the expectations, health beliefs and behaviour of patients seeking homœopathic and conventional...

British Hom~eopathic Journal October 1989. Vol. 78. pp. 210-218

The expectations, health beliefs and behaviour of patients seeking homceopathic and conventional medicine CLARE HARRISON BA (HONS) DTM, JENNY HEWISON MSc PhD, PETER DAVIES MA PhD, PATRICK PIETRONI FRCGP MRCP

KEY WORDS:Expectat ions , Hea l th beliefs, Heal th behaviour

Abstract Research was carried out to determine whether or not there was a difference in the health beliefs, expectations and behaviour of a sample of 92 patients attending a dermatological or rheumatological outpatient clinic which offered either homceopathic treatment (N=47) or conventional treatment (N--45).

Self-administered questionnaires were used which examined patients' pathways to care, expectations, beliefs, behaviour and multidimensional health locus of control.

The two key differences between those seeking homoeopathic and those seeking conventional medicine were in terms of (1) their reasons for attending a hom0eopathic or conventional clinic, and (2) their beliefs about their presenting dermatological or rheumatological condition.

Introduction There has been considerable debate over the characteristics of people who are attracted to complementary medicine and whether or not they are in any way different from those who opt for orthodox medicine. 1,2,3 In particular, such differences have been suggested as having a major effect on the outcome of treatment.

The aim of the present study was to determine if patients attending dermatological or rheu- matological outpatients clinics at a homceo- pathic hospital had different health beliefs, expectations and behaviour from those attend- ing hospitals offering conventional treatment.

Method Ninety-two out of a total of 107 consecutive patients attending four outpatient clinics at three different London NHS hospitals completed questionnaires. Questionnaires were self- administered, with a researcher on hand to help with any queries or difficulties. Of the total sample, 47 of the patients (group 1) were reg- ularly attending a hom~eopathic clinic, with the

remaining 45 patients (group 2) attending orthodox clinics. The two groups had near equal numbers of patients attending dermatology clinics (24 in both groups) and rheumatology clinics (23 in group 1, 21 in group 2).

The mean age of the sample was 46 years; 62% were from the UK or Ireland; 54% were mar- ried; 52% were in professional/managerial and non-manual employment; and 79% had had their condition for more than one year. In terms of these characteristics there was no significant difference between the two groups, although there were significantly more females than males seeking home~opathy (group 1) and significantly more females than males in the sample as a whole.

Questions were divided into five main sec- tions. A Pathways to Care section sought to identify previous treatments and the reasons for the patient coming to the present outpatient clinic. Questions in an Expectat ions section sought to identify what patients were expecting from the consultations they were receiving. A section on beliefs sought to identify the patients'

210

Volume 78, Number 4, October 1989 211

beliefs with respect to (a) the meaning of his/her present dermatological or rheumatological con- dition and (b) the meaning of illness in general. 4 The fourth section of the questionnaire sought to establish whether or not a patient was doing anything to keep him/herself mefitally, phys- ically or spiritually healthy both before and since the onset of their present condition. The final section was a multidimensional health locus of control scale based on a questionnaire devised by Wallston, Wallston, and deVellis. 5 This sought to measure three distinct dimensions: internality--the degree to which the patients perceived their health outcomes to be con- tingent on their own decisions and actions; powerful others externality--the degree to which they perceived their health to be determined by powerful other people (e.g. doctors, family); and chance externality--the degree to which they believed that health/illness is a matter of fate, luck or chance.

Data was analysed using chi-square tests or two-sample t-tests as appropriate.

Results Pathways to care. About one third of each group had sought 'complementary' treatment prior to coming to the present outpatient clinic. However, significantly more of group 1, the homceopathic group, had previously sought con- ventional medicine--91% as compared with 73% of group 2 (X 2 = 5.27; df = 1; p<0.05).

