019 Brazilian National Health Survey. Types of ICHP were categorized according to their purposes: health promotion (Tai chi/Lian gong/Qi gong, yoga, meditation, and integrative community therapy) or therapeutic practices (acupuncture, auricular acupressure, herbal treatment and phytotherapy, and homeopathy). Participants were classified as non-practitioners and practitioners, who in turn were grouped according to use of ICHP in the last 12 months: only used health promotion practices (HPP); only used therapeutic practices (TP); used both (HPTP). Multinomial logistic regressions were performed to estimate the associations of ICHP with sociodemographic characteristics, self-perceived health status, and chronic diseases.

RESULTS

Brazilian adults showed an ICHP use prevalence of 6.13% [95%CI = 5.75-6.54]. Compared to non-practitioners, women and middle-aged adults were more likely to use any ICHP. Afro-Brazilians were less likely to use both HPP and HPTP, whereas Indigenous people were more likely to use both HPP and TP. We found a positive gradient of association among participants with higher income and educational attainment and access to any ICHP. People from rural areas and those with negative self-perceived health were more likely to use TP. Participants with arthritis/rheumatism, chronic back problems, and depression were more likely to use any ICHP.

CONCLUSIONS

We found that 6% of Brazilian adults reported using ICHP in the previous 12 months. Women, middle-aged individuals, chronic patients, people with depression, and wealthier Brazilians are more likely to use any type of ICHP. Of note, rather than suggesting to expand the offer of these practices in the Brazilian public health system, this study diagnosed Brazilians' behavior of seeking for complementary healthcare.

Utilization of complementary and traditional medicine practitioners among middle-aged and older adults in India: results of a national survey in 2017-2018

BACKGROUND

Lack of information exists about the use of traditional and complementary medicine (TCM) use among middle-aged and older adults in India, which led to studying the estimates of past-12-month Ayurveda/Yoga/Naturopathy/Unani/Siddha/Homeopathy (AYUSH) practitioner and traditional health practitioner (THP) utilization in India.

METHODS

The study included 72,262 individuals (45 years and older) from the cross-sectional 2017-2018 Longitudinal Ageing Study in India (LASI) Wave 1.

RESULTS

The prevalence of past 12-month AYUSH practitioner utilization was 6.5%, THP use 7.0%, and AYUSH or THP use 13.0%. The rate of AYUSH practitioner utilization was determined by older age (≥60 years) (Adjusted Odds Ratio-AOR: 1.20, 95% Confidence Interval-CI: 1.07-1.34), having pain (AOR: 1.48, 95% CI: 1.29-1.69), any bone or joint diseases (AOR: 1.57, 95% CI: 1.35-1.82), current tobacco use (AOR: 1.30, 95% CI: 1.12-1.50), male sex (AOR: 0.76, 95% CI: 0.68-0.85), high subjective socioeconomic status (AOR: 0.72, 95% CI: 0.60-0.87), urban residence (AOR: 0.71, 95% CI: 0.57-0.88), diabetes (AOR: 0.66, 95% CI: 0.55-0.81), chronic heart disease (AOR: 0.52, 95% CI: 0.37-0.73), and having a health insurance cover (AOR: 0.36, 95% CI: 0.30-0.44). The rate of THP utilization was determined by depressive symptoms (AOR: 1.17, 95% CI: 1.01-1.35), sleep problems (AOR: 1.28, 95% CI: 1.08-1.51), having pain (AOR: 1.82, 95% CI: 1.55-2.15), current tobacco use (AOR: 1.35, 95% CI: 1.22-1.51), having health insurance cover (AOR: 0.41, 95% CI: 0.33-0.51), hypertension (AOR: 0.82, 95% CI: 0.71-0.95), diabetes (AOR: 0.50, 95% CI: 0.39-0.65), urban residence (AOR: 0.25, 95% CI: 0.19-0.34), and high subjective socioeconomic status (AOR: 0.70, 95% CI: 0.58-0.85).

CONCLUSION

A moderate prevalence of AYUSH practitioner and THP use among middle-aged and older adults in India was found and several factors associated with AYUSH practitioner and THP use were identified.

