Examining the use of complementary and alternative medicine among older persons in Ebonyi State, southeast Nigeria: a qualitative study

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This study aimed to explore the perceptions of older people in the communities of Ebonyi State regarding the use of complementary and alternative medicine. Methods: Qualitative data were collected through the use of focus group discussions (FGDs), from four communities two each from urban and rural areas of Ebonyi state, Nigeria. A total of 12 FGDs involving 96 participants were conducted. A thematic analysis of data was performed with the aid of NVivo software. Result: Almost all participants expressed a belief in the inherent benefits of complementary and alternative medicine, which were categorized into medical and non-medical reasons. Febrile illnesses, including malaria, typhoid fever, and hepatitis; respiratory; haematological; and dermatological conditions were reported as common health conditions for which participants used CAM. Additionally, participants mentioned using CAM for chronic conditions, such as diabetes mellitus, hypertension, and arthritis, as well as for health promotion and wellbeing. Preferences for CAM were influenced by beliefs in its effectiveness, perceived lower cost compared to conventional treatments, delays in hospital diagnoses and treatments, and belief in the spiritual origins of diseases. Safety concerns regarding CAM use included a lack of information on dosing, directions for safe use, and potential side effects. Conclusion: The study findings indicate a strong belief among participants in the benefits of complementary and alternative medicine which they believe offer both medical and non-medical advantages. However, despite these perceived benefits, safety concerns were also raised by the participants. Efforts to promote education and awareness about CAM, improve access to reliable information, and ensure the safe and effective use of CAM therapies are crucial for supporting the health and well-being of older persons who choose to incorporate CAM into their healthcare practices. complementary and alternative medicine CAM older persons healthcare use qualitative study Ebonyi State southeast Nigeria Background There has been an increasing trend in the use of various alternative medicine approaches in many countries in recent years. As an important part of health services, these practices, treatments and technologies popularly known as complementary and alternative medicine (CAM) have grown in popularity in the last few decades, even though, there is limited research data on their safety, efficacy and quality [ 1 , 2 ]. This global interest in these approaches is evident in the significant use reported in countries such as Belgium (66–75%), France (49%), Australia (46%), America (34%), the UK (33%), Germany (20–30%), and the Netherlands (18%) [ 3 ]. In developing countries, alternative medicine is the primary source of health care for up to 80% of the population, and sometimes, may be the only accessible health care resource in those settings [ 1 ]. In Nigeria and other parts of West Africa, CAM, especially herbal remedies and spiritual healing are particularly common [ 4 – 6 ]. An earlier study in Enugu south-east Nigeria reported that 84.7% of the participants had used CAM at one time or another [ 5 ]. There is no globally accepted definition for CAM, but the United States Center on Complementary and Integrative Health has defined it as a group of diverse medical and health care practices and products that are not presently considered to be part of conventional medicine.[ 7 ] In Nigeria it has been described as any treatment modality, option or service not often prescribed by orthodox medical doctors or taught in conventional medical schools.[ 8 ] They include options such as native herbs, garlic and medicinal teas; nutritional supplements; acupuncture; massage; meditation/yoga; spiritual therapy such as prayer and spiritual healing; body scarification and traditional surgery such as traditional bone setting.[ 8 ] The therapies are referred to as alternative medicines when used instead of conventional treatments, and complementary when used together with conventional treatments. Surveys indicate that these treatment modalities are used by all age groups for a wide range of conditions, including non-communicable diseases, psychological conditions such as anxiety and depression, and life-threatening illnesses including cancer and HIV infection [ 9 – 12 ]. Indeed, CAM use tends to be commoner among individuals who have more than one medical condition, and patients with cancers and other chronic diseases [ 10 , 13 ]. As elderly population are more susceptible to chronic health conditions due to the natural ageing processes, CAM has caught the attention of many older adults and their caregivers [ 14 ]. An analysis of the European social survey data from 21 countries showed that a third of older Europeans experiencing musculoskeletal pain reported using CAM within the 12 months preceding the study, and nearly 88% of older Americans were reported to be using CAM following a Health and Retirement Study. [ 15 , 16 ]. Similarly, evidence from different parts of Nigeria suggests that an older age group is associated with increased CAM use [ 5 , 6 , 17 ]. It is often thought that CAM offers gentler and safer approaches to addressing common health conditions suffered by elderly, and that CAM plays a substantial role in the health promotion, treatment and prevention of diseases and frailties in elderly people, which encompasses the wholesome approach of handling ageing and its effect as well [ 18 , 19 ]. Thus, they often incorporate alternative and complementary therapies into their health self-management routines, either as self-care behaviours, informal support, formal support, or medical care [ 20 ]. Moreover, there is a global trend of demographic ageing, an evidence that the onset of morbidities is postponed and compressed into a shorter period of older ages, and a change in disease patterns leading to the high rates of CAM use among older people [ 21 ]. Nigeria has the highest number of older people in the continent and the 19th highest across the globe, with the population of Nigerians aged 65 and older projected to triple by 2050, but the use of CAM by the elderly in the country has not been well studied [ 22 ]. In light of this, and the limited empirical evidence of efficacy for many CAM treatments, it is important to gain a fuller understanding of how CAM is perceived and used by older people. The findings from this study will provide the evidence base for health planners and policy makers in designing policies and programmes aimed at improving the health of elderly persons. Theoretical framework Leventhal’s self-regulatory model (SRM) provides a theoretical framework for understanding the use of complementary and alternative medicine among the elderly [ 23 ]. According to this framework, individuals engage in specific self-management behaviors, such as CAM use, based on several factors. These include beliefs about a symptom, state, or illness (individuals’ beliefs about their symptoms or health conditions play a significant role in determining their self-management behaviors. Older adults may turn to CAM therapies based on their perception of the effectiveness of these treatments in addressing their health concerns) [ 24 ]; their perceptions and understanding of their health (older persons who perceive themselves as having poor health or who believe in the holistic principles of CAM may be more inclined to explore alternative treatment options); their knowledge of treatments (to use CAM, individuals need to know them and their potential benefits) [ 25 ]; personal resources (individuals resort to CAM therapies which are perceived as affordable); and structural factors that affect access to a therapy (older persons are more likely to use CAM if they face barriers to accessing conventional healthcare services or if CAM is readily available and culturally accepted within their communities) [ 26 ]. Methods Study Area The study was carried out in Ebonyi State in the southeast geo-political zone of Nigeria. It shares border with Benue State to the north, Enugu State to the west, Imo and Abia States to the south and Cross River State to the east.[ 27 ] It is made up of thirteen local government areas, three of which are urban while ten are rural. The state is inhabited mainly by people of Igbo ethnic nationality and their main language is Igbo. The literacy level of the people is 70%.[ 28 ] It has a land area of 5,533 square kilometers and a 2022 projected population of4, 143, 100 people, based on 2006 population census, with the elderly constituting 3.1% of the population.[ 29 ] Being an agrarian entity, the occupation of Ebonyi people is predominantly farming supported with over 3525km 2 of very arable land, 75% of which is upland and 25%, swamp. This enhances growing of variety of cash and food crops, such as, rice, yam, cassava and also animal husbandry. Other occupation of Ebonyi people are civil service, trading and unskilled labour. Health services are provided through public and private health facilities in the State. Additionally, there are pharmacy shops, patent medicine, and grocery stores, which can be common sources of CAM for the people [ 30 , 31 ]. Study Design and Study Population This was a cross-sectional qualitative study. A total of 12 FGDs, each consisting of either 8 males or females were conducted using FGD guide. Thus, the study consisted of 96 participants, including 48 male and 48 female older persons (aged 65 years and above) who resided in the selected urban and rural communities of Ebonyi State, Nigeria. Sample selection A multi-stage sampling method was used in the study. In the first stage, the thirteen LGAs in Ebonyi State were stratified into urban and rural local government areas, and a simple random sampling technique was used to select two local government areas each from the urban and rural areas of the state. In the second stage, two communities were selected from each of the selected local government areas using simple random sampling technique. Participants were then purposively selected based on their age, sex, and highest level of education, until data saturation was achieved. Data Collection Detailed information on the types of CAM used, health problems for which they are used, other reasons for CAM use, and cost of CAM were collected. Before data collection, the FGD guide was pretested in two different communities not selected for the study. Deficiencies or ambiguities of the study instrument which were detected were amended. The discussions were held in secluded places like public primary schools and community town halls, and in English or Igbo language, depending on participants’ preferences. Each session was facilitated by a moderator, a note-taker, and a local guide/translator, and lasted between 45 to 60 minutes each. All FGDs were recorded manually and using audio recorders with the permission of the participants. Data Analysis The recorded discussions of focus group discussions were transcribed verbatim following each session by note-takers. All the discussions in Igbo language were translated into English. For quality assurance purposes, the scripts were compared with the written notes for completeness and accuracy. The notes were used to assign proper labels to the transcripts, and to further enrich the transcripts with nuances and non-verbal cues observed during the sessions. Thematic analysis of transcripts was performed using deductive-inductive approach, and with the aid of QDA Miner Lite v2.0.6. The results are structured according to four themes, which include perceived health benefits of CAM use, preference for CAM, belief in the spiritual origins of diseases, and safety concerns about CAM. Results Interviewers’ characteristics The FGDs were conducted by the researchers who are fellows of the West African College of Physicians, ENO is a Senior Lecturer at Ebonyi State University Abakaliki, Nigeria while CA is a Consultant Public Health Physician at Alex-Ekwueme Federal University Hospital, Abakaliki, Nigeria. Both are males and have skills and experiences in qualitative studies. Participants’ profile The age range of participants for focus group discussion in the urban area was 65 to 88 years while, in the rural area, it was 65- 85years. A total of 48 males and 48 females participated in 12 FGDs. Half of the urban participants had either completed secondary (24.7%), or tertiary education (25.3%), while most of the rural participants (66.7%) had no formal education. Most were either retired or unemployed (48.0%), about one-third (32.3%) were self-employed, while the rest were on salaried employment (19.7%). 