As illustrated in Table 1, responses indicated t h a t there was a significant difference between the two groups in terms of their reasons for attending the present outpatient clinic. More patients in group 1 were seeking hom~eopathy because they were unhappy with the approach and/or treatment their previous doctor/therapist

was offering, than patients in group 2. In addi- tion, significantly more in group 1 were doing so as a result of their own decisions and will. Expectations. Of nine different expectations portrayed in the questionnaire, there was a sig- nificant difference between the two groups in terms of only one. A significantly higher propor- tion of those seeking homeeopathic medicine were hoping to understand what their der- matological or rheumatological condition was saying to them and their lifestyle--its meaning-- 26% as compared with 9% of those seeking conventional medicine (X 2 = 4.43; df = 1; p<0.05). Beliefs. Of the seven questions asked concerning the patients' beliefs about their present con- dition, there was a significant difference in their responses in three of them. Namely, a signifi- cantly higher proportion of those attending the homoeopathic hospital believed their conditon could be partly psychological or that if they changed something in their life/lifestyle they could improve their condition. Conversely a significantly lower proportion of this group believed that their condition was caused by something over which they had no control. Details of these results are given in Table 2.

Although the trend evident in their beliefs about their present illness was still present when asked about their beliefs about health and illness in general, there were no significant differences between the two groups. Behaviour. Similarly, there were no significant differences between the two groups in terms of their behaviours either before or since the onset of their present condition. Multidimensional health locus of control Results for this section showed those who were seeking homeeopathic medicine to have signifi-

TABLE 1 Reasons for coming to the present outpatient clinic*

Group 1 Group 2 X 2 N % N % (dr=l)

Unhappy with their previous doctor/therapist's approach 11 23 3 6 4.99

Unhappy with the treatment the previous doctor/ therapist was offering 24 51 1 2 27.71

Own decision to see the doctor at present outpatient clinic 29 62 10 22 14.67

*The X 2 values reported above are significant at the .05 level. Group l--patients seeking homeeopathic treatment. Group 2--patients seeking orthodox treatment.

212

TABLE 2 Beliefs about present condition*

British Homveopathic Journal

Group 1 N %

Group 2 X 2 N % (dr=2)

That their condition could be partly psychological That by changing something in their life/lifestyle they

could improve their condition That their condition was caused by something over

which they had no control

17 36 4 9 13.22

22 47 10 22 11.48

18 38 29 64 6.70

*The X 2 values reported above are significant at the .05 level. Group 1--patients seeking homoeopathic treatment. Group 2--patients seeking orthodox treatment.

cantly higher internality scores than those who were seeking conventional medicine (t = 2.13; df = 81; p = 0.036). No group differences were found on either of the other two dimensions.

Discussion The present study clearly indicates that the two key differences between those seeking homoeo- pathic and those seeking conventional medicine were in terms of (1) their reasons for attending a homeeopathic or conventional outpatient clinic and (2) their beliefs about their presenting con- di t ion--namely a dermatological or rheu- matological condition.

Those who were attending the homceopathic hospital were doing so predominantly as a result of their dissatisfaction ~with the treatment they had been offered and/or approaches they had experienced elsewhere. Furthermore, 62% of those attending the hospital offering hommo- pathic medicine were doing so as a direct result of their own will and actions. Certainly in the instance of the present study--especially in the light of the long-term nature of most of the patients' conditions--it would seem that those seeking homoeopathy were reflecting dissatisfac- tion with conventional medicine and were actively seeking alternative solutions to their long-term condition. It is interesting to consider this in relation to Lewith's study in which in answer to his question 'why do people seek treat- ment by alternative medicine?', he concluded that they were not 'cranks', but were well- informed and seeking a solution to unresolved long-term problems. 2

In the present study, although some dissatis- faction was suggested with conventional medi- cine in terms of the treatment and approach experienced in relation to their present con- dition, this dissatisfaction is not as noticeably

extended into their beliefs about health and ill- ness in general. Thus although those currently seeking homeeopathic medicine may have been doing so as a result of dissatisfaction with the treatment and approach of conventional doctors concerning their present condition, they were not necessarily dissatisfied with conventional medicine generally, and may well still think first of seeking conventional medicine in the case of any other symptoms or illnesses.

