Abstract:
Background: Traditional, Complementary and Alternative Medicine (TCAM) refer
to a broad set of health care practices that are part of a country’s own tradition and are
not integrated in its dominant health care system (WHO 2002). Utilization of TCAM
is reported to be common amongst patients with chronic illnesses, including mental
illness. Medication adherence refers to the extent to which a person's behavior in
taking prescribed medications, whether it is by following a certain diet or executing
lifestyle changes, should correspond with agreed recommendation from a healthcare
provider(Brown & Bussell 2011).Poor adherence to medicines has severe
consequences which include; affecting the effectiveness of the treatment, quality of
life of the patient and the burden it creates on the family as well as the health care
system (Ennis 2014). This study seeks to find the association between the two with an
aim to improve adherence.
Objective: To determine the association between TCAM use and medication
adherence among mentally ill persons attending at Moi Teaching and Referral
Hospital (MTRH).
Methods: This cross-sectional study was carried out at the Mental Health
Clinic(MHC) in MTRH with a sample size of 426 respondents calculated using
Fisher’s formula. Systematic random sampling was used to pick the respondents. Data
was collected over a period of 52 weeks by means of questionnaires. The self
structured questionnaire collected data on socio-demographic characteristics and
utilization of TCAM while data on medication adherence was collected using the
Morisky Medictaion Adherence Scale 8 (MMAS-8). The ability to consent was
assesed using the University of California Brief Assessment of Capacity to Consent
(UBACC) questionaire. Key outcomes include the prevalence of TCAM, the types of
TCAM utilized, level of adherence among patients with mental illness attending
MTRH. Means and percentages were used for continous variables while pearson’s chi
square was used at bi variate level. At multivariate level logistic regression was used
to assess relationships.
Results: Prevalence of TCAM use was 59.4% with the most used TCAM being
herbal medication at 91.7% followed by spiritual type mainly prayer at 8.7%. The
other forms of TCAM including manipulative (massage), mind and body medicine
(yoga) and energy medicine(qigong). Older age (p 0.007) and married marital status
(p 0.015) were significantly associated with use of TCAM. The level of medication
adherence among the respondents was 70.7%. Other than TCAM (p 0.038) no other
factor was significantly associated with low medication adherence. Use of TCAM
significantly increased the odds of poor medication adherence AOR= 1.6 (1.02, 2.50).
Conclusion: Use of TCAM is common among mentally ill patients on follow up at
MTRH with the commonest being herbal medication followed by spiritual
intervention mainly prayer. TCAM use has been significantly associated with low
medication adherence.
Recommendations: Healthcare workers should ask about TCAM use and offer
psychoeducation on importance of adherence to medication as well as desensitize
against use of TCAM. Further studies to investigate causal relations is recommended.