1. Perceived health benefits of CAM use Almost all the participants were of the opinion that there are several health benefits inherent in the use of CAM. They believe that CAM can be effective in treating a wide range of health conditions. These include acute illnesses, such as febrile conditions (e.g., malaria, typhoid), and dermatological (eczema, acne) and haematogical disorders; non communicable diseases (hypertension, diabetes mellitus). i. Use for acute illnesses a. Febrile conditions Among the participants, the commonest condition for which CAM is used is febrile illness, ranging from malaria, typhoid to viral hepatitis. Participants were specific about the herbs that are used for the treatment of febrile illnesses, which included mango leaves, Neem (Azadirachta indica) , ‘mmimi ohia’, (ie finger root) (Uvaria chamae) , Lemon juice. Some of the participants shared their experiences thus: “Yes mango tree is also used by us for malaria treatment; just scrap the back, collect lime, slice it, peel and put lemon grass. If you drink this for malaria you will certainly recover from it.” (Male participants, urban) “If you have typhoid fever, or ‘iba ocha n’aya’(meaning hepatitis), just collect guava leaves, Mgbegbe and dogonyaro (Azadirachta indica), wash off dirt from them and cook them. Bring it down when it is still very hot, cover yourself with wrapper. The heat will penetrate into your body. When it gets cold, the person will still bathe with the water. It works very well for the two conditions.” (Female, participant, rural) b. Respiratory conditions The next group of medical conditions for which participants apply CAM for treatment are respiratory conditions. These conditions include those resulting in cough, catarrh, nasal discharge/blockage, hoarseness of voice, and even breathlessness. Such conditions may include, rhinitis, asthma, bronchitis, laryngitis and pneumonia. Participants’ experiences regarding the treatment of respiratory conditions were expressed in the following quotes: “Extracts from scent leaves are commonly used in the treatment of catarrh, nasal congestion and other forms of respiratory challenges in this community. For instance, it can be rubbed between the palms, sniffed and there is instant relief from nasal blockage”. (Female participant, rural) As I was talking about that ‘utazi’, (Gongronema latifolium), and scent leaf (Ocimum gratissium), we usually squeeze them together and drink the extract against cough. My husband used it towards the end of last year, around October and November; that time, cough (Covid − 19) disturbed people so much. (Male participant, urban). c. Dermatological conditions Another participant gave further insights concerning the use of CAM in the management of certain health conditions, such as dermatological conditions, including all manner of skin diseases. Some of these are allergic dermatitis, chicken pox, eczema, dandruff, and measles rash in children. She had this to say; “Concerning skin diseases, I have used crushed onions on some rashes and they were gone. Also, aloe Vera works wonders if used on dandruff. These are the two I have actually tried and they worked for me.” (Female participant, urban d. Haematological conditions Additionally, few participants had used CAM in other medical reasons, such as in the treatment of haematological conditions (anemia, blood loss etc), as well as for health promotion and wellbeing. The participants made their points this way: “There is an herb called physic plant (Jatropha curcas). It is used to stop bleeding in our community for people that have problems with blood clotting. Whenever someone has a cut and it is squeezed and the extract dropped on the cut the bleeding stops immediately. i.e for people whose blood does not clot well, so, it is used to arrest bleeding”. (Male participant, urban) ‘Egbaroko’ khaya ivorensis is a blood supplier. If you collect it and bring out the extract by crushing it, mix it with malt, it gives blood very well, so it is used to treating people with symptoms of anemia. (Male participant, rural) ii. Use for chronic diseases A lot of the participants also, utilized CAM products for non-communicable diseases, such as arthritis, hypertension, and diabetes. Most of them, particularly, the rural participants used it to treat arthritis. Some of the participants gave specific details regarding the CAM they used in treating these medical conditions in the following remarks: Arthritis The commonest non-communicable disease being treated using CAM especially among the participants was arthritis. This was emphasized more by participants in the rural communities. “Arthritis was a major problem to me, but after my son took me to where I did ‘acupuncture’ and thereafter, started using forever living product, I have not been having that challenge again. I can even climb my staircase these days unlike when I was using ‘oyibo’ medicine (orthodox medication) from the chemist (patent medicine vendor).” (Female participant rural) a. Diabetes mellitus The next disease after arthritis, was diabetes mellitus. However this was more pronounced among the urban participants. “I have been a diabetic for a long time and what has been very good at controlling my sugar level has been an herbal product which I prepare by myself. It is made up of scent leaf, bitter leaf, pumpkin leafs squeezed together and the extract filtered into a pot for boiling. After cooling, I take it morning and night.” (Male participant, urban) b. Hypertension A few of the participants also remarked on the use of CAM for the management of hypertension “I was on an antihypertensive and it was really giving me concern as I always had severe headache while taking the medicine. However, a friend introduced me to the use of olive oil, which I use now as it controls my blood pressure. (Female participant, urban) iii. Use for health promotion and wellbeing Further, many participants highlighted the role of CAM in promoting overall health and wellbeing, beyond just treating specific diseases. The participants explained that herbs could be used to maintain good health. A participant made his views known in the following statement: “There is this herb or vegetable we call ‘Ugu’, Telfairia occidentalis. If it is collected, and boiled with water, add tomatoes and mix. It helps to keep someone healthy.” Anyone who takes it regularly will hardly become sick. (Male participant, rural) 2. Preference for CAM i. Belief in CAM effectiveness The commonest non-medical reasons, particularly among the urban participants, for the preference of CAM in disease treatment is the belief in its effectiveness. “I wake every morning, I collect uvuru (Nauclea latifolia). There was a time I had headache and fever and I realized that all the drugs from the chemist was not helping me, so I resorted to uvuru and it took care of my health. I do it every early morning. I buy fifty naira uvuru and drink. (Male participant, urban) “Ginger and honey are also important, any cough that has resisted drugs cannot resist ginger and honey mixed and taken together. They clear all types of cough very well”. (Female participant, rural) “There is a plant called ‘Ahuji’, (scent leaf) that can cure what conventional/orthodox medicine or drugs can't cure. If the leaf is chewed, it will bring out the real symptoms of what is happening to you and then cure the disease in a wonderful way”. (Male participant, urban) The view that CAM products were more effective than orthodox medicine was supported by a participant in the rural study group, who even asserted that he had stopped taking orthodox medicine because of his past experience with it. He expressed his sentiments in the following manner: “I don’t take orthodox medicine. I depend so much on alternative drugs because that is what has kept me alive today, with God helping me. I had an ailment that threatened my life, and I had up to four investigations in a hospital, while my health deteriorated. It was this alternative medicine that finally cured me of the ailment.” (Male participant, rural) However, one of the participants in the urban community had a different opinion on the effectiveness of CAM. He argued that orthodox medicine was more effective than CAM, but that his ability to seek treatment was based on his financial capability which affects his health seeking behaviour. He made known his thoughts this way: “I know that orthodox medicine work very well even in comparison with some alternative medicine, but the main reason for going for alternative medicine is due to lack of money. If you are sick and you have money obviously you will go to a hospital. Whatever they (health providers) tell you to do, you do, and you will be okay; if it is orthodox medicine, it works sharp, sharp” (Male participant, urban). ii. Perceived lower cost of CAM Conversely, most of the rural participants cited lower cost of CAM as the major reason for opting for CAM treatment. Typical responses from the participants were: “There is an extent to which an illness could disturb one, and you don’t have money, you go to the village and collect leaves around you and cook. So, there are times one resorts to alternative medicine due to lack of money” (Female, participant rural) “My last comment or word concerning this thing we have discussed now, is that our people say that, ‘a normal person does not expose his eyes to fire’. Money is just the challenge. If there is money, even common headache will make one go to the hospital, but if you don’t have money you come home and sort yourself out with alternative medicine which costs little or nothing,” (Male, participant rural) iii. Delay in hospital diagnoses/treatments Other important reasons given for the preference of CAM use to orthodox medicine in treatment of diseases were “delay in hospital diagnoses/treatments” and the belief that “CAM products act more rapidly than orthodox medicines.” These viewpoints were expressed by urban and rural respondents respectively. Their perspectives were presented in the following quotes: “If you go for orthodox medicine, especially in the hospital, they will ask for test (laboratory investigations), the result of which may take time to come out, sometimes, even days, but if it is alternative medicine, no time is wasted; just bring certain leaves (herbs), prepare them and take, and you will be cured.” (Female participant, urban). “A sister, in fact that man’s wife, (pointing at a participant) was sick and nearly died. We went to the teaching, hospital, they did not do much, but kept giving one appointment after the other, eventually, we got alternative medicine which the woman took, and she is now healthy”. (Male participant, urban) iv. Belief that “CAM products act more rapidly than orthodox medicines “Let me say something on another reason for using it (CAM). It is not just because it is cheap or because we do not have money, but also, because it (CAM) is faster in action when compared to the other (orthodox) medicine. Just like what this woman said, somebody can go to hospital many times for an issue, without any improvement. So, for me, it is about the very rapid action of CAM that I use them”. (Female participant, rural) “Sometimes people would go to hospital severally for a particular issue without any improvement, then they will resort to alternative medicine and get well. That is what makes people to go for CAM” (Female participant, rural) 3. Belief in the spiritual origins of diseases i. Belief in rituals as solution to some spiritual conditions Moreover, few participants believed that certain diseases had spiritual origins and were better treated with some forms of CAM, such as rituals. Here are the expressions of these participants: “Last week, I was sick, and I was prepared to go to hospital but was hindered by some obstacles. I coughed and there was blood in my sputum. I met a herbalist that gave me ‘Nka’ to chew. I chewed it and got healed.” (Male, participant, urban) “There are some symptoms you will have, and it will not be wise to rush off to a hospital. In such a situation, it will be better to first of all, take some local medicine and rule out some spiritual diseases.” (Female, participant, urban) ii. Belief in prayer as sole remedy for some spiritual conditions However, two participants hinted that certain health conditions were only amenable to prayers. Their views were captured thus: “Sometimes, both CAM products and conventional medicine will fail, and only prayer will be used to cure the disease concerned. You can also, say only prayer and you get cured/relieved.” (Female participant, urban) “What I am saying is that sometimes poison can resist all manner of drugs,(both orthodox