The present study also indicated that in terms of their beliefs significantly more of those seek- ing homeeopathy indicated a greater sense of responsibility for and control over the cause, course and future of their condition, than did those seeking conventional medicine. This is clearly supported by the additional finding that those seeking hom0eopathic treatment had sig- nificantly higher internal health locus of control scores than did those seeking conventional treat- ment--indicating that they perceive their health outcomes to be contingent on their own decisions and actions.

It is interesting that there were no significant differences between the two groups in terms of their behaviour either before or since the onset of their present condition. Furthermore, there were no differences between the two groups in the nature of the changes made by those who had altered their behaviour patterns since the onset of their present condition. This finding may be attributable to a number of factors. For example, it could suggest that, contrary to what one might expect, the advice homoeopathic and conventional doctors give to their patients con- cerning their behaviour patterns may not differ to any large extent. Conversely, it could reflect lack of compliance of patients to doctors' advice concerning behaviour patterns. It is important to note that the results obtained in this section may solely reflect the behaviours of people with der-

Volume 78, Number 4, October 1989 213

matological or rheumatological conditions. This gains support from specific comments made by several patients that, for example, although they would like to continue regular exercise, their condition physically prevented them from doing SO.

This latter point is relevant to the study as a whole in that the results may not be generaliza- ble to all people seeking homeeopathy or con- ventional medicine. It is also likely that the results reflect most accurately people with chronic rather than acute conditions.

References

1 Fulder S & Munro R. Complementary Medicine in the United Kingdom: patients, practitioners and consultation. The Lancet 1985; ii: 542-5.

2 Lewith G. Why do people seek treatment by alternative medicihe? British Medical Journal 1985; 290: 28-29.

3 Which? Magic or medicine? October 1986; 443~6. 4 Pietroni PC. The Meaning of Illness. Journal of the Royal

Society of Medicine 1987; 80: 357-60. 5 Wallston KA, Wallston BS & DeVellis R. Development of

the multidimensional health locus of control scales. Health Education Monographs 1978; 6: 160-70.

Address for correspondence: Clare Harrison Marylebone Health Centre 17 Marylebone Road London NW1 5LT

214 British Hom~eopathic Journal

QUESTIONNAIRE For office use only

ID No . . . . . . . . . . Hospital [ ] O/P clinic D [ ]

R []

PLEASE MAKE SURE YOU INDICATE A RESPONSE TO EVERY QUESTION PLEASE DO NOT HESITATE TO ASK ME IF YOU ARE UNCLEAR ABOUT ANYTHING

SEX

MARITAL STATUS

DATE OF BIRTH PARENTS' COUNTRY OF ORIGIN OCCUPATION (Please be as specific as possible) AGE LEFT SCHOOL FURTHER EDUCATION FOR HOW LONG HAVE YOU HAD THIS CONDITION?

Male [ ] Female [ ] Single [ ] Married [ ] Divorced [ ] Widowed [ ] Other [ ] (Please specify)

......... / ......... / .........

PATHWAYS TO CARE Yes No

IN THE PAST have you sought any form of conventional treat- ment for this complaint (including from your G P) ? [] [] IF NO Please continue from Q.No.23 IF YES Was it private? [] []

Was it on the NHS? [] [] Who suggested it? You [ ] [ ] Relative [ ] [ ] Friend [ ] [ ] GP or other conventional therapist [ ] [ ] Complementary therapist* [ ] [ ] Other (please specify) [ ] [ ]

*Throughout this questionnaire complementary therapy refers to eg homeeopathy, acupuncture, osteopathy, herbalism, chiropractic etc

IN THE PAST have you sought any form of complementary therapy? [] [] IF NO Please continue from Q.No.32 IF YES Was it private? [] []

Was it on the NHS? [] [] Who suggested it? You [] [ ] Relative [ ] [ ] Friend [ ] [ ] GP or other conventional therapist [ ] [ ] Complementary therapist [ ] [ ] Other (please specify) [ ] [ ]

Q.No.

1-2 3 4

7-8 9 10 11 12

13

14

15 16

17 18 19 20 21 22

23

24 25

26 27 28 29 30 31

Volume 78, Number 4, October 1989 215

Why are you now coming to the doctor~therapist at this outpatient clinic? You were not happy with your previous doctor/therapists approach You were not happy with the treatment your previous doctor/ therapist was offering Your previous doctor/therapist decided s/he could not help you anymore? You decided your previous doctor/therapist could not help you anymore Your previous doctor/therapist suggested you see the doctor/ therapist at this clinic You decided you wanted to see the doctor/therapist at this clinic To get another opinion about this complaint Other (please specify)

Who suggested you come to this outpatient clinic? You Relative Friend GP or other conventional therapist Complementary therapist Other (please specify)

Yes

[]

[]

[]

[]

[] [] [] []

No

[]

[]

[]

[]

[] [] [] []

[] [] [] [] [] [] [] [] [] [] [] []

How manyconsultationshaveyouhadhere? Yes First visit [ ] 2-4 visits [ ] 5-9 visits [ ] 10+ visits [ ]

EXPECTATIONS Yes No What are~were you hoping to get out of your consultations with the doctor~therapist at this hospital? (Please tick up to 3 as 'yes' as the main expectations with which you came) To try to improve the symptoms (not to attack the underlying disease) [ ] [ ] To try and improve the illness (to get rid of the underlying disease) [ ] [ ] To try and prevent the illness getting worse [ ] [ ] To get a greater understanding of the cause of the complaint [ ] [ ] To get a greater knowledge about the complaint [ ] [ ] To try and understand what the complaint is saying to you and your life--its meaning [ ] [ ] To find out whether or not if you improve your general health level, your complaint is likely to improve [ ] [ ] To focus on your health in general [ ] [ ] To get a further referral [ ] [ ]

If yes, whose idea was this? Yours [ ] [ ] This doctor's [ ] [ ]

Other (please specify) [ ] [ ]

32

33

34

35

36 37 38 39

40 41 42 43 44 45

46

47

48 49 50 51

52

53 54 55 56 57 58

216 British Hom~eopathic Journal

BELIEFS The questions in this section are based around different points of view. They may not all apply to you, but please answer all of them as honestly as you can.

The first few questions refer to the complaint with which you have come here.

Not No Yes No sure idea

Do you believe this complaint is caused by something over which you have no control? Eg a virus, bacteria, something you were born with, a weakness over which you have no control [ ] [ ] [ ] [ ] Do you think this complaint could be partly psychological? Eg to do with your mind, the way you think and feel, to do with personal relationships or your childhood experiences [ ] [ ] [ ] [ ] Do you think you could have done anything to prevent this complaint occurring? Eg concerning your diet, exercise, rest, sleep, smoking, drink- ing, drugs [ ] [ ] [ ] [ ] Do you think that by changing anything in your life~lifestyle you could improve your condition? [] [] [] [] Do you think your complaint is due to factors such as housing, un/employment, financial situations; or any other social or cultural factors, eg nationality? [] [] [] [] Some people believe that whether or not we have an illness can be determined by our religious beliefs, beliefs in God or our relationships to the natural world. Do you feel this could be the case with this complaint? [] [] [] [] There is a belief that health and illness are determined by something called life force and that our level of well-being is somehow connected to the way energy flows through us. Do you believe this has been a relevant factor with this complaint? [] [] [] []

Having considered these points of view with regard to your present complaint could you please now answer the following questions with regard to illness in general.

Not No Yes No sure idea DC*

Do you believe peoples' illnesses are generally caused by some- thing over which they have no control? [] [] [] [] [] Do you think that being ill is partly psychological? [] [] [] [] [] Do you think that people could generally prevent illnesses from occurring? [] [] [] [] [] Do you feel that by changing something in their life~lifestyle people could usually improve an illness? [] [] [] [] [] Do you think that illnesses are often due to social and~or cultural characteristics? [] [] [] [] [] Do you think that illnesses can be determined by religious beliefs, beliefs in God or the relationship to the natural world? [] [] [] [] [] Do you believe that illnesses can be related to life force or the way energy flows through us? [] [] [] [] [] *DC=Depends on the Condition

BEItAVIOUR Yes No Before you had this complaint were you doing any of the follow- ing to keep yourself fit and healthy Paying special attention to your diet [ ] [ ] Regular exercise (at least once a week) [ ] [ ] Relaxation techniques (at least twice a week) [ ] [ ] Meditating (at least twice a week) [ ] [ ] Praying (at least twice a week) [ ] [ ] Seeing a psychotherapist [ ] [ ] Other (please specify) [ ] [ ]

59

60

61

62

63

64

65

66 67

68

69

70

71

72

73 74 75 76 77 78 79

Volume 78, Number 4, October 1989 217

Have you changed any of these since the onset of this complaint? Yes No DIET [] [] IF YES More attention []

Less attention [] Other []

EXERCISE [] [] IF YES More frequently []

Less frequently [] Other []

RELAXATION [] [] IF YES More frequently []

Less frequently [] Other []

MEDITATION [] [] IF YES More frequently []

Less frequently [] Other []

PRAYER [] [] IF YES More frequently []

Less frequently [] Other []

PSYCHOTHERAPY [] [] IF YES More frequently []

Less frequently [] Other []

OTHER (please specify) [] []

I f you have been prescribed treatment for this complaint by the doctor~therapist at this hospital, have you been complying with it? Yes Always [] Usually [] Sometimes [] Never [] Partially [] Not applicable [] Other (please specify) []

When you are feeling "stressed' what do you do to try and alleviate the stress? Yes No Talk to someone [] [] Watch television [] [] Listen to music [] [] Read [] [] Eat something [] [] Drink something--alcoholic [] []

---other [] [] Sleep [] [] Exercise [] [] Other (please specify) [] []

80 81

82 83

84 85

86 87

88 89

90 91

92

93

94 95 96 97 98 99 100 101 102 103

PLEASE TURN OVER

218 British Homceopathic Journal

QUESTIONNAIRE B

The questions below are broad and general and are not meant to apply to specific situations you may have experienced. For each statement, decide whether you agree or disagree with it, and circle the number (from I to 6) which most closely indicates how you feel about the statement. For the word 'sick' please read 'ill'.

Strongly Not Strongly disagree sure agree

1 2 3 4 5 6

1. If I become sick, I have the power to make myself well again. 1 2. Often I feel that no matter what I do, if I am going to get sick, I will

get sick. 1 3. If I see an excellent doctor regularly, I am less likely to have health

problems. 1 4. It seems that my health is greatly influenced by accidental

happenings. 1 5. I can only maintain my health by consulting health professionals. 1 6. I am directly responsible for my health. 1 7. Other people play a big part in whether I stay healthy or become

sick. ~ 1 8. Whatever goes wrong with my health is my own fault. 1 9. When I am sick, I just have to let nature run its course. 1

10. Health professionals keep me healthy. 1 11. When I stay healthy, I am just plain lucky, l 12. My physical wellbeing depends on how well I take care of myself, l 13. When I feel ill, I know it is because I have not been taking care of

myself properly. 1 14. The type of care I receive from other people is what is responsible

for how well I recover from an illness. 1 15. Even when I take care of myself, it's easy to get sick. 1 16. When I become ill, it's a matter of fate. 1 17. I can pretty much stay healthy by taking good care of myself. 1 18. Following doctor's orders to the letter is the best way for me to stay

healthy. 1

2 3 4 5 6

2 3 4 5 6

2 3 4 5 6

2 3 4 5 6 2 3 4 5 6 2 3 4 5 6

2 3 4 5 6 2 3 4 5 6 2 3 4 5 6 2 3 4 5 6 2 3 4 5 6 2 3 4 5 6

2 3 4 5 6

2 3 4 5 6 2 3 4 5 6 2 3 4 5 6 2 3 4 5 6

2 3 4 5 6