RESIDENT ’ S KNOWLEDGE , ATTITUDES AND PATTERNS OF USE TOWARDS COMPLEMENTARY AND ALTERNATIVE MEDICINES ( CAM )

Gilbert Anthony O. Abaño, RN, MAN and Joel D. Maraviles, LPT, Med. Faculty of Education, Eastern Visayas State UniversityOrmoc City Campus, Ormoc City, Leyte-PHILIPPINES 6541. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 14 March 2019 Final Accepted: 16 April 2019 Published: May 2019

Complementary and Alternative Medicines (CAM) has soared significantly in the recent years and current evidence suggest that there is a widespread trend for decades. This study intended to discern the knowledge, attitudes, and patterns of use towards the use of CAM. The study utilized a quantitative descriptive survey design and relevant data to the aforementioned aims were collected through self-made questionnaires from the barangays of Cabintan (n=47), Lake Danao (n=50), Tongonan (n=29), Patag (n=46) respectively and all were located in the highlands of Ormoc. Eleven classifications of CAM were listed as utilized by the respondents. Leaf extract (decoction), traditional or conventional massage (hilot), and Herbal medicine/tablets were the most conventional types of CAM across all studied areas, contributing 68% (n= 117), 72% (n= 124), and 44% (n=76) respectively. Moreover, their rampant usage was primarily due to the influence from friends or family members (36%, n=62) and they used it to treat health problems (40%, n= 69). Amongst the diverse diseases equated with the use of CAM, cough (72%, n= 124) and fever (67%, n=115) were the most alleviated. Generally, most respondents displayed an overall positive attitude of all forms of CAM documented in this study in all of the surveyed barangays. Hence, present study recognizes that Complementary and Alternative Medicine plays a vital health care role amongst the residents in upland Ormoc.

…………………………………………………………………………………………………….... Introduction:-
The CAM or also known as Complementary and Alternative Medicine or Modalities has been widely used worldwide by different medical professionals, herbalist, lay people and even indigenous tribes. CAM is defined as a different approach to health care with a history of use or practices that are not in the mainstream western medicine or standard medical care (National Center for Complimentary and Integrative Helath, 2014). A complementary therapy is generally used along with the standard medical treatment but are not considered to be standard. Alternative medicine on the other hand, are treatments that are used instead of standard medicine so it is imperative that health care providers and clients must know the risk factors associated with it. The NCCIH in 2014 has categorized Complimentary and Alternative Medicine (CAM) into 2 subgroups: Body and mind therapies and products that are deemed natural such as herbal products, botanicals, probiotics, minerals and vitamins where it is ISSN: 2320-5407 Int. J. Adv. Res. 7(5), 523-532 524 widely distributed and marketed in different pharmacies and stores and can easily be identified as dietary supplements.
The World Health Organization in 2000 has noted an increase in the use of various forms of CAM in developing countries as their primary health care practice for years and has shown a significant expansion worldwide in countries where the use of conventional or western medicine is predominant (1) . Several literatures were published connoting that the utilization of CAM is widespread in most developing countries which includes Africa Several studies reveal that different factors have influenced the restored interest in the use of CAM in the Philippines like the social, economic and political factors to name a few. In the Philippine setting, traditional medicine has been practiced since ancient times and its evolution is an interesting subject that is influenced by mysticism, religion, folklore, magic and superstition. The most common traditional medicine practitioner is called the hilot or manghihilot which then acts as midwives, and a chiropractor or a massage therapist that is believed to promote healing and health among residents in the rural areas. The increasing interest of the CAM modalities in developing countries such as the Philippines evinced that CAM is considered to be a vital aspect of public health care in the country.
Furthermore, the expensive cost of administering traditional western medicines, which is beyond reach and unsympathetic to families who belong to the marginalized sector of the society and to those people living in the country-side has also been found responsible for this trend. Regardless of the countless literatures published reporting on the significant use of CAM modalities in different countries, there is still scantiness of relevant information and statistical data on the usage of this modality, specifically the knowledge, attitudes and patterns of use of the people living in the upland areas of Ormoc City, Leyte, Philippines. This study is therefore initiated to bridge the gap in knowledge.

Methodology:-
The study utilized a quantitative descriptive survey design. This was the most appropriate design for this particular study because it allowed for a wide variety of in-depth data to be collected and analyzed regarding the subject of the research. This allowed the researcher to understand the topic better in order to provide opportunities for further studies. It also provided great detail about the studied concepts and did not manipulate variables or administer an intervention. The study was carried out in the upland barangays of Ormoc City namely: Tongonan, Cabintan, Lake Danao, and Patag. A total of 180 respondents. An average of 47 participants from each barangay were intentionally selected.
The researchers utilized a self-made questionnaire adopted from the study of Ching, Flores & Acelajado (2016) with slight modification of some of the parameters to congregate comprehensive data pertinent to the respondent's degree of attitudes, knowledge and patterns of use towards CAM. The procedure was duly assented by the Ethical Research Committee of EVSU -Ormoc Campus and the informed consent form was secured from the residents who were amenable to participate in the survey preceding the data collection.
The self-made questionnaires were shared out to the respondents and those participants needing support with regards to content comprehension and filling-out the survey form were facilitated by the assigned research assistants. The completed survey forms were reclaimed by the proponent two weeks after handing out and dissemination. Subsequently, a focus group discussion or FGD and face to face interviews were organized to cluster pertinent information that may not have been expressed by the respondents.
The researcher utilized descriptive statistics such as frequencies and percentages. A comparison technique was utilized to explore specific data collated across all the studied barangays. Moreover, the researchers used a Likert scale to assess the attitude of the residents towards Complimentary and Alternative Medicines, with 4= denoting as very strong and 1 denoting a very weak response.