"Hesitating and Puzzling": The Experiences and Decision Process of Acute Ischemic Stroke Patients with Prehospital Delay after the Onset of Symptoms

Despite campaigns to increase public awareness of stroke symptoms by advocating FAST (Face-Arms-Speech-Time), some stroke patients still show delays in the recognition of and response to stroke symptoms and miss the golden first 4.5 h to receive rt-PA (recombinant tissue plasminogen activator) treatment. The aim of this study was to explore how acute ischemic stroke patients with prehospital delay seek help and undergo the decision process before arriving at the hospital. A qualitative approach using a grounded theory was applied. There were 24 ischemic stroke patients recruited by purposive sampling. Our main findings were: “Hesitating and puzzling” was the core category to describe and guide the process of acute ischemic stroke patients with prehospital delay. During the process, “Awareness the sudden change of physical sensation and/or function” was the antecedent category. In the prehospital delay experience, the following five interaction categories were identified: (1) “Self-judgment and interpretation according to previous experience,” (2) “Puzzling and doubting—it may only be a minor problem,” (3) “Self-treatment or seeking medical attention nearby,” (4) “Unexpected symptoms getting worse” needing immediate advanced medical help and (5) “Rushing to ER with different transportation—self-alerting that serious disease is coming.” Eventually, the patients “Regret to delay seeking treatment and become a disable person.” The process of prehospital delay provides some hidden cues for patients to increase their knowledge about strokes. The study emphasizes the importance of educating community residents about identifying stroke symptoms, breaking the myth of folk therapy, and seeking medical attention immediately. These results will assist healthcare providers by offering references for designing patient-centric educational strategies for preventing stroke prehospital delay to improve the quality of stroke medical care.

Prevalence, expenditures, and associated factors of purchasing non-prescribed Chinese herbal medicine in Taiwan

BACKGROUND AND AIMS

Purchasing Chinese herbal medicine (CHM) without a physician's prescription may have adverse effects on health. However, the recent status of purchasing non-prescribed CHM and the associated factors are not completely understood. We aimed to report the prevalence of purchasing CHM and associated factors.

METHODS

Using data from the 2017 Taiwan Survey of Family Income and Expenditure, we identified 16,528 individuals (householders) aged 18 years and older. Sociodemographic factors, expenditures on medical services and health behaviours were compared between people with and without a history of purchasing non-prescribed CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis.

RESULTS

The one-year prevalence of purchasing non-prescribed CHM was 74.8% in Taiwan. In addition to sociodemographics, marital status (OR 2.14, 95% CI 1.88-2.44), the use of traditional Chinese medicine (OR 3.62, 95% CI 3.30-3.97), the purchasing of non-prescribed biochemical medications (OR 3.09, 95% CI 2.75-3.48), the purchasing of health foods (OR 2.59, 95% CI 2.33-2.86), the use of folk therapy (OR 2.27, 95% CI 1.95-2.64), and a high level of expenditure on alcohol (OR 3.79, 95% CI 3.29-4.36) were strongly correlated with purchasing non-prescribed CHM.

CONCLUSION

The one-year prevalence of purchasing non-prescribed CHM is very high in Taiwan and is correlated with sociodemographics, health behaviours, and the utilization of medical care. The interaction of non-prescribed CHM with physician-prescribed herbal medicine and biomedical medications requires more attention.

The relationship between health sciences students' perceptions of health news and their attitudes to using complementary and alternative medicine

PURPOSE

Written-visual and social media play a significant role in accessing knowledge about health issues. Media coverage of complementary and alternative medicine (CAM) can affect the beliefs, attitudes, behaviors and decisions to use of CAM the individuals. The research was planned as a descriptive, cross-sectional study was to evaluate the relationship between the health sciences students' perceptions of health news and their attitude towards using CAM.

METHOD

The sample included 736 students studying in a Department of Nursing, Physiotherapy and Rehabilitation, and Nutrition and Dietetics program in a Faculty of Health Sciences. A Students' Description Form, The Perception of Health News Scale (PHNS), and The Attitude towards Using Complementary Treatments Scale (ACTS) were used to collect the data in this study.

RESULTS

The students' mean PHNS scores were found to be 81.05 ± 13.42, and their mean ACTS scores were 30.07 ± 6.56. There was a statistically significant difference between HS students' mean PHMS scores and usage of CAM and following of health news on the written-visual media (p < 0.05). There was a statistically significant difference between HS students' mean ACTS scores and their department of study, year of study, usage of CAM, education on CAM, usage of social media, following of health news on the written-visual media and following health news on social media (p < 0.05). A weak positive correlation was found between the students' PHNS scores and their ACTS scores (r = 0.189, p = 0.000).

