Student nurses, midwives and health visitors' attitudes, knowledge, and experience of complementary and alternative medicine in Hungary

1 S uden nu ses, midwi es and heal h isi o s' a i udes, knowledge, and expe ience o complemen a y and al e na i e medicine in Hunga y And ea Sá á ya*, Lí ia Hajduné Demcsákb, Sándo né Radób, Pé e Takácsc, A ila Sá á yb aDepa men o Psychology, Facul y o Heal h, Uni e si y o Deb ecen, Hunga y pos al add ess: Facul y o Heal h, Uni e si y o Deb ecen, 4400 Nyí egyháza, Sós ói u. 2-4., Hunga y bDepa men o Nu sing Science, Facul y o Heal h, Uni e si y o Deb ecen, Hunga y pos al add ess: Facul y o Heal h, Uni e si y o Deb ecen, 4400 Nyí egyháza, Sós ói u. 2-4., Hunga y cDepa men o Heal h In o ma ics, Facul y o Heal h, Uni e si y o Deb ecen, Hunga y pos al add ess: Facul y o Heal h, Uni e si y o Deb ecen, 4400 Nyí egyháza, Sós ói u. 2-4., Hunga y E-mail add esses: sa a y.a[email p o ec ed]ideb.hu (A. Sá á y), hajdune.demcsak.li [email p o ec ed]eb.hu (L.H. Demcsák), ado.sando ne@ oh.unideb.hu (S. Radó), akacs.pe e @ oh.unideb.hu (P. Takács), sa a y.a [email p o ec ed]deb.hu (A. Sá á y) *Co esponding au ho : And ea Sá á y e-mail add ess: sa a y.and[email p o ec ed]deb.hu, pos al add ess: Facul y o Heal h, Uni e si y o Deb ecen, 4400 Nyí egyháza, Sós ói u. 2-4., Hunga y phone numbe : +36 42 404411/147 2 Abs ac In oduc ion: Complemen a y and al e na i e medicine (CAM) has become an impo an pa o heal hca e. This s udy aimed o compa e h ee g oups o heal h ca e s uden s' a i udes owa ds, knowledge o , pe sonal use o , and opinions abou he in eg a ion o CAM in o highe educa ion and heal h ca e in Hunga y. Compa isons we e made be ween hose pa icipa ing and hose who did no pa icipa e in a Complemen a y Medicine (CM) cou se as an op ional cou se du ing s uden aining. Me hods: A su ey o he 314 ull ime s uden s (nu ses, midwi es and heal h isi o s) we e asked o ake pa in an online su ey using a sel -comple e ques ionnai e. Da a we e analyzed using desc ip i e s a is ics. Resul s: S uden s' a i udes owa ds CAM we e posi i e. The mos commonly known al e na i e me hods we e massage, elaxa ion, acupunc u e, he bal medicine and medi a ion. The mos commonly pe sonally used and pe cei ed as being e ec i e CAM modali ies we e he bal medicine, massage and elaxa ion. Mos s uden s belie ed ha he in eg a ion o CAM in o highe educa ion and in o heal h ca e is necessa y. The e we e no di e ences in a i udes owa ds CAM be ween s uden s who pa icipa ed and hose who did no pa icipa e in he CM cou se. Pa icipan s conside ed he cou se o be use ul and epo ed highe knowledge abou h ee CAM modali ies and p e e ed o mal educa ion as in o ma ion sou ces. Conclusion: Heal h ca e s uden s a e open o lea ning CAM. Inc easing he numbe o heal h ca e s uden s in he CM cou ses would esul in ensu ing ha u u e heal h ca e p o essionals ob ain eliable knowledge abou CAM p ac ices which may in u n make hei wo k mo e e ec i e. Key wo ds: complemen a y and al e na i e medicine; a i ude; knowledge; nu sing, heal h isi o and midwi e y s uden s; Complemen a y Medicine cou se 3 1.In oduc ion The use o complemen a y and al e na i e medicine (CAM) o a ious heal h p oblems con inues o inc ease wo ldwide [1-5]. I s popula i y is simila o e en highe among pa ien s wi h ch onic illnesses compa ed o he a e age popula ion [1,6,7]. Since 2000s he numbe o e idence based CAM modali ies has d ama ically inc eased al hough e idence gaps s ill exis [8,9]. Howe e , heal h ca e p o ide s may no be awa e o he e idence base and may be ha d p essed o p o ide eliable ad ice o pa ien s and in o m hem abou he a ailable he apeu ic op ions and hei use [10]. Mo eo e , he he apeu ic app oach o heal h p o essions, like nu sing, midwi e y and heal h isi o s ha e been acknowledged as ha ing a mo e holis ic app oach o ca e and welcomed mo e ‘complemen a y’ app oaches o heal h [11,12]. In e na ional esea ch has in es iga ed he knowledge abou CAM and a i udes owa ds CAM among medical, pha macy, nu sing and midwi e y s uden s and di e en heal h p o essionals [10,12-19]. Mos o he s udies ha e shown posi i e a i udes owa ds