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Influence of Chinese cultural health beliefs among Malaysian Chinese in a suburban population: a survey

Authors:

Abstract

In a multiethnic nation, it is not uncommon for doctors to encounter patients of different cultural backgrounds. Often, patients' cultural beliefs influence their perception of health and illnesses, and their treatment option. Many Chinese cultural beliefs are influenced by the Taoist concept of yin-yang balance. We interviewed 50 Malaysian Chinese from the general public of a suburban population in order to unravel the impact of Chinese cultural health beliefs on their decision-making, and this was compared with the opinions of 50 Chinese medical students from second to final year. Convenience sampling was then applied. From the survey, 78 percent of the general public believed that 'too much heat' or 'too much coldness' in the body could cause diseases. Compared to the medical students, a significantly higher number of the respondents held such beliefs, including the beliefs that abdominal colic is due to excessive 'wind' in the abdomen, consuming certain food can dispel wind from the body, and the importance of observing taboos during the confinement period after delivery. The majority of respondents from both groups believed that it is acceptable to combine both traditional Chinese medicine and modern medicine. There is a discrepancy in the extent to which these beliefs influence the perception of health and illnesses among the general public and among medical students. Healthcare providers need to be aware of such beliefs and practices regarding traditional Chinese medicine among their Chinese patients.
Singapore Med J 2011; 52(4) : 252
Original Article
School of Medical
Sciences,
Universiti Sains
Malaysia,
Kubang Kerian
16150,
Malaysia
Chew KS, MD,
MMed
Senior Lecturer
Tan TW
Medical Student
Ooi YT
Medical Student
Correspondence to:
Dr Chew Keng-
Sheng
Tel: (60) 19986 9520
Fax: (60) 9765 9630
Email: cksheng74@
yahoo.com
Influence of Chinese cultural health
beliefs among Malaysian Chinese in a
suburban population: a survey
Chew K S, Tan T W, Ooi Y T
ABSTRACT
Introduction: In a multiethnic nation, it is not
uncommon for doctors to encounter patients of
different cultural backgrounds. Often, patients’
cultural beliefs influence their perception of
health and illnesses, and their treatment option.
Many Chi nese cultura l beliefs are infl uenced by the
Taoist concept of yin-yang balance.
Methods: We interviewed 50 Malaysian Chinese
from the general public of a suburban population
in order to unravel the impact of Chinese cultural
health beliefs on their decision-making, and this
was compared with the opinions of 50 Chinese
medical students from second to final year.
Convenience sampling was then applied.
Results: From the sur vey, 78 percent of t he general
public believed that ‘too much heat’ or ‘too
much coldness’ in the body could cause diseases.
Compared to the medica l students, a significantly
higher number of the respondents held such
belief s, including th e beliefs that a bdominal colic is
due to exces sive ‘wind’ in t he abdomen , consuming
certain food can dispel wind from the body, and
the importance of observing taboos during the
confinement period after delivery. The majority
of respondents from both groups believed that it
is acceptable to comb ine both traditional Chinese
medicine and modern medicine.
Conclusion: There is a discrepancy in the extent
to which these beliefs influence the perception of
health and illnesses among the general public and
among medical students. Healthcare providers
need to be aware of such beliefs and practices
regarding traditional Chinese medicine among
their Chinese patients.
Keywords : cultura l background , Malaysia , modern
medicine, traditional Chinese medicine
Singapore Med J 2011; 52(4): 252-256
INTRODUCTION
Malaysia is a multiethnic, multicultural and multilingual
society with a population of about 28.3 million people
(as of July 2009).(1) The majority of its population in
2004 consisted of Malays (50.4%), Chinese (23.7%),
indigenous groups (11%), Indians (7.1%) and other races
(7.8%).(2) Each ethnic group in Malaysia is rich in its own
culture and traditions.
 Culture,denedasanintegratedsharedpatternof
learned convictions and behaviours,(3) has permeated
and inuenced health-seeking decisions among the
various Malaysian ethnic groups. With such diverse
ethnicities, Malaysians’ perception of health and
illnesses, healthcare expectations as well as treatment
choices are often heavily coloured by their cultural
beliefs and practices.(3-6) It is not uncommon for
physicians to encounter patients from different cultural
backgrounds, be it in the emergency department,
outpatient clinics or wards.(3) Within their local practice
context,doctorsshouldpossessknowledgeofsomeof
theseculturalbeliefs thatmayinuencetheirpatients’
decisions. Furthermore, many traditional medications
have side effects that may be compounded by potential
Table I. Demographic data of the respondents.
