Comparison of the knowledge, attitudes and practice with antibiotic use between traditional Chinese medicine and western medicine usual attenders in Hong Kong
Introduction
Misuse of antibiotics is widespread in the community;1 alternative medicine was suggested as a mean of reducing antibiotic use and hence resistance.2, 3 Harbarth et al. attributed the much lower prevalence of penicillin-resistant pneumococci in Germany (than in France) to her much higher prevalence of using alternative medicine.4 However a study of children in UK showed that the use of homeopathic products was not associated with decreased antibiotic consumption.5 There are too few studies on the use of antibiotics by people opting for alternative medicine to examine if alternative medicine could diminish antibiotic resistance.
A systematic review shows that the prevalence of the use of alternative medicine ranges from 9% to 65% in different parts of the world.6 People choose alternative medicine based on the perceived nature of their illness or their expectations from the alternative therapies.7, 8 One of their common concerns is the potency and associated side-effects of western drugs.8, 9, 10, 11 Antibiotics are among them.12 While their attitudes about antibiotics are known, their knowledge and use of antibiotics are largely understudied.
This study aims to compare the knowledge, attitude, and practice (KAP) with antibiotics between people using alternative medicine and people using the western-medicine (WM). In Hong Kong, traditional Chinese medicine (TCM) is part of the healthcare system with a similar statutory status as WM and is by far the most major alternative medicine used. The Government's Thematic Household Survey in 2010 showed that 13.2% of the residents who had sought medical care in the previous 30 days attended TCM.13 As TCM practitioners do not have the legal right to prescribe antibiotics, patients who need antibiotics must attend WM. The use of antibiotics can thus be compared between the public who usually attend TCM and those usually attend WM (defined in this study as TCM-attenders and WM-attenders).
We hypothesized that there were significant differences in KAP between these two groups. The results would reveal whether TCM was a significant factor for reducing antibiotic use. Besides, the knowledge and other behaviour (e.g. finishing a full course of antibiotics or not) of the TCM-attenders could be better understood. The findings will be useful for the individual patient education and public campaigns for the appropriate use of antibiotics in the community.
Section snippets
Methods
This is part of a larger study on the general public's KAP with antibiotics. The findings of other study themes have been reported elsewhere.12, 14 Fifty-six residents aged 20–73 years from different socio-economic strata were purposively recruited via local community centres for a qualitative study. Eight focus groups were held with an interview guide to discuss their KAP with antibiotics. Based on the findings from the focus-groups, a questionnaire was designed for a territory-wide telephone
Recruits
Of 3996 successful calls to households, 813 refused, 336 did not complete the interviews, and 376 were excluded due to language problems (n = 157) or under age (n = 219). Of the 2471 who completed the interviews (response rate 68.3%), 270 (10.9%) usually attended TCM practitioners and 2092 (84.7%) the western doctors and the other 109 (4.4%) were uncertain (no particular preference).
The TCM-attenders were more likely to be female and from the lower income-group (Table 1). These two characteristics
Discussion
This study compared the TCM-attenders and the WM-attenders in Hong Kong, TCM being the main alternative medicine used locally. The TCM-attenders were significantly more likely to be female and from the lower income-group. Compared with the WM-attenders, they were less likely to accept antibiotics. They were less likely to be treated with antibiotics for URTI. But they were also less likely to always finish the full course. In the knowledge test of antibiotics, the TCM- and WM-attenders achieved
Conclusion
There are similarities and differences in KAP with antibiotics between the attenders of TCM and WM. Taking TCM as representative of alternative medicine, this study found that the users of alternative medicine were significantly less likely to accept and be treated with antibiotics. But they were also less likely to always finish a full course of antibiotic.
Conflicts of interest statement
The authors have no conflicts of interest in regard to this paper.
Funding
This work was supported by a grant from the Research Fund for the Control of Infectious Diseases of the Hong Kong Special Administrative Region, China (Project no. 09080852).
References (19)
- et al.
The use and abuse of antibiotics and the development of antibiotic resistance
Advances in Experimental Medicine and Biology
(2010) - et al.
Therapies help reduce antibiotic resistance?
Alternative Medicine Review
(2003) Antibiotics and the development of resistant microorganisms. Can homeopathy be an alternative?
Homeopathy
(2003)- et al.
Outpatient antibiotic use and prevalence of antibiotic-resistant pneumococci in France and Germany: a sociocultural perspective
Emerging Infectious Diseases
(2002) - et al.
Complementary or alternative? The use of homeopathic products and antibiotics amongst pre-school children
BMC Family Practice
(2008) Prevalence of use of complementary/alternative medicine: a systematic review
Bulletin of the World Health Organization
(2000)- et al.
Predicting traditional Chinese medicine's use and the marginalization of medical care in Hong Kong
The American Journal of Chinese Medicine
(2001) - et al.
Great expectations: what do patients using complementary and alternative medicine hope for?
The Patient
(2011) - et al.
Attitudes of Hong Kong Chinese to traditional Chinese medicine and western medicine: survey and cluster analysis
Complementary Therapies in Medicine
(2003)