BMJ. Each participant was given €25 as an incentive. Consumer usage and reasons for using dietary supplements: report of a series of surveys. This lead people to access HM again when needed, and to maintain this specific treatment approach: In the past, I have always suffered from a cold. Am J Health-Syst Pharm. Results from the National Omnibus survey. The prevalence and predictors of herbal medicine use in surgical patients. Accessed April 4, 2016. Two groups with young, middle-aged and elderly participants, respectively. Zaffani S, Cuzzolin L, Benoni G. Herbal products: behaviors and beliefs among Italian women. Accessed April 4, 2016. This research was supported under grant number NIH/NCI K23CA141052, awarded to Dr Heather Greenlee. In light of our finding that dissatisfaction with conventional medicine was the most important reason for a preferred use of herbal medicine, government bodies, doctors, and pharmaceutical companies need to be aware of this problem and should aim to establish a certain level of awareness among users concerning this issue. 1999;319:693–6. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. The fact that this criterion predominantly attracted female participants is seen as an indication that the user of HM is primarily female, similar to previous results [19, 36, 37, 53, 54]. German. San Diego unified practice research in family medicine network. found that only one-third of the study participants used a majority of HM treatments in accordance with evidence-based indications [37]. To our knowledge, this is the first study to examine the likelihood of specific CAM modality use by multiple chronic conditions as defined by DHHS (4). Bethesda (MD): National Center for Complementary and Integrative Health; 2013. https://nccih.nih.gov/health/integrative-health. JAMA. National Center for Complementary and Integrative Health. There were specific differences by age group: Promoting health with HM was solely important for elderly participants, who mentioned this aspect four times, but it was not mentioned in the other groups. Complementary and alternative medicine use in chronic liver disease patients. As cautioned by Eardley et al. Secondary infection with a different DENV serotype is beleived to involve with severe dengue disease. Although herbal medicine is used mostly for treating mild to moderate illnesses and participants were aware of its limits, the combination of self-medication, non-expert consultation and missing risk awareness of herbal medicine is potentially harmful. The number of chronic conditions was calculated by using the list developed by the Multiple Chronic Conditions Working Group (4). Herbal medicines: prevalence and predictors of use among Malaysian adults. See https://www.maxqda.com/. Telephone: 212-342-4130. according to Table 1. Note that the potential side-effects and/or harm due to HM use were not mentioned. These studies are similar to the results of our analyses, where adults with multiple conditions reported a higher likelihood of CAM use. Accessed April 4, 2016. BMC Complementary and Alternative Medicine Available from: http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-7-25. that head and chest colds are the most common diseases for the use of HM. In using it, the aim is not to address a statistically-representative pool of opinions. People with multiple chronic conditions face health care burdens because of the complexity of coordinating disease management, including treatment by medical professionals and self-care (3). 2005;39:643–8. A narrative review of demographic characteristics and health factors associated with CAM use. The aforementioned influence of family traditions on the use of HM can also be examined from a different viewpoint, namely when considering the sources of information about HM summarised in Table 4. As shown in Table 3, head and chest colds, flu infection, sleeping disturbances and musculoskeletal issues are the most frequently mentioned illnesses treated with HM. Another important aspect that influences participants´ choice of treatment with HM was the specific disease per se. Then, we adapted the coding system further by analysing the transcripts of all the discussions, repeating this again until no more changes were noted. Utilization of complementary and alternative medicine by United States adults: results from the 1999 national health interview survey. Hypothesized confounders included region, body mass index (BMI), marital status, and the following in the past 12 months: feeling frequently stressed and/or anxious (yes/no), perceived health status (fair or poor vs excellent to good), and fatigue (yes/no). Gesundheitswesen. Complement Ther Med. A priori confounders included respondent-reported race/ethnicity, sex, age, employment status in the previous year (yes/no), imputed family income, and highest level of education. (FG No. Springer Nature. Bruno JJ, Ellis JJ. Canaway R, Manderson L. Quality of life, perceptions of health and illness, and complementary therapy use among people with type 2 diabetes and cardiovascular disease. All involved researchers were experienced in the moderation of group discussions. Food Funct. Notably, several participants also mentioned giving HM to their children. 