Traditional, complementary and alternative medicine use and medication adherence among patients with mental illness at Moi Teaching and Referral Hospital, Eldoret- Kenya

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.