Assessment of Perception, Experience, and Information-seeking Behavior of the Public of Ras Al-Khaimah, United Arab Emirates, Toward Usage and Safety of Complementary and Alternative Medicine.

AIMS AND
OBJECTIVES: This study was conducted to identify the different types of complementary and alternative medicine (CAM) used, reasons for the use of CAM, and the perceptions, experience, and information seeking-behavior toward usage and safety of CAM by the general public of Ras Al-Khaimah, UAE.
MATERIALS AND METHODS: This was a prospective cross-sectional study. A validated, self-administered, or interviewer-assisted survey questionnaire was used to collect the data. Data from 403 respondents satisfying inclusion criteria were collected and were analyzed using the Statistical Package for the Social Sciences version 24.0.
RESULTS: A majority of the respondents (218 [54.1%]) were females. The most commonly (210 [52.1%]) used CAM among the study respondents was herbal medicine. A total of 91 (22.6%) of the survey respondents mentioned that they receive conventional medications along with their CAM. Majority (213 [52.9%]) of the survey respondents opted for CAM to prevent illness. Good number (208 [51.6%]) of the survey respondents mentioned that CAM usage was beneficial in improving their health condition, and they (216 [53.6%]) do believe it as safe and effective. However, a small group (26 [6%]) of respondents reported side effects or complications with the use of CAM.
CONCLUSION: Widespread use of CAM for different medical problems was evident in our study. Although majority of the CAM users believe it as safe and effective, CAM usage should be discussed with the health-care providers to understand the safety issues involved in the use of majority of CAM.

INTRODUCTION

Complementary and alternative medicine (CAM) usage has been documented in the history since thousands of years, and people are considering CAM for the management of different health conditions or diseases.[1] The prevalence of use of CAM is widespread and is growing worldwide and reported to be varied from 9% to 65%.[23] National Committee of CAM defines CAM as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.”[4] Natural products, deep breathing, yoga, meditation, massage, chiropractic, diet-based therapies, prayer, guided imagery, relaxation therapies, and homeopathic medicine, etc., are categorized under CAM.[456]

Studies have documented the practice of CAM in various health/disease conditions from common cold, headache, body pain, obesity to chronic health conditions such as hypertension, diabetes, and cancer.[7891011] Few studies have addressed the benefits of CAM in conditions such as backache and arthralgia.[1213] Although some scientific evidence exists regarding CAM therapies, data from well-designed studies, evaluating the efficacy of CAM therapy are lacking.[14] Despite of positive evidence regarding effectiveness of some CAM therapies in treatment of certain medical conditions, usage of CAM along with the conventional medicine, or solely in their place as an alternative treatment option is a matter of concern because of its effectiveness and safety reasons.[15]

In some instances, CAM usage without the advice or supervision of a health-care practitioner could be harmful to the patient, causing adverse effects or worsening of their health/disease conditions.[16] Health-care professionals including pharmacist can play an important role in educating or creating awareness among the public regarding benefits and limitations of CAM usage.[1617] Vast numbers of studies from different parts of the world have made an attempt to evaluate the knowledge, attitude, and practice of health-care students toward CAM usage and a considerable number of studies addresses the CAM usage pattern among general public and patients.[518192021222324] The data from these studies reveal that there is a wide variation in the knowledge, attitude, and practice of medical professionals, patients, and general public toward CAM usage.

The data regarding the nature of the CAM usage among general public of the UAE is in scarce and relatively few studies have addressed the CAM usage pattern in gulf region, including UAE.[252627] Understanding the different types CAM used by the general public of the UAE and conditions, for which it is being used could be beneficial in planning appropriate educational interventional strategies to avoid the adverse effects or negative consequences or in planning further studies in this area.[28]

The aims and objectives of the study were to find out the different types of CAM used by the general public of Ras Al-Khaimah, UAE; to evaluate the different reasons, for which CAM therapy is frequently used. The study also made an attempt to document the perception, experience, and information-seeking behavior of general public toward usage and safety of CAM and to identify the sociodemographic variables associated with herbal medication usage.

MATERIALS AND METHODS

This was a prospective cross-sectional survey-based study conducted between September 2015 and February 2016 after obtaining the permission from Ras Al-Khaimah Research and Ethics Committee. The study population consisted of general population of Ras Al-Khaimah, UAE. The estimated target sample size required was 403 respondents based on the regional prevalence rate (30%) of CAM usage and power of the study being 80%, and level of precision is projected to be 0.05 with Zα at 5% level of significance, which is 1.96.