2004;104:27–34. The … PubMed  “it has always been done this way” was the fourth most important reason for preferring HM as a treatment method: Well, I mean this actually started when we were still kids. (DOCX 13 kb). This study derives insights for the use of herbal medicine in Germany regarding the usage aims, role played by the type of illness, reasons for preferred usage and sources of information. As regards the reasons why HM is preferred as a treatment method, in our FGs the most commonly-mentioned ones were dissatisfaction with CM, positive experiences with HM in the past, and positive aspects and beliefs associated with HM. You will be subject to the destination website's privacy policy when you follow the link. Barnes PM, Bloom B, Nahin RL. Wiesbaden: VS Verlag für Sozialwissenschaften; 2010. Accessed April 4, 2016. many users who currently do not even have a specific condition still use HM. Accessed April 4, 2016. (FG No. I already use teas, (…) for example to treat a bladder infection. BMC Complement. The use of herbal medicines by people with cancer in the UK: a systematic review of the literature. The use of herbal medicines by people with cancer: a qualitative study. A SURF*NET study. The high use of dietary supplements among people with comorbid conditions is of major importance in disease management because of potential drug interactions. 2000;8:32–6. More than 50% of the US population uses dietary supplements including multivitamins or minerals and singular vitamin and mineral supplements, and this use has increased over the past 20 years (22). As discussed in the literature on CAM, the first reason can be categorised as a ‘push’ factor (negative aspects/beliefs regarding CM), and the latter two as so-called ‘pull’ factors (positive aspects/beliefs regarding HM) [56]. J Natl Med Assoc 2010;102(7):562–9. Herbal use among US elderly: 2002 National Health Interview Survey. Article  Complement Ther Nurs Midwifery. Clin Med Lond Engl. Use of complementary and alternative medicine in a large sample of anxiety patients. Ethics approval was not applicable for the type of human data presented in this study, as detailed in official documents by the German Research Foundation (DFG) and the German Society for Sociology (DGS) [71, 72]. However, as with CAM, the prevalence rates in EU countries vary significantly (6% - 48%), due to similar reasons, i.e. With respect to most common diseases for which participants discussed the use of HM, we can confirm literature results. Table 1 provides an overview of the focus groups, including their classification according to age including the age range of the participants, the number of participants and gender distribution per group. Complement Ther Med. However, it is very difficult to generalise use-related factors and reasons related to, e.g. It was conservatively assumed that any missing value for a single condition would be recoded as a “no” response. 1995;311:299–302. Teleconferences and electronic-based discussion among … 2007;62:S142–9. Article  Additionally, these studies report data from the 2002 and 2007 surveys, suggesting this study’s results support an ongoing trend of CAM use in association with chronic conditions. Krueger RA, Casey MA. All the authors contributed to the development of the ideas and the design of the study. These were the only differences found in the discussions of the studied age groups. DHHS has created 4 goals to improve factors related to multiple chronic conditions, including changes to the health care system; empowering people with multiple conditions by creating community wellness programs; providing clinicians with education, training, and clinical practice guidelines; and improving research practices to include a focus on comorbid conditions as opposed to specific diseases (29). Oncol Nurs Forum 2010;37(1):E7–15. In addition to this, a significant source of knowledge for users is provided by independent reading. Our study has an inclusive definition of multiple chronic conditions. Of the 20 chronic conditions listed by the working group, 13 conditions were ascertained in the NHIS 2012 interview (4,20). However, one study among patients with chronic liver disease showed an inverse association between additional comorbidities and current CAM use (19). J Am Diet Assoc. We also acknowledge Ludwig Aschenbrenner and Nikola Mucanov for helping with the organisational issues of the focus groups and for writing the transcripts. Many of these syntheses use a strictly exhaustive search strategy to collect articles, mirroring the standard template developed by major review organizations such as the Cochrane and Campbell Collaboration. Quite on the contrary, HM was discussed as being harmless and having many advantages in the FGs. To improve disease management, an open dialogue between CAM practitioners and medical professionals could help improve decisions on care for patients with multiple chronic conditions. 2004;11:327–34. This is particularly relevant for elderly users as, even though they appeared to be more aware of health-related issues, they generally use more medicine compared to younger ones. CrossRef external icon PubMed external icon George J, Ioannides-Demos LL, Santamaria NM, Kong DC, Stewart K. Use of complementary and alternative medicines by … & Menrad, K. Why people use herbal medicine: insights from a focus-group study in Germany. Bishop FL, Yardley L, Lewith GT. A stand-alone meeting was held for all panel members in December 2015. For the latter, with the exception of a threat of a serious disease, preventative medication was clearly not relevant: I try to eat healthily, but I do not take herbal medicine as a preventative care, for not becoming ill later. Google Scholar. note), whether one likes it or not. Garrow D, Egede LE. Herbal remedy use as health self-management among older adults. In addition, there may be people with chronic conditions who discontinue CAM within the past year because of factors related to their disease status, which would overestimate the number of regular CAM users. National patterns and correlates of complementary and alternative medicine use in adults with diabetes. http://www.cdc.gov/pcd/issues/2013/12_0203.htm. Mayo Clin Proc. Weinheim Basel: Beltz Juventa; 2016. 