Views on traditional Chinese medicine amongst Chinese population: a systematic review of qualitative and quantitative studies
Corresponding Author
Vincent C. H. Chung BCM PhD
Assistant Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Correspondence
Vincent C. H. Chung
Assistant Professor
School of Public Health and Primary Care
Prince of Wales Hospital
Rm 412, Shatin
Hong Kong SAR
China
E-mail: [email protected]
Search for more papers by this authorPolly H. X. Ma MPH
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorChun Hong Lau MSSc PhD
_Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorSamuel Y. S. Wong MPH MD
Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorEng Kiong Yeoh MBBS FHKAM
Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorSian M. Griffiths MB BChir FFPH
Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorCorresponding Author
Vincent C. H. Chung BCM PhD
Assistant Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Correspondence
Vincent C. H. Chung
Assistant Professor
School of Public Health and Primary Care
Prince of Wales Hospital
Rm 412, Shatin
Hong Kong SAR
China
E-mail: [email protected]
Search for more papers by this authorPolly H. X. Ma MPH
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorChun Hong Lau MSSc PhD
_Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorSamuel Y. S. Wong MPH MD
Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorEng Kiong Yeoh MBBS FHKAM
Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorSian M. Griffiths MB BChir FFPH
Professor
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
Search for more papers by this authorAbstract
Background
Health-care professionals worldwide have started to appreciate patients' perspectives on the use of complementary and alternative medicine (CAM) particularly given its popularity. However, cultural perspectives may vary and it may not be possible to apply research findings on the use of CAM from the west to the east.
Objective
This systematic review aims to synthesize usage patterns of traditional Chinese medicine (TCM) amongst Chinese populations in different parts of the world and explore potential geographical variations.
Search strategy
Six international and four Chinese databases were searched, and manual searches of relevant monographs and government publications were carried out.
Inclusion criteria
Quantitative, qualitative or mixed-method research that aimed to investigate Chinese patients' perception of, and perspectives on, TCM was included.
Data extraction and synthesis
For each study included, texts under the headings of ‘results’ or ‘findings’ were extracted and subjected to analysis. A thematic synthesis approach was adopted for synthesizing qualitative and quantitative studies.
Main results
Amongst the 28 studies included, twenty were quantitative surveys, six were qualitative studies and two were mixed-method studies. The overall methodological quality was mediocre. Data synthesis suggested that patients from all regions share a common cultural affinity to TCM and consider it to be an effective complement to western medicine (WM) for treating chronic or serious diseases. However, heterogeneous views on (i) disclosing TCM use to WM doctors and (ii) the potential harm of herbs emerged across different study locations.
Discussion and conclusions
Future research should explore how variation in health systems may influence patients' perception of CAM in different countries.
References
- 1Harris P, Rees R. The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature. Complementary Therapies in Medicine, 2000; 8: 88–96.
- 2Sierpina VS, Schneeweiss R, Frenkel MA, Bulik R, Maypole J. Barriers, strategies, and lessons learned from complementary and alternative medicine curricular initiatives. Academic Medicine, 2007; 82: 946–950.
- 3Robinson A, McGrail M. Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complementary Therapies in Medicine, 2004; 12: 90.
- 4 WHO Congress on Traditional Medicine, 2008. Beijing declaration. Available at: http://www.who.int/medicines/areas/traditional/congress/beijingdeclaration/en/index.html, accessed 11 December 2009.
- 5Bishop FL, Yardley L, Lewith GT. A systematic review of beliefs involved in the use of complementary and alternative medicine. Journal of Health Psychology, 2007; 12: 851–867.
- 6Koehn PH. Globalization, migration health, and educational preparation for transnational medical encounters. Globalization and Health, 2006; 2: 2.
- 7Tang JL, Liu BY, Ma KW. Traditional Chinese Medicine. The Lancet, 2008; 372: 1938–1940.
- 8 National Centre for Complementary and Alternative Medicine (NCCAM). What is CAM? Available at: http://nccam.nih.gov/health/whatiscam/overview.htm. Accessed 19 January 2010.
- 9 National Centre for Complementary and Alternative Medicine. What is Integrative Medicine? Available at: http://nccam.nih.gov/health/whatiscam/overview.htm#integ, accessed 19 January 2010.
- 10Kaptchuk TJ. The Web That Has No Weaver: Understanding Chinese Medicine. New York: McGraw-Hill, 2000.
- 11Xu J, Yang Y. Traditional Chinese medicine in the Chinese health care system. Health Policy, 2009; 90: 133–139.
- 12Harden A, Garcia J, Oliver S et al. Applying systematic review methods to studies of people's views: an example from public health research. Journal of Epidemiology and Community Health, 2004; 58: 794–800.
- 13Mills EJ, Nachega JB, Bangsberg DR et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Medicine, 2006; 3 : 2039–2064.
- 14Crowe M, Sheppard L. A review of critical appraisal tools show they lack rigor: alternative tool structure is proposed. Journal of Clinical Epidemiology, 2011; 64: 79–89.
- 15Higgins DJPT, Green S. Cochrane handbook for systematic reviews of interventions: Wiley Online Library; 2008.