Demographic No. (%)
General public Medical students
(n = 50) (n = 50)
Mean age ± SD (yrs) 43.7 ± 17.7 22.0 ± 1.1
Gender
Male 22 (44) 22 (44)
Female 28 (56) 28 (56)
Religion
Buddhism 25 (50) 36 (72)
Taoism 25 (50) 0
Christianity 0 14 (28)
Occupation
Medical students 50 (100)
Self-employed 5 (10)
Employee 9 (18)
Retiree 2 (4)
School students 10 (20)
Housewife 22 (44)
Others 2 (4)
SD: standard deviation
Singapore Med J 2011; 52(4) : 253
drug interactions when the patient uses both traditional
and modern medicine together.(7) Although cultural
inuence on health and the practice of traditional
medicine are not one and the same entity, they are
intrinsicallylinked.
Traditional Chinese medicine (TCM) views the
body,soul andspirit as anintegrated whole withwell-
balanced yin-yang forces, and considers man and his
environmenttobelinkedasoneentity.(3,7) Yin and yang
is a dialectical Taoist concept that is deeply embedded
in the Chinese culture. According to this philosophy, the
yin and yang are complementary opposite forces that
are interconnected and interdependent.(3) Everything
has both the yin and yang aspects, and together with
the ‘qi’ energy, these complementary forces control
the multifaceted relationship between humans and
their surroundings.(3) Within the health context, an
imbalance in these two forces or in the ‘qi’ results in
illnesses.(7) Many patients who use TCM, therefore,
believe that modern medicine is not holistic enough, as
it disregards the interaction between the individual and
his environment.(7)
Many commonly held Chinese cultural health
beliefs among Malaysian Chinese have been elucidated
in length in a previous article by Ariff and Beng in
2006,(3) but the extent to which these beliefs affect the
attitude and behaviour of Chinese patients has not been
well studied. Therefore, we formulated a set of questions
based on some of the beliefs mentioned in the previous
study(3) so as to evaluate the extent to which common
cultural Chinese beliefs inuence the perception of
health and illnesses among the Chinese residing in
Senai,atransittownsituated25 kmnorthwestof Johor
Bahru, Malaysia.(8)
METHODS
This was a cross-sectional voluntary interview study
conducted over a period of two months starting from
June 2009. Convenience sampling was applied. The
participants were briefed on the purpose of the study,
i.e. to determine the extent to which cultural beliefs
inuencetheirperception, andnot toproveor disprove
the accuracy of these beliefs from a scientic point of
view.We randomly interviewed adult residents aged ≥
18 years in housing areas around Senai town using a
bilingual (English and Chinese) questionnaire (Appendix
1). Categorical data analysis was conducted using the
Statistical Package for the Social Sciences version
12.0.1 (SPSS Inc, Chicago, IL, USA). We repeated the
questionnaire on 50 medical students of Chinese ethnicity
fromyear twoto yearve,andcomparedtheresponses
of the two groups.
RESULTS
Out of the 50 respondents from the general public, 22
(44%) were male. This was matched with 22 males
(44%) among the 50 Chinese medical students (Table I).
Theresultsof the inuenceof Chinese culturalbeliefs,
Table II. Comparison of respondents who agreed with statements regarding cultural beliefs.
Statements that respondents agreed on No. (%)
General Medical p-value
public students
1. Certain diseases are caused by ‘too much heat’ or ‘too much coldness’ in the body. 39 (78.0) 41 (82.0) 0.617
2. Fever is due to excessive heat inside the body. 44 (88.0) 27 (54.0) < 0.001
3. One should consume less amount of rice or totally abstain from taking rice when having fever. 31 (62.0) 14 (28.0) 0.001
4. Joint pain/rheumatism is due to excessive ‘wind’ accumulated in that joint. 21 (42.0) 8 (16.0) 0.004
5. Abdominal colic is due to excessive ‘wind’ accumulated in the abdomen. 33 (66.0) 22 (44.0) 0.027
6. Consuming certain fruits like jackfruits or watermelon can precipitate excessive ‘wind’ 22 (44.0) 17 (34.0) 0.305
to enter the body.
7. Consuming certain vegetables like bean sprout can precipitate excessive ‘wind’ 21 (42.0) 18 (36.0) 0.539
to enter the body.
8. Consuming certain food like garlic and ginger can help dispel ‘wind’ from the body. 45 (90.0) 32 (64.0) 0.002
9. Consuming certain ‘toxic’ food like crabs and prawns can cause skin diseases with rashes. 45 (90.0) 42 (84.0) 0.372
10. Exposure to rain water can cause respiratory tract infection. 23 (46.0) 14 (28.0) 0.062
11. In chickenpox, consuming beans can leave behind spotty scars. 35 (70.0) 15 (30.0) < 0.001
12. In chickenpox, consuming soy sauce can leave behind black marks. 33 (66.0) 27 (54.0) 0.221
13. Consuming certain ‘heaty’ food or herbs/spices can result in miscarriages. 12 (24.0) 19 (38.0) 0.130
14. After childbirth, a woman must observe a period of confinement and taboos. 48 (96.0) 39 (78.0) 0.007
15. After childbirth, a woman must not wash her hair during the period of confinement. 29 (58.0) 20 (40.0) 0.072
16. After childbirth, a woman must take ‘hot’ food like ginger and red wine during the period 48 (96.0) 33 (66.0) < 0.001
of confinement.