CAM among heal h ca e s uden s, bu di e ences we e ound be ween gende s, among yea s and special ies o he s uden s [14-17]. P e ious s udies ha e also explo ed nu ses’ a i udes owa ds CAM, hei knowledge abou i and i s p o essional use. Nu ses’ a i udes abou CAM ha e been gene ally posi i e bu hei knowledge p o ed o be poo abou he use o CAM modali ies he e o e hey el hey could no gi e c edible in o ma ion and ad ice conce ning CAM modali ies [10,18- 21]. Since heal h ca e p o ide s play an impo an ole in he educa ion o he pa ien s, a high demand has eme ged o educa ional ins i u ions o heal h ca e wo ke s o each his discipline. The medical and heal h ca e educa ional o ganiza ions and ins i u ions ecognized he inc easing demand o CAM and i s in eg a ion in o he cu iculum. Di e en o ganiza ions de eloped ecommenda ions and co e cu iculum o highe ins i u ions in he USA. Fo example, he Socie y o Teache s o Family Medicine G oup on Al e na i e Medicine de eloped a cu iculum guideline [22] and he Educa ion Wo king G oup o he Conso ium o Academic Heal h Cen e s o In eg a i e Medicine published a lis o co e compe encies o in eg a i e medicine o medical uni e si ies de eloped by 23 academic heal h cen e s [23]. The Ame ican Associa ion Colleges o Nu sing in he co e cu iculum ou lined in 1998 also included he main elemen s o CAM desi ed o in eg a e i o he cu iculum. [24]. As ea ly as 1999, he suppo he in eg a ion o CAM in o he educa ion he Na ional Ins i u e o Heal h and he Na ional Cen e o Complemen a y and Al e na i e Medicine (now Na ional Cen e o Complemen a y and In eg a i e Medicine - NCCIM) unded 14 highe ins i u ions o pe o m such p og ams [25]. I is impo an o no e ha since 2015 he NCCIM has been using he e m Complemen a y Heal h App oach ins ead o Complemen a y and Al e na i e Medicine. P e ious s udies e ealed ha he e was no di e ence conce ning he need o he in eg a ion o CAM in o he cu iculum among s uden s [15,16]. In a s udy om Tu key compa ing nu sing and medical s uden s’ knowledge and a i ude owa ds CAM showed signi ican di e ence be ween he wo g oups bo h in in eg a ion o CAM in o clinical p ac ice (57.8% s. 32.6%) and in o cu iculum (61.3% s. 37.9%) wi h he highe a e o nu ses [13]. Howe e , hese esul s we e no s eng hened by ano he s udy ca ied ou a se en acul ies o medicine co e ed all egion o Tu key [14]. Acco ding o he esul s o his s udy, medical s uden s wi h high a e belie ed ha CAM should be included in he cu iculum, knowledge o CAM would be use ul in hei p o essions, and doc o s should be amilia wi h CAM me hods [14]. These esul s we e also suppo ed by a s udy om Kuwai [15]. 4 Du ing he e a o socialism in Hunga y only some ypes o CAM we e ole a ed (e.g. he bal medicine). Di e en ypes o CAM appea ed a he end o he 1980s and since he change o he egime a apid inc ease has occu ed in his ield. The ma ke ela ing o CAM was uncon olled o a long ime and he egula ion o CAM en e ed in o o ce only in 1997 [26]. The dec ee (11/1997 (V. 28) NM end.) lis s he ypes o non-con en ional he apies and de e mines which ones can be pe o med by medical doc o only (e.g. manual he apies, T adi ional Chinese Medicine, neu al he apies) o by o he g adua ions (e.g. acup essu e, e lexology). Al hough he educa ion o he T adi ional Chinese Medicine s a ed in 1987 a a medical uni e si y, he in oduc ion o op ional cou ses o some ypes o CAM did no begin un il he end o he 1990s in o he medical uni e si ies [26]. In Hunga y, he educa ion o heal h isi o s (s a ed in 1975) and midwi es (s a ed in 2004) is a BSc le el in highe educa ion. Nu sing s uden s’ educa ion is a h ee di e en le els: a oca ional school, in highe educa ion a BSc (s a ed in 1989) and a MSc le el (s a ed in 2010). Heal h isi o s a e p e en i e p o essionals, who ca e o child en un il 18 yea s. They wo k in dis ic s wi h close connec ions wi h pedia ic amily doc o s/gene al p ac i ione s o in schools. Using CAM he apies heal h ca e p o ide s ha e a good oppo uni y o p ess pa ien s o ake pa in hei ca e and healing p ocess ac i ely [10,12]. Thus he knowledge o CAM has become e y impo an o nu sing p ac ice [12] and o he p ac