Study questionnaire

A self-administered or interviewer-assisted survey questionnaire consisting of 13 closed-ended types of questions was prepared to assess the CAM usage. The questionnaire was validated for its content through expert review and was translated to the Arabic language. Before field-testing, questionnaire was evaluated for its content validity.[29] After content validity evaluation, the questionnaire was pilot tested on a convenient sample of subjects, to assess its reliability. All the necessary and relevant data, such as sociodemographic (age, sex, nationality, education, and occupation) information, questions related to type, reason for usage of CAM, knowledge, opinion regarding safety, and effectiveness were included in the questionnaire.

Study population

Male and female respondents of more than 18 years of age and of either gender were included in the study. Participation in the study was on voluntary basis. General public with hearing impairment, who cannot speak or understand English or Arabic language and those who are mentally challenged were excluded from the study.

Study procedure

The survey respondents satisfying inclusion criteria were contacted by the study investigators. The study participants were briefed regarding the purpose of the study, and informed consent was obtained. The questionnaire was administered to all the enrolled participants, and their responses regarding the CAM usage pattern were recorded.

Proposed data analysis

All the necessary and relevant data collected from participants was summated and entered into the Microsoft Excel sheet, and results were analyzed using the Statistical Package for the Social Sciences version 24.0 (IBM, Armonk, NY, United States of America).

The categorical data were expressed as percentage whereas the continuous data were expressed as mean ± standard deviation. Chi-square or Fischer exact tests were performed to compare the significant difference between two categorical variables. Multivariate regression analysis was performed to estimate the association between CAM usage and the predictor variables. A probability value of < 0.05 was considered statistically significant. The data such as age, gender, nationality, type of CAM use reason for usage were presented in the form of text, tables, figures, and graphs.

RESULTS

Demographic characteristics

Majority of the survey respondents (218 [54.1%]) were female and in the age group of 18–28 years (294 [73%]). Substantial number (363 [90.1%]) of the survey respondents were expatriates and were Arabs (320 [79.4%]). A higher number (273 [67.7%]) of study respondents had a Bachelor's degree and were students [Table 1].

Table 1

Sociodemographic details of study respondents (n=403)

Complementary and alternative medicine usage pattern among the survey respondents

The most commonly used CAM as cited by the survey respondents was herbal medicine (210 [52.1%]), followed by meditation/prayer (162 [40.2%]), and dietary supplement (145 [36%]) usage [Table 2].

Table 2

Complementary and alternative medicine usage pattern among survey participants (n=403)

Reasons for which complementary and alternative medicine being used

The preponderance (213 [52.9%]) of the survey respondents opted for CAM to prevent illness or for general wellness followed by as safer alternatives (150 [37.2%]) [Table 3]. Only few respondents (52/403) specified their health conditions, for which CAM being used. The majority (13 [25%]) of them have used it for diabetes followed by hypertension 9 (7.3%) [Table 4].

Table 3

Different reasons for complementary and alternative medicine usage

Table 4

Different health conditions for which complementary and alternative medicine is used (n=52)

Perception, experience, and information-seeking behavior

Greater number of survey respondents (208 [51.6%]) mentioned that CAM usage was beneficial in improving their health condition and considered it as safe and effective 216 (53.6%). A total of 91 (22.6%) of the survey respondents mentioned that they receive conventional medications along with their CAM. Conventional medications have been stopped by (110 [27.3%]) of the survey respondents after they have started using CAM. A higher percentage (157 [39%]) of survey respondents mentioned that they seek advice or suggestion before using CAM [Table 5]. Family members and friends were the chief source of information according to 273 (67.7%) of respondents, followed by media 147 (36.5%) [Figure 1].

Table 5

Perception, experience, and information.seeking behavior of study respondents towards complementary and alternative medicine usage (n=403)

Figure 1

Different sources of information for complementary and alternative medicine use

Vast number of respondents (260 [64.5%]) mentioned that they do not discuss with their doctor or other health-care professional regarding their CAM usage. Majority (134 [33.3%]) of the respondents were not aware about the importance of disclosing the CAM usage information to their physician [Tables 5 and 6].

Table 6

Information seeking behavior of study respondents

The prevalence of side effects or complications with the use of CAM was reported by 26 (6%) of the study respondents. Diarrhea was the main side effect reported to CAM [Table 7]. More than half percentage (53.8%) of the respondents mentioned that they will contact physician if they develop any complication or side effects to CAM followed by stopping (40.9%) the CAM usage [Table 7]. A majority (182 [45.2%]) of them have purchased or obtained their CAM supply from pharmacy followed by friends and family members (129 [32%]) [Figure 2].