and CAM), but if you go for prayers, you receive your healing.” (Male participant, rural) Perceived dangers of conventional therapy for a spiritual condition Some participants expressed the view that administering orthodox medicine, particularly injections to patients with such diseases would result in their death. “That thing called ‘oke ezenwu’, (a disease condition) is not cured in the hospital. Some people with the condition, may go to a hospital without knowing that they have the disease. If they take orthodox medicine, they will die from the disease. It is only ‘Igbo’ medicine (referring to herbs) that cures the sickness, perhaps with ritual performance.” (Male, participant, rural) “It is not every disease that is cured with modern medicine. For example, there is a particular boil (furunculosis) that can be on the body or inside the body, if somebody with it mistakenly goes to a hospital or chemist and is given injection, the person will simply die.” (Male, participant, urban) 4. Safety concerns about CAM i. Lack of information on dosing and directions for safe use Despite the widespread use of CAM among both the urban and rural participants, and the various views expressed in support of the preference for its use, most of the participants in the study agreed that there were crucial issues surrounding the safety of some of the CAM products, particularly, the unprocessed herbal preparations. They opined that most CAM products had no information on dosage, potential side-effects, and directions for safe use. A rural participant made his point in this quote: “The challenge is that most CAM products don’t have dosage, especially the local herbs or direction on usage. One just takes it anyhow, but if it were the orthodox medicine, you know what quantity at any point in time, and even if you don’t know how to read, someone can help you with the written prescription.” (Male participant, rural) Two urban participants declared that they did not take alternative medicine because of CAM products had no dosages. One of the participants even went further to advocate that herbs should not be taken. Their views are captured thus: “What I am saying is that anything that doesn’t have dosage should not be taken because those alternative medicines are just, O’ God help me, (Laughs). You don’t have information on what you take or how much of it to take.” (Male participant, urban) “This issue of alternative medicine; there are people who take it but we can’t say if it is good or not, but I don’t take it because it doesn’t have dosage. That is why I don’t take it.” (Male participant, urban) ii. Potential side-effects Other adverse effects attributed to CAM by the participants were liver or other gastro-intestinal problems, renal pathology and even death associated with the use of some form of CAM. “There are some alternative medicines, such as the one called ‘Nchala’ that causes passage of watery stool on consumption, and if not controlled with something like palm oil it may lead to the death of the person.” (Female participant, rural) “Alternative medicine can cause liver problem because it does not have dosage guide. No instruction on how to use it; some have taken it and had their abdomen swollen due to liver or kidney damage” (Male participant, urban). Discussion This study explored the use of complementary and alternative medicine among the elderly in communities in Ebonyi State, Southeast Nigeria. It showed that almost all the participants believed that there are health benefits associated with the use of CAM. This is similar to findings from a study in Australia [ 25 ]. This widespread belief underscores the importance of CAM in the healthcare landscape and suggests a high level of acceptance and trust in its potential efficacy among the participants. In contrast, a study in Enugu, south east Nigeria observed that only a quarter of the respondents could describe specific benefits from the use of CAM [ 32 ]. This discrepancy might be due to differences in the methodologies of the studies. The finding that the commonest condition for which CAM is used is febrile illness, ranging from malaria, and typhoid fever to hepatitis is contrary to the results from a study in Saudi Arabia, which reported musculoskeletal disorders, cardiac problems, and neurological problems as the primary health reasons for CAM use among the elderly [ 33 ]. The difference in findings may be due to variations in disease patterns between the regions, and this may be attributed to various factors, including environmental conditions, and access to healthcare services. In regions, such as the study area where infectious diseases are endemic or where access to conventional healthcare is limited, individuals may turn to CAM for managing acute illnesses such as febrile conditions. On the other hand, in more developed regions with aging populations, chronic conditions like musculoskeletal disorders and cardiovascular diseases may be more prevalent, driving the utilization of CAM for symptom management and holistic care. The findings from our study suggest that the elderly commonly turn to CAM due to two primary non-medical reasons which are belief in its effectiveness, and lower costs. These findings further affirm an earlier study in another part of the state which reported that most older persons preferred alternative medicine to conventional medicine due to presumed efficacy and cost among other factors [ 24 ]. Also, the findings are consistent with similar studies conducted in Bangladesh, and Germany [ 34 , 35 ]. The belief in the effectiveness of CAM reflects a common perception among the elderly population that these modalities offer therapeutic benefits beyond those provided by conventional medicine. This belief may stem from personal experiences, or cultural traditions, as many older adults have lifelong experience with alternative medicine due to unavailable conventional care during their childhood [ 36 ]. In addition, the perception of lower costs associated with CAM aligns with global trends of seeking more affordable healthcare options, particularly among older adults who may be facing financial constraints. Another rationale for the use of CAM by the elderly as observed from our study is dissatisfaction with conventional health service delivery. There was a perception among most of the participants that there is poor quality of care in orthodox healthcare settings, such as delay in diagnoses and treatments. Such people believe that traditional healthcare services are quicker, and that CAM products act more swiftly compared to orthodox medicines. This further affirms the findings from previous studies in sub-Saharan Africa that one of the major reasons for non-use of health facilities is poor quality of care coupled with attendant delays in accessing care, often attributed to drug and equipment shortages, under-staffing, or poor infrastructure and poor attitudes among health workers. [ 37 – 39 ]. Further, few of the participants believed that certain diseases have spiritual origins and were better treated with some forms of CAM, such as rituals. Earlier studies in different parts of the country reported that certain disease conditions are considered incurable with western medicine because of belief in their spiritual origins and, as such, are only treated with alternative medicine [ 40 , 41 ]. This finding is not unique to Nigeria, but was also reported in various parts of both the developed and the developing nations [ 42 ]. This finding reflects a cultural and religious perspective on health and illness that is common in many societies. The notion that certain diseases can only be addressed through alternative therapies due to their spiritual origins underscore the complexity of health beliefs and practices in the region. In Nigeria, several people believe that prayer alone can effectively address all their challenges, including sickness. As a result, a large number of people attend miracle healing services seeking relief from various health conditions [ 43 ]. This highlights the significant influence of religious beliefs on health-seeking behaviours, and the need to understand them in healthcare provision. In spite of the widespread use of CAM among the participants, few participants raised concerns about lack of appropriate dosing and potential side effects. The finding is similar to a previous study carried out in Lagos, southwest Nigeria, and this suggests that the issue may not be an isolated one, but rather reflects a broader pattern across different regions of the country [ 17 ]. This lack of dosing could potentially lead to misuse or overuse of alternative therapies, which in turn may increase the risk of adverse effects. Thus, efforts should focus on promoting evidence-based practices, and strengthening regulatory measures to ensure the safe and effective use of alternative therapies. The major limitation of this study is that it is not easy to generalize since this is a qualitative study. However, the use of FGD enabled an in-depth exploration of the perspectives of older persons in the communities, while data synthesis was based on Leventhal’s self-regulatory model which provided a theoretical framework for understanding the use of CAM among the elderly. Future research should explore the efficacy and safety of CAM therapies and their integration into mainstream healthcare practice. Conclusion The study findings indicate a strong belief among participants in the benefits of complementary and alternative medicine which they believe offer both medical and non-medical advantages. The use of CAM was prevalent among the participants particularly for managing febrile illnesses like malaria, typhoid, and hepatitis, as well as for other health conditions, such as respiratory, haematological and chronic conditions. Their preference for CAM were influenced by factors, such as perceived effectiveness, cost advantages compared to conventional medicine, delays in hospital treatments and belief in the spiritual origins of diseases. Despite the perceived benefits of CAM, safety concerns were also raised by the participants. These include lack of information on dosing, directions for safe use, and potential side effects associated with CAM therapies. The findings underscore the interplay of beliefs, preferences, and safety considerations surrounding the use of CAM among the participants. Efforts to enhance education and awareness about CAM, improve access to reliable information, and ensure the safe and effective use of CAM therapies are crucial for supporting the health and well-being of older persons who choose to incorporate CAM into their healthcare practices. Abbreviations CAM Complementary and alternative medicine FGDs Focus group discussions SRM self-regulatory model QDA Qualitative data analysis Declarations Acknowledgement: Not applicable Funding The author(s) received no specific funding for this work. Competing interests The authors have no competing interests to declare that are relevant to the content of this article. Data availability Some of the data generated or analysed during this study are included in this published article. Additional data are available from the corresponding author on reasonable request. Authors’ contributions Chibuike Innocent Agu and Edmund Ndudi Ossai contributed to the study conception and design. All the authors participated in the material preparation, data collection and analysis. The first draft of the manuscript was written by Chibuike Innocent Agu. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate Ethical approval for the study was obtained from the Health Research and Ethics Committee of Alex-Ekwueme Federal University Teaching Hospital, (AEFUTA) Abakaliki with approval number 19/111/2019-13/01/2020. Participation was voluntary and participants were not coerced into participating in the study. The participants were required to sign or thumb print to a written informed consent before the interview. However, before signing, participants were informed of the objectives of the study, its relevance and the methods that would be used for data collection. Privacy and confidentiality were assured, and data collected were anonymised as codes were used. References World Health Organization (WHO). WHO Traditional Medicine Strategy 2014-2023. World Heal Organ [Internet]. 2013 [cited 2019 Mar 15];1–76. Available from: www.who.int Kasilo OM, Trapsida J-M MN. An Overview of the Traditional Medicine Situation in the African Region | African Health Observatory [Internet]. African Heal. Monit. 2010 [cited 2019 Apr 19]. p. 7–15. Available from: http://www.aho.afro.who.int/en/ahm/issue/13/reports/overview-traditional-medicine-situation-african-region Anbari K, Gholami M. Evaluation of Trends in the Use of Complementary and Alternative Medicine in Health Centers in Khorramabad (West of Iran). Glob J Health Sci [Internet]. 