ice o o he heal h p o essions. A he Uni e si y o Deb ecen, Facul y o Heal h he educa ion o CAM o nu ses and heal h isi o s and la e on o midwi es also s a ed in 1995 i led Complemen a y Medicine cou se. The e is only limi ed da a conce ning he use o CAM in Hunga y. Two na ional ep esen a i e su eys showed a signi ican inc ease in isi ing CAM p ac i ione s om 6.6% o 23.9% om 1991 o 1999 [27,28]. Howe e , based on he da a om he na ional ep esen a i e heal h su eys in 2000, only a small numbe o he Hunga ian popula ion consul ed CAM p ac i ione s in he p e ious 12 mon hs (males: 3%, emales: 4%) and his sligh ly inc eased o 2003 (males: 3.6%, emales: 6.1%) [29,30]. I is impo an o no e ha hese a es did no include hose CAM he apies, which we e used as home emedies o sel - ea men . The e was also no dis inc ion be ween hose isi ing physicians who we e also CAM he apis s and hose isi ing only CAM p ac i ione s. The e o e, hese a es may unde es ima e he eal use o CAM and a e no compa able wi h he a o emen ioned na ional da a o wi h he in e na ional da a. In he li e a u e he e ha e been only a ew s udies compa ing a i udes owa ds CAM and i s knowledge in di e en g oups o heal h ca e s uden s [13,16,31], and no su eys we e ound om Hunga y. Nu ses, midwi es and heal h isi o s spend he mos ime wi h pa ien s du ing hei heal h ca e. The e o e he p ima y aim o he esea ch was o in es iga e and compa e nu sing, heal h isi o and midwi e y s uden s’ a i udes and knowledge owa ds CAM, i s pe sonal use and i s pe cei ed e ec i eness. In addi ion, he s udy aimed o e eal he in o ma ion sou ces used by hese s uden s and hei opinions abou he in eg a ion o CAM in o high educa ion as well as heal h ca e sys em in Hunga y. As he hi d aim o he s udy compa isons we e made be ween s uden s who pa icipa ed and hose who did no pa icipa e in he Complemen a y Medicine cou se. 2.Me hods 2.1.S udy Ques ionnai e A c oss-sec ional su ey was designed using a sel -adminis e ed ques ionnai e. The eigh een CAM he apies included we e: T adi ional Chinese Medicine, acupunc u e, homeopa hy, medi a ion, elaxa ion echniques, hypno he apy, Mind Con ol ( elaxa ion echnique), 5 magne s, P ananadi1, Reiki2, he apeu ic ouch, kinesiology, massage, acup essu e, chi op ac ic, e lexology, he bal medicine and non-he bal supplemen s [20]. Some o hese he apies we e selec ed due o hei popula i y in Hunga y. The e m al e na i e medicine was de ined in he ques ionnai e as ollows: ‘a g oup o di e se medical and heal h ca e sys ems, p ac ices, and p oduc s ha a e no gene ally conside ed pa o con en ional medicine, and a e no augh in medical uni e si ies, and a e no used in hospi als and a e no in eg a ed in o he dominan heal h ca e sys em and mos o hem can be p ac iced wi hou ha ing M.D. (medical doc o ) deg ees’ [32,33]. The ques ionnai e was p e- es ed among 8 s uden s o con en , language cla i y, easy o use, and ime equi ed o ill ou he ques ionnai e. Modi ica ions we e made as necessa y in o de ha he ques ionnai e could be simple o answe . 2.1.1.Gene al a i udes owa ds CAM The s uden s’ gene al a i udes owa ds CAM we e measu ed by an i em lis . A e selec ing s a emen s based on o he ques ionnai es [34,35], eigh expe s (six women and wo men) classi ied hem as ollows: i ems accep ed by people cha ac e ized wi h a posi i e and accep ing a i ude owa d CAM (G oup A); hose wi h nega i e ( ejec ing) a i ude (G oup B); and hose ha a e neu al (nei he accep ing no ejec ing) (G oup C). Those i ems we e selec ed in he inal lis , which had been conside ed o cha ac e ize nega i e o posi i e a i ude owa d CAM by all expe s. The inal e sion consis ed o 7 posi i e (see able 2: 1-7 s a emen s) and 5 nega i e s a emen s (see able 2: 8-12 s a emen s). Responses we e gi en on a 7 poin Like - ype scales, anging om 1 (s ongly disag ee) o 7 (s ongly ag ee). 2.1.2.Knowledge o CAM S uden s we e asked o indica e hei knowledge abou each CAM modali y using a 4-poin scale (none, e y li le, some, a lo ). 