17. After childbirth, a woman must not be exposed to excessive wind or water, as it can cause 40 (80.0) 24 (48.0) 0.001
‘wind-related’ illnesses such as chronic joint pain.
Chi-square test is employed for the categorical data analysis.
Singapore Med J 2011; 52(4) : 254
the attitude toward TCM and the practice of TCM
among our respondents are shown in Tables II and III,
respectively. The mean age of the general public was
43.7 ± 17.7 years, while that of the more homogeneous
group of medical students was 22.0 ± 1.1 years. Half of
the respondents from the general public were Taoists and
half were Buddhists. None indicated Christianity as a
religion. On the other hand, 14 (28%) medical students
wereChristiansand36(72%)wereBuddhists,butnone
was a Taoist. Nevertheless, we believed that Taoism and
Buddhism may often be mixed and practiced together
among many Malaysian Chinese, and as such, we
anticipatedfew differencesin theinuencesofChinese
cultural beliefs between these two groups. However,
contrary to expectation, our subgroup analysis in Table
IV shows few differences even between Christian and
Buddhist medical students with regard to the impact of
some of the selected cultural beliefs.
DISCUSSION
It is believed that disease results from an obstruction to
any of the ow of yin-yang channels.(3,7) For example,
a ear infection is thought to be due to ‘excessive heat’,
and therefore, the restoration of balance can be achieved
by avoiding ‘hot’ food such as scrambled eggs and
by increasing the intake of ‘cold’food such as winter
melon.(6)
The majority (78%) of respondents from the general
public interviewed agreed that ‘too much heat’ or ‘too
much coldness’ in the body could cause certain diseases.
Thisisgenerallyinagreementwiththeyin-yangconcept.
Disruptionoftheyin-yangbalanceinthebodyisbelieved
toresultin diseasesthat manifestinthe weakersideof
the two forces, e.g. when the yang becomes stronger,
symptoms such as heaty rash and fever arise, but when
the yin becomes stronger, symptoms of cough and cold
arise.(9) The majority (80%) of the medical students
interviewed also subscribed to this concept.
However, when asked the next question “Do
you believe that fever is due to excessive heat inside
the body?”, a signicant difference in the number
of respondents who agreed was observed between
respondents from the general public and the medical
students (88% vs. 54%, p < 0.001). This could be due
tothemedicalstudents’supercialunderstandingofthe
inuence of this particular Chinese cultural belief on
health, or the fact that they regarded this belief as hearsay
when judged in the light of modern medicine.
Nevertheless, as the mean age of the general public
was higher than that of the medical students (43.7 ± 17.7
vs.22.0±1.1years),theagefactormayhaveinuenced
the perceptions of the respondents. Interestingly, two
recent studies conducted in Taiwan found that one of the
signicantlyassociatedpredisposingfactorsinuencing
TCM use is age.(10,11) In both studies, TCM use in Taiwan
peakedinindividualsaged30–40years.(11,12)
No. (%) p-value
General Medical
public students
1. Ever sought traditional Chinese medicine. 47 (94.0) 33 (66.0) < 0.001
2. Would rather choose traditional Chinese medicine alone as the initial choice of treatment. 25 (50.0) 3 (6.0) < 0.001
3. Believe that modern medicine, comprising ‘manufactured’ drugs can weaken the body’s 44 (88.0) 35 (70.0) 0.027
immune system.
4. Believe that it is acceptable to combine both traditional Chinese medicine and modern 45 (90.0) 46 (92.0) 0.727
medicine for consumption.
5. Would be uncomfortable to reveal to their doctor that he/she has taken traditional 48 (96.0) 49 (98.0) 0.558
Chinese medicine prior to consultation.
Chi-square test is employed for categorical data analysis.
Table III. Attitude and practice regarding traditional Chinese medicine among the respondents.
Table IV. Subgroup analysis of medical students according to religion.
Statements that medical students agreed on No. (%) p-value
Buddhist Christian
(n = 36) (n = 14)
1. Certain diseases are caused by ‘too much heat’ or ‘too much coldness’ in the body. 33 (91.7) 8 (57.1) 0.040
2. Consuming certain food like garlic and ginger can help dispel ‘wind’ from the body. 25 (69.4) 11 (30.6) 0.198
3. Consuming certain ‘toxic’ food like crabs and prawns can cause skin diseases with rash. 30 (83.3) 12 (85.7) 0.837
4. After childbirth, a woman must observe a period of confinement and taboos. 28 (77.8) 11 (78.6) 0.951
Chi-square test is employed for categorical data analysis.
