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WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Abdalla et al.

World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 6.041

Volume 5, Issue 8, 223-230

Research Article

ISSN 2278 – 4357

MEDICAL BARRIERS, DIFFERENT MODALITIES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) TO BE USED BY MEDICAL STUDENTS’, 2015 Sawsan M. Abdalla1*, Mohamed A. Al mansour2, Elsadig Y. Mohamed1, Syed A. Meraj1, Khalid A. Medani1 and Waqas S. Mohamed3 1

Department of Community Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia. 2

Department of Family Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia.

3

Department of Biostatistics and Public Health, College of Medicine, Majmaah University, Kingdom of Saudi Arabia.

Article Received on 08 June 2016,

ABSTRACT Purpose• To identify modalities and to determine barriers toward

Revised on 28 June 2016, Accepted on 18 July 2016

complementary and alternative medicine (CAM) use among medical

DOI: 10.20959/wjpps20168-7441

students at Majmaah University college of Medicine, Saudi Arabia. Method• the study was descriptive design. The population was the first

*Corresponding Author

and the second batches of medical students in the College of Medicine,

Dr. Sawsan M. Abdalla

Majmaah University, in Saudi Arabia. The sample size included total

Department of

enumeration of the first and second batches of medical students who

Community Medicine,

studded the CAM module. The data was collected by pre-tested

College of Medicine,

questionnaire and analyzed by SPSS for Windows software. Results•

Majmaah University, Kingdom of Saudi Arabia.

Nearly all (91%) students agreed that “CAM includes ideas and methods from which medicine could benefit”; more than 85% agreed

that “knowledge about CAM is important to me as a student/future practicing health professional”; Among all students, the most frequently indicated level of desired training was “sufficient to advise patients about use,” for 11 of the 15 modalities. Conclusions• Interest in and enthusiasm about CAM modalities was high in this sample; personal experience was much less prevalent. Students were in favor of CAM training in the curriculum to the extent that they could provide advice to patients; the largest proportions of the sample planned to

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endorse, refer patients for, or provide 8 of the 15 modalities surveyed in their future practice. (Altern Ther Health Med. 2007; 13(1): 30-35.) ABSTRACT Background Complementary and alternative medicine (CAM) is a growing industry in the health care system, and the use of CAM is rapidly evolving. In Saudi Arabia, Little research has addressed the barriers for use of medical students of CAM. The objectives of the current study were to determine the barrier for medical student’s to use CAM. Methodology: The study was descriptive design. The population was the first and the second batches of medical students in the College of Medicine, Majmaah University, in Saudi Arabia. The sample size included total enumeration of the first and second batches of medical students who studded the CAM module. The data was collected by pre-tested questionnaire and analyzed by SPSS for Windows software. Results: The most important CAM modalities used were prayers 46 (66.7%), herbal products 42 (60.9%), and massage 32 (46.4%). In response to the perception of the students towards studying CAM, 43 (62%) will utilize CAM knowledge in the future. 22% to 51.9% were neutral in their perceptions of barriers to the use of CAM, compared to less than 10% who were neutral about whether lack of evidence was a barrier. Conclusion: The study concluded that, The most commonly used CAM modalities by the students were prayers, herbal products, massage, nutritional supplements and acupuncture. The perception of the respondents towards CAM is moderate. The 3 most widely perceived barriers were lack of evidence (87.6% agreed), lack of staff training (74.3% agreed) and lack of credentialed providers (71.8% agreed). INTRODUCTION Complementary and alternative medicine (CAM) is a group of diverse medical and health care interventions, practices, products or disciplines that are not generally considered part of conventional medicine[1]. Complementary and alternative medicine (CAM) is a growing industry in the health care system, and the use of CAM is rapidly evolving. In Saudi Arabia, Little research has addressed the barriers for use of medical students of CAM. The objectives of the current study were to determine the barrier for medical student’s to use CAM. There continues to be growing interest in the use of complementary and alternative medicine (CAM) therapies for a wide array of common health concerns. A number of studies (e.g.1, 2, 3, 4, 5 and 6) have documented a significant and increasing trend towards CAM use in the U.S. adult population. For example, Kessler et al. (2001) found that nearly 68% of www.wjpps.com