2015;8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803943/ Oreagba I, Oshikoya K, Amachree M. Herbal medicine use among urban residents in Lagos, Nigeria. BMC Complement Altern Med. 2011;11:117. Okoronkwo I, Onyia-Pat J-L, Okpala P, Agbo M-A, Ndu A. Patterns of Complementary and Alternative Medicine Use, Perceived Benefits, and Adverse Effects among Adult Users in Enugu Urban, Southeast Nigeria. Evid Based Complement Alternat Med [Internet]. 2014 [cited 2019 Mar 5];2014:239372. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24803945 Li S, Odedina S, Agwai I, Ojengbede O, Huo D, Olopade O. Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. BMC Complement Med Ther. 2020;20:93. National Center for Complementary and Integrative Medicine. collections.html - U.S. National Library of Medicine Collection Development Manual. [cited 2019 Mar 16]; Available from: https://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html Adesola BO, Emmanuel GO, Matthew AS, Adewumi AO, Oluseyi AI, Toyin EO. Complementary and Alternative Medicine Usage Among Patients Attending a Tertiary Hospital in Nigeria. 2017;2:111–5. Pitetti R, Singh S, Hornyak D, Garcia S, S H. Complementary and alternative medicine use in children. Pediatr Emerg Care. 2001;165–9. Saydah SH, Eberhardt MS. Use of Complementary and Alternative Medicine Among Adults with Chronic Diseases: United States 2002. J Altern Complement Med [Internet]. 2006 [cited 2019 Apr 6];12:805–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17034287 Astin J. Why patients use alternative medicine: results of a national study. JAMA. 1998;279:1548–53. Molassiotis A, Fernández-Ortega P, Pud D, Ozden G, Scott JA, Panteli V et al. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol [Internet]. 2005;16:655–63. Available from: https://academic.oup.com/annonc/article/16/4/655/173492 Bishop FL, Lewith GT. Who Uses CAM? A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use. 2010 [cited 2019 Apr 16];7:11–28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18955327 Eliopoulos C. Complementary and Alternative Therapies in Geriatric Care. Medscape Nurse [Internet]. 2006; Available from: https://www.medscape.com/viewarticle/542207 Morrissey A, O’Neill A, O’Sullivan K, Robinson K. Complementary and alternative medicine use among older adults with musculoskeletal pain: findings from the European Social Survey (2014) special module on the social determinants of health. Br J Pain. 2022;109–118. Ness J, Cirillo D, Weir D, Nisly N, Wallace R. Use of complementary medicine in older Americans: Results from the health and retirement study. Gerontologist. 2005;45:516–24. Ilori OS, Olakunlehin O, Ilori OR, Awodutire PO, Ugwuoke C, Shittu O. Safety perception and determinants of complementary and alternative medicine usage among surgery out-patients in LAUTECH Teaching hospital, ogbomoso, Nigeria. Heliyon. 2024;10:e24835. Jamshed S, Min C, Siddiqui M, Verma R. Role of complementary and alternative medicine in geriatric care: A mini review. Pharmacogn Rev [Internet]. 2014 [cited 2019 Mar 13];8:81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25125879 Eliopoulos C. Integration of Complementary and Alternative Therapies in Geriatric Care [Internet]. 2006 [cited 2019 Nov 8]. Available from: https://www.medscape.com/viewarticle/542207 Effoe V, Suerken C, Quandt S, Bell R, Arcury T. The Association of Complementary Therapy Use With Prescription Medication Adherence Among Older Community-Dwelling Adults. J Appl Gerontol. 2015;36:1054–69. Adams J, Lui C-W, McLaughlin D. The use of complementary and alternative medicine in later life. Rev Clin Gerontol [Internet]. 2009 [cited 2019 Mar 13];19:227. Available from: http://www.journals.cambridge.org/abstract_S0959259809990360 Mbam K, Halvorsen C, Okoye U. Aging in Nigeria: A Growing Population of Older Adults Requires the Implementation of National Aging Policies. Gerontologist. 2022;62:1243–50. Arcury T, Grzywacz J, Bell R, Neiberg R, Lang W, Quandt S. Herbal Remedy Use as Health Self-Management among Older Adults. J Gerontol Soc Sci. 2007;62B. Emma-Echiegu N, Mbam E. Experiences of older adults in healthcare choice: voices from Igbeagu, Izzi local government area, Ebonyi state Nigeria. J Psychol Sociol Stud 2. 2017;1:115–32. Oh B, Butow P, Mullan B, Beale P, Pavlakis N, Rosenthal D, et al. The use and perceived benefits resulting from the use of complementary and alternative medicine by cancer patients in Australia. Asia. Pac. J. Clin. Oncol. 2010. p. 342–9. Tangkiatkumjai M, Boardman H, Walker D. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther. 2020;20. About Ebonyi State | Ebonyi Online [Internet]. [cited 2019 Dec 29]. Available from: https://www.ebonyionline.com/about-ebonyi-state/ The National Literacy Survey Media & Marketing Communications Company Group National Commission For Mass Literacy, Adult And Non Formal Education [Internet]. 2010. Available from: www.nigerianstat.gov.ng Ebonyi (State, Nigeria) - Population Statistics, Charts, Map and Location [Internet]. [cited 2020 Jan 4]. Available from: https://www.citypopulation.de/php/nigeria-admin.php?adm1id=NGA011 What is the Pharmacist’s Role in Assessing CAM Use? [Internet]. [cited 2020 Jul 26]. Available from: https://www.pharmacytimes.com/resource-centers/vitamins-supplements/what-is-the-pharmacists-role-in-assessing-cam-use Prevalence, Cost, and Patterns of CAM Use - Complementary and Alternative Medicine in the United States - NCBI Bookshelf [Internet]. [cited 2020 Jul 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83794/ Ezeome ER, Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complement Altern Med [Internet]. 2007 [cited 2019 Apr 15];7:28. Available from: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-7-28 Aljawadi MH, Khoja AT, AlOtaibi AD, Alharbi KT, Alodayni MA, AlMetwazi MS et al. The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study. Evidence-Based Complement Altern Med [Internet]. 2020; Available from: https://www.hindawi.com/journals/ecam/2020/4357194/ Schnabel K, Binting S, Witt CM, Teut M. Use of complementary and alternative medicine by older adults – a cross-sectional survey. BMC Geriatr [Internet]. 2014 [cited 2019 Mar 13];14:38. Available from: http://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-14-38 Shahjalal Md, Gow J, Rahman MdA, Hossain MdJ, Khan MdNA, Alam MdS et al. Proportion and associated factors of the utilisation of complementary and alternative medicine exclusively in a hospital in Bangladesh. BMC Complement Med Ther. 2022;22:1–8. Oshikoya KA, Senbanjo IO, Njokanma OF, Soipe A. Use of complementary and alternative medicines for children with chronic health conditions in Lagos, Nigeria. BMC Complement Altern Med [Internet]. 2008 [cited 2019 Mar 19];8:66. Available from: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-8-66 Ezeome E. Delays in presentation and treatment of breast cancer in Enugu, Nigeria. Niger J Clin Pract. 2010;13:311–6. Fantaye A, Okonofua F, Ntoimo L, Yaya S. A qualitative study of community elders’ perceptions about the underutilization of formal maternal care and maternal death in rural Nigeria. Reprod Heal. 2019;16. Sumankuuro J, Crockett J, Wang S. Maternal health care initiatives: causes of morbidities and mortalities in two rural districts of upper West region, Ghana. PLoS One. 2017;12:e0183644. Anizoba E. Traditional Igbo Belief in Causes of Disease: An Evaluation. Pharos J Theol online. 2023;104:1–13. Kunnuji M, Wammanda R, Ojogun T, Quinley J, Oguche S, Odejimi A, et al. Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria’s 2019 VASA. BMC Public Heal. 2022;22:850. Qureshi N, Khalil A, Alsanad S. Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh. J Relig Health. 2020;59:845–869. Ekanem S, Asira A. Religion and Medicine in the 21st Century Nigeria. An African J Philos. 2007;9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 Jul, 2024 Editor assigned by journal 04 Jul, 2024 Submission checks completed at journal 04 Jul, 2024 First submitted to journal 31 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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As an important part of health services, these practices, treatments and technologies popularly known as complementary and alternative medicine (CAM) have grown in popularity in the last few decades, even though, there is limited research data on their safety, efficacy and quality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This global interest in these approaches is evident in the significant use reported in countries such as Belgium (66\u0026ndash;75%), France (49%), Australia (46%), America (34%), the UK (33%), Germany (20\u0026ndash;30%), and the Netherlands (18%) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In developing countries, alternative medicine is the primary source of health care for up to 80% of the population, and sometimes, may be the only accessible health care resource in those settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Nigeria and other parts of West Africa, CAM, especially herbal remedies and spiritual healing are particularly common [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. An earlier study in Enugu south-east Nigeria reported that 84.7% of the participants had used CAM at one time or another [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is no globally accepted definition for CAM, but the United States Center on Complementary and Integrative Health has defined it as a group of diverse medical and health care practices and products that are not presently considered to be part of conventional medicine.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] In Nigeria it has been described as any treatment modality, option or service not often prescribed by orthodox medical doctors or taught in conventional medical schools.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] They include options such as native herbs, garlic and medicinal teas; nutritional supplements; acupuncture; massage; meditation/yoga; spiritual therapy such as prayer and spiritual healing; body scarification and traditional surgery such as traditional bone setting.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] The therapies are referred to as alternative medicines when used instead of conventional treatments, and complementary when used together with conventional treatments.\u003c/p\u003e \u003cp\u003eSurveys indicate that these treatment modalities are used by all age groups for a wide range of conditions, including non-communicable diseases, psychological conditions such as anxiety and depression, and life-threatening illnesses including cancer and HIV infection [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Indeed, CAM use tends to be commoner among individuals who have more than one medical condition, and patients with cancers and other chronic diseases [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. As elderly population are more susceptible to chronic health conditions due to the natural ageing processes, CAM has caught the attention of many older adults and their caregivers [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. An analysis of the European social survey data from 21 countries showed that a third of older Europeans experiencing musculoskeletal pain reported using CAM within the 12 months preceding the study, and nearly 88% of older Americans were reported to be using CAM following a Health and Retirement Study. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Similarly, evidence from different parts of Nigeria suggests that an older age group is associated with increased CAM use [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is often thought that CAM offers gentler and safer approaches to addressing common health conditions suffered by elderly, and that CAM plays a substantial role in the health promotion, treatment and prevention of diseases and frailties in elderly people, which encompasses the wholesome approach of handling ageing and its effect as well [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Thus, they often incorporate alternative and complementary therapies into their health self-management routines, either as self-care behaviours, informal support, formal support, or medical care [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Moreover, there is a global trend of demographic ageing, an evidence that the onset of morbidities is postponed and compressed into a shorter period of older ages, and a change in disease patterns leading to the high rates of CAM use among older people [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Nigeria has the highest number of older people in the continent and the 19th highest across the globe, with the population of Nigerians aged 65 and older projected to triple by 2050, but the use of CAM by the elderly in the country has not been well studied [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In light of this, and the limited empirical evidence of efficacy for many CAM treatments, it is important to gain a fuller understanding of how CAM is perceived and used by older people. The findings from this study will provide the evidence base for health planners and policy makers in designing policies and programmes aimed at improving the health of elderly persons.