Singapore Med J 2011; 52(4) : 255
Other cultural beliefs that a signicantly higher
number of respondents from the general public agreed
on included the following: joint pain/rheumatism is due
to excessive ‘wind’ accumulated in that joint; abdominal
colic is due to excessive ‘wind’ in the abdomen;
consuming certain food can dispel ‘wind’ from the body;
and observing certain taboos during the connement
period after delivery of a baby is important. A comparable
number of medical students and respondents from the
general public believed that consuming certain ‘toxic’
foodlike crabsandprawnscancause skindiseases and
rash. This is not surprising given the fact that medical
students learn that food allergy manifests as rashes, and
itisalsoawell-knownfactthatconsumingseafoodmay
cause allergy. Hence, there is a discrepancy in the extent
to which cultural beliefs inuence the perception of
health and illnesses among our respondents.
Furthermore, the majority of the respondents and
medical students agreed that it is acceptable to combine
TCM and modern medicine (90% and 92%, respectively),
and admitted that they would be uncomfortable to reveal
to their doctors if they have used TCM prior to their
medicalconsultation(96%and98%,respectively).The
signicanceofthisiscompoundedbythefactthatmost
TCM decoctions are prepared and boiled by the family
members at home; thus, decoctions prepared in an
unscienticway(e.g.withoutastandardisedamountof
water used, or with differing temperatures and duration
of heating) can result in variable dosages, resulting in
adversesideeffectsifthedosetakenbythepatientistoo
high. In addition, there are many possible interactions
when both modern medicine and TCM are taken
together.(7)
In terms of pregnancy and the postpartum
connement period, an overwhelming majority of
respondentsfromthegeneralpublic(96%)interviewed
believed unequivocally that all mothers should observe
aperiodof connement.This periodof connement is
also known as ‘zuo yuezi’in Chinese, or translated as
‘the sitting month’, as the women literally sit or stay
in bed for many hours and are not allowed to leave
the home.(12) Many agreed that certain taboos must be
observed,including theadvice notto washhair(56%),
increasing the consumption of certain ‘hot’ food like
ginger and red wine (96%), and avoiding exposure to
wind or water (80%). These taboos are not only common
in Malaysia, but are also commonly observed in many
Chinese communities worldwide.(12)
Besides the confounding inuence of age, as
elucidated earlier, education level is another limitation
ofthisstudy,as it mayalso inuencetheperception of
these two groups. While the medical students would
homogenously have had post secondary education, the
education level of the respondents from the general public
wasunknownandcouldwellhavebeenverydiverse.This
is especially so, as 22 of the 28 female respondents from
the general public were housewives. Their education
level may have coloured their preferences for healthcare
treatment modalities.
Our study has shown that there is a discrepancy in
the extent of inuence that cultural health beliefs have
on medical students and members of the general public
in Senai. Healthcare providers should be reminded that
whenpatientsfall sick,their goal isto recoverquickly,
regardless of whether they use TCM or modern medicine,
as long as the treatment is effective and affordable.
Unfortunately, combining TCM and modern medicine
can result in potential adverse drug reactions.
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Singapore Med J 2011; 52(4) : 256
Appendix I
Section A: Demographic data
Gender: Male/Female
Age: _____________________________________________
Occupation: _______________________________________
Religion: __________________________________________
Section B: Influence of Chinese cultural health beliefs
Do you believe that
1. Certain diseases are caused by ‘too much heat’ or ‘too much coldness’ Yes/No
in the body (disruption of yin-yang balance)?
2. Fever is due to excessive heat inside the body? Yes/No
3. One should consume less amount of rice or totally abstain from taking rice when having fever. Yes/No
4. Joint pain/rheumatism is due to excessive ‘wind’ accumulated in that joint? Yes/No
5. Abdominal colic is due to excessive ‘wind’ accumulated in the abdomen? Yes/No
6. Consuming certain fruits like jackfruit or watermelon can precipitate excessive wind to enter the body? Yes/No
7. Consuming certain vegetables like bean sprout can precipitate excessive wind to enter the body? Yes/No
8. Consuming certain food like garlic and ginger can help dispel wind from the body? Yes/No
9. Consuming certain ‘toxic’ food like crabs and prawns can cause skin diseases with rash? Yes/No
10. Exposure to rain water can cause respiratory tract infection? Yes/No
11. In chickenpox, consuming beans can leave behind spotty scars? Yes/No
12. In chickenpox, consuming soy sauce can leave behind black marks? Yes/No
13. Consuming certain ‘heaty’ food or herbs/spices can result in miscarriages? Yes/No
14. After childbirth, a woman must observe a period of confinement and taboos? Yes/No
15. After childbirth, a woman must not wash her hair during the period of confinement? Yes/No
16. After childbirth, a woman must take ‘hot’ food like ginger and red wine during the period of confinement? Yes/No
17. After childbirth, a woman must not be exposed to excessive wind or water as it can cause ‘wind-related’ Yes/No
illnesses such as chronic joint pain?
Section C
1. Have you ever sought traditional Chinese medicine (TCM)? Yes/No
2. Would you rather choose TCM alone as the initial choice of treatment? Yes/No
3. Do you believe that modern medicine, comprising ‘manufactured’ drugs can weaken the body’s Yes/No
immune system?
4. Do you believe that it is acceptable to combine both TCM and modern medicine together for Yes/No
consumption?
