Developing a Patient Decision Aid for Complimentary Traditional Medicine Use by Hypertensive Patients at Red Cross Clinic, Harare

Abstract

Non-communicable diseases burden including hypertension has led to a further rise in the use of complementary traditional medicine globally and regionally. The aim of the paper was to explore the prevalence and determinants of CTM use by patients with hypertension attended to at the Red Cross Clinic in Harare and to design a patient decision aid so as to influence safe and effective use. An analytic cross sectional survey was conducted with a sample of 300 participants selected from adults with hypertension accessing care at Red Cross Clinic. Fifteen key informants were selected for review of the Patient Decision Aid developed. The Ottawa Decision Support Framework was used for decision aid development and the Andersen socio-behavioural model for assessing determinants of Complementary Traditional Medicine use. Of all participants, 63.1% of the respondents seen at Red Cross Clinic reportedly used complementary alternative traditional medicine for the control of hypertension at some point in time. Of those who used CTM, 98.3% utilised herbal products for BP control, whilst 17.4% use exercise, 14.6% use body, mind control methods and 1.1% use manipulation methods. The major sources of herbal products were the backyard garden (68.0%) and local market place (67.4%). Identified determinants of Complementary Traditional Medicine use were; cost relative to conventional medicine (odds ratio=23.9; p-value <0.001), perceived safety odds ratio=47.8, p-value<0.001) and presence of co-morbidities (odds ratio=0.5, pvalue= 0.007). All of the clients (100%) highlighted that the aid made decision making about hypertension management easier. All the practitioners were of the opinion that use PtDA was a cost effective way of helping patients make decisions. Forty percent of practitioners felt that use of the PtDA may cause/result in more harm than benefit. The majority of hypertensive patients seen at Red Cross Clinic utilised complementary traditional medicine with the CTM of choice being herbal medicines. Determinants of CTM use were health factors such as cost of CTM and perceived safety of CTM modalities. The PtDA designed was generally accepted by both patients and health practitioners, however respondents highlighted need for its further development and public education of CTM use. Regulation regarding the use off and sell of Complementary Traditional Medicine by regulatory authorities is recommended because it is crucial for safe utilisation by patients.