Original article
Parents’ and practitioners’ differing perspectives on traditional and complementary health approaches (TCAs) for children

https://doi.org/10.1016/j.eujim.2010.02.002Get rights and content

Abstract

Aim

To compare parents’ and practitioners’ perspectives on traditional and complementary healthcare approaches (TCAs) used for children in a multi-ethnic community. TCA includes not only complementary and alternative medicine (CAM) but also folk/ethno-medicine.

Methodology

An exploratory qualitative study in multi-ethnic community settings and primary care in Northwest London. Eleven focus groups explored parents’ use of TCA for their children, sources of information, decision-making processes and communication with healthcare practitioners about TCA use. Translation was available. Semi-structured individual interviews were conducted with 30 GPs, nurses, health visitors and midwives to explore their attitudes, beliefs and knowledge. Sampling was purposive and iterative to capture the range of ethnicities. Data were analysed using Framework Analysis and Atlas.ti software.

Results

A wide range of TCA was used for children. Parents’ and practitioners’ perspectives on TCA differed, including: definition, categorisation, plausibility, efficacy, epistemology and evidence. Parents’ perspectives were generally more pragmatic, including what was classified as TCA and how they evaluated effectiveness. Practitioners focussed on more theoretical issues, in particular approving of TCA with plausible mechanisms of action and research evidence. Parents relied on family members and other mothers to inform their TCA use.

Discussion

Mismatch in perspectives and criteria regarding TCA may create communication problems during consultation. Practitioners need to appreciate the range and extent of TCA used for children and understand reasons behind this use. Discussions with families on whether these can be integrated with current medical treatment in a safe and acceptable way can then occur.

Introduction

Traditional and complementary healthcare approach (TCA) is an umbrella term, encompassing complementary and alternative medicine (CAM) and traditional, ‘folk’ or ‘ethno’ medicine [1]. Traditional medicine is often passed down through generations, is relatively informal and non-commercial [2].

Estimates of TCA use for children in primary care or the general population vary from 1.8% to 70% [3], [4], [5], depending on the country of study, ethnic origin of participants and differing definitions of CAM/TCA. The most prevalent types used for children are dietary supplements (vitamins and minerals) [6], [7], [8], homeopathy [9], [10], [11] and herbal medicine [11], [12].

Between 18% and 80% of practitioners report discussing TCA with patients [13], [14], [15], over half of practitioners recommend some form of TCA [16], [17], [18] and up to 95% have referred patients to TCA practitioners [19], [20].

Quantitative surveys have shown that the majority of practitioners have an ‘ambivalent’ or ‘neutral’ attitude to TCA [14], [21], [22], others have shown that few practitioners have overtly negative attitudes to TCA [14], [23] and two surveys have shown predominantly positive attitudes [24], [25]. A qualitative UK study of academic GPs found their beliefs about TCA could be viewed as on a spectrum from enthusiastic to skeptical, with those who were undecided being in the middle. The main influence on their attitude was their professional experience [26].

Studies rarely compare patient and practitioner reported data [27]. Studies have generally found that patients have more positive attitudes and greater expectations regarding TCA than practitioners. A survey comparing physician and patient knowledge of and attitudes to traditional Chinese medicine (TCM) found that knowledge levels were similar but patients were slightly more positive, and patients knew more about practical aspects compared to practitioners’ basic concepts [28]. However, this quantitative survey does not explore the details of these constructs. Two other studies investigated cancer patients, one is ongoing [27], the other found disparities in: definition of ‘unconventional’; reasons for communication; and decision making [29]. Two studies have included the triad of patient, physician and CAM practitioner [27], [30]. Ben-Arye et al. [30] found that patients perceived CAM as safer and more efficacious and had greater expectations of the physician's role in CAM than physicians. Adler emphasise the need to study all the stakeholders in order to gain a realistic view of healthcare communication [27]. Stevenson et al. [48] studied self-treatment in the consultation, using audio-taping of consultations and qualitative interviews with patients and practitioners. Kleinman highlights the significance of patients’ and practitioners’ differing explanatory models of health and illness [31]. These studies highlight potential discrepancies but rarely explore in-depth the beliefs behind these differing behaviours and expectations.

Other studies show that practitioners may underestimate how many of their patients use TCA [17], [32] and many agree they should have greater TCA knowledge [18], [21], [33].

This study aimed to compare parents’ and practitioners’ perspectives on traditional and complementary healthcare approaches (TCAs) used for children in a multi-ethnic community.

Section snippets

Methods

An exploratory qualitative study was conducted within community settings and primary care in Northwest London.

Focus groups were conducted with parents to explore their use of TCA for their children, sources of TCA information, their decision-making processes and whether they communicated with healthcare practitioners about the use of TCA. Sampling was purposive to achieve a broadly representative range of ethnicities. Parents were recruited from community settings such as mother and toddler

Participants

Groups invited to participate in focus groups were as follows: 47 community groups (from lists on community websites); 3 refugee groups; 13 GP practice mother and toddler/baby clinic groups; 4 nurseries; 8 schools; 29 places of worship; 1 parenting website; 1 early years centre and 1 baby massage class. Reasons for non-response or non-participation were lack of time, lack of resources, commitments to other projects and concerns about confidentiality. 11 focus groups were conducted in the

Discussion

This study identified that parents and practitioners have a number of disparate perspectives on TCA, mainly related to definition, categorisation, range, plausibility, efficacy, epistemology (source and nature of knowledge) and evidence.

Parents’ perspectives on TCA were in general more pragmatic, including their classification of treatments and decision making, which was informed by effectiveness. Practitioners focussed on more theoretical issues such as theories of how TCA work and the

Conclusions

Practitioners’ professionally guided criteria for assessing TCA are likely to differ greatly from parents’ more pragmatic criteria. This mismatch in perspectives regarding TCA may create communication problems during consultation. Practitioners need to appreciate the range and extent of TCA used for children and understand the reasons behind this use. They can then ask families about TCA use and make judgements with them about whether and how these can be integrated with current medical

Financial support

This study was supported by a grant from the King's Fund, a healthcare charity based in London.

Conflict of interest

No conflict of interest declared.

Acknowledgements

We would like to thank all the parents and practitioners who took part in this study.

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