5. If you have taken TCM prior to visiting your doctor, would you be uncomfortable to reveal to your Yes/No
doctor that you have taken TCM prior to the consultation?
... The illness perception among cancer patients is related to their cultural background [29]. For example, yin and yang, as a concept in Taoism, has deeply influenced Chinese culture and health beliefs [30]. Traditional Chinese medicine believes that health cannot be achieved without a balance of yin and yang [30]. ...
... For example, yin and yang, as a concept in Taoism, has deeply influenced Chinese culture and health beliefs [30]. Traditional Chinese medicine believes that health cannot be achieved without a balance of yin and yang [30]. People in the Chinese culture often believe that the reason they can control the disease is mainly because they fully understand the disease [31]. ...
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... The source of Hui medicine is different from the theoretical system of traditional Chinese medicine. Traditional Chinese medicine is guided by Taoist philosophy (Chew et al., 2011;Ma, 2005). Hui Medicine is guided by Sinicized Islamic philosophy. ...
... A study by Shah, Rosenberg [33] also found that Malay was the highest percentage of undiagnosed hypertension and uncontrolled among the older population in Selangor. Applying cultural beliefs and combining modern and Chinese traditional medicines make Chinese respondents have better hypertension control compared to other races in Malaysia [34]. ...
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Hypertension is a major modifiable determinant of the increasing burden of cardiovascular disease (CVD) in Malaysia. The aim of this study is to determine the factors associated with hypertension control in men and women among the low-income individuals (B40) group with hypertension in Malaysia. The communities were selected from rural and urban populations in four peninsular states. Following a multistage sampling approach, communities in each stratum were selected according to probability proportional to the size and identified based on national census data by the community and administrative registers. Eligible individuals were those aged between 35 and 70 years old, self-reported or identified as hypertensive at screening. A survey using validated questionnaires was conducted. The prevalence of controlled hypertension was 33.1% (95%CI: 24.7, 41.5) in men and 34.0% (95%CI: 29.0, 39.0%) in women respondents. In men, hypertension control rates were positively associated with individuals who received or heard any information about hypertension [(Adj. OR: 2.95 (95%CI: 1.02, 8.52)], having two or more comorbidities [Adj. OR: 6.38 (955CI: 1.37, 29.62)] and those who had regular treatment for hypertension [Adj. OR: 14.51 (95%CI: 1.46, 44.21)]. Whereas, in women, hypertension control rates were positively associated with race whereas the non-Malay had more controlled status compared to Malay [Adj. OR: 5.94, (95%CI: 1.26, 28.09)] and those who regularly see the health professional [Adj. OR: 5.68 (95%CI: 1.94, 16.63)]. Health education and promotion programs need to be conducted to disseminate more information about hypertension to the community. Clinical services need to be improved mostly on regular follow up, giving proper consultation on treatment and treating patients to increase the prevalence of hypertension control.
... Cultural background may influence one's orientation of illness perception and coping mechanism. For example, influenced by traditional Chinese medicine (TCM) perspective, general Chinese Malaysians reportedly viewed illnesses as imbalance of forces within a body system (Chew et al., 2011). A stroke could be conceptualised as poor blood flow due to "wind" blocking and thick blood (Yap et al., 2019). ...
Chapter
Religious community is a cultural system that embodies specific interpretation of illnesses and healing signs. Ignoring its influence on epidemic perception and coping has been a cultural myopia in current psychological science. Therefore, this paper set out to conduct systematic review on the past psychological studies on how different religious believers perceived and coped with a pandemic. A rigorous literature search using PRISMA guidelines on EBSCOHost, Ovid, and PubMed databases was conducted. Any empirical studies that were published in 2000–2020 which contained participants from certain religious groups, and constructs that fell under “illness perception” and/or “coping strategies” within a human pandemic context were included. From the originally generated 12,438 references, after cleaning, screening and quality evaluation, 17 quality papers remained for critical analysis. Due to the timeframe of the selected papers, most of the studies revolved around HIV/AIDS as an epidemic in the American and African continents. Only three major religious traditions were identified – Christianity, Islam, and Buddhism. Themes of research findings were extracted through thematic analysis and consensus coding.
... Several of them hold Thai citizenship are also married to Malaysians. Previous research revealed that cultural beliefs impacted their perspective of health and treatment choices [35]. As a result, we anticipate that non-Malaysian citizenship Siamese ethnic may return to their homeland after having first treatment in Malaysia, resulting in non-compliance with the Rabies PEV series. ...