Table 7

Type of side effects reported to different complementary and alternative medicine

Figure 2

Different sources of CAM supply. CAM: Complementary and alternative medicine

Association between demographic variables and herbal medicine use

A statistically significant association was documented between age (χ2 = 18.5; P = 0.001), ethnicity (χ2 = 9.2; P = 0.003), and occupation (χ2 = 16.2; P = 0.001) of the study respondents and herbal medicine use [Table 8].

Table 8

Association between demographic variables and herbal medicine use

Demographic predictors of herbal medicine use

Age was the (R2 = 0.020, F (1, 399) =7.99, β =0.140, P = 0.005) significant positive predictors of herbal medicine use while ethnicity was significant negative (R2 = 0.023, F (1, 400) =9.46, β = −0.152, P = 0.002) predictor [Table 9].

Table 9

Multivariate regression analysis of the variables and herbal medicine use

DISCUSSION

Herbal medicines were the most commonly used CAM among the respondents, followed by meditation/prayer, and dietary supplements. These findings of ours are consistent with the other findings, which reported herbal medicines/natural products as most commonly used CAM.[2430] Although CAM usage pattern varies among countries and population, majority of studies reported herbal and natural products were most commonly used.[6] This could be due to easy availability and accessibility of herbal medicines and dietary supplements and consumers often presume them as safe over conventional medicines.[31] However, studies have mentioned Ayurveda, chiropractic, massage therapy, phytotherapy, and yoga as most prevalent CAM practices.[23323334]

The majority of the respondents mentioned that they used CAM for general wellness or to prevent illness followed by safety reasons. In a study conducted by Mathew et al. at Ajman, UAE, also reported the reason for the use of CAM as “good previous experience” and less treatment complications.[25] A total of 22.6% of respondents were using CAM along with their conventional treatment. This prevalence rate was lower than the Okoronkwo et al., who reported 40% of study respondents combined CAM along with conventional medicines.[35] The practice of combining CAM medications with conventional medications could result in serious adverse effects or complications, especially if they are taking medications with narrow therapeutic index or for chronic diseases.[1528]

Only small percentage (6%) of study respondents reported side-effects or complications due to CAM usage. This was considerably lower than a study conducted at North East England, where 45.8% of study respondents reported side effects to CAM therapy. In another survey-based study majority (42.8%) of the respondents disagreed that CAM usage is unsafe.[18] However, the type of study population assessed was hospitalized inpatients.[35] While few studies have reported incidence rate of 0.2%–57.6%.[3637] The reported incidence of side effects to CAM varies between the studies. This difference could be due to difference in the CAM usage pattern among study respondents from different geographical locations.

Gastrointestinal side effects such as diarrhea and constipation were the most commonly experienced side-effects to CAM therapies. In line with our findings, Bello et al. have documented gastrointestinal complications as the most frequently experienced side-effects to CAM.[37] Although some types of CAM therapies (for, e.g. yoga, meditation/prayer, aroma therapy, massage therapy) are generally considered safe when supplemented with regular conventional treatment, while herbal medicines can cause serious life-threatening conditions like including death.[3839]

Only small percentage of respondents disclosed their CAM usage to their physicians, which is almost in agreement with the findings of Hori et al., who documented it as 42%.[40] Disclosing CAM usage practice is very important to identify actual/or potential complications that may occur due to usage of CAM alone or in combination with other medications. Such patients may warrant regular monitoring and/or change in therapy by health-care professional.[16] Age, ethnicity, and occupation were associated with herbal medicine usage. However, this finding is inconsistent with other studies worldwide, which reported significant associations between demographic characteristics and CAM usage.[353740]

The main limitation of the study was it included a small number of respondents, which may not be a true representative sample population of the emirate. The responses related to positive and negative outcomes of CAM usage were completely based on the perception of the respondents and were not assessed and confirmed by any health-care professionals. In addition, the study did not evaluate the likelihood of CAM and drug interactions. It might be possible that patients who were using CAM along with conventional medications have interactions of their CAM product with allopathic drugs. Possibilities of interaction between CAM and conventional drugs have been documented in earlier literature.[41]

CONCLUSION

The most commonly used CAM was herbal medicines, followed by meditation/prayer, and dietary supplements. The most common reasons for considering the usage were to prevent illness. Friends and family members were the major source of information for CAM usage. Variables such as age and ethnicity were associated with herbal medicine usage. The pharmacist can play a significant role in educating the general public regarding pros and cons of CAM; possible consequences combining herbal medications along with conventional medications; importance of adherence to prescribed medications if they have chronic disease conditions and importance of discussing CAM usage with their health-care provider.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.