2000;320:114–6. London: SAGE Publications, Inc.; 2012. Each CAM therapy was analyzed in separate unadjusted and adjusted Poisson regression models with a robust error variance that estimated the relative risk of CAM use, comparing participants with 1 and 2 or more chronic conditions with participants with no chronic conditions (the reference group). 1987;14:411–48. Kowalski A, Enck P. [Statistical methods: multiple significance tests and the Bonferroni procedure.] b Adjusted for age, sex, race, income, employment status, and education. To name just one example, in 2007 Gardiner et al. The authors declare that they have no competing interests. Being familiar with a plant, either because of knowing the name, or even because of cultivating the plant in the own garden, was said to provide a basis of trust for the users of HM. A major strength of this study is the examination of CAM use as separate therapies. Harris P, Rees R. The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature. Complement Ther Clin Pract. One possibility is that chronic conditions influence people to use specific CAM therapies. benchmarked prevalence rates for the use of CAM-based therapy in the US [].They found that the use of CAM increased from 34% in 1990 … George J, Ioannides-Demos LL, Santamaria NM, Kong DC, Stewart K. Use of complementary and alternative medicines by patients with chronic obstructive pulmonary disease. Barnes PM, Powell-Griner E, McFann K, Nahin RL. (FG No. Many of these studies examined singular chronic conditions or a limited number of chronic conditions. Focus group interview: an underutilized research technique for improving theory and practice in health education. de Souza Silva JE, Santos Souza CA, da Silva TB, Gomes IA, Brito Gde C, de Souza Araújo AA, et al. Bethesda (MD): National Institutes of Health; 2014. https://ods.od.nih.gov/pubs/DS_WhatYouNeedToKnow.pdf. 2011;68:52–5. b P values for association between CAM therapies and number of chronic conditions. Since 2002 and every 5 years thereafter, the NHIS has included a survey supplement on CAM use. Lower participation in screening, later diagnosis of cancer, poor continuity of care, and poorer … Morgan DL. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. That is how it is, but it also convinced me of the synthetic route compared to plant medicine. SAGE: Thousand Oaks, California; 2015. g P value <.003 (a = .003 after Bonferroni adjustment for multiple comparisons). (FG No. Thus, different reasons vary in their degree of contributing to the initial and maintained use of HM. b Rao-Scott ?2 tests were used to assess associations between population characteristics and number of chronic conditions. The use of complementary and alternative medicine by primary care patients. Dietary supplements were used most commonly. Nahin RL, Byrd-Clark D, Stussman BJ, Kalyanaraman N. Disease severity is associated with the use of complementary medicine to treat or manage type-2 diabetes: data from the 2002 and 2007 National Health Interview Survey. ; Millennium Cohort Study Team. 2007 [cited 2017 Apr 20];7:25–37. The composite variable was categorized into 3 levels: none, 1, and 2 or more of the 13 selected chronic conditions. Beverly Hills, Calif: Sage Publications; 1985. BMJ. 2001;61:2163–75. TUM Campus Straubing for Biotechnology and Sustainability, Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315, Straubing, Germany, Alexandra N. Welz, Agnes Emberger-Klein & Klaus Menrad, You can also search for this author in Available from: http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-105. An investigation of the health beliefs and motivations of complementary medicine clients. To recruit the participants of the focus groups, articles in local and regional newspapers were published in July 2016. a Each n reported in the table is not weighted, but all averages and percentages are weighted. Understanding use of specific CAM modalities among people with multiple chronic conditions could increase knowledge about CAM therapies and disease management. PubMed  Confounders to be included in the final models were identified by using the minimally adjusted models, which included all a priori confounders. Jacobson IG, White MR, Smith TC, Smith B, Wells TS, Gackstetter GD, et al. 1996;22:129–52. Use of herbs among adults based on evidence-based indications: findings from the National Health Interview Survey. Correspondence to After cross-checking the transcripts against the records by the first author twice, and several readings of the transcripts and memos, the transcripts were analysed using the ‘MaxQDA’ [48] qualitative data analysis software. Tolerance and variance inflation factors are statistical values that describe the percentage by which 1 predictor is explained by the other predictors in the model. The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. 1999;56:125–38. Hypothesized confounders were added to minimally adjusted models for all of the separate CAM outcomes. supervised learning and unsupervised learning) that use, in general, only a few labeled samples. Each focus group discussion lasted approximately two hours and was moderated by two of the authors (ANW and KM) using a semi-structured guideline. 2001;9:2–11. 5). Fouladbakhsh JM, Stommel M. Gender, symptom experience, and use of complementary and alternative medicine practices among cancer survivors in the U.S. cancer population. Factors associated with herbal therapy use by adults in the United States. Expenditure on complementary medicine in England: a population-based survey. However, these definitions showed the same overall relationship as the all-inclusive CAM index (Table 3). Complement Ther Med 2007;15(1):21–9. Psychother Psychosom Med Psychol 2010;60(7):286–7. I only had these once a year instead. [cited 2017 Apr 11]. the unclear terminology and definition of HM used in different studies and country-specific variations [12, 16]. Stjernberg L, Berglund J, Halling A. JAMA 2014;312(12):1199–200. ANW wrote the manuscript, which was revised by AEK and KM. To maintain confirmability and reduce the influence of subjective bias, during the entire data collection and analysis period the researchers held frequent meetings, reflexive and critical discussions, and debriefings. 