2.1.3.In o ma ion sou ces S uden s we e asked o indica e sou ces whe e hei knowledge abou CAM comes om by esponding ‘yes’ o ‘no’. The ollowing knowledge sou ce ca ego ies we e gi en: ‘scien i ic jou nals o books’ ‘TV o adio’ ‘ he In e ne ’ ’ o he people ( amily membe s, ela i es, iends)’ ‘newspape s o magazines’ ’ o mal educa ion’, ‘special cou ses’ and ‘heal h ca e ela ed p o essions’. 2.1.4.Pe sonal use and pe cei ed e ec i eness o CAM S uden s we e asked o espond using ‘yes’ o ‘no’ wi h e e ence o 18 CAM p ac ices and i used o assess hei e ec i eness on a 7-poin Like - ype scale anging om 1 (i was comple ely ine ec i e) o 7 (i was comple ely e ec i e). 2.1.5.In eg a ion o CAM in o highe educa ion and heal h ca e sys em S uden s we e asked o indica e how much hey ag ee wi h ou i ems conce ning in eg a ion o CAM modali ies in o unde g adua e cu iculum and heal h ca e sys em on a 7-poin Like - ype scale anging om 1 (s ongly disag ee) o 7 (s ongly ag ee). 2.1.6.E alua ion o Complemen a y Medicine cou se Complemen a y Medicine cou se is a wo semes e op ional cou se, which can be chosen by 2nd, 3 d and 4 h yea s heal h ca e s uden s. The cou se con ains heo y (14 hou s) and p ac ice (28 hou s) in bo h semes e s. Lec u es co e he mos popula and he mos widely used CAM and o he ea men me hods in Hunga y (e.g.: basic o T adi ional Chinese Medicine, he bal medicine, acupunc u e, massage, chi op ac ic, balneo he apy). Du ing his wo semes e cou se 6 s uden s ob ain knowledge abou indica ions and con aindica ions o CAM he apies, abou hei e iciency and abou hei side e ec s. On he p ac ice he eache p esen s he mos equen ly used CAM echniques, e.g. p epa ing me hods and indica ions o he b eas, comp ess and balneo he apy, moxa ea men , manual he apy, acupunc u e and chi op ac ic. The cou se is augh by a physician, acupunc u e p ac i ione , who is esponsible o he con en o he p og am. S uden s we e asked o indica e (‘yes’ o ‘no’) whe he hey had pa icipa ed in he Complemen a y Medicine cou se and how much o i was use ul on a 7-poin Like - ype scale anging om 1 (i was comple ely useless) o 7 (i was comple ely use ul). Fu he , hey we e asked o indica e he app op ia e o m o educa ion o his subjec : op ional, elec i e o compulso y cou se. (Op ional cou se: du ing hei s udies s uden s can eely choose cou ses om a gi en lis o cou ses ha a e no absolu ely ela ed o hei special y. Elec i e cou se: du ing hei s udies s uden s ha e o selec cou ses om a gi en lis o cou ses ha a e connec ed o hei special y.) 2.2.S udy sample The s udy sample consis ed o s uden s in Facul y o Heal h a he Uni e si y o Deb ecen om 1s , 2nd, 3 d and 4 h yea s. The sample was composed o he all ull ime nu sing (124), midwi e y (204) and heal h isi o (196) s uden s (524, emales: 506, males: 18). As he s udy aimed o make compa isons be ween s uden s who pa icipa ed (131) and hose who did no pa icipa e (63) in Complemen a y Medicine cou se 2nd, 3 d and 4 h yea s uden s consis ed a subsample (194). Fi s yea s uden s we e excluded om he subsample, because hey had no possibili y o ake pa in his cou se. 2.3.Da a collec ion The s udy was conduc ed a he Uni e si y o Deb ecen, Facul y o Heal h in Nyí egyháza be ween Ap il and June 2013. The E a-sys online e sion o he ques ionnai e was used in o de o inc ease he e iciency o da a collec ion. Da a collec ion ook place du ing semina s when compu e s we e a ailable o s uden s. S uden s had one occasion o comple e he ques ionnai e. Be o e illing in he ques ionnai e he s uden s we e gi en a b ie desc ip ion o wha he s udy en ailed. The pa icipa ion in he s udy was olun a y. W i en pe mission o p oceed he esea ch was ob ained om he Uni e si y o Deb ecen Facul y o Heal h. 2.4.S a is ical analysis Da a we e e alua ed wi h he help o S a is ical Package o Social Sciences (SPSS) so wa e p og am (Ve sion 22.0). Simila ly o o he s udies [36,37], all Like -scale esponses wi h any deg ee o ag eemen we e g ouped oge he as posi i e esponses, and all esponses wi h any deg ee o disag eemen we e g ouped oge he as nega i e esponses. Fo ins ance, ‘ag eed a li le’ and ‘ag eed mode a ely’ and ‘ag eed s ongly’ (indica ing 5 o 6 o 7 on he Like scale) we e conside ed and g ouped oge he as posi i e esponse. To e alua e esponden s’ a i udes, a scale was de eloped