\u003c/p\u003e\n\u003ch3\u003eTheoretical framework\u003c/h3\u003e\n\u003cp\u003eLeventhal\u0026rsquo;s self-regulatory model (SRM) provides a theoretical framework for understanding the use of complementary and alternative medicine among the elderly [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. According to this framework, individuals engage in specific self-management behaviors, such as CAM use, based on several factors. These include beliefs about a symptom, state, or illness (individuals\u0026rsquo; beliefs about their symptoms or health conditions play a significant role in determining their self-management behaviors. Older adults may turn to CAM therapies based on their perception of the effectiveness of these treatments in addressing their health concerns) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]; their perceptions and understanding of their health (older persons who perceive themselves as having poor health or who believe in the holistic principles of CAM may be more inclined to explore alternative treatment options); their knowledge of treatments (to use CAM, individuals need to know them and their potential benefits) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]; personal resources (individuals resort to CAM therapies which are perceived as affordable); and structural factors that affect access to a therapy (older persons are more likely to use CAM if they face barriers to accessing conventional healthcare services or if CAM is readily available and culturally accepted within their communities) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area\u003c/h2\u003e \u003cp\u003eThe study was carried out in Ebonyi State in the southeast geo-political zone of Nigeria. It shares border with Benue State to the north, Enugu State to the west, Imo and Abia States to the south and Cross River State to the east.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] It is made up of thirteen local government areas, three of which are urban while ten are rural. The state is inhabited mainly by people of Igbo ethnic nationality and their main language is Igbo. The literacy level of the people is 70%.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] It has a land area of 5,533 square kilometers and a 2022 projected population of4, 143, 100 people, based on 2006 population census, with the elderly constituting 3.1% of the population.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Being an agrarian entity, the occupation of Ebonyi people is predominantly farming supported with over 3525km\u003csup\u003e2\u003c/sup\u003e of very arable land, 75% of which is upland and 25%, swamp. This enhances growing of variety of cash and food crops, such as, rice, yam, cassava and also animal husbandry. Other occupation of Ebonyi people are civil service, trading and unskilled labour. Health services are provided through public and private health facilities in the State. Additionally, there are pharmacy shops, patent medicine, and grocery stores, which can be common sources of CAM for the people [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Study Population\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional qualitative study. A total of 12 FGDs, each consisting of either 8 males or females were conducted using FGD guide. Thus, the study consisted of 96 participants, including 48 male and 48 female older persons (aged 65 years and above) who resided in the selected urban and rural communities of Ebonyi State, Nigeria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample selection\u003c/h2\u003e \u003cp\u003eA multi-stage sampling method was used in the study. In the first stage, the thirteen LGAs in Ebonyi State were stratified into urban and rural local government areas, and a simple random sampling technique was used to select two local government areas each from the urban and rural areas of the state. In the second stage, two communities were selected from each of the selected local government areas using simple random sampling technique. Participants were then purposively selected based on their age, sex, and highest level of education, until data saturation was achieved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eDetailed information on the types of CAM used, health problems for which they are used, other reasons for CAM use, and cost of CAM were collected. Before data collection, the FGD guide was pretested in two different communities not selected for the study. Deficiencies or ambiguities of the study instrument which were detected were amended. The discussions were held in secluded places like public primary schools and community town halls, and in English or Igbo language, depending on participants\u0026rsquo; preferences. Each session was facilitated by a moderator, a note-taker, and a local guide/translator, and lasted between 45 to 60 minutes each. All FGDs were recorded manually and using audio recorders with the permission of the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe recorded discussions of focus group discussions were transcribed verbatim following each session by note-takers. All the discussions in Igbo language were translated into English. For quality assurance purposes, the scripts were compared with the written notes for completeness and accuracy. The notes were used to assign proper labels to the transcripts, and to further enrich the transcripts with nuances and non-verbal cues observed during the sessions. Thematic analysis of transcripts was performed using deductive-inductive approach, and with the aid of QDA Miner Lite v2.0.6. The results are structured according to four themes, which include perceived health benefits of CAM use, preference for CAM, belief in the spiritual origins of diseases, and safety concerns about CAM.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eInterviewers\u0026rsquo; characteristics\u003c/h2\u003e\n \u003cp\u003eThe FGDs were conducted by the researchers who are fellows of the West African College of Physicians, ENO is a Senior Lecturer at Ebonyi State University Abakaliki, Nigeria while CA is a Consultant Public Health Physician at Alex-Ekwueme Federal University Hospital, Abakaliki, Nigeria. Both are males and have skills and experiences in qualitative studies.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eParticipants\u0026rsquo; profile\u003c/h2\u003e\n \u003cp\u003eThe age range of participants for focus group discussion in the urban area was 65 to 88 years while, in the rural area, it was 65- 85years. A total of 48 males and 48 females participated in 12 FGDs. Half of the urban participants had either completed secondary (24.7%), or tertiary education (25.3%), while most of the rural participants (66.7%) had no formal education. Most were either retired or unemployed (48.0%), about one-third (32.3%) were self-employed, while the rest were on salaried employment (19.7%).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003e1. Perceived health benefits of CAM use\u003c/h2\u003e\n \u003cp\u003eAlmost all the participants were of the opinion that there are several health benefits inherent in the use of CAM. They believe that CAM can be effective in treating a wide range of health conditions. These include acute illnesses, such as febrile conditions (e.g., malaria, typhoid), and dermatological (eczema, acne) and haematogical disorders; non communicable diseases (hypertension, diabetes mellitus).\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003ei. Use for acute illnesses\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003cp\u003ea. Febrile conditions\u003c/p\u003e\n \u003cp\u003eAmong the participants, the commonest condition for which CAM is used is febrile illness, ranging from malaria, typhoid to viral hepatitis. Participants were specific about the herbs that are used for the treatment of febrile illnesses, which included mango leaves, Neem \u003cem\u003e(Azadirachta indica)\u003c/em\u003e, \u0026lsquo;mmimi ohia\u0026rsquo;, (ie finger root) \u003cem\u003e(Uvaria chamae)\u003c/em\u003e, Lemon juice. Some of the participants shared their experiences thus:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Yes mango tree is also used by us for malaria treatment; just scrap the back, collect lime, slice it, peel and put lemon grass. If you drink this for malaria you will certainly recover from it.\u0026rdquo;\u003c/em\u003e (Male participants, urban)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;If you have typhoid fever, or \u0026lsquo;iba ocha n\u0026rsquo;aya\u0026rsquo;(meaning hepatitis), just collect guava leaves, Mgbegbe and dogonyaro (Azadirachta indica), wash off dirt from them and cook them. Bring it down when it is still very hot, cover yourself with wrapper. The heat will penetrate into your body. When it gets cold, the person will still bathe with the water. It works very well for the two conditions.\u0026rdquo;\u003c/em\u003e (Female, participant, rural)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003cp\u003eb. Respiratory conditions\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe next group of medical conditions for which participants apply CAM for treatment are respiratory conditions. These conditions include those resulting in cough, catarrh, nasal discharge/blockage, hoarseness of voice, and even breathlessness. Such conditions may include, rhinitis, asthma, bronchitis, laryngitis and pneumonia. Participants\u0026rsquo; experiences regarding the treatment of respiratory conditions were expressed in the following quotes:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Extracts from scent leaves are commonly used in the treatment of catarrh, nasal congestion and other forms of respiratory challenges in this community. For instance, it can be rubbed between the palms, sniffed and there is instant relief from nasal blockage\u0026rdquo;.\u003c/em\u003e (Female participant, rural)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAs I was talking about that\u003c/em\u003e \u0026lsquo;utazi\u0026rsquo;, \u003cem\u003e(Gongronema latifolium), and\u003c/em\u003e scent \u003cem\u003eleaf (Ocimum gratissium), we usually squeeze them together and drink the extract against cough. My husband used it towards the end of last year, around October and November; that time, cough (Covid \u0026minus;\u0026thinsp;19) disturbed people so much.\u003c/em\u003e (Male participant, urban).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003cp\u003ec. Dermatological conditions\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eAnother participant gave further insights concerning the use of CAM in the management of certain health conditions, such as dermatological conditions, including all manner of skin diseases. Some of these are allergic dermatitis, chicken pox, eczema, dandruff, and measles rash in children. She had this to say;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Concerning skin diseases, I have used crushed onions on some rashes and they were gone. Also, aloe Vera works wonders if used on dandruff. These are the two I have actually tried and they worked for me.\u0026rdquo;\u003c/em\u003e (Female participant, urban\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003cp\u003ed. Haematological conditions\u003c/p\u003e\n \u003cp\u003eAdditionally, few participants had used CAM in other medical reasons, such as in the treatment of haematological conditions (anemia, blood loss etc), as well as for health promotion and wellbeing. The participants made their points this way:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;There is an herb called physic plant (Jatropha curcas). It is used to stop bleeding in our community for people that have problems with blood clotting. Whenever someone has a cut and it is squeezed and the extract dropped on the cut the bleeding stops immediately. i.e for people whose blood does not clot well, so, it is used to arrest bleeding\u0026rdquo;.\u003c/em\u003e (Male participant, urban)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026lsquo;Egbaroko\u0026rsquo; khaya ivorensis is a blood supplier. If you collect it and bring out the extract by crushing it, mix it with malt, it gives blood very well, so it is used to treating people with symptoms of anemia.