Satisfaction and Preference for Traditional Chinese Medicine Drugs Among Guardians of Children with Acute Bronchiolitis

Introduction

Traditional Chinese medicine (TCM), as an important part of complementary and alternative medicine (CAM), has long been practiced in China and many Asian countries. It is becoming increasingly popular and widespread in western countries as well. ^1,2 In a World Health Organization survey, 30%–70% of the general population in developed countries have used CAM at least once, but as much as 60%–90% of the general population in undeveloped countries use traditional medicine. ^3,4 Likewise, in China, more than 90% of people reported TCM use in their lifetime, and even more than three fourths of western medicine (WM)–trained doctors choose TCM, mainly herbal medicine, to treat their patients. ^5,6

Currently, TCM makes up therapies provided in the Chinese health care system in parallel with WM. About 60% of health care is provided by WM and 40% by TCM practitioners. Moreover, even though non-TCM hospitals are based on WM, most tertiary non-TCM hospitals are equipped with TCM pharmacies and TCM outpatient departments. ¹ TCM drugs are the most common and important type of TCM and have been used for various pediatric diseases, especially respiratory and viral infections. ^{7 –10} However, the proportion of TCM drug use is lower in children age 0–2 years than in older groups. ⁹ While this may be due to fear of adverse effects or toxicity of TCM drugs in young children, there is little information in the literature on guardians' satisfaction and preference for TCM drugs. ¹¹

Acute bronchiolitis is the most common lower respiratory tract infection in children younger than age 2 years. ¹² The one study that investigated CAM use in hospitalized children with acute illness, including acute bronchiolitis did not assess the parents' satisfaction or preference. ¹³ The objectives of the current study were to evaluate guardians' satisfaction, concerns, and preference for TCM drugs as treatment for their children with acute bronchiolitis; to assess the agreement between their satisfaction and preference for TCM drugs; and to explore the factors associated with guardians' satisfaction.

Materials and Methods

Results

A total of 286 children with acute bronchiolitis and their guardians were recruited, and 208 guardians (72.7%) were interviewed in the two non-TCM hospitals. Children's ages ranged from 27 days to 34.4 months, and 279 (97.6%) children were younger than 24 months. As shown in Table 1, guardians' characteristics were fairly balanced between non-TCM and TCM hospitals. However, the TCM hospital had children who were younger and had higher proportions of preterm birth and low birth weight.

Guardians' satisfaction with and concerns about TCM drugs are presented in Table 2. Satisfaction was generally high, with about three fourths of guardians reporting they were satisfied with TCM drugs. Most guardians were more concerned about the efficacy and safety of TCM drugs and less concerned about the cost. Satisfaction with TCM drugs did not significantly differ between guardians attending TCM and non-TCM hospitals. Guardians preferred TCM drugs no matter which type of hospital they brought their child to (Table 3). More than half of respondents preferring TCM drugs indicated they believed TCM drugs had less toxicity or fewer adverse effects. The most common reason for preferring WM drugs was better taste.

The agreement between guardians' satisfaction and preference for TCM drugs is shown in Table 4. In non-TCM hospitals, the agreement was fair, even after adjustment for prevalence. In general, the level of agreement between guardians' satisfaction and preference, with adjustment for prevalence, was moderate. Seven factors, including maternal education level, paternal education level, annual PCDI, concerns about efficacy, concerns about safety, concerns about price, and preference for TCM drugs had p-value less than 0.2; only preference was a significant factor in the multiple logistic regression (adjusted OR, 2.77; 95% CI, 1.47–5.20).

Discussion

In this study, guardians who sought treatment for children at a TCM hospital had children who were younger and had a history of preterm birth or low birth weight. Guardians were concerned most about the safety of TCM drugs and least concerned with cost. Guardians with higher annual PCDI were more satisfied with TCM drugs. Over half of the guardians thought TCM drugs had fewer adverse effects and less toxicity than WM drugs. Three fourths of the guardians were satisfied with and preferred TCM drugs for their sick children. However, the agreement between satisfaction and preference was not very high.

Guardians' satisfaction with TCM drugs or herbal medicine is not well researched, even though it was the main therapy children received in previous studies throughout the world. ^{9,15 –17} In an Italian study, the levels of mothers' satisfaction with CAM use for respiratory symptoms in young children was similar to the levels found in the current study. ¹⁸ However, herbal medicine was not the most frequently used CAM. Another study conducted in a general pediatric clinic showed that CAM users had less satisfaction with their children's primary care than nonusers. ¹⁶ This point was not supported by a Chinese study that found no difference in satisfaction with general practitioners between CAM users and nonusers.

Many studies have explored the reasons for TCM drug use in children. ^7,9,16 As in those studies, most participants in the current study believed that TCM drugs were safer than WM drugs. ^9,16,19 However, compared with adults, children are more vulnerable to adverse effects or toxicity of TCM drugs by virtue of their smaller size and different capacity for detoxification. ¹¹ The children recruited for this study had acute bronchiolitis, a condition most common in children under 2 years, especially younger than 6 months. Thus, in this study half of the children were younger than 6 months old, and guardians were most concerned about safety. This may explain the moderate agreement between guardians' satisfaction and preference for TCM drugs in this study. There was no significant difference in guardians' satisfaction or preference between TCM and non-TCM hospitals. This is probably due to cultural similarities in beliefs about TCM and WM. ²⁰

This appears to be the first study to explore the satisfaction with, concerns about, and preference for TCM drugs among guardians with young children in a country dominated by both WM and TCM practices. It also provides an idea of guardians' perceptions of TCM drugs that determine their preference for TCM drugs for children.

The study had a few limitations. First, it did not document the association between parent ages and parent satisfaction with or preference for TCM drugs. However, instead of parent ages, maternal education was associated with CAM use in pediatric populations, and education level and socioeconomic status were the associated characteristics in adults' CAM use. ^7,21 Second, this study was conducted in China, so the probability of satisfaction with or preference for TCM is likely to be higher than elsewhere. Finally, the participants had young children with acute bronchiolitis. Thus, the study results may not represent the perceptions of the general pediatric population toward TCM drugs.

In conclusion, satisfaction with and preference for TCM drugs were high in Chinese guardians of children with acute bronchiolitis. Considering the vulnerability of infants and young children to certain adverse effects of TCM drugs, it is important for pediatricians to be aware of the preference of their patients' guardians. ⁷ Further studies on education interventions for guardians of children are needed to improve awareness of the benefits and safety of TCM drugs.