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Introduction: Rabies post-exposure vaccination (Rabies PEV) remains the most fundamental prevention of human Rabies if administered in a timely and appropriate manner. The study was aimed to determine the proportion and determinants of non-compliance on Rabies PEV among dog bite patients in Perlis, Malaysia from July 2015 to June 2020. Methods: A retrospective cohort study was conducted using Perlis Rabid Potential Animal Bite Registry data. Independent variables and compliance status were obtained from the registry. Logistic regression analysis was utilized on 507 dog bite patients. Results: Most of dog bite patients were age group of 46-60 years old (23.1%), male (61.3%), Chinese (49.5%), seeking treatment less than 24 h after the exposure (78.3%), category two of exposure (76.3%) and bitten on lower extremities (57.8%) by an owned dog (58.4%). Only 19.5% were non-compliance to Rabies PEV. Siamese had significantly two-timed (AOR: 2.00; 95% CI 1.06, 3.76) odd higher to become non-compliance. Being bitten during 3rd (AOR: 0.27; 95% CI 0.12, 0.59), 4th (AOR: 0.24; 95% CI 0.11, 0.52) and 5th (AOR: 0.20; 95% CI 0.09, 0.44) year of the outbreak had significantly lower odds to non-comply with Rabies PEV. Conclusion: 19.5% of dog bite patients still did not comply with the Rabies PEV series. Siamese would likely to non-comply whereas bitten on the 3rd, 4th and 5th years of outbreak less tendency to non-comply. Continuous health promotion to the public in the various languages despite outbreak status are ongoing to improve the perception of risk and benefit toward compliance of Rabies PEV.
... Onyishi et al. (2021), Yuniarti et al. (2013) and Kanbara et al. (2008) posit that religiosity and spirituality are employed by patients with diabetes mellitus to cope with emotional stressors such as anxiety, depression and apprehension. In a larger and more specific contexts, communities and societies resort to spiritual approaches in practical ways to manage illness and health situations (Abdoli et al., 2011;Casarez et al., 2010;Chew et al., 2011;Villani et al., 2019). ...
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Given the importance Ghanaians attribute to spirituality and religiosity in terms of disease causation and management, this study explored the use of religious capital as a coping strategy by individuals with type 2 diabetes mellitus in self-care at the Techiman Holy Family Hospital Diabetes Clinic in the Bono East Region of Ghana. An exploratory descriptive qualitative research design was employed for the study. Semi-structured interviews were conducted with a convenience sample of twenty-seven (27) individuals recruited from the diabetes clinic. Content analysis was employed to find themes, which included: (1) Use of Prayer and Fasting for Courage from God, (2) Reliance on God as the Creator of Human Beings who Cures and Heals Diseases in the Body, (3) God as Source of life in times of Illness (Drawing life from God in times of illness), (4) Faith and Hope in God, and (5) Doctors and Nurses as Substitutes for God. The findings advocate the need to incorporate religiosity and spirituality into the provision of healthcare for individuals with diabetes to help them live productive lives.
... Belief in the health properties of food is one of the driving forces of food choices in SEA. 27 Studies on cultural beliefs about health have shown that such beliefs are still very common among the general population in the SEA 30 and also around perinatal practices in this region. 31 An example of a cultural belief is where certain foods are thought to impact on the well-being of the mother. ...
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Purpose Galactagogues are substances that increase breast-milk production. They can be medication, herbs or food. Use of galactagogues may be different among the major ethnic groups in Malaysia. The primary objective of this cross-sectional study is to determine the prevalence of galactagogues use among breastfeeding mothers in a multi-ethnic community. Patients and Methods Self-administered questionnaires were distributed between November 2016 and January 2017 to mothers attending the health clinics and private hospital paediatric clinics in Penang, Malaysia, whose infants were below 6 months of age. The questionnaire enquired about use of galactagogues, types of galactagogue used, perceived effectiveness and sources of information. It also asked mothers about what they would do to increase milk supply. Results We analyzed 322 out of 530 questionnaires distributed where 76% of mothers reported use of galactagogues; most of which were food-based: dates (66%), oats (58%) and soya bean (56%). Each major ethnic group had a different preference for galactagogues: Malays (dates), Chinese (soya bean) and Indians (oats). Only one mother used pharmacological galactagogues alone. Galactagogues were perceived to be effective by 65% of mothers who used them. Multivariate analysis showed that use of galactagogues was not related to ethnicity, education, work, perception of milk supply or use of formula milk. The most common source of information on galactagogues came from family and friends. Conclusion Use of galactagogues is common in our population, especially food-based ones, and the choice of galactagogues differs by ethnicity. Future studies on efficacy and safety galactagogues should be focused these commonly used ones. There is also a need for qualitative studies to improve our understanding of why they are widely used in this region.
... A large proportion of patients (21 of 53 patients) had only received surgery despite being offered multimodal therapy. It is our postulation that one of the underlying factors contributing to non-adherence may be the cultural perception of the majority ethnic Chinese (87.6% in our study) population towards chemotherapy toxicity [28,29]. There is a prevalent cultural perception from a Traditional Chinese Medicine (TCM) point of view that chemotherapy is "toxic", "heaty" and "weakens the body". ...
