A qualitative insight on complementary and alternative medicines used by hypertensive patients

摘要

Background: The self-treatment with complementary and alternative medicines (CAMs) in chronic diseases is portraying an expanding trend worldwide. Yet, little is known concerning patients’ motives to use CAM in the control of blood pressure. Objective: This study aims to explore the self-use of CAM in the management of hypertension and explore patients’ attitudes, perceived benefits, and disclosure to the physician. Materials and Methods: A qualitative technique was adopted and face-to-face interviews, using a validated interview guide, were carried out among twenty hypertensive patients. A purposive sampling method was used to recruit patients at Al-Karama Teaching Hospital in Baghdad; the capital of Iraq; from January to April 2015. All the interviews were audio-recorded, then transcribed verbatim and examined for thematic relationships. Results: Three major themes were identified through thematic content analysis of the interviews. These encompassed patients’ understanding of CAM; experience and perceived benefits; and communication with the doctors. The use of CAM was prevalent among the majority of the respondents. The most commonly used therapies were biological-based practices (herbal remedies, special diet, vitamins, and dietary supplements); traditional therapies (Al-Hijama or cupping); and to a less extent of manipulative body-based therapies (reflexology). Factors influencing the use of CAM were traditions, social relationships, religious beliefs, low-cost therapy, and safety of natural products. Conclusion: The use of CAM was common as a practice of self-treatment among hypertensive patients in Iraq. This was underpinned by the cultural effects, social relationships, religious beliefs, and the perception that natural products are effective and safe. Understanding patients’ usage of CAM is of great importance as long as patient's safety and interaction with the standard prescribed treatment are major concerns. KEY WORDS: Al-hijama, complimentary alternative medicines, hypertension, Iraq The recent decades witnessed an increased attention to the use of complementary and alternative medicines (CAMs) in the management of different health conditions. Despite available researches that addressed patient's usage of CAM in various chronic diseases, little is known concerning hypertension. Hypertension is a chronic disorder, affecting approximately 27% of the population worldwide and accounts for 12.8% of the total deaths.[ 1 ] In Iraq (the Eastern region of the Arab world), the prevalence of hypertension is about 25% of the total population and accounts for 5% of all deaths in the country.[ 2 ] It is necessary for patients diagnosed with hypertension to achieve adequate blood pressure levels to prevent cardiovascular risk and serious renal complications.[ 3 ] The overall strategy to maintain normal blood pressure level involves standard medical treatment as well as patient self-care. Recent studies have identified the self-use of CAM among patients with hypertension to control their blood pressure and improve the quality of life.[ 4 , 5 ] CAM is defined by the world health organization as “The sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.”[ 6 ] This nondrug treatment encompasses several modalities such as biological therapies (herbal products, vitamins, and dietary supplements); cupping or “Al-Hijama” in Arabic culture; body-based therapies (massage and reflexology); mind-body therapies (meditation, prayer, and relaxation); and whole-medical system (Chinese acupuncture and homeopathy). It is generally regarded as a complementary medicine when it is used alongside standard treatments; whereas, alternative medicine when it is used instead of the standard treatment.[ 7 ] Some previous researches reported that hypertensive patients are attracted to use CAM alongside their conventional treatment as an attempt to control their blood pressure.[ 3 , 5 , 8 , 9 ] This surge is generally prompted by the perceived natural effect of CAM; cost and skepticism of orthodox medicines; and psychosocial and cultural factors.[ 5 , 8 , 10 ] CAM therapy, in particular, herbal products, in the Arab region is common and dated back to a long history. Several studies conducted in the Arab societies have reported the self-use of herbs and dietary supplements in the management of hypertension and cardiovascular diseases.[ 11 , 12 , 13 ] However, patients’ perspectives concerning CAM treatment is still not well understood. To the best of our knowledge, most studies in this field are quantitative in nature. Hence, this study intended to understand hypertensive patient's point of view towards CAM through a qualitative scenario. Our study aims to understand the use of CAM among patients with hyp