CONCLUSION

In the conclusion of our research, it was found that HS students' perception of health news may affect their attitudes towards using CAM.

New Users of Herbal Medicine Containing Aristolochic Acids and the Risk of Dementia in the Elderly: A Nationwide, Population-Based Study in Taiwan

BACKGROUND

Herbal medicine containing aristolochic acids (HMCAA) was used for inflammatory and infectious diseases. This study aimed to investigate the association between the usage of HMCAA and the risk of dementia.

METHODS

A total of 199 new users of HMCAA were enrolled, along with 597 controls without the usage of HMCAA, at a ratio of 1:3 - matched by age, sex, and comorbidity, between 2000 and 2003 - from the National Health Research Institutes Database (NHRID) of Taiwan, which contains two million randomly sampled subjects, in this cohort study. We used Fine and Gray's survival analysis (competing with mortality) to compare the risk of developing dementia during a 15-year follow-up period (2000-2015).

RESULTS

In general, HMCAA was not significantly associated with dementia (adjusted subdistribution hazard ratio [SHR] = 0.861, 95% confidence interval [CI] = 0.484-1.532, p = 0.611) for the HMCAA-cohort, although differential risk was observed among the groups at risk. The patients with usage of HMCAA aged ≧ 85 years were associated with a higher risk in dementia (adjusted SHR: 6.243, 95% CI=1.258-21.084, p = 0.001), in comparison to those aged 50-54 years. Furthermore, the patients with usage of HMCAA that had cerebrovascular accidents were associated with an increased risk of dementia.

CONCLUSION

The usage of HMCAA was associated with the risk of developing dementia in the patients aged ≧ 85 years.

The utilization of complementary and alternative medicine in Taiwan: An internet survey using an adapted version of the international questionnaire (I-CAM-Q)

BACKGROUND

In Taiwan, numerous studies have been conducted to investigate the use of complementary and alternative medicine (CAM). However, most of them focused on specific diseases or the use of particular methods. Therefore, the results of those studies were quite different and difficult to compare with those of studies from other countries. The International CAM Questionnaire (I-CAM-Q), meanwhile, is a unified tool that can provide comparable results for studies conducted worldwide. Thus, the aim of this study was to discover the proportions of people in Taiwan receiving CAM treatments from different types of health care providers by using an adapted version of I-CAM-Q (I-CAM-QT).

METHODS

I-CAM-QT was developed by translating the Korean version of I-CAM-Q (I-CAM-QK) into traditional Chinese language because of the similarity of CAM usage and doctor licensing system. This study had two stages: the first was a pretest survey used to adjust the questionnaire, while the second was an internet-based survey used to collect data from the community.

RESULTS

Of the 1200 survey respondents, 37% and 37.7% were prescribed or advised to use Chinese herbal medicine (CHM) by Western medicine (WM) physicians and traditional Chinese medicine (TCM) doctors, respectively. Other than CHM, dietary supplements and massage were the forms of CAM most commonly prescribed or recommended by WM physicians or TCM doctors. Overall, walking and relaxation techniques were the most commonly used self-help practices (used by 61.9% and 40.4% of the respondents, respectively). Additionally, 70.3% of the respondents had used at least one kind of dietary supplement in the past 12 months.

CONCLUSION

Regarding the utilization of CAM in Taiwan, this internet-based survey revealed that CHM, dietary supplements, and massage were the types of CAM most commonly prescribed or recommended by WM physicians or TCM doctors.

Utilization of traditional and complementary medicine in Indonesia: Results of a national survey in 2014-15

BACKGROUND AND PURPOSE

Scant information exists about traditional, complementary and alternative medicine (TCAM) use in Indonesia, which prompted investigating its prevalence and correlates in Indonesia.

MATERIALS AND METHODS

Participants were 31,415 individuals 15 years and older that participated in the cross-sectional Indonesia Family Life Survey in 2014-15.

RESULTS

In all, 24.4% had used a traditional practitioner and/or traditional medicine in the past four weeks, and 32.9% had used complementary medicine in the past four weeks. In adjusted logistic regression analysis, being of older age, being a Muslim, residing in an urban area or on Java, being unhealthy, having a chronic condition, having depression symptoms, experiencing sleep disturbance, and having high social support were associated with both current traditional practitioner and/or medicine use and complementary medicine use.

CONCLUSION

The study shows a high prevalence of TCAM use in Indonesia and several sociodemographic and health related factors of its use were identified.

Use of Complementary Traditional Chinese Medicines by Adult Cancer Patients in Taiwan: A Nationwide Population-Based Study

BACKGROUND

Many patients with cancer seek complementary and alternative medicine treatments. We investigated the use of traditional Chinese medicine (TCM) by adult cancer patients in Taiwan.

METHODS

We reviewed the Registry for Catastrophic Illness Patients Database of Taiwan, and included all adult patients diagnosed cancer, based on the International Classification of Diseases (ninth revision), from 2001 to 2009 and followed until 2011. This database allowed categorization of patients as TCM users (n = 74 620) or non-TCM users (n = 508 179). All demographic and clinical claims data were analyzed.

RESULTS

Compared with non-TCM users, TCM users were younger and more likely to be female, white-collar workers, and reside in highly urbanized areas. The average interval between cancer diagnosis and TCM consultation was 15.3 months. The most common cancer type was breast cancer in TCM users (19.4%), and intrahepatic bile duct cancer in non-TCM users (13.6%). The major condition for which TCM users visited clinics were endocrine, nutritional and metabolic diseases, and immunity disorders (23.2%). A total of 33.1% of TCM users visited TCM clinics more than 9 times per year and their time from diagnosis to first TCM consultation was 5.14 months. The most common TCM treatment was Chinese herbal medicine. The common diseases for which cancer patients sought TCM treatment were insomnia, malaise and fatigue, dizziness and headache, gastrointestinal disorders, myalgia and fasciitis, anxiety, and depression. Overall, TCM users had a lower adjusted hazard ratio (aHR) for mortality (aHR = 0.69, 95% CI = 0.68-0.70) after adjustment for age, sex, urbanization of residence, occupation, annual medical center visits, and annual non-medical center visits.

CONCLUSIONS

This study provides an overview of TCM usage among adult cancer patients in Taiwan. TCM use varied among patients with different types of cancer. Physicians caring for cancer patients should pay more attention to their patients' use of complementary TCM.

The prevalence, characteristics, and factors associated with purchasing Chinese herbal medicine among adults in Taiwan

Background

The objective of this study was to investigate the prevalence and factors associated with purchasing Chinese herbal medicine (CHM) without a physician’s prescription among adults.

Methods

Using data from the 2005 National Health Interview Survey and National Health Insurance, we identified 16,756 individuals aged 20 years and older. Socio-demographic factors, lifestyle, medical services utilization and health behaviors were compared between people with and without a history of purchasing CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis.

Results

The one-month prevalence of purchasing CHM without a physician’ prescription was 5.2% in Taiwan. People more likely to purchase CHM included people aged ≥70 years (OR 2.84, 95% CI 2.03-3.99), women (OR 1.28, 95% CI 1.11-1.48), non-indigenous people (OR 2.61, 95% CI 1.29–5.30), and people with an illness not receiving medical care (OR 2.69, 95% CI 2.19-3.31).

Conclusion

The prevalence of purchasing CHM without a physician’s prescription is high in Taiwan and is correlated with factors such as socio-demographics, disease history, and behaviors surrounding the utilization of medical care.

Prevalence and Determinants of Traditional, Complementary and Alternative Medicine Provider Use among Adults from 32 Countries

OBJECTIVE

To estimate recent prevalence data (2011-2013) on traditional, complementary and alternative medicine (TCAM) provider use and sociodemographic and health related correlates in nationally representative population samples from 32 countries from all world regions.

METHODS

This secondary analysis was based on the International Social Survey Program (ISSP), 2011-2013, Health and Health Care Module. In a cross-sectional population-based survey (N=52,801), simple or multi-stage stratified random sampling was used, resulting in representative samples of the adult population of respective countries.

RESULTS

Overall, the 12-month TCAM provider use prevalence was 26.4%, ranging from under 10% in Bulgaria, Poland and Slovenia to over 50% in China mainland, the Philippines and Republic of Korea. Over 80% TCAM treatment satisfaction was found in Europe in Denmark, Slovenia, Spain and Switzerland, in Asia in Taiwan (China) and USA. Multivariate logistic regression found sociodemographic variables (middle age, female sex, lower educational status, not having a religious affiliation, and lower economic indicators) and health variables (perceived poor or fair health status, being unhappy and depressed, having a chronic condition or disability, and having positive attitudes towards TCAM) were associated with TCAM provider use.

CONCLUSIONS

A high prevalence TCAM provider use was found in all world regions and several sociodemographic and health related factors of its use were identified.