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respondents to their telephone survey had used at least one CAM therapy in their lifetime. Further, there has been a concomitant increase in healthcare expenditures for CAM therapies with out of pocket expenditures estimated at approximately 27 million dollars for 1997.[3,5] Scientific literature indicates an increased interest in complementary and alternative medicine (CAM) among the general public and a tendency towards increased use, especially in patients with chronic diseases[2]. Complementary and alternative medicine (CAM) is a growing industry in the health care system and the use of CAM in health care is rapidly evolving. The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine[3]. A national survey in the United States in 1993 stated that 1 in 3 adults use some sort of CAM[4]. More recently, the Centers for Disease Control and Prevention’s National Center for Health Statistics reported that 62% of 31,044 adults surveyed used some form of CAM in the previous 12 months[5]. Attitudes of students towards CAM were generally positive and many stated that CAM includes ideas and methods from which Western medicine could benefit. The lack of evidence supporting CAM practices was considered to be the major barrier toward more students using CAM and advising their patients to use in the future[6, 7, 8]. Despite the popularity of CAM among the general public, mainstream medicine has been slow to embrace many of its concepts and techniques. The credibility of CAM relative to mainstream Western medicine has been hampered by several factors. First, there is a vast and heterogeneous array of practices being lumped under the rubric of CAM. These practices can range widely from various forms of “folk medicine” to sophisticated computerized biofeedback systems. Second, some of these practices have supporting data and show promise as viable treatment options (both as primary and adjuvant therapies), while others may show little or no promise and may even be harmful under certain clinical circumstances. In support of CAM therapies, there is growing support for the role of various forms of relaxation training and biofeedback in clinical practice to control anxiety, pain and other manifestations of sympathetic drive like hypertension (e.g.7, 8, 9 and 10). In other circumstances CAM use may interfere or complicate care (e.g.11, 12 and 13). Because of (or perhaps in spite of) these factors, there has been increased attention to CAM efficacy, prompting the National Institutes of Health to establish the National Center for

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complementary and alternative medicine in 1998 in an attempt to bring greater methodological rigor and financial resources to CAM research endeavors. In the Kingdom of Saudi Arabia KSA, Little research has addressed the satisfaction, use and perception of medical students towards complementary and alternative medicine. In the kingdom, there is no CAM specialized track or postgraduate education in any health college. Eleven (12.2%) colleges are teaching CAM courses in their curricula. Fifteen (16.7%) colleges are teaching topics related to CAM in different study subjects. Five (5.6%) colleges conducted continuing medical education (CME) activities related to CAM. Among faculty members, there are only 16 CAM specialists working in 7 colleges and 84 interested staff members, working in 20 colleges.[9] In a study conducted in KSA among pharmacists, 72.6% were satisfied with CAM and 79.4% indicated they would recommend CAM to family and friends. Eighty-one percent (81%) of pharmacists felt they had inadequate skills and knowledge to counsel patients and 90.5% felt the professional curricula should have more components on CAM [10]. OBJECTIVES General To determine Barriers behind Medical students’ not using Complementary and Alternative Medicine (CAM), Majmaah University, 2014. Specific 

To determine the barriers that make medical students not using CAM



To determine the medical student use of different CAM modalities.

