Views on traditional Chinese medicine amongst Chinese population: a systematic review of qualitative and quantitative studies.

BACKGROUND: Health-care professionals worldwide have started to appreciate patients' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east. OBJECTIVE: This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations. SEARCH STRATEGY: Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out. INCLUSION CRITERIA: Quantitative, qualitative or mixed-method research that aimed to investigate Chinese patients' perception of, and perspectives on, TCM was included. DATA EXTRACTION AND SYNTHESIS: For each study included, texts under the headings of 'results' or 'findings' were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies. MAIN RESULTS: Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed-method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations. DISCUSSION AND CONCLUSIONS: Future research should explore how variation in health systems may influence patients' perception of CAM in different countries.

Developing policy for integrating biomedicine and traditional chinese medical practice using focus groups and the delphi technique.

In Hong Kong, statutory regulation for traditional Chinese medicine (TCM) practitioners has been implemented in the past decade. Increasing use of TCM on top of biomedicine (BM) services by the population has been followed; but corresponding policy development to integrate their practices has not yet been discussed. Using focus group methodology, we explore policy ideas for integration by collating views from frontline BM (n = 50) and TCM clinicians (n = 50). Qualitative data were analyzed under the guidance of structuration model of collaboration, a theoretical model for understanding interprofessional collaboration. From focus group findings we generated 28 possible approaches, and subsequently their acceptability was assessed by a two round Delphi survey amongst BM and TCM policy stakeholders (n = 12). Consensus was reached only on 13 statements. Stakeholders agreed that clinicians from both paradigms should share common goals of providing patient-centered care, promoting the development of protocols for shared care and information exchange, as well as strengthening interprofessional connectivity and leadership for integration. On the other hand, attitudes amongst policy stakeholders were split on the possibility of fostering trust and mutual learning, as well as on enhancing innovation and governmental support. Future policy initiatives should focus on these controversial areas.

Emotionless holism: factor and Rasch analysis of the Chinese Integrative Medicine Attitude Questionnaire / 中国结合医学杂志

<p><b>OBJECTIVE</b>To examine the Eastern-Western difference in the interpretation of Integrative Medicine Attitude Questionnaire (IMAQ) by assessing the psychometric properties of a revised Chinese medicine (CM)-specific version of IMAQ (CM-IMAQ).</p><p><b>METHODS</b>Factor and Rasch analysis were performed with data collected from a mail survey of 165 Hong Kong Western medical doctors (WMD) randomly sampled from the official registry. The structural validity, unidimensionality, item fit, and differential item functioning (DIF) of the Hong Kong CM-IMAQ were evaluated.</p><p><b>RESULTS</b>Confirmatory factor analysis (CFA) demonstrated that the original IMAQ factor structure was not concordant with our data on Chinese WMD, and subsequent explanatory factor analysis (EFA) validated a new three-factor model for CM-IMAQ: (1) attitude towards "tonification", (2) attitude towards the effectiveness of CM, and (3) attitude towards CM knowledge. The original IMAQ factor on holism and doctor-patient relationship disappeared. Rasch analysis confirmed the unidimensionality of "tonification" and the effectiveness domains, but further refinement of the knowledge domain is needed.</p><p><b>CONCLUSIONS</b>Cultural adaptation of the IMAQ has demonstrated differences between Eastern and Western doctors trained in allopathic medicine in their interpretations of holism in healthcare. For Chinese WMD, the emphasis of holistic care is placed on "tonifying" the body rather than on nurturing the mind and spirit. Confucian and Taoist conceptualizations of mental health as well as the persistent stigma towards mental illness within modern Chinese culture may explain why Chinese WMD do not regard mental health promotion as part of routine healthcare.</p>

Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong.

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.

Use of chinese and western over-the-counter medications in Hong Kong.

