Student: Kris Wilson
Supervisors: Claire Dowson, Dr Derelie Richards
Sponsor: Canterbury Medical Research Foundation
The popularity of Complementary and Alternative Medicine (CAM) among the general public is indisputable. It is also increasing. In parallel with this rise there is increasing evidence citing reactions and side effects of in CAM use as well as possible interactions with conventional medicine. While there are a wide range of therapies that may be described as CAM, in this study we are interested in the potential risks of pharmacological actions and interactions and so have operationally defined CAM as non-prescribed medicines administered orally, nasally or topically. We wished to develop understanding of those groups most at risk of the dangers of CAM use.
This study had two aims:
- To carry out an exploratory study of the prevalence of CAM use in a paediatric population.
- To develop a tool to assess possible predictors of CAM.
Participants; Parents of children under 12 were recruited from a primary healthcare setting (N = 50). Procedure; Six GP surgeries representing a spread of socioeconomic status, based on proportion of community service card holders, were invited and agreed to take part. A researcher in surgery waiting rooms approached parents of children under 12 who had an appointment. After informed consent parents answered a structured questionnaire either in the surgery or later by telephone. Data Collection Instrument; a CAM use questionnaire was developed after an extensive literature search and piloting with 15 parents. The main predictors of CAM use cited in the literature were included in the questionnaire, which was divided into sections assessing four main areas potentially related to CAM use. The first section detailed prevalence and type of CAM use and demographic characteristics. We also included questions about the timing and combination of CAM and conventional treatment that parents administered to their children. We also assessed three possible predictors of CAM use with established scales: parent preference for a patient centred consultation style, using the Ogden Patient-Centredness Questionnaire (OP-CQ) , the extent of their holistic outlook on healthcare using the Holistic Healthcare (HH) sub scale of the Holistic CAM Questionnaire , and their beliefs about conventional medicines using the Beliefs about Medicines Questionnaire (BMQ).
Data was entered into and Excel spreadsheet and analysis was carried out using the software package SPSS. Nominal and quantitative were analysed using Chi Square, two tailed t-tests and Factorial ANOVA as appropriate.
During the course of this study 3 participants who chose to take part could not be contacted, 6 people who refused to take part and 9 who were approached but did not fit the criteria. Although this study was a pilot, significant results were found. A total of 36 out of 50 parents (72% (95% CI 58%, 84%)) had given CAM to their children. Several factors were associated with CAM use. Mothers were more likely to report CAM use (76%, 35/46) for their children than fathers (25%, 1/4), X²(1) =4.77, p<0.05, as were parents with income over $50,000 (83%, 25/30) compared to those with income under $50,000 (56%, 9/16), X²(1, N=46) =3.98 p<0.05. Parents education level and parents age failed to gain significance as predictors but both showed trends toward association with higher education level and higher age that might gain significance if explored with a larger sample size. The OP-CQ means for CAM and non CAM using parents were 90.2 and 86.4, t (48) = 1.691 p<0.09 suggesting a trend of parents who use CAM preferring a patient-centred consultation style. Means for CAM and non CAM use for the HH scale were 26 and 24.6, t (49) = 1.709, p<0.09, suggesting a trend of parents who use CAM having a more holistic outlook on healthcare. Interesting results were found with the specific necessity and specific concern sub-scales of the BMQ that measures parent’s specific levels of concern about using conventional medicine and beliefs about the necessity of using these types of medicines. When analysed across CAM use, and whether the visit was for a chronic or acute problem there was a main effect for the necessity sub-scale (for ‘CAM’ F (2,49) = 5.927, p<0.019, and for visit type that approached significance F (2,49) = 3.724, p<0.06). The interaction between ‘CAM’ and ‘visit’ variables on the necessity scale was also significant, F (1,49) = 5.656 p<0.022, suggesting that while those who used CAM for their children did not differ in their necessity score across visit type, those who didn’t use CAM for their children differed substantially on their ‘necessity’ scores across visit type, with those whose children presented for a chronic reason scoring far higher on the necessity sub scale. The interaction on the concern scale approached significance, F (1,49) = 3.966, p<0.053, suggesting that parents who used CAM did not vary much in their concerns about medicines across ‘visit’ types (which were generally high). However, parents who didn’t use CAM for their children did differ across ‘visit’ types with parents whose child was there for a chronic reason scoring lower concerns about medicines and those there for acute reasons. Of those that had given CAM to their child, 7 out of 36 (19%) disclosed this use to their GP.
Prevalence of CAM use in children was found to be high. Non-disclosure of use to primary care physicians is also high. This indicates there may be significant potential for adverse events and interactions in this group. A number of factors were found which are associated with parent’s choice to use CAM for their children, which may allow identification of groups at higher risk and studies to facilitate greater understanding of the reasons for these choices. Parents who used CAM for their child were more likely to prefer patient-centred consultations and have a more ‘holistic’ outlook on health care. Other associated factors included female parental sex, and higher income. Parental education and age should be explored with a larger sample size. Scoring low on feeling the ‘necessity for’ and high on ‘concerns about’ conventional medicines may predict CAM use in those presenting for a ‘chronic’ but not for ‘acute’ conditions. The latter group score low on ‘necessity’ and high on ‘concern’ regardless of CAM use. These results should be viewed as exploratory as there was a small sample size. It has however produced a tool with which it is possible to further research the position that CAM has established in the healthcare practices of New Zealanders.
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