om he 12 s a emen s. Since, he in e nal consis ency o his measu e was ound high (C onbach’s coe icien alpha = 0.851, Gu man λ2= 0.858), his measu e was ound eliable. To summa ize he da a, desc ip i e s a is ics we e used. ANOVA was used o e eal whe he he di e ence o Like scale a e ages is signi ican among nu sing, heal h isi o and midwi e y s uden s. An independen sample T- es was used o e eal whe he he di e ence o Like scale a e ages is signi ican be ween s uden s who pa icipa ed and hose who did no pa icipa e in he Complemen a y Medicine cou se. Simple c oss- abula ions, Chi-squa e es s (Pea son) and Fishe exac es we e used oanalyze di e ences in ag eeing wi h s a emen s, knowledge, pe sonal use, pe cei ed e ec i eness o CAM, in o ma ion sou ces, and opinion abou he in eg a ion o CAM among 7 he h ee g oups o heal h ca e s uden s, and be ween s uden s who pa icipa ed and hose who did no pa icipa e in he Complemen a y Medicine cou se. Resul s we e conside ed o be signi ican when he p alue was less han 0.05. 3.Resul s Th ee hund ed and ou een s uden s ( emales: 299, males: 15) comple ed he ques ionnai e om 1s , 2nd, 3 d and 4 h yea s, gi ing a esponse a e o 59.9% (314/524). Ou s udy sample was ep esen a i e wi h he espec o p opo ions o gende and special ies o s uden s. Responden s consis ed o h ee g oups: 83 (26.4%) nu ses, 126 (40.1%) midwi es and 105 (33.4%) heal h isi o s. Da a we e collec ed om 1s (120, 38.2%), 2nd (74, 23.6%), 3 d (79, 25.2%) and 4 h (41, 13.1%) yea s uden s (Table 1). The mean age was 21.6 yea s ( ange 18- 31). Table 1 Yea and special y cha ac e is ics o he s udy sample Special y o s uden s Yea No (%) To al No (%) 1s 2nd 3 d 4 h nu sing 28 (33.7) 30 (36.1) 23 (27.7) 2 (2.4) 83 (26.4) midwi e y 48 (38.1) 23 (18.3) 35 (27.8) 20 (15.9) 126 (40.1) heal h isi o 44 (41.9) 23 (21.9) 19 (18.1) 19 (18.1) 105 (33.4) To al No (%) 120 (38.2) 76 (24.2) 77 (24.5) 41 (13.1) 314 (100) As o he subsample, one hund ed and hi y one s uden s pa icipa ed in he Complemen a y Medicine cou se om 2nd, 3 d and 4 h yea (131/194, 67.5%): 33 (33/57, 57.9%) nu ses, 48 (48/78, 61.5%) midwi es and 50 (50/59, 84.7%) heal h isi o s. This op ional cou se was he mos popula among heal h isi o s uden s (Table 2). Table 2 Nu sing, Midwi e y and Heal h Visi o S uden s pa icipa ing in he Complemen a y Medicine cou se Yea Pa icipa ing in he Complemen a y Medicine cou se No. Nu sing s uden s Midwi e y s uden s Heal h isi o s uden s o al yes no o al yes no o al yes no 2nd (n=74) 30 14 16 23 6 17 21 14 7 3 d (n=79) 25 17 8 35 24 11 19 19 0 4 h (n=41) 2 2 0 20 18 2 19 17 2 o al (n=194) 57 33 24 78 48 30 59 50 9 3.1.Gene al a i udes owa ds CAM 8 In gene al, all h ee g oups o s uden s’ a i udes we e ound o be posi i e acco ding o he Like scale a e ages: midwi es’ a i udes we e he mos posi i e (Mean (M) = 5.08, s anda d de ia ion (s d) = 0.96), ollowed by heal h isi o s (M = 5.02, s d = 0.92) and nu ses (M = 4.93, s d = 0.77). The e we e no signi ican di e ences in nu sing, heal h isi o and midwi e y s uden s’ a i udes (p=0.511). The e we e no signi ican di e ences (p=0.322) in a i udes be ween he g oups who pa icipa ed in he Complemen a y Medicine cou se (M = 5.3, s d= 0.9) and hose who did no (M = 5.1, s d = 0.8). O e 70% o he s uden s ag eed (Table 3) ha CAM b ings abou an imp o emen in pa ien s’ well-being (232, 74.4%), and conside ed i o be a use ul supplemen o egula medicine (227, 72.3%). Mos s uden s also belie ed ha CAM does ha e impo an esul s (225, 71.9%) and i can p o ide an answe in cases whe e con en ional medicine has no solu ion (223, 71.7%). O e one- hi d o s uden s belie ed ha he esul s o CAM a e in mos cases due o a ’placebo- e ec ’ (118, 37.7%). Fu he mo e, app oxima ely one-qua e o s uden s belie ed ha CAM was dange ous because i aised un ounded hopes and may lead o disappoin men la e (87, 27.7%) and ha pa ien s almos ne e ge be e using only CAM (69, 22.0%). Less han 20% o s uden s conside ed CAM o be dange ous because i inc eases he possibili y o nega i e side e ec s (52, 16.9%) and a mino i y o s uden s ag eed ha ea men wi h CAM modali ies should be o bidden by law (31, 9.9%). The e was a signi ican di e ence be ween nu sing (51, 61.4%), heal h isi o (75, 73.5%) and midwi e y s uden s’ (97, 77.0%) opinions ega ding whe he CAM ea men s can p o ide an answe in cases whe e con en ional medicine has no solu ion (p = 0.045). The e we e no signi ican di e ences in he a i ude s a emen s be ween s uden s who pa icipa ed and hose who did no pa icipa e in he Complemen a y Medicine cou se. Table 3 Nu sing, Heal h Visi o and Midwi e y S uden s’ Gene al A i udes owa ds Complemen a y and Al e na i e Medicine (CAM) S a emen s Ag eed* No. (%) o al No. (%) N = 314 nu ses No. (%) N= 83 heal h isi o s No. (%) N = 105 midwi e s No. (%) N = 126 p 1. CAM b ings abou an imp o emen in pa ien s’ well-being. 232 (74.4) 56 (68.3) 78 (75.0) 98 (77.8) 0.305 2. CAM is use ul supplemen o egula medicine. 227 (72.3) 57 (68.7) 81 (77.1) 89 (70.6) 0.377 3. CAM does ha e impo an esul s. 225 (71.9) 57 (68.7) 75 (71.4) 93 (74.4) 0.662 4. CAM ea men s can p o ide an answe in cases whe e con en ional medicine has no solu ion. 223 (71.7) 51 (61.4) 75 (73.5) 97 (77.0) 0.045 5. I belie e ha CAM may ha e posi i e e ec on gene al heal h ou comes. 209 (67.0) 53 (64.6) 70 (67.3) 86 (68.3) 0.860 6. I belie e in al e na i e app oaches in heal h a ea. 196 (63.0) 50 (61.0) 66 (63.5) 80 (64.0) 0.902 9 7. CAM has ad anced conside ably in ecen yea s in unde s anding o illness and diseases. 168 (53.5) 45 (54.2) 59 (56.2) 64 (50.8) 0.707 8. The esul s o CAM a e in mos cases due o a ’placebo-e ec ’. 118 (37.8) 31 (37.8) 46 (43.8) 41 (32.8) 0.230 9. The inc ease in CAM use is dange ous because i aises un ounded hopes and leads o disappoin men la e . 87 (27.7) 22 (26.5) 27 (25.7) 38 (30.2) 0.724 10. Pa ien s almos ne e ge be e using only CAM. 69 (22.0) 15 (18.1) 24 (22.9) 30 (23.8) 0.597 11. The inc ease in CAM use is dange ous because i inc eases he possibili y o nega i e side e ec s. 52 (16.9) 9 (11.1) 22 (21.6) 21 (16.8) 0.172 12. T ea men wi h CAM modali ies should be o bidden by law. 31 (9.9) 4 (4.8) 13 (12.4) 14 (11.1) 0.188 *Pe cen ages o ‘ag eed a li le’, ‘ag eed mode a ely’, and ‘ag eed s ongly’ esponses we e combined 3.2.Knowledge o CAM Mo e han 80% o he s udy pa icipan s epo ed (Table 4) ha hey knew some hing o a lo abou massage (269, 86.5%). The knowledge abou he o he modali ies (o e 60%) was as ollows: elaxa ion (242, 77.3%), acupunc u e (211, 67.8%), he bal medicine (207, 66.6%), medi a ion (206, 66.5%) and homeopa hy (204, 66.0%). Among he leas known ypes o CAM we e kinesiology (36, 11.6%), Reiki (34, 10.9%) and P ananadi (22, 7.1%). The e was no signi ican di e ence be ween he h ee g oups’ knowledge abou CAM modali ies. Howe e , signi ican di e ences we e ound be ween s uden s who pa icipa ed and hose who did no pa icipa e in he Complemen a y Medicine cou se in he knowledge abou T adi ional Chinese Medicine (58, 45.0%, s. 18, 29.0%, p = 0.027), acupunc u e (99, 76.2%, s. 37, 59.7%, p = 0.011) and chi op ac ic (80, 61.1%, s. 29, 46.0%, p = 0.032). Table 4 Nu sing, Heal h Visi o and Midwi e y S uden s’ Knowledge o CAM modali ies CAM modali ies Knowledge* No. (%) To al N= 314 Nu ses N = 83 Heal h isi o s N = 105 Midwi es N = 126 p massage 269 (86.5) 73 (88.0) 87 (84.5) 109 (87.2) 0.753 elaxa ion 242 (77.3) 57 (69.5) 86 (81.9) 99 (78.6) 0.121 acupunc u e 211 (67.8) 59 (71.1) 77 (74.0) 75 (60.5) 0.070 he bal medicine 207 (66.6) 55 (66.3) 69 (67.0) 83 (66.4) 0.993 medi a ion 206 (66.5) 56 (68.3) 75 (72.1) 75 (60.5) 0.165 homeopa hy 204 (66.0) 53 (64.6) 75 (71.4) 76 (62.3) 0.334 chi op ac ic 181 (58.4) 45 (54.2) 65 (64.4) 71 (56.3) 0.318 T adi ional Chinese Medicine 126 (40.5) 33 (40.2) 39 (37.1) 54 (43.5) 0.615 non-he bal supplemen s 124 (40.3) 34 (42.0) 42 (40.4) 48 (39.0) 0.915 Mind Con ol 124 (40.0) 37 (45.1) 43 (41.3) 44 (35.5) 0.363 acup essu e 113 (36.6) 31 (38.3) 39 (38.2) 43 (34.1) 0.761 hypno he apy 108 (35.0) 24 (30.0) 39 (37.5) 45 (36.0) 0.543 16 Re e ences [1] Akinci AC, Zengin N, Yildiz H, Sene E, Gunaydin B. The complemen a y and al e na i e medicine use among as hma and ch onic obs uc i e pulmona y disease pa ien s in he sou he n egion o Tu key. In J Nu s P ac 2011;17571–82, doi:10.1111/j.1440-172X.2011.01976.x. [2] Ba nes PM, Bloom B, Nahin RL. Complemen a y and al e na i e medicine use among adul s and child en: Uni ed S a es, 2007. Na l Heal h S a Repo 2008;12:1–23. [3] Büssing A, Os e mann T, Heusse P, Ma hiessen PF. Usage o al e na i e medical sys ems, acupunc u e, homeopa hy and an h oposophic medicine, by olde Ge man adul s. Zhong Xi Yi Jie He Xue Bao 2011;9:847-56. [4] Fishe P, Wa d A. Complemen a y medicine in Eu ope. B Med J 1994;309:107-10. [5] Kessle RC, Da is RB, Fos e DF, Van Rompay MI, Wal e s EE, Wilkey SA, e al. Long- e m ends in he use o complemen a y and al e na i e medical he apies in he Uni ed S a es. Ann In e n Med 2001;135:262-268. [6] Akyol AD, Oz B. The use o complemen a y and al e na i e medicine by pa ien s wi h cance : in Tu key. Complemen The Clin P ac 2011;17:230–4, doi:10.1016/j.c cp. 2010.12.003. [7] Molassio is A, Fe nandez-O ega P, Pud D, Ozden G, Pla in N, Humme s on S, e al. Complemen a y and al e na i e medicine use in colo ec al cance pa ien s in se en Eu opean coun ies. Complemen The Med 2005;13:251-7. [8] Hu C, Zhang H, Wu W, Yu W, Li Y, Bai J, e al. Acupunc u e o Pain Managemen in Cance : A Sys ema ic Re iew and Me a-Analysis. E id Based Complemen Al e na Med 2016;2016:1720239. doi: 10.1155/2016/1720239. [9] Salehi A, Hashemi N, Imanieh MH, Sabe M. Chi op ac ic: Is i E icien in T ea men o Diseases? Re iew o Sys ema ic Re iews. In J Communi y Based Nu s Midwi e y 2015; 3(4):244-54. [10] Chang HY, Chang HL. A e iew o nu ses' knowledge, a i udes, and abili y o communica e he isks and bene i s o complemen a y and al e na i e medicine. J Clin Nu s. 2015;24:1466-78. doi: 10.1111/jocn.12790. [11] Lo enc A, Blai M, Robinson N. Pe sonal and p o essional in luences on p ac i ione s’ a i udes o adi ional and complemen a y app oaches o heal h in he UK. Jou nal o T adi ional Chinese Medical Sciences 2014;1:148–155. h p://dx.doi.o g/10.1016/j.j cms.2014.09.002 [12] O kaby B, G eenbe ge C: Is aeli nu ses' a i udes o he holis ic app oach o heal h and hei use o complemen a y and al e na i e he apies. J Holis Nu s. 2015;33(1):19-26. doi: 10.1177/0898010114542876. 17 [13] Yıldı ım Y, Pa la S, Eyigö S, Se öz O, Eyigö C, Fadıloğlu Ç, Uya M. An analysis o nu sing and medical s uden s’ a i udes owa ds and knowledge o complemen a y and al e na i e medicine (CAM). JCN 2010;19:1157–1166. [14] Akan H, Izbi ak G, Kaspa EC, Kaya ÇA, Aydin S, Demi can N, e al. Knowledge and a i udes owa ds complemen a y and al e na i e medicine among medical s uden s in Tu key. BMC Complemen Al e n Med 2012;12:115. [15] Awad AI, Al-Ajmi S, Waheedi MA. Knowledge, Pe cep ions and A i udes owa d Complemen a y and Al e na i e he apies among Kuwai i Medical and Pha macy S uden s. Med P inc P ac 2012;21:350–354, doi: 10.1159/000336216. [16] Çamu dan Ç, Gül A. Complemen a y and al e na i e medicine use among unde g adua e nu sing & midwi e y s uden s in Tu key. Nu se Educ P ac 2013;13:350-4, doi: 10.1016/j.nep .2012.09.015. [17] G een ield SM, B own R, Dawla ly SL, Reynolds JA, Robe s S, Dawla ly RJ. Gende di e ences among medical s uden s in a i udes o lea ning abou complemen a y and al e na i e medicine. Complemen The Med 2006;14:207-12. [18] T ail-Mahan T, Mao CL, Bawel-B inkley K. Complemen a y and Al e na i e Medicine: Nu ses’ A i udes and Knowledge. Pain Manag Nu s 2013;14:277-286. [19] Chu FY, Wallis M. Taiwanese nu ses’ a i udes owa ds and use o complemen a y and al e na i e medicine in nu sing p ac ice: a c oss-sec ional su ey. In J Nu s S ud 2007; 44:1371-8. [20] Sho o i SA, A bon P. Nu ses' knowledge, a i udes, and p o essional use o complemen a y and al e na i e medicine (CAM): a su ey a i e me opoli an hospi als in Adelaide. Complemen The Clin P ac 2010;16:229-34, doi:10.1016/j.c cp.2010.05.008. [21] Yom Y, Lee K. A compa ison o he knowledge o , expe ience wi h, and a i udes owa d complemen a y and al e na i e medicine be ween nu ses and pa ien s in Ko ea. J Clin Nu s 2008;17:2565-2572. [22] Kligle B, Go don A, S ua M, Sie pina V. Sugges ed cu iculum guidelines on complemen a y and al e na i e medicine: ecommenda ions o he Socie