|Year : 2016 | Volume
| Issue : 1 | Page : 34-38
Knowledge, perceptions, and attitudes toward complementary and alternative medicines among pharmacy students of a Malaysian Public University
Shazia Qasim Jamshed1, Muhammad Umair Khan2, Akram Ahmad2, Ramadan M Elkalmi1
1 Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University , Kuantan Campus, Pahang 25200, Malaysia
2 Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Cheras 56000, Kuala Lumpur, Malaysia
|Date of Submission||13-Apr-2015|
|Date of Decision||15-May-2015|
|Date of Acceptance||03-Jun-2015|
|Date of Web Publication||13-Jan-2016|
Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Cheras 56000, Kuala Lumpur
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background:The use of complementary and alternative medicine (CAM) is consistently on the rise worldwide. Consumers often consider pharmacists as a major source of information about CAM products and their safety. Due to the limitation of data, it is worth exploring the knowledge, perceptions, and attitudes of pharmacy students toward CAM. Objective: The objective of this study was to explore the knowledge, perceptions, and attitudes of pharmacy students regarding the use of CAM in Malaysia. Materials and Methods: A cross-sectional study was conducted for 3 months among Bachelor of Pharmacy students in a public sector University of Malaysia. A pretested, self-administered questionnaire, comprised four sections, was used to collect the data from 440 participants. Descriptive analysis was used, and Chi-square test was used to test the association between dependent and independent variables. Results: Of 440 questionnaire distributed, 287 were returned giving a response rate of (65.2%). The results showed that 38.6% participants gave correct answers when asked about the use of herbal products with digoxin. Majority of the participants were knowledgeable about supplementary therapy (25.3%) while the lack of knowledge was mostly evident in traditional Chinese medicines (73.7%). Majority of the students were either neutral (49.5%) or disagreed that (42.8%) CAM use is unsafe. Females were more in disagreement to the statements than males (P = 0.007). Majority of students also agreed to use CAM therapies for their health and well-being (51.2%). Conclusion: The study revealed that pharmacy students did not have adequate knowledge of CAM though their attitudes and perceptions were relatively positive.
Keywords: Complementary and alternative medicine, pharmacy, students, Malaysia
|How to cite this article:|
Jamshed SQ, Khan MU, Ahmad A, Elkalmi RM. Knowledge, perceptions, and attitudes toward complementary and alternative medicines among pharmacy students of a Malaysian Public University. J Pharm Bioall Sci 2016;8:34-8
|How to cite this URL:|
Jamshed SQ, Khan MU, Ahmad A, Elkalmi RM. Knowledge, perceptions, and attitudes toward complementary and alternative medicines among pharmacy students of a Malaysian Public University. J Pharm Bioall Sci [serial online] 2016 [cited 2019 Nov 17];8:34-8. Available from: http://www.jpbsonline.org/text.asp?2016/8/1/34/171686
World Health Organization has defined complementary and alternative medicine (CAM) as the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. Pandey et al., 2011, has done a systemic review on CAM use in the management of diabetes mellitus and showed that CAM very effective. Gari et al., 2015, showed in their study that most of the participants used but showed poor knowledge regarding source of preparation, CAM use related side effects, method of preparation, and administration of CAM medications among community in west Ethiopia. The use of CAM has become widespread in both developed and developing nations. In United Kingdom, at least 1 of 10 physicians is involved in practicing CAM therapies. In Canada, 89% of the pharmacies sell herbal medicines, and 31% of the Canadians have reported a use of the herbal preparation. Due to an upsurge in the use of CAM, it is important for the healthcare professionals to acquire essential knowledge about the CAM. In healthcare settings, the pharmacist offers a great insight into the use of CAM in terms of different types of CAM therapy. It is also reported consumers often consider pharmacists as a major source of information about CAM products and their safety.
In Malaysia, the CAM is usually referred to as traditional and complementary medicine (TCM). Ministry of Health (MOH), Malaysia, has defined it as a type of practice that is related to health in preventing, treating, managing, and/or preserving the human well-being. It is classified into six major groups; Traditional Malay Medicine, Traditional Chinese Medicine, Traditional Indian Medicine, Homeopathy, Complementary Medicine, and Islamic Medical Practice. Integration of CAM courses in pharmacy curricula of various universities has shown to increase students' knowledge and application in practice. The CAM courses are common in the curricula of US, Canada, Australia, and other European countries. In Malaysia, till date, 10 health care institutions are providing CAM services, following the National TCM Policy in 2001. Due to the multi-ethnicity and cultural diversity in Malaysia, the figure is expected to rise, and, therefore, the understanding of healthcare professionals about TCM is growing the area of interest.
