Use of Complementary Therapies for Health Promotion Among Older Adults

Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research

AIMS

To describe sources of health information and health-seeking behaviours of adults (aged ≥18) living in medically underserved communities in the Philippines.

DESIGN

This is a secondary, quantitative analysis from a cross-sectional parent study. Participants completed a 10-item, self-report survey on their sources of health information, healthcare providers sought for health and wellness and health-seeking behaviours when ill. Responses were evaluated across two age groups (<60 vs. ≥60 years) and genders using generalized linear mixed models.

RESULTS

Surveys were completed by 1202 participants in rural settings (64.6% female, mean age 49.5 ± 17.6). Friends and/or family were their key source of health information (59.6%), followed by traditional media (37%) and healthcare professionals (12.2%). For health promotion, participants went to healthcare professionals (60.9%), informal healthcare providers (17.2%) or others (7.2%). When ill, they visited a healthcare professional 69.1% of the time, self-medicated (43.9%), prayed (39.5%) or sought treatment from a rural health clinic (31.5%). We also found differences in health-seeking behaviours based on age and gender.

CONCLUSIONS

Our findings highlight the need to organize programs that explicitly deliver accurate health information and adequate care for wellness and illness. Study findings emphasize the importance of integrating family, friends, media and healthcare professionals, including public health nurses, to deliver evidence-based health information, health promotion and sufficient treatment to medically underserved Filipinos.

IMPLICATIONS

New knowledge provides valuable information to healthcare providers, including public health nurses, in addressing health disparities among medically underserved Filipinos.

IMPACT

This study addresses the current knowledge gap in a medically vulnerable population. Healthcare professionals are not the primary sources of health information. Approximately one-third of participants do not seek them for health promotion or treatment even when ill, exacerbating health inequities. More work is necessary to support initiatives in low- and middle-income countries such as the Philippines to reduce health disparities.

REPORTING METHOD

We adhered to the reporting guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution as our study design and methodology do not make this necessary.

Complementary, alternative, and integrative medicine-specific COVID-19 misinformation on social media: A scoping review

Background

The sharing of health-related information has become increasingly popular on social media. Unregulated information sharing has led to the spread of misinformation, especially regarding complementary, alternative, and integrative medicine (CAIM). This scoping review synthesized evidence surrounding the spread of CAIM-related misinformation on social media during the COVID-19 pandemic.

Methods

This review was informed by a modified version of the Arksey and O'Malley scoping review framework. AMED, EMBASE, PsycINFO and MEDLINE databases were searched systematically from inception to January 2022. Eligible articles explored COVID-19 misinformation on social media and contained sufficient information on CAIM therapies. Common themes were identified using an inductive thematic analysis approach.

Results

Twenty-eight articles were included. The following themes were synthesized: 1) misinformation prompts unsafe and harmful behaviours, 2) misinformation can be separated into different categories, 3) individuals are capable of identifying and refuting CAIM misinformation, and 4) studies argue governments and social media companies have a responsibility to resolve the spread of COVID-19 misinformation.

Conclusions

Misinformation can spread more easily when shared on social media. Our review suggests that misinformation about COVID-19 related to CAIM that is disseminated online contributes to unsafe health behaviours, however, this may be remedied via public education initiatives and stricter media guidelines. The results of this scoping review are crucial to understanding the behavioural impacts of the spread of COVID-19 misinformation about CAIM therapies, and can inform the development of public health policies to mitigate these issues.

Mind-Body Interventions in Patients With Heart Failure: State of the Science

Complementary and alternative medicine are broadly considered mind-body interventions (MBIs) that support physical and mental wellness in patients with heart failure (HF). The aims of this review were to integrate and summarize current evidence from MBIs in patients with HF and to identify gaps for future research. We used PRISMA guideline and conducted a literature search through six databases. Fifteen publications met the criteria, published between 2013 and 2021. This review stipulated that MBIs included yoga, Tai Chi, meditation, reflexology, massage, relaxation, and breathing interventions. The findings emphasized that MBIs could reduce physical and psychological symptoms and improve health outcomes in patients with HF. MBIs had encouraging results for patients with HF on selected physiological and behavioral outcomes. Despite the early state of the evidence in this field, it seems that MBIs will play an essential role in the future for alleviating the symptoms of patients with HF.