METHODOLOGY The study was descriptive institutional-based design. The population was the first and the second batches of medical students in the College of Medicine, Majmaah University, in the Kingdom of Saudi Arabia. Majmaah, which is located in the center of the kingdom, is one of Riyadh region’s provinces, lies 180 Km from the capital Riyadh [11]. The college of Medicine is established in 2010 and adopting an innovative outcome-based curriculum in medical education

[12]

. The collage introduced CAM as a core module in the curriculum for semester

seven students. The course is introductory planned to provide overview of CAM practices

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used to be conducted with cooperation of the National Center for Complementary and Alternative Medicine (NCCAM). The sample size included total enumeration of the first and second batches of medical students who studded the module on CAM. The data was collected using a pre-tested questionnaire after obtaining written informed consents. The questionnaire composed of questions regarding perception, use and satisfaction of the students with studying CAM; it also included their suggestions to improve the module. The SPSS for Windows software, version 20 (SPSS, Chicago, Illinois, USA) was employed to analyze the data. RESULTS Regarding use of CAM modalities by medical students, results showed that the most important modalities used were prayers 46 (66.7%), herbal products 42 (60.9%), massage 32 (46.4%), nutritional supplements 29 (42.0%), acupuncture 24 (34.8%) and aromatherapy 17 (24.6%) as shown in table 1. Table (1) Use of different modalities of Complementary and Alternative Medicine by medical students (n=69) CAM modality Prayer/spiritual healing Herbal medicine Massage Nutritional supplements Acupuncture Aromatherapy Cauterization Naturopathy Music Chiropractic Meditation Bio electromagnetic therapies, e.g., magnets Hypnosis/guided imagery Cupping (Hijama) Osteopathy Homeopathy Rolfing (structural reintegration)

Use 46 42 32 29 24 17 16 16 14 13 12 11 11 11 10 10 7

Percent 66.7 60.9 46.4 42.0 34.8 24.6 23.2 23.2 20.3 18.8 17.4 15.9 15.9 15.9 14.5 14.5 10.1

Barriers to use of CAM practices by medical Students,2014 N=81

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Barriers to use of CAM practices Lack of evidence for practices Institutional concerns about legal issues

Agree 28 30

% 34,6 37.0

Neutral 22 28

% 27.1 34.6

Unavailability of credentialed providers

24

29.6

42

51.9

Lack of staff training

26

32.0

29

35.8

Lack of reimbursement

24

29.6

38

46.9

Lack of appropriate equipment

31

38.3

25

30.9

Too time consuming

20

24.7

18

22.2

Students’ thoughts about barriers to acceptance of CAM modalities are presented in Table 2. Overall, students tended not to have fixed opinions about 6 of these 7 barriers; on average, 22% to 51.9% were neutral in their perceptions of barriers to the use of CAM, compared to less than 10% who were neutral about whether lack of evidence was a barrier. This was agreed with the study as part of ongoing efforts to integrate CAM into the curriculum at GUSOM, a paper-and-pencil survey was administered. The survey instrument was adapted from one developed by the University of Minnesota where 19% to 40% were neutral in their perceptions of barriers to the use of CAM .The 3 most widely perceived barriers were lack of evidence (87.6% agreed), lack of staff training (74.3% agreed) and lack of credentialed providers (71.8% agreed). Minorities or bare majorities also agreed that legal issues (52.5%), lack of appropri ate equipment (42%), and CAM being too time-consuming (36.7%) were barriers to the acceptance of CAM in Western medical settings.Students are familiar with the western medicine so may are not accepting to study CAM which they think is related to traditional medical practices. Lack of evidence supporting CAM practices was considered to be the major barrier towards studying and using CAM [13]. The results showed that the most common CAM modalities used by the medical students were: Prayers, herbal products, massage nutritional supplements and acupuncture. These findings contradict the results of a study conducted in University of Texas where the most common therapies used were massage, deep breathing exercises, yoga, chiropractic and meditation

[16]

. These findings are in line with the findings of a survey conducted to explore

use, knowledge and attitudes toward complementary and alternative medicine (CAM) among pharmacy students at the college of pharmacy, King Saud University. In this survey herbal medicine, nutrition, massage, relaxation exercises, yoga and mega-dose vitamin were the most CAM used by the students

[17]

. This may be explained by the fact that all students are

Muslims and prayers are justified to be the first modality used by the students.

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