y o Teache s o Family Medicine G oup on Al e na i e Medicine. Fam Med 2000;32:30–33. [23] Kligle B, Maizes V, Schach e S, Pa k C.M, Gaude T, Benn R, e al. Co e compe encies in in eg a i e medicine o medical school cu icula: A p oposal. Acad Med 2004;79:521–531. [24] Boo h-La o ce C, Sco CS, Hei kempe MM, Co nman BJ, Lan MC, Bond EF, Swanson KM. Complemen a y and Al e na i e Medicine (CAM) a i udes and compe encies o nu sing s uden s and acul y: esul s o in eg a ing CAM in o he nu sing cu iculum. J P o Nu s 2010;26:293-300, doi:10.1016/j.p o nu s.2010.03.003. [25] Na ional Cen e o Complemen a y and Al e na i e Medicine. P og am announcemen : eques o p oposals o CAM educa ion g an s. Be hesda, Md: Na ional Ins i u es o Heal h, 1999. 18 [26] Hegyi G. A komplemen e medicina színes pale ája és jelenlegi helyze e Magya o szágon. Komplemen e Medicina 2010;3:39-42 [a icle in Hunga ian]. [27] An al Z, Szán ó Zs. A e mésze gyógyásza és az o os udomány kon lik usa. Lel á . MTA Tá sadalmi Kon lik usok Ku a ó Közpon jának kiad ánya. Budapes , 1992 [a icle in Hunga ian]. [28] Buda L. Az al e na í medicina udományos o osláshoz aló iszonyának, á sadalmi- lélek ani, egészség-szociológiai há e ének elemzése és az egészségügyi ellá ásban be öl ö sze epének komplex empi ikus izsgála a. PhD é ekezés. Pécsi Tudományegye em Ál alános O os udományi Ka 2013 [a icle in Hunga ian]. [29] O szágos Lakossági Egészség elmé és OLEF2000. Ku a ási jelen és. O szágos Epidemiológiai Közpon 2002, Budapes [a icle in Hunga ian]. [30] O szágos Lakossági Egészség elmé és OLEF2003. Ku a ási jelen és. Egészségügyi ellá ás igénybe é ele. O szágos Epidemiológiai Közpon 2005, Budapes [a icle in Hunga ian]. [31] Baugnie J, Boon H, Os bye T. Complemen a y/al e na i e medicine: compa ing he iew o medical s uden s wi h s uden s in o he heal h ca e p o essions, Fam Med 2000; 32:178-84. [32] Eisenbe g DM, Kessle RC, Fos e C, No lock FE, Calkins DR, Delbanco TL. Uncon en ional medicine in he Uni ed S a es. P e alence, cos s, and pa e ns o use. N Engl J Med 1993;328:246-52. [33] NCCAM (Na ional Cen e o Complemen a y and Al e na i e Medicine): CAM basics. NCCAM, 2012, a ailable a h ps://nccih.nih.go /si es/nccam.nih.go / iles/D347_05-25-2012.pd [access: 11 May 2016]. [34] Hussain S, Malik F, Ahmed A, Ahmed S, Riaz H, Abbasi N, Malik PM. Pakis ani Pha macy S uden s’ Pe cep ion Abou Complemen a y and Al e na i e Medicine. Am J Pha m Educ 2012;76:21. [35] Fadlon J, G anek-Ca a i as M, Rozine I, Weinga en MA. Familia i y b eeds discon en : Senio hospi al doc o s’ a i udes owa ds complemen a y/al e na i e medicine. Complemen The Med 2008;16:212-219, doi: 10.1016/j.c im.2007.09.001. [36] Ha is IM, Kings on RL, Rod iguez R, Chouda y V. A i udes Towa ds Complemen a y and Al e na i e Medicine Among Pha macy Facul y and S uden s. Am J Pha m Educ 2006; 70:A icle 129. [37] James PB, Bah AJ. Awa eness, use, a i ude and pe cei ed need o Complemen a y and Al e na i e Medicine (CAM) educa ion among unde g adua e pha macy s uden s in Sie a Leone: a desc ip i e c oss-sec ional su ey. BMC Complemen Al e n Med 2014;14:438, doi:10.1186/1472-6882-14-438. [38] Alis O, Ganime S, Nu an B, Mum az MM, Nazan B, Isik B. An analysis o nu sing and medical s uden s’ a i udes owa ds and knowledge o complemen a y and al e na i e medicine (CAM). J Al e n Complemen Med 2007;13:1007–1010; doi:10.1089/acm.2007.7168. 19 [39] Wilkinson JM, Simpson MD. Complemen a y he apy use by nu sing, pha macy and biomedical science s uden s. Nu s Heal h Sci 2001;3:19-27. [40] Lie D, Boke J. De elopmen and alida ion o he CAM Heal h Belie Ques ionnai e (CHBQ) and CAM use and a i udes amongs medical s uden s. BMC Med Educ 2004;4:2. [41] A onson E. Mass communica ion, P opaganda, and Pe suasion. in: A onson E. The Social Animal. New Yo k, NY: Wo h Publishe s; 2011, pp. 59-112. [42] Al Mansou MA, Al-Bedah AM, AlRukban MO, Elsubai IS, Mohamed EY, El Olemy AT e al. Medical s uden s' knowledge, a i ude, and p ac ice o complemen a y and al e na i e medicine: a p e-and pos -exposu e su ey in Majmaah Uni e si y, Saudi A abia. Ad Med Educ P ac 2015;6:407-20. doi: 10.2147/AMEP.S82306.