Complementary therapy use among people with type 2 diabetes or cardiovascular disease: an Australian cross-sectional study

The popularity of complementary and alternative medicines (CAMs) has been increasing in Australia and high levels of CAM use have been documented among people with chronic conditions. Yet little is known about how people with chronic disease manage their continuing need for medical care and make decisions about using CAM and/or conventional medicines. This thesis describes the use of CAM among people in Victoria, Australia, with two common chronic conditions, type 2 diabetes and cardiovascular disease. Using both qualitative (n=88) and quantitative (n=2,915) data from the CAMELOT study (Complementary and Alternative Medicine, Economics Lifestyle and Other Therapeutic approaches for chronic conditions), new knowledge is provided which contributes to the understanding of care-seeking and health management among people with these conditions. This thesis contains seven articles for publication (and Appendices) which use literature review, descriptive statistics, logistic regression, thematic analysis and discussion to analyse and explore aspects of the use of CAM and conventional healthcare products and services. Areas investigated include: (l) use of CAM products and/or practitioners - prevalence, extent (quantity), modalities used, reasons for and motivators of use, costs, outcomes of CAM practitioner use, factors that would increase the likelihood of visiting a CAM practitioner, disclosure of use to medical doctors and communication between CAM and medical practitioners; (2) use of conventional medical services - frequency of consultations, numbers of doctors visited and pharmaceuticals used, and costs; (3) demographic, health status, quality of life, and care-seeking differences between CAM users and non-users; (4) participants’ perspectives on CAM and conventional medical healthcare services and treatment; and (5) concepts of integration of CAM and conventional medicine. While this study has limitations, many of which are inherent in self-report data and in research of such a diverse and highly pluralistic field as CAM, it highlights the perceived significance and benefits of CAM use for consumers in chronic condition prevention and management, the affordability barrier of access to CAM, the perceived shortfalls of mainstream services, and the potential benefits of greater interaction and communication between CAM and conventional medical providers in Australia. The research brings focus to the multiple ways in which people incorporate CAMs in their lives, often using it to maintain a sense of control or empowerment when faced with living with a chronic condition. Many participants reported improved blood sugar or blood pressure readings and ability to cope, and CAM practitioner use was associated with benefits such as improved confidence in condition management and improved knowledge and understanding of condition(s}. The benefits of CAM use should be viewed at a higher level than solely research on clinical efficacy allows, and further investigation of how the CAM workforce might be incorporated into mainstream pathways for chronic disease prevention and management is warranted. The application of comparable standards and subsidies across conventional and complementary healthcare would help to remove significant barriers currently limiting access to CAM and could encourage a more consumer-centred health system.