Benefits of engaging community pharmacists in providing wider primary care are internationally acknowledged; in Hong Kong, however, strategies for harnessing their potential contributions are yet to be launched. Here, community pharmacist and Chinese medicine retailers are responsible for providing western and Chinese over-the-counter (OTC) medications. Patterns of OTC uses reflect the characteristics of populations who rely on community pharmacists and Chinese medicine retailers as their main point of contact with the healthcare system. Analyzing the data from a Hong Kong survey (n = 33,263) on self medication and medical consultation patterns, we propose, in this article, an extended role for community pharmacists and Chinese medicine retailers, which entails aspects as follows: (1) referring patients to other medical services where appropriate; (2) providing health education and preventative services; (3) safeguarding the use of Chinese herbal medicines.

Using Chinese version of MYMOP in Chinese medicine evaluation: validity, responsiveness and minimally important change.

BACKGROUND: Measure Yourself Medical Outcome Profile (MYMOP) is a patient generated outcome instrument applicable in the evaluation of both allopathic and complementary medicine treatment. This study aims to adapt MYMOP into Chinese, and to assess its validity, responsiveness and minimally important change values in a sample of patients using Chinese medicine (CM) services. METHODS: A Chinese version of MYMOP (CMYMOP) is developed by forward-backward-forward translation strategy, expert panel assessment and pilot testing amongst patients. 272 patients aged 18 or above with subjective symptoms in the past 2 weeks were recruited at a CM clinic, and were invited to complete a set of questionnaire containing CMYMOP and SF-36. Follow ups were performed at 2nd and 4th week after consultation, using the same set of questionnaire plus a global rating of change question. Criterion validity of CMYMOP was assessed by its correlation with SF-36 at baseline, and responsiveness was evaluated by calculating the Cohen effect size (ES) of change at two follow ups. Minimally important difference (MID) values were estimated via anchor based method, while minimally detectable difference (MDC) figures were calculated by distribution based method. RESULTS: Criterion validity of CMYMOP was demonstrated by negative correlation between CMYMOP Profile scores and all SF-36 domain and summary scores at baseline. For responsiveness between baseline and 4th week follow up, ES of CMYMOP Symptom 1, Activity and Profile reached the moderate change threshold (ES>0.5), while Symptom 2 and Wellbeing reached the weak change threshold (ES>0.2). None of the SF-36 scores reached the moderate change threshold, implying CMYMOP's stronger responsiveness in CM setting. At 2nd week follow up, MID values for Symptom 1, Symptom 2, Wellbeing and Profile items were 0.894, 0.580, 0.263 and 0.516 respectively. For Activity item, MDC figure of 0.808 was adopted to estimate MID. CONCLUSIONS: The findings support the validity and responsiveness of CMYMOP for capturing patient centred clinical changes within 2 weeks in a CM clinical setting. Further researches are warranted (1) to estimate Activity item MID, (2) to assess the test-retest reliability of CMYMOP, and (3) to perform further MID evaluation using multiple, item specific anchor questions.

Geographical and household variation in health-related quality of life in Hong Kong.

OBJECTIVE: This study investigated individual, household, and area effects in the distribution of mental and physical health scores in Hong Kong. METHOD: Analysis of data from a large representative survey of randomly sampled 29,561 Chinese adults in 2002. Multilevel regression methods were used to model variance in the physical and mental component of the SF-12 at the individual, household and area levels. RESULTS: Little variance in scores occurred at the area level (0.3% for physical health and 2.1% for mental health), whereas substantial variance occurred at the household level (23.2% for physical health and 37.2% for mental health), and individual level (76.5% for physical health and 60.7% for mental health). CONCLUSIONS: Similar to studies conducted in Western countries, these results confirm the importance of individual-, household- and area-level characteristics as important determinants of both mental and physical health. It suggests that area-level characteristics may be more important for mental than physical health.

Age, chronic non-communicable disease and choice of traditional Chinese and western medicine outpatient services in a Chinese population.

BACKGROUND: In 1997 Hong Kong reunified with China and the development of traditional Chinese medicine (TCM) started with this change in national identity. However, the two latest discussion papers on Hong Kong's healthcare reform have failed to mention the role of TCM in primary healthcare, despite TCM's public popularity and its potential in tackling the chronic non-communicable disease (NCD) challenge in the ageing population. This study aims to describe the interrelationship between age, non-communicable disease (NCD) status, and the choice of TCM and western medicine (WM) services in the Hong Kong population. METHODS: This study is a secondary analysis of the Thematic Household Survey (THS) 2005 dataset. The THS is a Hong Kong population representative face to face survey was conducted by the Hong Kong Administrative Region Government of China. A random sample of respondents aged >15 years were invited to report their use of TCM and WM in the past year, together with other health and demographic information. A total of 33,263 persons were interviewed (response rate 79.2%). RESULTS: Amongst those who received outpatient services in the past year (n = 18,087), 80.23% only visited WM doctors, 3.17% consulted TCM practitioners solely, and 16.60% used both type of services (double consulters). Compared to those who only consulted WM doctor, multinomial logistic regression showed that double consulters were more likely to be older, female, NCD patients, and have higher socioeconomic backgrounds. Further analysis showed that the association between age and double consulting was curvilinear (inverted U shaped) regardless of NCD status. Middle aged (45-60 years) NCD patients, and the NCD free "young old" group (60-75 years) were most likely to double consult. On the other hand, the relationship between age and use of TCM as an alternative to WM was linear regardless of NCD status. The NCD free segment of the population was more inclined to use TCM alone as they become older. CONCLUSION: In Hong Kong, most patients have chosen WM provided in the public sector as their sole outpatient service provider for NCD. Amongst TCM service users, middle aged NCD patients are more likely to choose both TCM and WM outpatient services. Meanwhile, older people without NCD are more likely to use TCM as their main form of care, but the size of this population group is small. These utilization patterns show that patients choose both modalities to manage their NCD and TCM should be considered within policies for supporting patients with NCD under the wider primary health and social care system that supports patient choice.

Perceived quality of communication amongst outpatients in western and traditional Chinese medicine clinics in a Chinese population.

OBJECTIVE: This study investigates differences in perceived communication by patients of the quality of outpatient episodes in an urban Chinese population. METHODS: A representative, population based survey was conducted in Hong Kong, China. A random sample of respondents aged >15 years who had received outpatient care the 30 days previous to enumeration were invited to evaluate communication with their doctors and the overall quality of their latest consultation. RESULTS: The majority thought that their clinicians were listening carefully (93.5%), explaining clearly (93.1%), expressing appropriate respect (93.8%), and were allocating sufficient time for consultation (89.5%). 97.6% gave 5-10 points out of 10 for overall healthcare quality. Compared to users of private western medicine (WM) services, multivariate analysis showed that traditional Chinese medicine (TCM) patients were more likely to rate their clinicians highly for listening skills but low for respect. Users of WM public services were more likely to be dissatisfied with all evaluated aspects. Favourable ratings were more likely to be expressed by those who are older, less educated, and those who paid by indemnity insurance. CONCLUSIONS: We have highlighted three unique observations: first, patients' perception of clinician-patient communication in out patients differs between WM and TCM. Second, patients who used public WM services rate the quality of their visits lower than those in the private WM sector. Lastly, we have observed a negative association between higher education background and satisfaction level. Further researches are warranted.

Heavy internet use and correlations with interpersonal behaviours among university entrants in Hong Kong.

This paper summarizes the effects of Internet use on interpersonal behaviours among university students in Hong Kong. 2427 university matriculants in Hong Kong (mean age = 18.9, response rate 92.1%) completed an anonymous, self-administered questionnaire at the pre-enrollment health check-up. In the week preceding the survey, 99.4% of students had used the Internet with an average of 2.8 h/day; 14.9% reported heavy Internet use (> 4 h/day). Males (OR = 2.48) and Hong Kong-born students were more likely to be heavy users (OR = 1.67) while students with a religious affiliation (OR = 0.70), with a parent with tertiary education (OR = 0.68), or those in a romantic relationship (OR = 0.72) were less likely to be heavy users. Heavy users were less likely to socialize face-to-face (OR = 0.75) or talking to someone in person (OR = 0.61) in order to relieve feelings of stress, but were more likely to engage in online chatting (OR = 1.73) and online interactive games (OR = 2.43). They were also more likely to skip school (OR = 2.21), to be yelled at by family members (OR = 2.05) and to meet strangers from the Internet in person (OR = 3.31). There is strong evidence of the adverse effects of heavy internet use on interpersonal behaviours among Hong Kong university students, warranting further studies.