- 16Lucas PJ, Baird J, Arai L, Law C, Roberts HM. Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Medical Research Methodology, 2007; 7: 4.
- 17Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 2008; 8: 45.
- 18Pope C, Mays N, Popay J. Stages in Reviewing Evidence Systematically. Synthesizing Qualitative and Quantitative Health Evidence: A Guide to Methods: Open University Press, 2007; 19–44.
- 19Koo LC. Concepts of disease causation, treatment and prevention among Hong Kong Chinese: diversity and eclecticism. Social Science and Medicine, 1987; 25: 405–417.
- 20Wong VW, Law MY, Hui AY et al. A hospital clinic-based survey on traditional Chinese medicine usage among chronic hepatitis B patients. Complementary Therapies in Medicine, 2005; 13: 175–182.
- 21Fok MS, Chan K, Tse SH, Chan TM. Development of a data collecting tool to explore the consuming patterns of Chinese and Western medicines in Hong Kong. Contemporary Nurse, 2005; 20: 143–151.
- 22Lee A, Chui P, Aun C, Lau A, Gin T. Incidence and risk of adverse perioperative events among surgical patients taking traditional Chinese herbal medicines. Anesthesiology, 2006; 105: 454.
- 23Tse M, Lau F. Traditional Chinese Medicine use among emergency patients in Hong Kong. Journal of Emergency Medicine, 2007; 14: 151–153.
10.1177/102490790701400304 Google Scholar
- 24Wong RS, Cheng G, Chan TY. Use of herbal medicines by patients receiving warfarin. Drug Safety, 2003; 26: 585–588.
- 25Lau J, Yu A. The choice between Chinese medicine and Western medicine practitioners by Hong Kong adolescents. American Journal of Chinese Medicine, 2000; 28: 131.
- 26Chen FP, Chen TJ, Kung YY et al. Use frequency of traditional Chinese medicine in Taiwan. BMC Health Services Research, 2007; 7: 26.
- 27Chan KF, Ng YN, Bian ZX, Shi Y, Lee SP, Ng KY. Social Work at the Chinese Medicine System in Hong Kong. Social Work in Health Care, 2008; 46: 39–55.
- 28Ong CO, Chan LY, Yung PB, Leung TN. Use of traditional Chinese herbal medicine during pregnancy: a prospective survey. Acta Obstetricia et Gynecologica Scandinavica, 2005; 84: 699–700.
- 29WONG TW. Traditional Chinese Medicine and Western Medicine in Hong Kong: A Comparison of the Consultation Processes and Side Effects. Journal of the Hong Kong Medical Association, 1993; 45: 278–284.
- 30Chan M, Mok E, Wong Y et al. Attitudes of Hong Kong Chinese to traditional Chinese medicine and Western medicine: survey and cluster analysis. Complementary Therapies in Medicine, 2003; 11: 103.
- 31Pu CY, Lan VM, Lan CF, Lang HC. The determinants of traditional Chinese medicine and acupuncture utilization for cancer patients with simultaneous conventional treatment. European Journal of Cancer Care, 2008; 17: 340–349.
- 32Ferro M, Leis A, Doll R, Chiu L, Chung M, Barroetavena M. The impact of acculturation on the use of traditional Chinese medicine in newly diagnosed Chinese cancer patients. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 2007; 15: 985.
- 33Xu W, Towers A, Li P, Collet J. Traditional Chinese medicine in cancer care: perspectives and experiences of patients and professionals in China. European Journal of Cancer Care, 2006; 15: 397.
- 34Huang L, Chen JY, Zhu M, Wu KP. Patients' Choice for Outpatient Chinese Medicine Service: An Investigation on Intention (In Chinese). Jiangsu Journal of Traditional Chinese Medicine, 2007; 39: 51–53.
- 35Xie YG. Demand and Utilization of Chinese Medicine Service in Beijing: An Investigation(in Chinese). Beijing Journal of Traditional Chinese Medicine, 2004; 23: 135–138.
- 36Hou YC, Huang WF. Factors influencing patient's choice of hospital and satisfaction with the ambulatory service of seven Chinese medicine hospitals in Taichung. Chinese Journal of Public Health (Taiwan), 1999; 18: 34–43.
- 37Kang JT, Chen CF, Chou P. Knowledge, Attitude and Behavioral Intention of Chinese Traditional Medicine Among Outpatients (In Chinese). Chinese Journal of Public Health (Taiwan), 1994; 13: 432–441.
- 38Lew-Ting CY. Antibiomedicine belief and integrative health seeking in Taiwan. Social Science and Medicine, 2005; 60: 2111–2116.
- 39 Hong Kong Census and Statistic Department. Thematic Househould Survey. Printing Department, 2000.
- 40 Hong Kong Census and Statistic Department. Thematic Household Survey. Printing Department, 2002.
- 41Simpson PB. Family beliefs about diet and traditional Chinese medicine for Hong Kong women with breast cancer. Oncology Nursing Forum, 2003; 30: 834–840.