\u003c/em\u003e (Male participant, rural)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003cp\u003eii. Use for chronic diseases\u003c/p\u003e\n \u003cp\u003eA lot of the participants also, utilized CAM products for non-communicable diseases, such as arthritis, hypertension, and diabetes. Most of them, particularly, the rural participants used it to treat arthritis. Some of the participants gave specific details regarding the CAM they used in treating these medical conditions in the following remarks:\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003cp\u003eArthritis\u003c/p\u003e\n \u003cp\u003eThe commonest non-communicable disease being treated using CAM especially among the participants was arthritis. This was emphasized more by participants in the rural communities.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Arthritis was a major problem to me, but after my son took me to where I did \u0026lsquo;acupuncture\u0026rsquo; and thereafter, started using forever living product, I have not been having that challenge again. I can even climb my staircase these days unlike when I was using \u0026lsquo;oyibo\u0026rsquo; medicine (orthodox medication) from the chemist (patent medicine vendor).\u0026rdquo;\u003c/em\u003e (Female participant rural)\u003c/p\u003e\n \u003c/div\u003e\u003cspan\u003e\n \u003cp\u003ea. Diabetes mellitus\u003c/p\u003e\n \u003c/span\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe next disease after arthritis, was diabetes mellitus. However this was more pronounced among the urban participants.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I have been a diabetic for a long time and what has been very good at controlling my sugar level has been an herbal product which I prepare by myself. It is made up of scent leaf, bitter leaf, pumpkin leafs squeezed together and the extract filtered into a pot for boiling. After cooling, I take it morning and night.\u0026rdquo;\u003c/em\u003e (Male participant, urban)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003cp\u003eb. Hypertension\u003c/p\u003e\n \u003cp\u003eA few of the participants also remarked on the use of CAM for the management of hypertension\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I was on an antihypertensive and it was really giving me concern as I always had severe headache while taking the medicine. However, a friend introduced me to the use of olive oil, which I use now as it controls my blood pressure.\u003c/em\u003e (Female participant, urban)\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003cp\u003eiii. Use for health promotion and wellbeing\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eFurther, many participants highlighted the role of CAM in promoting overall health and wellbeing, beyond just treating specific diseases. The participants explained that herbs could be used to maintain good health. A participant made his views known in the following statement:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;There is this herb or vegetable we call \u0026lsquo;Ugu\u0026rsquo;, Telfairia occidentalis. If it is collected, and boiled with water, add tomatoes and mix. It helps to keep someone healthy.\u0026rdquo; Anyone who takes it regularly will hardly become sick.\u003c/em\u003e (Male participant, rural)\u003c/p\u003e\n \u003c/div\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e2. Preference for CAM\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003cp\u003ei. Belief in CAM effectiveness\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eThe commonest non-medical reasons, particularly among the urban participants, for the preference of CAM in disease treatment is the belief in its effectiveness.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I wake every morning, I collect uvuru (Nauclea latifolia). There was a time I had headache and fever and I realized that all the drugs from the chemist was not helping me, so I resorted to uvuru and it took care of my health. I do it every early morning. I buy fifty naira uvuru and drink.\u003c/em\u003e (Male participant, urban)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Ginger and honey are also important, any cough that has resisted drugs cannot resist ginger and honey mixed and taken together. They clear all types of cough very well\u0026rdquo;.\u003c/em\u003e (Female participant, rural)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;There is a plant called \u0026lsquo;Ahuji\u0026rsquo;, (scent leaf) that can cure what conventional/orthodox medicine or drugs can\u0026apos;t cure. If the leaf is chewed, it will bring out the real symptoms of what is happening to you and then cure the disease in a wonderful way\u0026rdquo;.\u003c/em\u003e (Male participant, urban)\u003c/p\u003e\n \u003cp\u003eThe view that CAM products were more effective than orthodox medicine was supported by a participant in the rural study group, who even asserted that he had stopped taking orthodox medicine because of his past experience with it. He expressed his sentiments in the following manner:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I don\u0026rsquo;t take orthodox medicine. I depend so much on alternative drugs because that is what has kept me alive today, with God helping me. I had an ailment that threatened my life, and I had up to four investigations in a hospital, while my health deteriorated. It was this alternative medicine that finally cured me of the ailment.\u0026rdquo;\u003c/em\u003e (Male participant, rural)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eHowever, one of the participants in the urban community had a different opinion on the effectiveness of CAM. He argued that orthodox medicine was more effective than CAM, but that his ability to seek treatment was based on his financial capability which affects his health seeking behaviour. He made known his thoughts this way:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;I know that orthodox medicine work very well even in comparison with some alternative medicine, but the main reason for going for alternative medicine is due to lack of money. If you are sick and you have money obviously you will go to a hospital. Whatever they (health providers) tell you to do, you do, and you will be okay; if it is orthodox medicine, it works sharp, sharp\u0026rdquo;\u003c/em\u003e (Male participant, urban).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003cp\u003eii. Perceived lower cost of CAM\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eConversely, most of the rural participants cited lower cost of CAM as the major reason for opting for CAM treatment. Typical responses from the participants were:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;There is an extent to which an illness could disturb one, and you don\u0026rsquo;t have money, you go to the village and collect leaves around you and cook. So, there are times one resorts to alternative medicine due to lack of money\u0026rdquo;\u003c/em\u003e (Female, participant rural)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;My last comment or word concerning this thing we have discussed now, is that our people say that, \u0026lsquo;a normal person does not expose his eyes to fire\u0026rsquo;. Money is just the challenge. If there is money, even common headache will make one go to the hospital, but if you don\u0026rsquo;t have money you come home and sort yourself out with alternative medicine which costs little or nothing,\u0026rdquo;\u003c/em\u003e (Male, participant rural)\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003cp\u003eiii. Delay in hospital diagnoses/treatments\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eOther important reasons given for the preference of CAM use to orthodox medicine in treatment of diseases were \u0026ldquo;delay in hospital diagnoses/treatments\u0026rdquo; and the belief that \u0026ldquo;CAM products act more rapidly than orthodox medicines.\u0026rdquo; These viewpoints were expressed by urban and rural respondents respectively. Their perspectives were presented in the following quotes:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;If you go for orthodox medicine, especially in the hospital, they will ask for test (laboratory investigations), the result of which may take time to come out, sometimes, even days, but if it is alternative medicine, no time is wasted; just bring certain leaves (herbs), prepare them and take, and you will be cured.\u0026rdquo;\u003c/em\u003e (Female participant, urban).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;A sister, in fact that man\u0026rsquo;s wife, (pointing at a participant) was sick and nearly died. We went to the teaching, hospital, they did not do much, but kept giving one appointment after the other, eventually, we got alternative medicine which the woman took, and she is now healthy\u0026rdquo;.\u003c/em\u003e (Male participant, urban)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n \u003cp\u003eiv. Belief that \u0026ldquo;CAM products act more rapidly than orthodox medicines\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Let me say something on another reason for using it (CAM). It is not just because it is cheap or because we do not have money, but also, because it (CAM) is faster in action when compared to the other (orthodox) medicine. Just like what this woman said, somebody can go to hospital many times for an issue, without any improvement. So, for me, it is about the very rapid action of CAM that I use them\u0026rdquo;.\u003c/em\u003e (Female participant, rural)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes people would go to hospital severally for a particular issue without any improvement, then they will resort to alternative medicine and get well. That is what makes people to go for CAM\u0026rdquo;\u003c/em\u003e (Female participant, rural)\u003c/p\u003e\n \u003c/div\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e3. Belief in the spiritual origins of diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\n \u003cp\u003ei. Belief in rituals as solution to some spiritual conditions\u003c/p\u003e\n \u003cp\u003eMoreover, few participants believed that certain diseases had spiritual origins and were better treated with some forms of CAM, such as rituals. Here are the expressions of these participants:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Last week, I was sick, and I was prepared to go to hospital but was hindered by some obstacles. I coughed and there was blood in my sputum. I met a herbalist that gave me \u0026lsquo;Nka\u0026rsquo; to chew. I chewed it and got healed.\u0026rdquo;\u003c/em\u003e (Male, participant, urban)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;There are some symptoms you will have, and it will not be wise to rush off to a hospital. In such a situation, it will be better to first of all, take some local medicine and rule out some spiritual diseases.\u0026rdquo;\u003c/em\u003e (Female, participant, urban)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\n \u003cp\u003eii. Belief in prayer as sole remedy for some spiritual conditions\u003c/p\u003e\n \u003cp\u003eHowever, two participants hinted that certain health conditions were only amenable to prayers. Their views were captured thus:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes, both CAM products and conventional medicine will fail, and only prayer will be used to cure the disease concerned. You can also, say only prayer and you get cured/relieved.\u0026rdquo;\u003c/em\u003e (Female participant, urban)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;What I am saying is that sometimes poison can resist all manner of drugs,(both orthodox and CAM), but if you go for prayers, you receive your healing.\u0026rdquo;\u003c/em\u003e (Male participant, rural)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived dangers of conventional therapy for a spiritual condition\u003c/strong\u003eSome participants expressed the view that administering orthodox medicine, particularly injections to patients with such diseases would result in their death.\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;That thing called \u0026lsquo;oke ezenwu\u0026rsquo;, (a disease condition) is not cured in the hospital. Some people with the condition, may go to a hospital without knowing that they have the disease. If they take orthodox medicine, they will die from the disease. It is only \u0026lsquo;Igbo\u0026rsquo; medicine (referring to herbs) that cures the sickness, perhaps with ritual performance.