"Then I went to a hospital abroad": acknowledging implications of stakeholders' differing risk understandings related to use of complementary and alternative medicine in European health care contexts

A triangulated perspective for understanding CAM use in Lebanon: a qualitative study

Background

Existing evidence marked a prevalent use of Complementary and Alternative Medicine (CAM) therapies in Lebanon that is concomitant with low rates of disclosure to health care providers and limited knowledge among the general public of safety and side effects of CAM use.

Objectives

To examine the perspectives of Lebanese CAM users, CAM providers, and health care providers (HCPs) regarding their understanding of CAM and of the Push and Pull factors that drive its use.

Methods

A qualitative research study was conducted using in-depth interviews, targeting Lebanese adults (CAM users; 18-65 years) (n=14), CAM providers such as yoga instructors, owners of CAM product outlets, herbalists, and religious figures (n=13); and HCPs including physicians, nurses, dietitians, and pharmacists (n=14). The topic guide covered, in addition to the understanding of CAM, the Push and Pull factors driving CAM use. The adults were recruited by convenient sampling, and CAM providers and HCPs using a purposive sampling approach. Interviews were audiotaped, transcribed, and translated into English. Analysis was performed using a qualitative thematic approach. Similarities and differences in the perceptions of the participants with regards to factors that influence CAM use were charted and contrasted, using a triangulated approach.

Results

The three study groups exhibited a similar understanding of CAM, referring to non-conventional therapies used to prevent/treat diseases or to enhance wellbeing. CAM users and CAM providers identified “distrust in HCPs”, “lack of patient-centered care in CM”, and “limitations and side effects of CM” as important Push factors. All study groups highlighted the limited CAM knowledge of HCPs as a main reason for the lack of patient-centered care. All three groups also underscored the affordability and the social and cultural support for CAM as main enablers of its prevalent use. Unlike HCPs who were skeptical about the safety and effectiveness of CAM, CAM users and CAM providers indicated that most of CAM therapies are safe and efficient.

Conclusions

The triangulation of perspectives (CAM users, CAM providers, and HCPs) in this study allowed a comprehensive appraisal of CAM use and its drivers. Improving the HCPs’ CAM-related knowledge, promoting patient-centered care and fostering an open dialogue between HCPs and CAM providers are among the recommendations of the study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03685-z.

Complementary Therapies: A Risk of Rupture with General Medicine? A Qualitative Study About the Personal Health Care Journey of Shiatsu Users in France

Context: In 2014, the World Health Organization launched its second strategic plan on the development of complementary medicine. Shiatsu is one of eight alternative approaches worthy of interest. No study explored its users' health trajectories and the motives and experiences of their use of shiatsu. Aim: To explore motives and experiences of the use of shiatsu and its users' health care trajectories in France. Design and Setting: Qualitative study with shiatsu users. Methods: Semistructured telephone interviews with shiatsu users and audio recordings during shiatsu sessions. Shiatsu users were recruited across France by shiatsu practitioners who had no specific instructions on the profile of users to include. Descriptive then thematic analysis of data, with triangulation, according to a phenomenological approach, using MAXQDA© software. Results: Ten interviews and seven recordings were made to gather sufficient data. The major themes identified were the previous knowledge and representations of shiatsu, the symptoms leading to this use, the ineffectiveness of conventional medicine and the user's health trajectories. Users were looking for an alternative to conventional medicine and often resorted to other complementary medicines. They generally had no prior knowledge of shiatsu. They were advised to try shiatsu by those around them, never by a physician. Their main reasons for having recourse to shiatsu were pain, anxiety, and sleep disorders. Users initially tried conventional medicine. Some sought to modify or reduce their medicine intake. Shiatsu then became a regular practice. Users described derogatory reactions from their general practitioner (GP) to this complementary therapy. Conclusion: This study highlights a fluctuating and ambivalent relationship between complementary medicine and conventional medicine. Shiatsu users' health care trajectories include several phases: trust in conventional medicine then disappointment, rupture and risk taking for their health. To avoid this rupture, GP should be involved in the use of complementary therapies.

To Use or Not Use Complementary and Alternative Medicine (CAM) in Psychiatric Care: Interviews with Clinical Decision-Makers in Sweden

Complementary and alternative medicine (CAM) is used as a complementary intervention in psychiatric healthcare. The reasons for using or not using CAM in psychiatric care in Sweden, and how such decisions are taken, are largely unknown. The aim was to investigate arguments for and against the use of CAM in Swedish psychiatric care, and how decisions are made. Interviews with 10 persons in decision-making positions in psychiatric health care were analysed thematically. The result shows diverging understandings of the evidence base for CAM. Arguments against CAM referred to scepticism, the importance of evidence-based practice and the obligation to follow national guidelines. Arguments in favour of CAM were that CAM was person-centred, safe, cost-effective, nursing interventions with positive effects, appreciated and demanded by patients, providing space for non-verbal communication and reflection, supporting the therapeutic alliance. Decision paths were described as top-down through a hierarchical structure, or bottom-up, driven by committed staff members. We discuss how detailed national guidelines should be to achieve equal and evidence-based care, while still allowing clinics to make local exceptions, adjusting the care according to clinical expertise and patients' preferences. Conclusion: Evidence-based, safe and cost-effective CAM methods may be relevant complementary interventions in psychiatric care, or as self-care, not to cure the psychiatric disease, but to reduce symptoms and promote sleep. With better knowledge of CAM, health professionals could guide patients through the jungle of CAM methods. Due to research problems on complex multicomponent interventions, high-quality pragmatic trials, including biomarkers, and qualitative studies are recommended.

Regulatory environment for complementary and alternative medicine in Georgia-a health policy analysis

International bodies such as the WHO call on member states to regulate and, where possible, integrate Complementary and Alternative Medicine (CAM) into health systems, to the benefit and safety of patients. Research on CAM regulations in the Republic of Georgia has been limited. The aim of this study was to identify key actors and analyse the regulatory environment for CAM in Georgia in its local and international contexts. We conducted a health policy analysis using a triangle framework of content, context and processes. We used data from national government, professional associations and academia; and drew from primary qualitative data of stakeholders' perspectives and needs regarding CAM in Georgia. The several CAM associations we identified have limited capacities for self-regulation. CAM practices are currently not effectively regulated in Georgia, while the government has no expressed intention to develop regulatory frameworks. Georgia's CAM health policy is currently not compliant with WHO and European directives and recommendations. Government, lawmakers, public administration, academia, physicians, non-physician CAM practitioners and other actors should constitute a national working group dedicated to CAM regulations in Georgia to identify, classify CAM practices; and develop core principles for policy making for safe and effective CAM practiced in Georgia's health system.