Person-Centered Care in Nursing Homes: Potential of Complementary and Alternative Approaches and Their Challenges

A person-centered approach to care shifts the mind-set of care partners from a traditional medical model to a social model in managing chronic conditions. Using a qualitative descriptive approach, this study examines the barriers and facilitators to the implementation of person-centered care (PCC) and how the integration of complementary and alternative approaches (CAA) has the potential to improve residents' quality of life in nursing homes (NHs). Findings indicate that NHs offer a wide range of engagement activities, but these activities are not purposefully integrated into a person-centered plan of care. Factors such as turnover, "working short," supervisor support, and rising resident care needs make it challenging to implement PCC in NHs. This knowledge of the landscape of activities will help us identify and improve strategies for supporting residents at a deeper, more meaningful level. CAA has the potential to be therapeutic for residents if integrated into collaborative approaches to care.

Professionals' experiences and attitudes toward use of Traditional Chinese Medicine in hospice palliative inpatient care units: A multicenter survey in Taiwan

BACKGROUND

Medical staff may have difficulties in using conventional medicine to manage symptoms among terminally ill patients, including adverse effects of the treatment. Traditional Chinese medicine (TCM) is regarded as a complementary or alternative medicine, and has been increasingly used in the field of palliative medicine in recent years. This study aimed to investigate the experiences of and attitudes toward using TCM among palliative care professionals, and to provide preliminary information about its use in palliative care.

METHODS

This was a cross-sectional survey study conducted in eight inpatient hospice wards in Taiwan between December 2014 and February 2016. The questionnaire was self-administered, and was analyzed with descriptive statistics including Pearson's Chi-square test and Fisher's exact test.

RESULTS

A total of 251 palliative care professionals responded to the questionnaire, of whom 89.7% and 88.9% believed that the use of TCM could improve the physical symptoms and quality of life in terminally ill patients, respectively. Overall, 59.8%, of respondents suggested that TCM had rare side effects, and 58.2% were worried that TCM could affect the liver and kidney function of patients. In total, 89.7% and 88.0% of professionals agreed there were no suitable clinical practice guidelines and educational programs, respectively, for TCM use in palliative care.

CONCLUSIONS

Most of the respondents agreed there was insufficient knowledge, skills-training, and continuing education on the use of TCM in terminally ill patients in Taiwan. These results show that to address patient safety considerations, guidelines about use of TCM in palliative care should be established.

Where Have They Gone? Recruiting and Retaining Older Rural Research Participants

ISSUE

Rural-dwelling elderly have been shown to suffer from health disparities when compared to the general population. Research involving these individuals is important, and to have meaningful results, sample sizes must be adequate. Recruiting and retaining these individuals pose significant challenges.

CONTEXT

Nurse researchers in the rural northwestern United States conducted a 4-part educational intervention aimed at increasing general and complementary and alternative health care literacy of older rural dwellers. Significant challenges were faced in both recruiting and retaining participants over the 6-month study period. Despite careful planning and community selection, the team had to double the number of communities in which they carried out the project to meet recruitment goals. Retention was also a challenge. Of 127 participants initially enrolled in the study, only 52 remained to the end.

LESSONS LEARNED

Challenges of recruiting and retaining are complex and compounded when the target population is rural, older and the study is longitudinal. Recruitment challenges included reaching older adults, offering a compelling program, and offering it in an acceptable format at a convenient time and place. A variety of outreach activities were conducted including in-person presentations, advertising or public interest stories in local newspapers or radio stations, and flyers on bulletin boards in restaurants, clinics, churches, community centers, and libraries. A project champion, an individual well known and connected within the community and committed to the success of the proposed study, is a major asset. Retention strategies included developing relationships with the participants and maintaining contact with them over the course of the study through such mechanisms as appointment cards, e-mail or regular mail, telephone reminders, and thank you cards. Oversampling was important as factors beyond the control of the researcher occurred; for example, illness, death, family crises, unexpected relocations, and weather events that prevented travel to scheduled research events.