Various studies have been conducted around the world assessing the understanding and perception of healthcare students regarding CAM. However, the majority of the studies were focused on medical students. Among the studies conducted on pharmacy students, the results were generally positive regarding students' knowledge and attitudes.,, In Malaysia, the numbers of such studies are limited. Few of the studies, which explored the understanding and perception of pharmacy students in Malaysia,, generalizability of their findings was the major issue, highlighting the need of further research in this area. In view of this, the current study was conducted with the objectives of exploring knowledge, attitudes, and perception of pharmacy students toward CAM in Malaysia.
| Materials and Methods|| |
A descriptive and cross-sectional study was conducted for the period of 3 months from October to December 2013 among Bachelor of Pharmacy (B. Pharm) students in International Islamic University of Malaysia. The B. Pharm program of this public sector university was approved by Malaysian Pharmacy Board. A sampling frame involved all undergraduate pharmacy students enrolled at the time of study. A total of 440 participants were contacted during the study period. All the students are briefed about the nature and the objectives of the research before requesting them to their voluntary participation in this study. Students were also informed via a questionnaire about the operational definition of CAM given by MOH.
A self-administered questionnaire was used a tool to collect the data from the participants. A primary draft was designed by the authors after an extensive literature review,,,,,,,,,,, after which it was sent to pharmacy academicians and subject experts for content validity. The expert opinion was given in view of making the questionnaire more simple, relevant, and important. Questionnaire was then face validated through a pilot sample and cronbach alpha was 0.76. After getting a feedback from the students, necessary changes were made to the questionnaire with the aim of making it more brief and simple. The amendments proposed by the participants were then made in view of other published literature. The pilot study participants are not included in the final analysis of the study.
The questionnaire was formatted as a paper based survey and was divided into four sections covering the demographic characteristics of the participants, their knowledge, perception, and attitude toward CAM use. The demographic details consisted of year of study, gender, and the use of CAM by the respondents and their closely related people. The second part of the questionnaire, composed of 13 items, evaluated the knowledge of the participants. The third part comprised 10 items, which assessed the perception of respondents about CAM use. The last part explored the attitudes of the participants by involving 10 questions. The evaluation of knowledge was done in two ways. Initially, the level of knowledge was determined which was then followed by determination of perceived knowledge. The knowledge of the participants was evaluated by using multiple choice questions. Perceptions and attitudes of the participants were assessed on 5 point Likert scale of the agreement, which were strongly agree-1, agree-2, neutral-3, disagree-4, and strongly disagree-5.
Descriptive analysis was used to illustrate demographic characteristics. Results were reported as percentages and frequencies. The Shapiro–Wilk test was carried out to observe the nature of data distribution. Chi-square test was used to assess the association between dependent (knowledge, attitudes, and perception) and independent variables (demographic information). A P < 0.05 was considered as statistically significant (P < 0.05).
| Results|| |
Of 440 questionnaires distributed among the pharmacy students of (International Islamic University Malaysia (IIUM), 287 were returned giving a response rate of (65.2%). However, the analysis was done on 285 questionnaires since two questionnaires were discarded because of incomplete information. From the 285 respondents, 79 (26.3%) were male and 206 (68.7%) were female. The number of participants from 1st, 2nd, 3rd, and 4th professional year were 88 (29.3%), 91 (30.3%), 57 (19%), and 49 (16.3%), respectively. 243 (81%) students reported to have used CAM. The demographic information of the participants is presented in [Table 1].
Knowledge of complementary and alternative medicine
The results showed that slightly more than one-third of the participants (n = 110; 38.6%) gave correct answers when asked about the use of herbal products with digoxin. When asked about the effect of Ginkgo biloba, 18.2% (n = 52) students correctly answered the question. Regarding the questions on Labisia pumila and Eurycoma longifolia the frequency of correct responses were 15 (5%) and 13 (4.8%), respectively [Table 2]. The students' perceived level of knowledge about CAM therapies is listed in [Figure 1]. Highest level of knowledge was observed in supplementary therapy (25.3%) followed by massage therapy (17%) and faith healing therapy (13%). On the contrary, lack of knowledge among participants was evident in traditional Chinese medicines (73.7%), followed by ECPI water (67.7%), and acupuncture therapy (62.4%).
|Figure 1: Perceived knowledge of participants about complementary and alternative medicine|
Click here to view
Perceptions toward complementary and alternative medicine
Respondents were questioned on 10 statements regarding their perception about CAM use. Majority of the students were either neutral (49.5%) or disagreed that (42.8%) CAM use is unsafe. Gender was significantly associated with this statement (P = 0.007) as more females disagreed to it than males. Majority of respondents (47.4%) disagreed that CAM is a threat to public health with age (P = 0.008), and gender (0.046) was significantly associated with this statement. Furthermore, a large proportion of the participants strongly agreed (69.8%) that clinical care should integrate the best of conventional and CAM use. More than half of the participants were neutral (56.1%) and more than one quarter (26.3%) agreed that the benefits of CAM are related to their placebo effect. Year 2 students were more in agreement to this year as compared to other professional years (P = 0.001). The perception of CAM toward CAM is presented in [Table 3].
Attitudes toward complementary and alternative medicine
The results showed that 41% of the respondents agreed with the usage of CAM therapies for minor ailments, and this was found to be statistically significant with the respect to age (P = 0.020). Majority of students also agreed to use CAM therapies for their health and well-being (51.2%), with age (P = 0.042) and gender (P = 0.002) appeared to be statistically significant. More than half of the students were neutral about the safety of CAM use (54.3%). This was found to be in association with age (P = 0.014), gender (P = 0.013), and year of study (P = 0.010). A large cohort of students was neutral about their use of CAM with and without conventional medicines for their minor ailments (42.4%). This finding was statistically significant with respect to age (P = 0.008) and year of study (P = 0.012). The complete information about the attitudes of students toward CAM is mentioned in [Table 4].
| Discussion|| |
The knowledge of the IIUM students is assessed based on conventional medicines available in Malaysia. The results suggest that the knowledge of the pharmacy students on CAM is inadequate as it is reflected from the low percentage of correct answers. The results are in line with another study conducted in the University of Sains Malaysia. The likely reason of such findings could be due to insufficient exposure of pharmacy students toward CAM during their professional years. It is therefore suggested that more attention should be given to introduce courses regarding CAM in curricula of pharmacy schools of Malaysia. Similar results also reported in previous studies from Kuwait  and Pakistan. Our suggestion has been supported by many studies in developed region where pharmacy students were reported to be more knowledgeable about CAM. For the perceived knowledge, the students were mostly knowledgeable in supplements therapy and least familiar with the herbal Chinese medicine. Likewise, study done in Riyadh cited herbal and nutrition therapy as well-known among their students  whereas in a Singaporean study, students were reported to be more well-versed in acupuncture and herbal medicines. The difference in the perceived knowledge can be due to the diverse students' background based on the cultures and their exposure to the different type of CAM in their life.
Perception of IIUM students regarding the threat of CAM to public health is in accordance to the study conducted on pharmacy students in Pakistan. Respondents from both the studies disagreed that CAM is a threat to public health, however, in current study gender does not play any role in having different perception about this statement compared to respondents from Pakistan. In Pakistan, more male respondents believe that CAM is a threat to public health compared to female respondents. This could be due to the reason that male students were not interested in using CAM as compared to their female counterpart. Besides, the present study revealed that pharmacy students were uncertain that the benefits of CAM are related to their placebo effects. This again could be due to lack of exposure to CAM courses in the pharmacy curriculum. Our interpretation is well supported by another study, which reported the positive perception of CAM following the introduction of CAM courses in their curriculum. Approximately, half of the participants in the current study were uncertain about the safety of CAM. Specifically, students younger than 20 years were highly unsure about the safety than the students with higher age. Exposure to CAM courses could be the factor that may have affected the response of the participants. Similarly, more than half of the 1st year students have a neutral response about the safety of CAM. However, majority of the students disagree with the statement that CAM is a threat to public health. Therefore, the usage of CAM is not perceived as dangerous among the different age group. In contrast, the researchers have reported that lack of scientific evidence is the major barrier of CAM use and may pose some serious threats to the public health. Their argument was based on their findings, which revealed that a high proportion of the students agreed to the statement of health concerns due to CAM use. There is a need to for evidence-based CAM information in Malaysian pharmacy curricula as suggested by other researchers.
The attitudes of the students in current study are consistent with the previously published study. Respondents of both the studies reported to have used CAM for minor ailments such as burn, small cuts, stomach-ache, and others. This shows that the students are aware of the use of CAM for minor health issues. Besides, students of the both studies agreed that CAM therapies are used for improving health and well-being of the people. These findings are encouraging, however, are not consistent with the knowledge of the students about CAM. This could be ascertained by interpreting the results where students were not aware of the side effects of CAM. In comparison, and Australian study reported that pharmacy students agreed on the safety of CAM therapies. We hypothesized that presence of CAM courses in Australian pharmacy curricula could be the reason of the variation in the findings of both studies. Efforts should be made to standardize the pharmacy curricula in Malaysia by incorporating relevant components of CAM to enable the future pharmacist to deal with the complexities of integrated CAM therapy in health care settings of Malaysia.
The strength of this study is that it has explored an area, which is of great interest to researchers in Malaysia and worldwide. The findings of this study would be a great contribution to pharmacy education and CAM literature, and it may become the basis to revise pharmacy curricula in view of the current findings, at least in the studied university. However, the results should be interpreted with cautions, because of some limitations. First, the low response rate and single center nature of the study may not represent the pharmacy students from other universities of Malaysia. Second, as a general limitation to a questionnaire based research, we cannot ignore the tendency of participants to provide more socially desirable results.
| Conclusion|| |
The findings suggest that the knowledge of pharmacy students about CAM was inadequate, while their perception and attitudes toward CAM were relatively positive. It is suggested to integrate CAM as a core subject in pharmacy curriculum to bridge the knowledge gap and provide necessary skills to the future pharmacists to fulfill the expectations of the patient regarding the use of CAM.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]