- 42Lam CL, Catarivas MG, Munro C, Lauder IJ. Self-medication among Hong Kong Chinese. Social Science and Medicine, 1994; 39: 1641–1647.
- 43Cheung Y, Chiu W, Lee P. Health: Perceptions and Practices. In: S Lau, M Lee, P Wan, S Wong (eds) Indicators of Social Development: Hong Kong 2004, 1st edn. Hong Kong: Hong Kong Institute of Asia Pacific Studies, Chinese University of Hong Kong, 2005: 57–97.
- 44Lam T. Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese. Journal of Epidemiology and Community Health, 2001; 55: 762.
- 45Lau J, Leung E, Tsui H. Predicting traditional Chinese medicine's use and the marginalization of medical care in Hong Kong. American Journal of Chinese Medicine, 2001; 29: 547.
- 46Wong T, Yu T, Liu J, Lee N, Lloyd O. Factors associated with the utilization of traditional Chinese medicine in a small town in Hong Kong. American Journal of Chinese Medicine, 1997; 25: 367.
- 47Chan HK. The utilization and reasons of choice for Chinese or Western medicine among rheumatoid arthritis patients in Hong Kong. Hong Kong Nursing Journal, 2002; 38: 7–16.
- 48Wong TW, Wong SL, Donnan SP. Prevalence and determinants of the use of traditional Chinese medicine in Hong Kong. Asia-Pacific Journal of Public Health, 1995; 8: 167–170.
- 49Wong VC. Use of complementary and alternative medicine (CAM) in autism spectrum disorder (ASD): comparison of Chinese and western culture (Part A). Journal of Autism and Developmental Disorders, 2009; 39: 454–463.
- 50Critchley L, Chen D, Lee A, Thomas G, Tomlinson B. A survey of Chinese herbal medicine intake amongst preoperative patients in Hong Kong. Anaesthesia and Intensive Care, 2005; 33: 506.
- 51Lee RP. Perceptions and uses of Chinese medicine among the Chinese in Hong Kong. Culture, Medicine and Psychiatry, 1980; 4: 345–375.
- 52Wade C, Chao M, Kronenberg F. Medical pluralism of Chinese women living in the United States. Journal of immigrant and minority health/Center for Minority Public Health, 2007; 9: 255.
- 53Bishop FL, Lim CY, Leydon GM, Lewith GT. Overseas Chinese students in the UK: patterns and correlates of their use of Western and traditional Chinese medicine. Complementary Therapies in Clinical Practice, 2009; 15: 8–13.
- 54Zhang J, Verhoef M. Illness management strategies among Chinese immigrants living with arthritis. Social Science and Medicine, 2002; 55: 1795.
- 55Green G, Bradby H, Chan A, Lee M. “We are not completely Westernised”: dual medical systems and pathways to health care among Chinese migrant women in England. Social Science and Medicine, 2006; 62: 1498–1509.
- 56Lai DW, Surood S. Chinese health beliefs of older Chinese in Canada. Journal of Aging and Health, 2009; 21: 38–62.
- 57Wong-Kim E, Merighi JR. Complementary and alternative medicine for pain management in U.S.- and foreign-born Chinese women with breast cancer. Journal of Health Care for the Poor and Underserved, 2007; 4 Suppl: 118–129.
- 58Ma GX. Between two worlds: the use of traditional and Western health services by Chinese immigrants. Journal of Community Health, 1999; 24: 421–437.
- 59Yang LH, Corsini-Munt S, Link BG, Phelan JC. Beliefs in traditional Chinese medicine efficacy among Chinese Americans: implications for mental health service utilization. Journal of Nervous and Mental Disease, 2009; 197: 207–210.
- 60Wu AP, Burke A, LeBaron S. Use of traditional medicine by immigrant Chinese patients. Family Medicine, 2007; 39: 195–200.
- 61Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. Journal of Health Services Research & Policy, 2005; 10: 45.
- 62Rolfe G. Validity, trustworthiness and rigour: quality and the idea of qualitative research. Journal of Advanced Nursing, 2006; 53: 304.
- 63Teal CR, Street RL. Critical elements of culturally competent communication in the medical encounter: a review and model. Social Science and Medicine, 2009; 68: 533–543.
- 64Clarke DB, Doel MA, Segrott J. No alternative? The regulation and professionalization of complementary and alternative medicine in the United Kingdom. Health Place, 2004; 10: 329–338.
- 65Welsh S, Kelner M, Wellman B, Boon H. Moving forward? Complementary and alternative practitioners seeking self-regulation. Sociology of Health & Illness, 2004; 26: 216.
- 66Parker M. Chinese dragon or toothless tiger? Regulating the professional competence of traditional Chinese medicine practitioners. Journal of Law and Medicine, 2003; 10: 285–295.
- 67Chung V, Hong LC, Mok P, Yeoh EK, Wong E, Griffiths S. Attitudes and behaviors towards the use of traditional Chinese medicine amongst western trained doctors in Hong Kong. Social Science and Medicine, 2011; 72: 247–255.
- 68Yip WC, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet, 2010; 375: 1120–1130.
Citing Literature