Be Wise: A complementary and alternative medicine health literacy skill-building programme

BACKGROUND

Health literacy has been found to be the strongest predictor of health status; and without adequate health literacy, consumers may not understand/adequately evaluate the myriad of choices available. Older rural residents tend to use self-prescribed complementary and alternative medicine (CAM) therapies and glean information about these therapies primarily by word of mouth/media.

OBJECTIVES

The purpose of this article is to describe the Be Wise health literacy skill building programme and the participants' evaluation of the programme.

DESIGN

The programme involved four sessions delivered over 7 weeks at seniors' centres in rural communities.

METHOD

Data were collected initially (N = 127), at the end of the sessions (N = 67) and after 5 months (N = 52).

SETTING

Participants were primarily rural Caucasian women, mean age 76 years, and most had an associate/baccalaureate degree.

RESULTS

Questions were worded to ascertain satisfaction with the programme, usefulness of the information provided, willingness to recommend the programme, and the likelihood of using the programme. All scores were most favourable ranging from 3.35 to 4.41 on a 5-point scale. A question regarding the usefulness of the Be Wise programme in managing health received at mean score of 3.55 on a 5-point scale. Written comments on the questionnaires were overwhelmingly favourable.

CONCLUSION

Delivering programmes to older adults in small rural communities has special challenges and rewards. Participants were enthusiastic about learning more about making informed health care choices. There is a compelling need for continued programme development and long-term outcomes evaluation.

A National Survey of Complementary and Alternative Medicine Use for Treatment Among Asian-Americans

Asian Americans (AAs) are more likely to use complementary and alternative medicine (CAM) compared to other race/ethnicities, yet previous studies have conflicting results. The 2012 National Health Interview Survey data was analyzed to investigate AA's (n = 2214) CAM use for treatment. AAs were divided into four subgroups: Chinese, Asian Indian, Filipino, and Other Asian. Only 9% of AAs reported using CAM for treatment, with 6% indicating CAM use specifically for chronic conditions. This could be a form of medical pluralism, a mixture of Eastern and Western health approaches. The "Other Asian" subgroup reported highest use of CAM for treatment. Significant predictors included age (≥ 65 years) and high educational attainment (≥ college degree). Sociodemographic factors were also significant predictors within Asian subgroups. Further investigation of this and other forms of medical pluralism among AAs are needed to explore potential cofounders and risks like underreporting, CAM schedules/dosages, cultural influences, and CAM's impact on one's health.

A Cross-Sectional Evaluation of Complementary and Alternative Medicine Use in a Non-urban Malaysian Population

Complementary and alternative medicine (CAM) therapies have been an integral part of Malaysia culture for many centuries. In recent years influences from other parts of the world have gained a foot-hold in Malaysian popular culture. We investigated the engagement with CAM in a non-urban, Malaysian population. We investigated the association of CAM use with cultural influence, perceived health status, gender and age. We recruited 700 adult participants to this study across three sites in central Malaysia. We found massage, Vitamin supplements, Herbal medicine and traditional Chinese medicine to be the most popular CAM modalities with participation at 67.7%, 55.7%, 55.5% and 26.3% respectively. CAM use was equally high at 67% among those people who claimed a predominantly Malay or Chinese cultural influence. The use of vitamins and participation in yoga were at higher prevalence among female participants compared to males. There was no gender difference for other CAM modalities. There were differences between age groups for most CAM modalities, and those over 50 years tended to be the highest frequency users for most modalities. There is a high rate of CAM use in non-urban Malaysia with younger people being more engaged with less traditional modalities such as aromatherapy, yoga and music therapy.

