Ingrid Bauer 1 ; Juan Jose Guerra, MD 2 Introduction Among the many social determinants of health, cultural differences between Latino patients and health care providers have been cited as a barrier to care. Latino health beliefs and practices do not always fit within the framework of Western biomedicine, and many Latinos use some form of traditional, complementary or alternative medicine (TCAM). Although national and regional studies have assessed TCAM use among various Latino populations, none has simultaneously explored both TCAM use among patients and physician’s knowledge and communication skills regarding TCAM. Understanding physicians’ and patients’ beliefs and behaviors will help to tailor educational materials about TCAM for both physicians and patients with the goal of improving the quality of care and reducing health disparities among Latinos. Methods This mixed-methods study was conducted at Salud en Español, a bilingual module at Kaiser Permanente Oakland Medical Center from May to August 2011; it included telephone surveys with Latina patients and questionnaires with Latino physicians. Procedure Patients (n=65) completed a 15-minute telephone survey with closed- and open- ended questions about: •Whom they first consulted when sick or injured •Types of TCAM used (herbs, folk healers, alternative professionals, self-care therapies, prayer) •Knowledge and attitudes about folk illnesses •Communication with providers about TCAM Physicians (n=10) completed a 20-minute structured questionnaire with scaled and open-ended questions about: Conclusions • Patients had higher-than-expected rates of use of all TCAM modalities compared to national and regional studies. • There was no statistically significant correlation between age, nativity, time in the US, language, education, or health status and TCAM use. • Most of the herbal remedies used by Latinas in this study have a long history of safe use for minor health complaints. • Physicians varied in their knowledge of their Latino patients’ health beliefs and TCAM use; their frequency of asking about TCAM also varied. • Physicians believed that non-judgmental, direct questioning was the best way to elicit information about their Latino patients’ health beliefs and practices. • Reasons why some patients did not report TCAM use included: they didn’t know they should, because their doctor never asked, or because they were afraid their doctor would not approve. Limitations • The small sample size of the patient survey limited the power of statistical analysis, and makes the results not generalizable. Furthermore, questions about TCAM use did not specify time frame, so that data cannot be compared to other studies that reported use within the past 12 months. • Data from the provider questionnaire is self-reported, making it difficult to determine what physicians actually do in clinical practice. Implications • Increasing physician knowledge about the safety and efficacy of common Latino TCAM practices may increase the frequency with which they ask patients about TCAM, help them make better clinical decisions, and improve patient reporting and overall satisfaction with care. • Patient education about the safety and efficacy of common TCAM practices may Patient Survey Demographics: Results: Percent of patients consulting with folk healer, alternative practitioner, self-care, or spiritual practices (ever): 95.4% Percent of patients using herbal remedies (ever): 76.9 % Patient-reported frequency of patient reporting and physician asking about TCAM use Provider Questionnaire Demographics: Results: All physicians had at least some knowledge of their Latino patients’ use of herbal remedies, folk healers, and alternative therapies. Self-reported physician knowledge of Latino TCAM use Self-reported physician frequency of asking about TCAM Physicians’ attitudes and concerns about Latino TCAM use • All physicians described their attitude toward their patients’ use of TCAM as non-judgmental and open-minded. • Physicians believed that less-acculturated immigrants are more likely to use TCAM. They associated less TCAM use with higher education, income, and health insurance coverage. • Some physicians endorsed the use of evidence- based CAM practices such as acupuncture and herbs (ginger, honey & mint) • Physicians were less concerned about the safety of herbal remedies than about the misuse of unprescribed antibiotics and corticosteroids among Latino patients. Traditional, complementary and alternative medicine among Latinas: Patients’ patterns of use and physicians’ knowledge and communication skills Gender 3 men, 7 women Type of practice Internal medicine (6), family (3), pediatrics (1) Ethnic identity All Hispanic or Latino National origin US-born (8); Latin America or Carribean (2) Primary language English > Spanish (9); English = Spanish (1) TCAM therapy No knowledg e Some knowledge Extensive knowledge Herbal remedies 9 1 Folk healers 8 2 Alternative therapies 8 2 Prayer/ spirituality 1 6 3 TCAM therapy Rarely Sometimes Always Herbal remedies 5 3 2 Folk healers 4 3 3 Alternative therapies 3 4 3 Prayer/ spirituality 7 2 1 Characteristic Percent of patients (n=65) Nativity United States 15% Latin America 85% Time in US (foreign-born) 0-9 years 16% 10-29 years 66% Over 30 years 18% Primary language Spanish 80 % English 8 % Both 12% Education ≤9 th grade 51% Up to 12 th grade 32% ≥ some college 17% Mean age 43 years (±14) Sobador (bodyworker) Partera (Lay midwife Herbalist Curandero (Folk healer) 37% 11% 9% 6% Chiropractor Massage therapist Acupuncturist Homeopath 37% 25% 17% 12% Prayer Breathing exercises Meditati on Yoga Limpia/ spirit cleansing 51% 40% 11% 9% 9% Most common herbs Percent use Indications Chamomile 42% Stomach ache, colic Mint 35% Stomach ache Lemon 14% Sore throat, URI Honey 11% Sore throat, URI Aloe vera 9% Constipation, burns Cinnamon 9% URI, digestive problems Arnica 7% Post-partum recovery Ginger 6% URI stomach ache Horsetail 6% Kidney pain, UTI Patient reporting Never 61.5% Sometimes 16.9% Always 21.5% Physician asking Never 63.1 % Sometimes 16.9% Always 15.4% We would like to thank Kaiser Permanente East Bay, the UCB/UCSF Joint Medical Program, Karen Sokal-Gutierrez MD, Susan Ivey MD/MHSA, Tom Carlson MD/MS, Sylvia Guendelman PhD/MSW, and Maureen Lahiff PhD.
Ingrid Bauer 1 ; Juan Jose Guerra, MD 2 Introduction Among the many social determinants of health, cultural differences between Latino patients and health.
Jan 04, 2016
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Ingrid Bauer1; Juan Jose Guerra, MD2
IntroductionAmong the many social determinants of health, cultural differences between Latino patients and health care providers have been cited as a barrier to care. Latino health beliefs and practices do not always fit within the framework of Western biomedicine, and many Latinos use some form of traditional, complementary or alternative medicine (TCAM).
Although national and regional studies have assessed TCAM use among various Latino populations, none has simultaneously explored both TCAM use among patients and physician’s knowledge and communication skills regarding TCAM.
Understanding physicians’ and patients’ beliefs and behaviors will help to tailor educational materials about TCAM for both physicians and patients with the goal of improving the quality of care and reducing health disparities among Latinos.
Methods This mixed-methods study was conducted at Salud en Español, a bilingual module at Kaiser Permanente Oakland Medical Center from May to August 2011; it included telephone surveys with Latina patients and questionnaires with Latino physicians.
Procedure
Patients (n=65) completed a 15-minute telephone survey with closed- and open-ended questions about:
•Whom they first consulted when sick or injured
•Types of TCAM used (herbs, folk healers, alternative professionals, self-care therapies, prayer)
•Knowledge and attitudes about folk illnesses
•Communication with providers about TCAM
Physicians (n=10) completed a 20-minute structured questionnaire with scaled and open-ended questions about:
•Self-reported knowledge and understanding of their Latino patients’ health beliefs and practices
•Self-reported communication skills about TCAM
Quantitative answers were used to generate descriptive statistics. Data from the patient survey were analyzed by chi-squared and Fisher exact tests using STATA. Open-ended questions were analyzed using qualitative methods.
Conclusions• Patients had higher-than-expected rates of use of all TCAM modalities compared to national and regional studies.
• There was no statistically significant correlation between age, nativity, time in the US, language, education, or health status and TCAM use.
• Most of the herbal remedies used by Latinas in this study have a long history of safe use for minor health complaints.
• Physicians varied in their knowledge of their Latino patients’ health beliefs and TCAM use; their frequency of asking about TCAM also varied.
• Physicians believed that non-judgmental, direct questioning was the best way to elicit information about their Latino patients’ health beliefs and practices.
• Reasons why some patients did not report TCAM use included: they didn’t know they should, because their doctor never asked, or because they were afraid their doctor would not approve.
Limitations• The small sample size of the patient survey limited the power of statistical analysis, and makes the results not generalizable. Furthermore, questions about TCAM use did not specify time frame, so that data cannot be compared to other studies that reported use within the past 12 months.
• Data from the provider questionnaire is self-reported, making it difficult to determine what physicians actually do in clinical practice.
Implications• Increasing physician knowledge about the safety and efficacy of common Latino TCAM practices may increase the frequency with which they ask patients about TCAM, help them make better clinical decisions, and improve patient reporting and overall satisfaction with care.
• Patient education about the safety and efficacy of common TCAM practices may increase the frequency with which they report use.
Acknowledgments
Patient Survey
Demographics:
Results:Percent of patients consulting with folk healer, alternative practitioner, self-care, or spiritual practices (ever): 95.4%
Percent of patients using herbal remedies (ever): 76.9 %
Patient-reported frequency of patient reporting and physician asking about TCAM use
Provider Questionnaire
Demographics:
Results: All physicians had at least some knowledge of their Latino patients’ use of herbal remedies, folk healers, and alternative therapies.
Self-reported physician knowledge of Latino TCAM use
Self-reported physician frequency of asking about TCAM
Physicians’ attitudes and concerns about Latino TCAM use
• All physicians described their attitude toward their patients’ use of TCAM as non-judgmental and open-minded.
• Physicians believed that less-acculturated immigrants are more likely to use TCAM. They associated less TCAM use with higher education, income, and health insurance coverage.
• Some physicians endorsed the use of evidence-based CAM practices such as acupuncture and herbs (ginger, honey & mint)
• Physicians were less concerned about the safety of herbal remedies than about the misuse of unprescribed antibiotics and corticosteroids among Latino patients.
• All physicians believed that unbiased, direct questioning during medical encounters results in open, honest responses from patients.
Traditional, complementary and alternative medicine among Latinas: Patients’ patterns of use and physicians’ knowledge and communication skills
Gender 3 men, 7 women
Type of practice Internal medicine (6), family (3), pediatrics (1)
Ethnic identity All Hispanic or Latino
National origin US-born (8); Latin America or Carribean (2)
Primary language English > Spanish (9); English = Spanish (1)
TCAM therapy No knowledge
Some knowledge
Extensive knowledge
Herbal remedies 9 1
Folk healers 8 2
Alternative therapies
8 2
Prayer/spirituality
1 6 3
TCAM therapy Rarely Sometimes Always
Herbal remedies 5 3 2
Folk healers 4 3 3
Alternative therapies
3 4 3
Prayer/spirituality
7 2 1
Characteristic Percent of patients (n=65)
Nativity United States 15%
Latin America 85%
Time in US (foreign-born)
0-9 years 16%
10-29 years66%
Over 30 years18%
Primary language Spanish 80 %
English 8 %
Both 12%
Education ≤9th grade 51%
Up to 12th grade 32%
≥ some college 17%
Mean age 43 years (±14)
Sobador(bodyworker)
Partera(Lay midwife
Herbalist Curandero(Folk healer)
37% 11% 9% 6%Chiropractor Massage
therapist Acupuncturist Homeopath
37% 25% 17% 12%
Prayer Breathing exercises
Meditation
Yoga Limpia/ spirit cleansing
51% 40% 11% 9% 9%
Most common herbs Percent use Indications
Chamomile 42% Stomach ache, colic
Mint 35% Stomach ache
Lemon 14% Sore throat, URI
Honey 11% Sore throat, URI
Aloe vera 9% Constipation, burns
Cinnamon 9% URI, digestive problems
Arnica 7% Post-partum recovery
Ginger 6% URI stomach ache
Horsetail 6% Kidney pain, UTI
Patient reporting
Never 61.5%
Sometimes 16.9%
Always 21.5%
Physician asking
Never 63.1 %
Sometimes 16.9%
Always 15.4%
We would like to thank Kaiser Permanente East Bay, the UCB/UCSF Joint Medical Program, Karen Sokal-Gutierrez MD, Susan Ivey MD/MHSA, Tom Carlson MD/MS, Sylvia Guendelman PhD/MSW, and Maureen Lahiff PhD.
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