\u0026rdquo;\u003c/em\u003e (Male, participant, rural)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;It is not every disease that is cured with modern medicine. For example, there is a particular boil (furunculosis) that can be on the body or inside the body, if somebody with it mistakenly goes to a hospital or chemist and is given injection, the person will simply die.\u0026rdquo;\u003c/em\u003e (Male, participant, urban)\u003c/p\u003e\n \u003c/div\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e4. Safety concerns about CAM\u003c/strong\u003e\u003c/p\u003e\n \u003c/span\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\n \u003cp\u003ei. Lack of information on dosing and directions for safe use\u003c/p\u003e\n \u003cp\u003eDespite the widespread use of CAM among both the urban and rural participants, and the various views expressed in support of the preference for its use, most of the participants in the study agreed that there were crucial issues surrounding the safety of some of the CAM products, particularly, the unprocessed herbal preparations. They opined that most CAM products had no information on dosage, potential side-effects, and directions for safe use. A rural participant made his point in this quote:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;The challenge is that most CAM products don\u0026rsquo;t have dosage, especially the local herbs or direction on usage. One just takes it anyhow, but if it were the orthodox medicine, you know what quantity at any point in time, and even if you don\u0026rsquo;t know how to read, someone can help you with the written prescription.\u0026rdquo;\u003c/em\u003e (Male participant, rural)\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eTwo urban participants declared that they did not take alternative medicine because of CAM products had no dosages. One of the participants even went further to advocate that herbs should not be taken. Their views are captured thus:\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;What I am saying is that anything that doesn\u0026rsquo;t have dosage should not be taken because those alternative medicines are just, O\u0026rsquo; God help me, (Laughs). You don\u0026rsquo;t have information on what you take or how much of it to take.\u0026rdquo;\u003c/em\u003e (Male participant, urban)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;This issue of alternative medicine; there are people who take it but we can\u0026rsquo;t say if it is good or not, but I don\u0026rsquo;t take it because it doesn\u0026rsquo;t have dosage. That is why I don\u0026rsquo;t take it.\u0026rdquo;\u003c/em\u003e (Male participant, urban)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\n \u003cp\u003eii. Potential side-effects\u003c/p\u003e\n \u003cp\u003eOther adverse effects attributed to CAM by the participants were liver or other gastro-intestinal problems, renal pathology and even death associated with the use of some form of CAM.\u003c/p\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;There are some alternative medicines, such as the one called \u0026lsquo;Nchala\u0026rsquo; that causes passage of watery stool on consumption, and if not controlled with something like palm oil it may lead to the death of the person.\u0026rdquo;\u003c/em\u003e (Female participant, rural)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Alternative medicine can cause liver problem because it does not have dosage guide. No instruction on how to use it; some have taken it and had their abdomen swollen due to liver or kidney damage\u0026rdquo;\u003c/em\u003e (Male participant, urban).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the use of complementary and alternative medicine among the elderly in communities in Ebonyi State, Southeast Nigeria. It showed that almost all the participants believed that there are health benefits associated with the use of CAM. This is similar to findings from a study in Australia [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This widespread belief underscores the importance of CAM in the healthcare landscape and suggests a high level of acceptance and trust in its potential efficacy among the participants. In contrast, a study in Enugu, south east Nigeria observed that only a quarter of the respondents could describe specific benefits from the use of CAM [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This discrepancy might be due to differences in the methodologies of the studies.\u003c/p\u003e \u003cp\u003eThe finding that the commonest condition for which CAM is used is febrile illness, ranging from malaria, and typhoid fever to hepatitis is contrary to the results from a study in Saudi Arabia, which reported musculoskeletal disorders, cardiac problems, and neurological problems as the primary health reasons for CAM use among the elderly [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The difference in findings may be due to variations in disease patterns between the regions, and this may be attributed to various factors, including environmental conditions, and access to healthcare services. In regions, such as the study area where infectious diseases are endemic or where access to conventional healthcare is limited, individuals may turn to CAM for managing acute illnesses such as febrile conditions. On the other hand, in more developed regions with aging populations, chronic conditions like musculoskeletal disorders and cardiovascular diseases may be more prevalent, driving the utilization of CAM for symptom management and holistic care.\u003c/p\u003e \u003cp\u003eThe findings from our study suggest that the elderly commonly turn to CAM due to two primary non-medical reasons which are belief in its effectiveness, and lower costs. These findings further affirm an earlier study in another part of the state which reported that most older persons preferred alternative medicine to conventional medicine due to presumed efficacy and cost among other factors [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Also, the findings are consistent with similar studies conducted in Bangladesh, and Germany [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The belief in the effectiveness of CAM reflects a common perception among the elderly population that these modalities offer therapeutic benefits beyond those provided by conventional medicine. This belief may stem from personal experiences, or cultural traditions, as many older adults have lifelong experience with alternative medicine due to unavailable conventional care during their childhood [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In addition, the perception of lower costs associated with CAM aligns with global trends of seeking more affordable healthcare options, particularly among older adults who may be facing financial constraints.\u003c/p\u003e \u003cp\u003eAnother rationale for the use of CAM by the elderly as observed from our study is dissatisfaction with conventional health service delivery. There was a perception among most of the participants that there is poor quality of care in orthodox healthcare settings, such as delay in diagnoses and treatments. Such people believe that traditional healthcare services are quicker, and that CAM products act more swiftly compared to orthodox medicines. This further affirms the findings from previous studies in sub-Saharan Africa that one of the major reasons for non-use of health facilities is poor quality of care coupled with attendant delays in accessing care, often attributed to drug and equipment shortages, under-staffing, or poor infrastructure and poor attitudes among health workers. [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurther, few of the participants believed that certain diseases have spiritual origins and were better treated with some forms of CAM, such as rituals. Earlier studies in different parts of the country reported that certain disease conditions are considered incurable with western medicine because of belief in their spiritual origins and, as such, are only treated with alternative medicine [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This finding is not unique to Nigeria, but was also reported in various parts of both the developed and the developing nations [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This finding reflects a cultural and religious perspective on health and illness that is common in many societies. The notion that certain diseases can only be addressed through alternative therapies due to their spiritual origins underscore the complexity of health beliefs and practices in the region. In Nigeria, several people believe that prayer alone can effectively address all their challenges, including sickness. As a result, a large number of people attend miracle healing services seeking relief from various health conditions [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. This highlights the significant influence of religious beliefs on health-seeking behaviours, and the need to understand them in healthcare provision.\u003c/p\u003e \u003cp\u003eIn spite of the widespread use of CAM among the participants, few participants raised concerns about lack of appropriate dosing and potential side effects. The finding is similar to a previous study carried out in Lagos, southwest Nigeria, and this suggests that the issue may not be an isolated one, but rather reflects a broader pattern across different regions of the country [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This lack of dosing could potentially lead to misuse or overuse of alternative therapies, which in turn may increase the risk of adverse effects. Thus, efforts should focus on promoting evidence-based practices, and strengthening regulatory measures to ensure the safe and effective use of alternative therapies.\u003c/p\u003e \u003cp\u003eThe major limitation of this study is that it is not easy to generalize since this is a qualitative study. However, the use of FGD enabled an in-depth exploration of the perspectives of older persons in the communities, while data synthesis was based on Leventhal\u0026rsquo;s self-regulatory model which provided a theoretical framework for understanding the use of CAM among the elderly. Future research should explore the efficacy and safety of CAM therapies and their integration into mainstream healthcare practice.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study findings indicate a strong belief among participants in the benefits of complementary and alternative medicine which they believe offer both medical and non-medical advantages. The use of CAM was prevalent among the participants particularly for managing febrile illnesses like malaria, typhoid, and hepatitis, as well as for other health conditions, such as respiratory, haematological and chronic conditions. Their preference for CAM were influenced by factors, such as perceived effectiveness, cost advantages compared to conventional medicine, delays in hospital treatments and belief in the spiritual origins of diseases. Despite the perceived benefits of CAM, safety concerns were also raised by the participants. These include lack of information on dosing, directions for safe use, and potential side effects associated with CAM therapies. The findings underscore the interplay of beliefs, preferences, and safety considerations surrounding the use of CAM among the participants. Efforts to enhance education and awareness about CAM, improve access to reliable information, and ensure the safe and effective use of CAM therapies are crucial for supporting the health and well-being of older persons who choose to incorporate CAM into their healthcare practices.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eCAM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003eComplementary and alternative medicine\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFGDs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003eFocus group discussions\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSRM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003eself-regulatory model\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQDA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/em\u003eQualitative data analysis\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome of the data generated or analysed during this study are included in this published article. Additional data are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChibuike Innocent Agu and Edmund Ndudi Ossai contributed to the study conception and design. All the authors participated in the material preparation, data collection and analysis. The first draft of the manuscript was written by Chibuike Innocent Agu. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003cbr\u003eEthical approval for the study was obtained from the Health Research and Ethics Committee of Alex-Ekwueme Federal University Teaching Hospital, (AEFUTA) Abakaliki with approval number 19/111/2019-13/01/2020. Participation was voluntary and participants were not coerced into participating in the study. The participants were required to sign or thumb print to a written informed consent before the interview. However, before signing, participants were informed of the objectives of the study, its relevance and the methods that would be used for data collection. Privacy and confidentiality were assured, and data collected were anonymised as codes were used.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWorld Health Organization (WHO). WHO Traditional Medicine Strategy 2014-2023. World Heal Organ [Internet]. 2013 [cited 2019 Mar 15];1\u0026ndash;76. Available from: www.who.int\u003c/li\u003e\n \u003cli\u003eKasilo OM, Trapsida J-M MN. An Overview of the Traditional Medicine Situation in the African Region | African Health Observatory [Internet]. African Heal. Monit. 2010 [cited 2019 Apr 19]. p. 7\u0026ndash;15. 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Available from: http://www.ncbi.nlm.nih.gov/pubmed/24803945\u003c/li\u003e\n \u003cli\u003eLi S, Odedina S, Agwai I, Ojengbede O, Huo D, Olopade O. Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. BMC Complement Med Ther. 2020;20:93.\u003c/li\u003e\n \u003cli\u003eNational Center for Complementary and Integrative Medicine. collections.html - U.S. National Library of Medicine Collection Development Manual. [cited 2019 Mar 16]; Available from: https://www.nlm.nih.gov/tsd/acquisitions/cdm/subjects24.html\u003c/li\u003e\n \u003cli\u003eAdesola BO, Emmanuel GO, Matthew AS, Adewumi AO, Oluseyi AI, Toyin EO. Complementary and Alternative Medicine Usage Among Patients Attending a Tertiary Hospital in Nigeria. 2017;2:111\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003ePitetti R, Singh S, Hornyak D, Garcia S, S H. Complementary and alternative medicine use in children. 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A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM Use. 2010 [cited 2019 Apr 16];7:11\u0026ndash;28. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18955327\u003c/li\u003e\n \u003cli\u003eEliopoulos C. Complementary and Alternative Therapies in Geriatric Care. Medscape Nurse [Internet]. 2006; Available from: https://www.medscape.com/viewarticle/542207\u003c/li\u003e\n \u003cli\u003eMorrissey A, O\u0026rsquo;Neill A, O\u0026rsquo;Sullivan K, Robinson K. Complementary and alternative medicine use among older adults with musculoskeletal pain: findings from the European Social Survey (2014) special module on the social determinants of health. Br J Pain. 2022;109\u0026ndash;118.\u003c/li\u003e\n \u003cli\u003eNess J, Cirillo D, Weir D, Nisly N, Wallace R. Use of complementary medicine in older Americans: Results from the health and retirement study. Gerontologist. 2005;45:516\u0026ndash;24.\u003c/li\u003e\n \u003cli\u003eIlori OS, Olakunlehin O, Ilori OR, Awodutire PO, Ugwuoke C, Shittu O. Safety perception and determinants of complementary and alternative medicine usage among surgery out-patients in LAUTECH Teaching hospital, ogbomoso, Nigeria. Heliyon. 2024;10:e24835.\u003c/li\u003e\n \u003cli\u003eJamshed S, Min C, Siddiqui M, Verma R. Role of complementary and alternative medicine in geriatric care: A mini review. Pharmacogn Rev [Internet]. 2014 [cited 2019 Mar 13];8:81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25125879\u003c/li\u003e\n \u003cli\u003eEliopoulos C. Integration of Complementary and Alternative Therapies in Geriatric Care [Internet]. 2006 [cited 2019 Nov 8]. Available from: https://www.medscape.com/viewarticle/542207\u003c/li\u003e\n \u003cli\u003eEffoe V, Suerken C, Quandt S, Bell R, Arcury T. The Association of Complementary Therapy Use With Prescription Medication Adherence Among Older Community-Dwelling Adults. J Appl Gerontol. 2015;36:1054\u0026ndash;69.\u003c/li\u003e\n \u003cli\u003eAdams J, Lui C-W, McLaughlin D. The use of complementary and alternative medicine in later life. Rev Clin Gerontol [Internet]. 2009 [cited 2019 Mar 13];19:227. Available from: http://www.journals.cambridge.org/abstract_S0959259809990360\u003c/li\u003e\n \u003cli\u003eMbam K, Halvorsen C, Okoye U. Aging in Nigeria: A Growing Population of Older Adults Requires the Implementation of National Aging Policies. Gerontologist. 2022;62:1243\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eArcury T, Grzywacz J, Bell R, Neiberg R, Lang W, Quandt S. Herbal Remedy Use as Health Self-Management among Older Adults. J Gerontol Soc Sci. 2007;62B.\u003c/li\u003e\n \u003cli\u003eEmma-Echiegu N, Mbam E. Experiences of older adults in healthcare choice: voices from Igbeagu, Izzi local government area, Ebonyi state Nigeria. J Psychol Sociol Stud 2. 2017;1:115\u0026ndash;32.\u003c/li\u003e\n \u003cli\u003eOh B, Butow P, Mullan B, Beale P, Pavlakis N, Rosenthal D, et al. The use and perceived benefits resulting from the use of complementary and alternative medicine by cancer patients in Australia. Asia. Pac. J. Clin. Oncol. 2010. p. 342\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eTangkiatkumjai M, Boardman H, Walker D. Potential factors that influence usage of complementary and alternative medicine worldwide: a systematic review. BMC Complement Med Ther. 2020;20.\u003c/li\u003e\n \u003cli\u003eAbout Ebonyi State | Ebonyi Online [Internet]. [cited 2019 Dec 29]. Available from: https://www.ebonyionline.com/about-ebonyi-state/\u003c/li\u003e\n \u003cli\u003eThe National Literacy Survey Media \u0026amp; Marketing Communications Company Group National Commission For Mass Literacy, Adult And Non Formal Education [Internet]. 2010. Available from: www.nigerianstat.gov.ng\u003c/li\u003e\n \u003cli\u003eEbonyi (State, Nigeria) - Population Statistics, Charts, Map and Location [Internet]. [cited 2020 Jan 4]. Available from: https://www.citypopulation.de/php/nigeria-admin.php?adm1id=NGA011\u003c/li\u003e\n \u003cli\u003eWhat is the Pharmacist\u0026rsquo;s Role in Assessing CAM Use? [Internet]. [cited 2020 Jul 26]. Available from: https://www.pharmacytimes.com/resource-centers/vitamins-supplements/what-is-the-pharmacists-role-in-assessing-cam-use\u003c/li\u003e\n \u003cli\u003ePrevalence, Cost, and Patterns of CAM Use - Complementary and Alternative Medicine in the United States - NCBI Bookshelf [Internet]. [cited 2020 Jul 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83794/\u003c/li\u003e\n \u003cli\u003eEzeome ER, Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complement Altern Med [Internet]. 2007 [cited 2019 Apr 15];7:28. Available from: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-7-28\u003c/li\u003e\n \u003cli\u003eAljawadi MH, Khoja AT, AlOtaibi AD, Alharbi KT, Alodayni MA, AlMetwazi MS et al. The Utilization of Complementary and Alternative Medicine among Saudi Older Adults: A Population-Based Study. Evidence-Based Complement Altern Med [Internet]. 2020; Available from: https://www.hindawi.com/journals/ecam/2020/4357194/\u003c/li\u003e\n \u003cli\u003eSchnabel K, Binting S, Witt CM, Teut M. Use of complementary and alternative medicine by older adults \u0026ndash; a cross-sectional survey. BMC Geriatr [Internet]. 2014 [cited 2019 Mar 13];14:38. Available from: http://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-14-38\u003c/li\u003e\n \u003cli\u003eShahjalal Md, Gow J, Rahman MdA, Hossain MdJ, Khan MdNA, Alam MdS et al. Proportion and associated factors of the utilisation of complementary and alternative medicine exclusively in a hospital in Bangladesh. BMC Complement Med Ther. 2022;22:1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eOshikoya KA, Senbanjo IO, Njokanma OF, Soipe A. Use of complementary and alternative medicines for children with chronic health conditions in Lagos, Nigeria. BMC Complement Altern Med [Internet]. 2008 [cited 2019 Mar 19];8:66. Available from: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-8-66\u003c/li\u003e\n \u003cli\u003eEzeome E. Delays in presentation and treatment of breast cancer in Enugu, Nigeria. Niger J Clin Pract. 2010;13:311\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eFantaye A, Okonofua F, Ntoimo L, Yaya S. A qualitative study of community elders\u0026rsquo; perceptions about the underutilization of formal maternal care and maternal death in rural Nigeria. Reprod Heal. 2019;16.\u003c/li\u003e\n \u003cli\u003eSumankuuro J, Crockett J, Wang S. Maternal health care initiatives: causes of morbidities and mortalities in two rural districts of upper West region, Ghana. PLoS One. 2017;12:e0183644.\u003c/li\u003e\n \u003cli\u003eAnizoba E. Traditional Igbo Belief in Causes of Disease: An Evaluation. Pharos J Theol online. 2023;104:1\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eKunnuji M, Wammanda R, Ojogun T, Quinley J, Oguche S, Odejimi A, et al. Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria\u0026rsquo;s 2019 VASA. BMC Public Heal. 2022;22:850.\u003c/li\u003e\n \u003cli\u003eQureshi N, Khalil A, Alsanad S. Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh. J Relig Health. 2020;59:845\u0026ndash;869.\u003c/li\u003e\n \u003cli\u003eEkanem S, Asira A. Religion and Medicine in the 21st Century Nigeria. An African J Philos. 2007;9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"complementary and alternative medicine, CAM, older persons, healthcare use, qualitative study, Ebonyi State, southeast Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-4508284/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4508284/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAlthough complementary and alternative medicine is popular among older people, there is limited understanding of its use within this subpopulation. This study aimed to explore the perceptions of older people in the communities of Ebonyi State regarding the use of complementary and alternative medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eQualitative data were collected through the use of focus group discussions (FGDs), from four communities two each from urban and rural areas of Ebonyi state, Nigeria. A total of 12 FGDs involving 96 participants were conducted. A thematic analysis of data was performed with the aid of NVivo software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eAlmost all participants expressed a belief in the inherent benefits of\u003cstrong\u003e \u003c/strong\u003ecomplementary and alternative medicine, which were categorized into medical and non-medical reasons. Febrile illnesses, including malaria, typhoid fever, and hepatitis; respiratory; haematological; and dermatological conditions were reported as common health conditions for which participants used CAM. Additionally, participants mentioned using CAM for chronic conditions, such as diabetes mellitus, hypertension, and arthritis, as well as for health promotion and wellbeing. Preferences for CAM were influenced by beliefs in its effectiveness, perceived lower cost compared to conventional treatments, delays in hospital diagnoses and treatments, and belief in the spiritual origins of diseases. Safety concerns regarding CAM use included a lack of information on dosing, directions for safe use, and potential side effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThe study findings indicate a strong belief among participants in the benefits of complementary and alternative medicine which they believe offer both medical and non-medical advantages. However, despite these perceived benefits, safety concerns were also raised by the participants. Efforts to promote education and awareness about CAM, improve access to reliable information, and ensure the safe and effective use of CAM therapies are crucial for supporting the health and well-being of older persons who choose to incorporate CAM into their healthcare practices.\u003c/p\u003e","manuscriptTitle":"Examining the use of complementary and alternative medicine among older persons in Ebonyi State, southeast Nigeria: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-26 03:41:04","doi":"10.21203/rs.3.rs-4508284/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-05T09:41:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-04T11:43:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-04T11:42:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2024-05-31T10:33:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ff0cefee-35ad-49f8-8b74-684c6aa34a47","owner":[],"postedDate":"July 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-17T16:10:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-26 03:41:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4508284","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4508284","identity":"rs-4508284","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}