Evidence to Improve Physical Activity among Medically Underserved Older adults: A Scoping Review

BACKGROUND AND OBJECTIVES

Participation in leisure physical activity (PA) and engagement in PA interventions among older adults is influenced by socioeconomic status (SES), race/ethnicity, and environment. However, studies of PA for medically underserved older adults have not yet been systematically evaluated. The objective of this study is to map the nature and extent of research conducted on PA participation, interventions, and components of effective leisure PA programs for medically underserved older adults.

RESEARCH DESIGN AND METHODS

The five-stage approach was used to conduct this scoping review. We searched PubMed, CINAHL, and Cochrane Library for peer-reviewed studies published between 2006 and 2016. Data extracted from selected studies included study population, study type, purpose of intent, evidence level, barriers to PA participation, and components of PA intervention.

RESULTS

Three hundred and ninety-two articles were identified, and 60 studies were included in the final data charting. Existing literature showed that most studies remained descriptive in nature, and few intervention studies have achieved a high level of evidence. Among 21 intervention studies, only 4 were explicitly conducted for older adults. Culturally adapted materials, race/ethnicity-specific barriers and facilitators, and form of intervention were important components for intervention programs.

DISCUSSION AND IMPLICATIONS

Findings indicate that more studies are needed to reduce health disparities related to PA participation for medically underserved older adults. Intervention components such as race/ethnicity-relevant barriers and facilitators and culturally sensitive materials are also needed for PA interventions targeting underserved older adults in order to provide evidence for best practices.

Perceived Benefits of Using Complementary and Alternative Medicine by Race/Ethnicity Among Midlife and Older Adults in the United States

Objective: To describe, for a national sample of midlife and older adults, the types of complementary and alternative medicine (CAM) used for health and wellness and the perceived benefits of CAM use by race/ethnicity. Method: Using data from the 2012 National Health Interview Survey, we ran multiple logistic regression models to estimate the odds of each perceived benefit among adults ages 50 and older. Results: More than 38% of midlife and older adults used CAM in the past year. For six of seven perceived benefits examined, we found significant differences by race/ethnicity, with each group having higher odds of two or more perceived benefits compared with non-Hispanic Whites. Discussion: Although racial/ethnic minority groups are less likely to use CAM compared with non-Hispanic Whites, those who use CAM perceive great benefit. Future research should examine the potential contribution of evidence-based CAM to promoting health and well-being in a diverse aging population.

Associations between complementary medicine, satisfaction with body weight and shape, and the use of methods to lose or control weight: Results of a national survey of 8009 Australian women

OBJECTIVE

This study aimed to determine whether the use of complementary medicine (CM) is associated with body satisfaction and weight management methods in Australian women.

METHODS

Women aged 34-39 years from the Australian Longitudinal Study on Women's Health were surveyed regarding satisfaction with their body weight and shape, and the use of weight management methods. Associations with CM use were analysed using logistic regression modelling.

RESULTS

Women using CM less likely wanted to lose weight; and were more likely to cut down on fats and/or sugars, use low glycaemic diets, diet books and 'other' methods (OR: 1.33-2.83) compared to CM non-users. Women using herbal medicine products 'sometimes' were more likely to use meal replacements/slimming products (OR: 1.50-1.67) compared to non-users.

DISCUSSION

Australian women using CM are more likely to be satisfied with their body weight and shape, and to use a range of weight management approaches compared to CM non-users.

Fighting for wellness: strategies of mid-to-older women living with cancer

A significant portion of older adult cancer patients are using complementary and alternative medicine (CAM ) during and after treatment. I used four case studies to examine the strategies of older adult CAM-using cancer patients to maintain a sense of well-being as they transitioned to a post-treatment phase of life. Data were collected via qualitative interviews. Findings included strategies for financing CAM treatments, dealing with life disruption, and managing the complete nutritional overhaul recommended by their program. Participants worked to achieve new lifestyles and senses of wellness, finding ways to pay for expensive, out-of-pocket care while still meeting family obligations. These findings shed light on assumptions about older adult health-seeking behaviors, culturally embedded life course expectations, and raised questions about how the pursuit of health activities involving boundary crossings are received.

Social network bridging potential and the use of complementary and alternative medicine in later life

The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage.