Attitudes of healthcare professionals towards integrative medicine

Abstract

Background: There is high utilization of Traditional, Complementary, and Alternative Medical (TCAM) therapies in Africa with estimates that between 70% and 95% of the population in developing countries use TCAM. In Uganda, it is estimated that 60% to 79% of the population utilize TCAM sometimes concomitantly with utilization of conventional medical practice. Despite high TCAM utilization, there is limited evidence on: the proportions of medical schools in Africa that have incorporated it into their curriculum; and the attitudes of health care students towards the integration of TCAM into conventional medical education. Similarly, there is limited awareness of the disposition of Ugandan conventional healthcare professionals towards Integrative medicine (IM). Objective: To provide an understanding of the attitudes of conventional healthcare providers towards TCAM and how this treatment approach could be integrated within the mainstream healthcare system in Uganda. Methods: A questionnaire based cross-sectional survey was carried out among Conventional Healthcare Professionals (CHPs) working at General Military Hospital (GMH), Bombo and interviews were conducted with Ministry of Health (MOH) policy makers. Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS Version 25) while qualitative data was analysed through content and thematic analysis. Results: About 64.1 % of all the respondents had used at least one form of TCAM with administrators (72.7 %) and nurses (51.1 %) being the highest and least users respectively. Conventional healthcare professionals had mixed perceptions about the effectiveness of TCAM, rating its effectiveness with a mean score of 3 (neutral). Almost three quarters (73.2 %) of the CHPs reported a limited knowledge of TCAM (average mean score of 2), with Medical Doctors (82.6 %) and nurses (62%) being the most and least knowledgeable about TCAM respectively. The majority (90.2%) of CHPs registered a moderate interest (average mean score of 3) to learn more about TCAM with Medical Doctor (95.7%) and administrators (45.4%) most and least keen to learn more about TCAM respectively. More than three quarters (80.4%) of CHPs were willing to discuss TCAM during medical consultation despite them being undecided (average mean score of 3) about the level of comfort while discussing TCAM issues. Clinical officers (92.8%) were the most willing and nurses (68.9%) were the least willing to discuss TCAM during a medical consultation. Three quarters (77.1%) of the CHPs were moderately (average mean score of 3) willing to recommend patients to use TCAM with administrators (81.8%) being the most willing and nurses (73.3%) being the least willing to recommend patients to use TCAM. CHPs perceive safety of most TCAM modalities as slightly safe with an average mean score on the perception of safety of the TCAM modalities as 2.56. The majority of the CHPs found a lack of scientific evidence (35.2%) and inadequate knowledge (27.3%) about TCAM as the limitations to implementing integration of evidence-based TCAM into conventional medical practice. Almost three quarters (71.5%) of the CHPs feel that they neither have the capacity (42.4%) nor are they involved enough (29.1 %) to implement initiation of integration of TCAM into conventional medical practice in their organisation. Two thirds of the CHPs prefer implementation of integrative medicine into their organisation through a healthcare program (40.8 %) and research (28.3%). This is further reinforced as a strategy voiced through interviews for the need for Ministry of Health to lead the integrative process through setting the TCAM research agenda, research funding and research dissemination and also integrative medicine policy formulation, establishment of guidelines, standard setting, promoting and monitoring their implementation. Conclusion: Conventional healthcare professionals have a lukewarm attitude towards TCAM with the majority of CHPs reporting low TCAM knowledge levels, scepticism of TCAM effectiveness and are cautious about TCAM recommendation. Causes of this attitude are mainly lack of scientific evidence, lack of formative education, lack of information sources, lack of experience and lack of policy support. The main strategy to implementing integrative medicine is by the Ministry of Health playing a leadership role in the integrative process through: setting standards, guidelines / formularies, regulation and policies, and promoting and monitoring their implementation; setting of the TCAM research agenda, increased TCAM research funding and TCAM research publication; planning and implementation of sustainable capacity building in regards to integrative medicine, and offering technical support through the recruitment of specialists to guide the integration and change management process.