Patients’ reasons for seeking traditional Chinese medicine: a qualitative study
Asmita Patel 1 2 , Yiyi Chen 11 New Zealand College of Chinese Medicine, Auckland, New Zealand
2 School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
Correspondence to: Asmita Patel, New Zealand College of Chinese Medicine, P.O. Box 17467, Auckland 1050, New Zealand. Email: asmita.patel@aut.ac.nz
Journal of Primary Health Care 10(4) 338-342 https://doi.org/10.1071/HC17092
Published: 7 December 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Acupuncture is one of the most well-known and utilised forms of traditional Chinese medicine (TCM). Very little is known about the factors that influence individuals to seek this type of treatment. The aim of this study was to identify and examine patients’ reasons for seeking TCM treatment, which was mainly in the form of acupuncture.
METHODS: Participants were 15 Auckland-based patients who attended a student acupuncture clinic. Participants were individually interviewed. An inductive thematic approach was used to analyse data.
RESULTS: Three main themes were identified regarding factors that influenced individuals to seek TCM: the perceived limitations of pharmaceutical treatment for certain conditions; a previous positive experience of acupuncture; and word-of-mouth regarding the perceived effectiveness of acupuncture in the treatment of certain conditions.
DISCUSSION: Users perceive TCM-based acupuncture to be an effective form of treatment for their condition, especially after having previously received conventional medical treatment. Past and present users of TCM appear to have an advocate-based role with family and friends regarding the promotion of TCM-based acupuncture.
KEYWORDS: Acupuncture; traditional Chinese medicine; patient perspectives; complementary and alternative medicine; CAM utilisation
| WHAT GAP THIS FILLS |
| What is already known: Acupuncture is the most well-known and utilised form of traditional Chinese medicine treatment, but little is known about the reasons why New Zealanders seek treatment with it. |
| What this study adds: Perceived limitations of conventional medicine (especially for pain management), previous utilisation of acupuncture, and endorsement from others for traditional Chinese medicine treatment were all identified as being salient reasons for the utilisation of acupuncture. |
Introduction
New Zealand has experienced an increase in the use of complementary and alternative medicine (CAM).1–5 Over a 12-month period, one-quarter of the adult New Zealand population will seek treatment from a CAM practitioner.4,6
One of the most well-known and utilised forms of CAM treatment in New Zealand is acupuncture.2,4,7,8 Acupuncture is a treatment that falls within traditional Chinese medicine (TCM).9
Although there has been some research into the prevalence of CAM utilisation in New Zealand,1,3–5,10 limited research exists that has focused specifically on the utilisation of TCM treatment modalities, such as acupuncture.11 Therefore, the aim of the present study was to identify and examine patients’ reasons for seeking TCM treatment, especially acupuncture.
Methods
Participants
Fifteen patients (nine female and six male) who attended a Student Acupuncture and Herbal Teaching Clinic in Auckland participated in the present study. Participants were aged between 22 and 70 years. All participants permanently resided in New Zealand. Six participants were New Zealand born, four were born in China, with the remaining five born in Fiji, Ireland, Korea, Malaysia and New Caledonia. To be eligible to participate in the study, potential participants must have had three or more treatments at the clinic and had to be interviewed within a month of their last treatment (for recall purposes regarding their treatment). Potential participants had to be aged ≥18 years. Participants sought treatment for a range of conditions, including: pain management (lower and upper limb, arm and shoulder and neck and back pain), gynaecological conditions (irregular menses and prolapsed uterus), irritable bowel syndrome, type 2 diabetes, asthma, fatigue and erectile dysfunction.
An interview schedule was developed for the study, comprising two main parts. The first section involved questions that focused on TCM use, and the second section consisted of questions relating to previous treatment that had been sought before attending our TCM clinic.
Participants were recruited over a 4-week period by members of the research team and clinic reception staff. Information explaining the study was given to prospective participants by clinic reception staff, as they know how many visits (treatments) each patient has had, and could identify potential patients to recruit. To obtain 15 positive responders, 25 patients were approached. Patients who were interested in participating contacted the first author via email or phone. Participants were individually interviewed in a private room at the clinic by either the first or second author before or after their treatment at the clinic. Interviews took 15–30 min to complete.
Informed written consent was obtained from each participant before the commencement of their interview. Ethical approval for this study was obtained from the New Zealand College of Chinese Medicine’s Research and Ethics Committee (Reference number 2015/003).
Data analysis
All interviews were audio-taped and transcribed verbatim. Auerbach and Silverstein’s four-step process of thematic analysis was used to analyse the data.12 The first two steps in the process involved reading and re-reading all interview transcripts for each individual question to find commonalities (repeating ideas) in the discourse used by participants to answer each question. The third step involved coding the repeating ideas, which resulted in the emergence of themes. A theme is an organisation of repeating ideas (ie similar words or experiences that participants use in response to a question) that is given a name, which communicates what participants are trying to convey. The final step in the analysis process is concerned with verifying the trustworthiness of the findings and ensuring that all members of the research team have independently verified all themes.12
Results
Data were examined under the two main topic areas: (1) reasons for seeking TCM treatment; and (2) treatment experience. The themes for each topic area, including representative quotes, are shown in Table 1.
|
Reasons for seeking TCM treatment
Three main themes emerged within this topic area that explored patients’ reasons for seeking TCM treatment.
Experience of previous conventional medical treatment
Participants discussed how their previous experience of conventional medical treatment influenced their decision to try acupuncture. This was mainly related to the perceived limitations of prescription medication, including its side-effects. Communication in the therapeutic relationship was also raised as an issue.
Previous experience of acupuncture
Previous experience of acupuncture treatment was a factor in determining participants’ current use of acupuncture.
Word-of-mouth
Word-of-mouth also appeared to be a factor in determining one’s decision to have acupuncture, especially in the case of muscular pain related to injury.
Treatment experience
Two main themes emerged within this topic area that examined patients’ experiences of their TCM treatment. Also examined within this topic area was whether patients made suggestions to family, friends or colleagues to attend the student clinic.
Perceived helpful nature of TCM
Several participants perceived acupuncture as effective in helping to treat their condition, as it resulted in some form of improvement.
Word-of-mouth in action
Some participants recommended either the student clinic or acupuncture treatment in general to either their family, friends or colleagues.
Discussion
Perceived limitations of conventional pharmaceutical treatment for the management of certain conditions, as well as the negative side-effects of certain medications, was identified as being a factor that influenced some patients to seek TCM treatment. These findings have been substantiated in both national4,7,11 and international literature regarding CAM utilisation.13–16
Communication in the therapeutic relationship was also identified as a reason for seeking TCM treatment, a finding substantiated in previous New Zealand research.1 The patient–health care practitioner relationship is considered reciprocal in Chinese medicine, as patients have an active role in their healing.17,18
Some participants perceived acupuncture to be beneficial in treating their condition. This was especially the case for musculoskeletal pain and chronic health conditions. Earlier research by our group found that over a 4-month period, new patients at our student clinic sought treatment for pain management more than for any other ailment.7 Numerous international studies have also found that people mostly seek acupuncture treatment for pain management purposes rather than the treatment and management of any other condition.16,19–22 Acupuncture has been found to be clinically effective in the management of musculoskeletal pain.23,24 In New Zealand, the Accident Compensation Corporation (ACC) funds acupuncture for injury-related conditions because of its efficacy in the management of musculoskeletal pain.8
A previous positive experience of acupuncture was also identified as a factor influencing utilisation of acupuncture. A recent New Zealand-based study discussed how individuals who have had a successful experience of acupuncture are more likely to seek acupuncture for a similar condition in the future.8 Another study found that acupuncture for chronic pain was more effective if an individual had a previous positive experience of acupuncture.25
Findings from the present study indicate that word-of-mouth was an important factor in influencing some individuals to seek TCM treatment. This appeared to be related to the perceived effectiveness of acupuncture for the treatment of pain-related conditions. Our findings are in line with the international literature, which also cites family and friends as having an instrumental role in influencing individuals to seek TCM-based acupuncture.26–28
This study also demonstrated the contribution of word-of-mouth, and several participants indicated that they had recommended to their family, friends or colleagues that they have treatment at the college’s clinic or to have acupuncture treatment in general. This reinforces the importance of word-of-mouth in endorsing acupuncture for certain conditions. In line with this finding, a previous US-based study emphasised the advocate-based role that family and friends have in recommending acupuncture.29
A limitation of the present study is the small sample size that can constrain the generalisability of the findings to the wider New Zealand population. Also, the cost of treatment at our student clinic is considerably lower than industry standards. However, the findings of the present study have been substantiated in the international literature.
Conclusions
The decision to have TCM treatment was related to the perceived limitations of conventional medicine in treating certain conditions, previous experience of acupuncture, or word-of-mouth regarding the perceived effectiveness of TCM in treating and managing certain conditions. Future research in this area will focus on patient experiences of treatment for a specific condition, such as insomnia.
FUNDING
This study was internally funded by New Zealand College of Chinese Medicine.
COMPETING INTERSTS
None.
ACKNOWLEDGEMENTS
We would like to thank the participants who took part in this study.
References
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