Results And Discussion:-
A total of 172 participants with ages 15 years old and above from the selected barangays in Ormoc City revealed that they make use of Complementary and Alternative Medicines, thus implying that this kind of modality is universally recognized amongst all age brackets in the areas studied. In terms of the gender of the respondents, male (35%, n = 60) and female (65%, n= 112), the numbers are not from each other. There were 114 (66%) of the respondents whose educational attainment are up to high school or elementary, and 58 (34%) with college or graduate level. The distribution of the participants to this study into different categories is a good indicator to gather the common knowledge, attitude, and patterns of use about CAM. This also buttresses the common perception that most CAM users obtained lower educational qualifications.  Table 1 shows that all four barangays were influenced by Cebuano/Bisaya traditions on their decisions regarding the use of CAM. The overall percentage for the upland city is reflected in figure 1. The graph dislplays that Cebuano/Bisaya tradition is the most influencial with 88% (n=151) of all the respondents. This result elucidated that almost all the people in Ormoc City and its connected municipalities within Leyte are cebuano/bisaya.   Table 2 shows that all four barangays were influenced by Roman Catholic traditions on their decisions regarding the use of CAM. The overall percentage for the upland city is reflected in figure 2. The graph dislplays that Roman Catholic tradition is the most influencial with 87% (n=150) of all the respondents. This statistic has a positively high correlation with the religion of the residents of Ormoc City, Leyte with a very high percentage. Since most of the residents in Ormoc City are Roman Catholic, then most of the residents are influenced by Roman Catholic traditions.    Based on the survey conducted, there were 11 recorded as the most traditional forms of CAM utilized by the respondents. Among these 11, Traditional Massage/HILOT and Leaf Extract/Decoction are the most traditional types of CAM utilized by the upland residents. Table 4 reveals the detailed distribution of responses.

Different Forms of CAM
The overall responses were recorded too and is presented in figure 4. Leaf Extract/Decoction has 68% (n=117) and Traditional Massage/HILOT has 72% (n=124). Only these forms of CAM have more than 50% of the respondents used these. This conclusion is relatively in parallel with previously published work in the Philippines by the  From table 5, it can be noticed that the four barangays have common reasons of using CAM. The respondents were persuaded to use CAM by their friends and family and for an expected reason; they are using it to treat health problems. Those are the top two reasons why they use CAM. The figure below (5) Table 6:-Different ailments associated with CAM usage.

Ailments Associated with CAM Usage (%) Barangay Cabintan
Lake Danao  Tongonan  Patag  n=47  n=50  n=29  n=46  common colds  34  36  62  54  cough  91  70  72  54  fever  79  60  76  57  flu  21  18  55  33  high blood pressure  36  26  41  30  muscle pains  21  26  41  35  diabetes  13  8  45  22  abdominal pains  81  38  38  33  asthma  15  12  7  24  burns  21  16  14  30  skin diseases  21  16  24  39  UTI  68  26  7  24  diarrhea  81  46  10  46 Among the 13 recorded ailments in table 6, the four barangays had 1 in common to be the top ailment associated with CAM usagethe cough.  Figure 6 displays the overall comparison among the 13 ailments.    Respondents residing in the barangay of Cabintan, Lake Danao, Tongonan and Patag in upland Ormoc City answered positively towards CAM utilization, revealing a mean range of 2.93 to 3.13 which has a striking elucidation of agree. Table 8 revealed that, generally residents from upland Ormoc City concurred on the utilization of Complementary and Alternative Medicines, showing a mean average score of 3.01. This further indicated that the behavior of the community towards CAM modalities have incredibly transformed positively. Moreover, it revealed that these kind of modalities are turning progressively tolerable and reasonable amongst the respondents in the studied areas. The determined positive attitudes and behavior demonstrated by the upland residents in the recent study towards CAM utilization is strongly attributed to the belief of the effectiveness of different types of these modalities for prevention and remedy of the mainstream illnesses identified in their community.

Conclusion:-
Apparently, Traditional Massage (HILOT) and leaf extract/decoction appeared to be the most prevailing form of CAM utilized by the study respondents. This holds true to all the barangays in upland Ormoc. The ramification of this research further revealed that the surveyed respondents were mostly influenced by their belief that the utilization of these modalities will treat their health problems. Respondents were further influenced by Bisaya/Cebuano culture and Roman Catholicism appeared to have greatly influence them in CAM utilization.
The preeminent indisposition treated with CAM in upland Ormoc encompasses cough and flu. Overall, the medicament used to treat these common ailments were mainly prepared by herbal medicine concoctions which includes "Herba Buena", "Dahon sa Kapayas", "Dahon sa Bayabas" and "Banaba leaves". The four barangays