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Background Multidisciplinary tumor board (MDT) discussion is standard practice in the management of Upper Gastrointestinal (UGI) cancers. However, poor adherence to MDT recommendations may account for the lack of improved oncological outcomes with MDTs. We aim to quantify adherence rates and compare outcomes between adherent and non-adherent patients. Methods We included all patients with potentially curable primary UGI carcinomas who were discussed at UGI MDT from 2017 to 2018. MDT recommendations were compared to actual treatment received. Oncological and survival outcomes were compared between both groups. Results Amongst 153 patients, 64 (41.8%) were non-adherent to MDT recommendations. Reasons for non-adherence were patient refusal (50.0%), treatment-related complications (31.3%), disease factors (17.2%) and clinician decision (1.56%). Univariate analysis showed that non-adherent patients were older (71.6 vs 65.2 years, p < 0.001), with higher clinical stage at point of diagnosis (p = 0.028), pathological stage after resection (p < 0.001) and were more likely to be recommended for multimodal therapy. No significant factors were associated with non-adherence at multivariate analysis. Non-adherent patients had worse median overall survival (19.5 months) compared to adherent patients (not reached at follow-up) with both unmatched and propensity-score matched analysis. Patients who received only part of the intended adjuvant chemotherapy course had worse median overall survival and disease-free survival compared to patients who completed or did not initiate adjuvant chemotherapy. Conclusions Non-adherence to MDT recommendations was associated with advanced age and tumor stage, and potentially contributes to the worse oncological outcomes in a group of patients already predisposed to poor outcomes.
... Cultural background may in��uence one's orientation of illness perception and coping mechanism. For example, in��uenced by traditional Chinese medicine (TCM) perspective, general Chinese Malaysians reportedly viewed illnesses as imbalance of forces within a body system (Chew et al., 2011). A stroke could be conceptualised as poor blood ��ow due to "wind" blocking and thick blood (Yap et al., 2019). ...
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Religious community is a cultural system that embodies specific interpretation of illnesses and healing signs. Ignoring its influence on epidemic perception and coping has been a cultural myopia in current psychological science. Therefore, this paper set out to conduct systematic review on the past psychological studies on how different religious believers perceived and coped with a pandemic. A rigorous literature search using PRISMA guidelines on EBSCOHost, Ovid, and PubMed databases was conducted. Any empirical studies that were published in 2000–2020 which contained participants from certain religious groups, and constructs that fell under “illness perception” and/or “coping strategies” within a human pandemic context were included. From the originally generated 12,438 references, after cleaning, screening and quality evaluation, 17 quality papers remained for critical analysis. Due to the timeframe of the selected papers, most of the studies revolved around HIV/AIDS as an epidemic in the American and African continents. Only three major religious traditions were identified – Christianity, Islam, and Buddhism. Themes of research findings were extracted through thematic analysis and consensus coding
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Traditional Chinese medicine (TCM) has remained an integral part of Chinese culture and society for thousands of years. In Taiwan TCM is a recognized element of its National Health Insurance Scheme. However, there is no knowledge about how TCM is accessed by foreign workers from a non-Asian cultural background. The objectives of this study were to investigate the prevalence and patterns of TCM use among non-Asian white-collar workers living in Taiwan, and examine factors likely to influence their use of TCM. This study applied a cross-sectional survey design. A total of 207 white-collar foreign workers of a non-Asian background currently holding National Health Insurance cards who had lived in Taiwan for 4 months or more participated in this study. The prevalence of TCM use was 45%. The most frequently used therapies were traditional Chinese herbs/medicine and acupuncture. Factors indicating the likelihood of TCM usage were age 31-40 years, visit to an allopathic medical doctor in the last year, ability to read Chinese, having a friend or family member available to assist in the use of TCM, and access to information about TCM services available in Taiwan. Utilization of TCM by people of a non-Asian background living in Taiwan appears to be most influenced by enabling factors including language ability, access to information, and informal reference persons.
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A study was carried out in a primary healthcare clinic in the Hulu Langat district of Malaysia to assess the parental knowledge, attitudes and antibiotic use for common childhood acute upper respiratory tract infection (URTI). A cross-sectional study involving 421 parents, who were surveyed by using an interviewer-administered questionnaire, from April to June 2001. Approximately 59 percent of parents from this study believed that weather was the main cause of acute URTI of their children, 13 percent thought it was due to food, and only about 27 percent said it was caused by germs. Nearly 68 percent, 69 percent and 76 percent of them believed that antibiotics was helpful in treating the common cold, cough and fever, respectively. 29 percent of parents who thought that their child with acute URTI needed antibiotics were not prescribed with any. On the other hand, 17 percent believed that antibiotics were unnecessary when prescribed. 28 percent of parents had requested for antibiotics, and 93 percent received what they requested for their child with acute URTI. About 31 percent of parents who did not request any antibiotics claimed that private general practitioners habitually prescribed antibiotics. The antibiotic compliance was poor with only 74 percent completing the entire course, with 85 percent of them stopping once they improved symptomatically. 15 percent of parents gave "leftover" antibiotics, 24 percent gave "shared" antibiotics, and 5.5 percent bought antibiotics for their child with acute URTI without consulting a doctor. This study shows that parents often have inadequate knowledge and misconceptions on antibiotic use for acute URTI in children. Improved parental education may reduce unnecessary antibiotic prescription and antimicrobial resistance in the community.
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'Sitting month' is a Chinese tradition for women's postpartum custom. The present study aims to explore the postpartum dietary and health practices of puerperal women and identify their influential factors in three selected regions of Hubei, China. A cross-sectional retrospective study was conducted in the selected urban, suburban and rural areas in the province of Hubei from 1 March to 30 May 2003. A total of 2100 women who had given birth to full-term singleton infants in the past two years were selected as the participants. Data regarding postpartum practices and potentially related factors were collected through questionnaire by trained investigators. During the puerperium, 18% of the participants never ate vegetables, 78.8% never ate fruit and 75.7% never drank milk. Behaviour taboos such as no bathing, no hair washing or teeth brushing were still popular among the participants. About half of the women didn't get out of the bed two days after giving birth. The average time they stayed in bed during this period was 18.0 h. One third of them didn't have any outdoor activities in that time periods. The educational background of both women and their spouses, location of their residence, family income, postnatal visit, nutrition and health care educational courses were found to be the influencing factors of women's postpartum practices. Traditional postpartum dietary and health behaviours were still popular among women in Hubei. Identifying the factors associated with traditional postpartum practices is critical to develop better targeting health education programs. Updated Information regarding postpartum dietary and health practices should be disseminated to women.
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Use of Traditional Chinese medicine (TCM), an important category of complementary and alternative medicine (CAM), has increased substantially in Western countries during the past decade. Use of TCM is also widespread in the Chinese population. However, few informative data have been obtained to date by large-scale investigations of TCM use in the Chinese population. This study was aimed at elucidating the demographics and patterns of TCM use in Taiwan. We employed the complete datasets of TCM outpatient reimbursement claims from 1996 to 2001, including the use of Chinese herbal remedies, acupuncture and traumatology manipulative therapy, to analyse use frequencies, the characteristics of TCM users, and the disease categories that were treated by TCM in Taiwan. At the end of 2001, 6,142,829 (28.4%) among the 21,653,555 valid beneficiaries of the National Health Insurance in Taiwan had used TCM during the year. However, 13,536,266 subjects (62.5%) had used TCM at least once during the whole 6-year period from 1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The mean number of TCM users per annum was 5,733,602, with a mean increment of 1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher than male (female:male = 1.13:1), and the age distribution displayed a peak at around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%) were the most common TCM modality used by this population, followed by acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private TCM clinics provided most of the TCM care (82.6%), followed by private TCM hospitals (12.0%). The top ten major disease categories for TCM visits were diseases of the respiratory system, musculoskeletal system and connective tissue; symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the digestive system, genitourinary system, skin and subcutaneous tissue, nervous system and sense organs, circulatory and endocrine system; nutritional and metabolic diseases; and immunological disorders. TCM was popular among the Chinese population in Taiwan during the period studied. More than 60% of all subjects had used TCM during the 6-year interval. TCM was widely used by the Chinese population to treat problems and diseases of major human organ systems recognised by western medicine. This study provides information about the use frequencies of TCM and the disease categories treated by TCM, which should be useful for health policy makers and for those considering the integration of TCM and Western medicine.
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This paper, focussed on medical care in the Chinese communities of Peninsular Malaysia, offers a preliminary view of what is known of traditional Malaysian Chinese medical beliefs, practices, and personal health related behaviour. Some thoughts are also offered on the implications of these facts for physicians and surgeons whose professional training and experience has been very largely within a medical tradition usually designated as scientific, modern, or Western, i.e. 'cosmopolitan medicine'.
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Understanding the sociocultural dimension of a patient's health beliefs is critical to a successful clinical encounter. Malaysia with its multi-ethnic population of Malay, Chinese and Indian still uses many forms of traditional health care in spite of a remarkably modern rural health service. The objective of this paper is discuss traditional health care in the context of some of the cultural aspects of health beliefs, perceptions and practices in the different ethnic groups of the author's rural family practices. This helps to promote communication and cooperation between doctors and patients, improves clinical diagnosis and management, avoids cultural blind spots and unnecessary medical testing and leads to better adherence to treatment by patients. Includes traditional practices of 'hot and cold', notions of Yin-Yang and Ayurveda, cultural healing, alternative medicine, cultural perception of body structures and cultural practices in the context of women's health. Modern and traditional medical systems are potentially complementary rather than antagonistic. Ethnic and cultural considerations can be integrated further into the modern health delivery system to improve care and health outcomes.
Key StatisticsPopulation of Malaysia In: Department of Statistics Malaysia Official Website [online]. Available at: www.statistics.gov.my
  • Federal Government
  • Administrative Centre
Federal Government Administrative Centre. Key StatisticsPopulation of Malaysia. In: Department of Statistics Malaysia Official Website [online]. Available at: www.statistics.gov.my/.