A mixed methods sequential explanatory study of the utilisation and practice of traditional Chinese medicine by Chinese people in Hong Kong and Guangzhou

Little is known about why traditional Chinese (TCM) continues to be used and practised by Chinese people despite the existence of evidence-based Western medicine (WM). This study aims to explore Chinese patients and TCM practitioners’ attitudes and beliefs towards the utilisation and practice of TCM and to determine if there are any differences in the way in which Chinese people use and practice TCM in different regions of China, in this study, Hong Kong and Guangzhou. A mixed-method, sequential explanatory study was undertaken that involved two phases. In the first phase, a structured questionnaire translated into Chinese was used to collect data from a convenience sample of Chinese patients attending outpatient clinics in Hong Kong and Guangzhou. A Chinese research assistant who could speak Cantonese and Mandarin distributed the questionnaires to patients attending the TCM outpatient clinics in Hong Kong and Guangzhou. Also, a random sample of Chinese medicine practitioners in Hong Kong was sent a questionnaire by post, as a list of Chinese medicine practitioners names, and clinic addresses in Hong Kong are available on the Chinese Medical Council’s Internet website. For TCM practitioners in Guangzhou, a Chinese research assistant distributed the questionnaire in-person to a random sample of TCM doctors working at the Guangzhou University of Traditional Chinese medicine in Guangzhou. In the second phase of the study, semi-structured interviews were conducted with patients and Chinese medicine practitioners in Hong Kong and patients and TCM practitioners in Guangzhou. Patients and TCM practitioners who took part in an interview were randomly selected from a list of patients and TCM practitioners who had previously filled out a questionnaire in the first phase of the study. A total of 1,200 patients and 400 TCM practitioners took part in the study, which comprised of 600 patients attending an out-patient TCM clinic in Hong Kong and 600 attending an out-patient TCM clinic in Guangzhou. The response rate for patients who took part was 81.4% (n= 505) and for Guangzhou 91.6% (n=550). For TCM practitioners, the response rate was 55% (n=110) for practitioners in Hong Kong and 61.5% (n= 123) for practitioners in Guangzhou. Patients’ mean age was 44.6 years, and the sample consisted of 41.2% males and 58.8% females. For TCM practitioners, the mean age was 45.4 years and the sample consisting of 66.1% males and 33.9% females. In the second phase of the study, semi-structured interviews were conducted with 16 patients and 16 TCM practitioners in Hong Kong and Guangzhou, respectively. The results showed that for patients in Hong Kong and Guangzhou the most common use of TCM was for the treatment of acute medical conditions, such as colds and flu and also for chronic medical conditions, such as rheumatism and diabetes. Also, patients in Guangzhou were found to use TCM to “recuperate” the body after taking Western medicines prescribed by WM doctors, or after suffering a chronic illness. Concurrent use of TCM and WM was found to be more common in patients in Guangzhou, than in patients in Hong Kong. The integration of TCM services in hospitals in Hong Kong is notably different from that of China. Unlike China, where TCM practitioners are permitted to treat in-patients inside state-run hospitals, in Hong Kong, TCM practitioners are only permitted to treat patients on an outpatient basis and not as in-patients. The results of this study contribute to the existing body of literature about the utilisation and practice of TCM by Chinese people in Hong Kong and Guangzhou. The study also provides unique information about the practice of TCM in Hong Kong since the implementation of the Chinese medicine Ordinance and the establishment of the Chinese Medicine Council of Hong Kong. Although the study contributes to the existing body of literature concerning the utilisation and practice of TCM by Chinese people and TCM practitioners ‘respectively, it does have several inherent limitations. Among the significant limitations is the fact that, as a cross-sectional survey design was used, therefore no “cause and effect” relationships can be drawn from the results. Furthermore, because statistical tests, in general, require a large sample size to ensure a representative distribution of the population being studied, the total number of patients and TCM practitioners who participated in the study is relatively small