2002;8:42–7. Factors influencing the use of complementary and alternative medicine and whether patients inform their primary care physician. Too many side-effects of CM, a lack of treatment effect, as well as dissatisfaction with the conventional doctor were issues mentioned in this context: I have suffered from neurodermatitis for several decades . This ensured that every step during the data analysis procedure was well-documented. Google Scholar. 2009;17:300–8. Looking ahead, a consistent terminology and common set of CAM definitions, for example, what exactly constitutes HM as a form of treatment and whether, or to what extent, it is part of CAM, would be an important step towards more validity and comparability in this field [32]. PubMed Google Scholar. benchmarked prevalence rates for the use of CAM-based therapy in the US [1]. Google Scholar. Each focus group discussion began with an introduction round, in which the participants, the moderators, as well as the research assistant, introduced themselves. 1994;309:107–11. It did me good. Richmond JA, Bailey DE, Patel K, Jezsik JA, Muir A, Lin JR, et al. Focus groups. Why consumers maintain complementary and alternative medicine use: a qualitative study. Calixto JB. It clearly showed me – stop, there is a limit. CAM use was defined as self-reported use of one or more of 16 therapies in the previous 12 months. From this, I started to investigate further and now I just take everything (herbal – Eds. 1998;280:1569. The NHIS contains dichotomous (yes/no) information on use of 20 different CAM therapies: body-based therapies including chiropractic or osteopathic manipulation, massage, acupuncture, and movement therapy; mind–body therapies including yoga, tai chi, qi gong, energy healing therapy, hypnosis, and biofeedback; alternative therapies including Ayurvedic medicine, chelation therapy, craniosacral therapy, homeopathy, naturopathy, and traditional healing; dietary supplements including vitamins, minerals, multivitamin or multimineral, and other nonvitamin or herbal therapies; and special diets. [22,23,24,25,26]. When recruiting the FG participants, one important inclusion criterion was a general interest in and/or experiences with HM. In: Breakwell GM, Smith JA, Wright DB, editors. The selection of participants in line with these criteria provided focus groups of participants who were aligned, as regards a general interest in the use of HM, to our core questions. In an initial step, the coding system, with relevant reasons and attitudes concerning the use of HM, was developed by ANW, based on a literature review (deductive). Ann Intern Med. Available from: http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-8-16. Risk ratios were used in this analysis because many of the specific CAM therapies were reported as being used by more than 10% of the population. For decades now, I have not needed a dermatologist. http://www.cdc.gov/pcd/issues/2014/13_0389.htm. e P value <.001 (a = .003 after Bonferroni adjustment for multiple comparisons). Standard laboratory diagnosis to identify DENV serotypes in dengue patient specimens is performed by sophisticated genome … No collinearity between predictors was observed for the final adjusted models (data not shown). Arcury TA, Grzywacz JG, Bell RA, Neiberg RH, Lang W, Quandt SA. Med.. 2006 [cited 2017 Apr 13];6:40–47. 2014;33:176–82. Self-reported health symptoms and conditions among complementary and alternative medicine users in a large military cohort. Ni H, Simile C, Hardy AM. and evidence-based approach in reviewing the literature to develop these guidelines. Exploring attitudes toward, and knowledge of, homeopathy and CAM through focus groups. Dietary supplement use among US adults has increased since NHANES III (1988-1994). Forsch Komplementärmed Res Complement Med. Basch CE. Second, our study examines specific CAM therapies as opposed to other studies, which have focused on combined variables for any CAM therapy. By using this website, you agree to our Description of data: The questioning route used in the focus group discussions is shown. The target group of our focus groups was the general population, but specifically people with a general interest in and/or experiences with HM that were 18 years or older and German-speaking. 2010;18:389–95. f Values are RR (95% CI). In our study, we had a total of six focus groups with six to nine members each, and followed the recommendations given by Krüger & Casey [46]. Multiple chronic conditions among US adults: a 2012 update. The use of complementary and alternative medicine (CAM) has continuously increased over the past decades. This issue is problematic, especially for elderly users, who appeared to be more aware of health-related issues, but also use more prescribed and non-prescribed medicine compared to younger ones [67,68,69,70]. Google Scholar. Indeed, participants of the young, middle-aged and elderly FGs discussed different aims for the use of HM, which indicates that health awareness and maintenance become increasingly important with people’s growing age. The GENCODE consortium was initially formed to identify and map all protein-coding genes within the regions selected in the framework of the ENCODE project [29, 30], representing 1% of human genome sequence.