Health beliefs, treatment preferences and complementary and alternative medicine for asthma, smoking and lung cancer self-management in diverse Black communities

Abstract

Objectives The purpose of this literature review is to characterize unconventional health beliefs and complementary and alternative medicine (CAM) for asthma, smoking and lung cancer as those that are likely safe and those that likely increase risk in diverse Black communities. These findings should provide the impetus for enhanced patient-provider communication that elicits patients’ beliefs and self-management preferences so that they may be accommodated, or when necessary, reconciled through discussion and partnership. Methods Original research articles relevant to this topic were obtained by conducting a literature search of the PubMed Plus, PsychINFO and SCOPUS databases using combinations of the following search terms: asthma, lung cancer, emphysema, chronic obstructive pulmonary disease (COPD), smoking, beliefs, complementary medicine, alternative medicine, complementary and alternative medicine (CAM), explanatory models, African American, and Black. Results Using predetermined inclusion and exclusion criteria, 51 original research papers were retained. Taken together, they provide evidence that patients hold unconventional beliefs about the origins of asthma and lung cancer and the health risks of smoking, have negative opinions of standard medical and surgical treatments, and have favorable attitudes about using CAM. All but a small number of CAM and health behaviors were considered safe. Conclusions When patients’ unconventional beliefs and preferences are not identified and discussed, there is an increased risk that standard approaches to self-management of lung disease will be sub-optimal, that potentially dangerous CAM practices might be used and that timely medical interventions may be delayed. Practice implications Providers need effective communication skills as the medical dialogue forms the basis of patients’ understanding of disease and self-management options. The preferred endpoint of such discussions should be agreement around an integrated treatment plan that is effective, safe and acceptable to both.

Perceptions of complementary/alternative medicine use and influence on evidence-based asthma medicine adherence in Malaysian children

“…In line with previous studies, 10,19,28,29 cultural norms influenced the use of CAM among carers in our study. Many of these studies were from minority communities in the US or Europe with African, Asian or Latin American ethnic background.…”

“…Most studies recruited participants from healthcare centres effectively excluding carers/patients who avoid E-B medicine. 10,28 In contrast, our study which recruited from primary schools in Malaysia—a country in which CAM-use is embedded within majority communities—identified a small, but important minority (4 of the 46 participants were classified as ‘CAM-users’) in whom CAM-use was preferred with E-B medicine being considered as a last resort.…”

<p>New insights to improve treatment adherence in asthma and COPD</p>

“…Good communication by health care providers helps with increased satisfaction and better adherence, in turn improving health outcomes and reducing the use of health care resources 2,47. Assessing patients’ beliefs about their preferred treatment strategies and their prescribed medications is critical 48. For example, a recent German study showed that patients with asthma or COPD who believed their specific medications were necessary were more likely to be adherent, whereas patients with asthma who were concerned about overpresciption of medication by doctors were less likely to adhere to their prescribed treatment 49…”

Inner City Asthma

“…26 Adherence to an asthma management program involves use of controller medication, appointment keeping and applying an emergency plan of action. [29][30][31] Even when a controller medication was prescribed by a physician, more than one third of caregivers did not report it, and this discordance was related to caregivers' beliefs about treatment. 27 Concern about side-effects and negative caregiver beliefs regarding efficacy of medications are more likely in nonadherent compared to adherent children.…”