ABSTRACT
raditi tion onal al Mala Malay y Medi Medici cine ne (TMM (TMM)) is popu popula larr amon among g the the Mala Malay y Purpose: Tradi population despite of its limited scientific evidence based on the safety and also effectiveness effectiveness of this treatment. treatment. As we all know that UiTM is the only university that has bum bumiput iputera era and Malay students students.. This This study study is conducte conducted d to investig investigate ate the understanding, attitudes and patterns of uses of TMM among UiTM uncak Alam students. Method ! A cross sectional study has been conducted to "## undergraduate undergraduate students of UiTM uncak Alam. The respondents respondents have been divided into " different groups based on the " main courses in UiTM uncak Alam. $ata were collected using a specific %uestionnaire for each student that content of several part about know knowle ledg dge, e, atti attitu tude de and and uses uses of TMM MM.. Results! A tota otal of &' &' (*.+' *.+' ) %uestionnaires were collected. There were a positive knowledge and attitude among each student from different courses regarding the use of TMM. Apart from that, they have some doubt about the scientific evidence-based of the safety and effectiveness of the TMM. The main factor for using TMM is because of health maintenance (p#.##*) and the differences between the previous study stated that low cost and easier to get are one of the main reasons. Apart from that, there are significantly differences between each group regarding the patterns of use of as p-value is less than #.#' e/cept for the fre%uency of using TMM. Conclusion! Most of the students from each course have a positive knowledge and attitude towards the TMM. This study also presented a high percentage of TMM use among the students in each different course. Traditiona ionall Malay Malay Medicine Medicine (TMM), (TMM), TM TMM M use, use, TM TMM M knowled knowledge, ge, Keywor Keyw ords ds:: Tradit Attitude towards TMM.
2
CHAPTER 1
INTRODUCTION
1.1
Overview
Traditional Traditional medicine medicine is a primary health care system that gives a main contribution contribution to the human health care system long before the modern medicine start to establish. establish. 0owadays, traditional medicine is still an important system in the primary health care system of several developing developing countries in the world. Moreover, Moreover, in some countries like Asian Asian countries where the modern medicine is already available in the market, traditional medicine still maintains its popularity in a long run due to its significant and the cultural effects there. 1n Malaysia, for e/ample, there are a variety of traditional medicines that have been used ages ago and there are three main groups of traditional medicines that have been used such as Traditional Traditional Malay medicin medicine, e, Tradi Tradition tional al 2hinese 2hinese medicin medicinee and also Tradit Traditiona ionall 1ndian 1ndian medicin medicine. e. The cost estimation of e/penditure towards the use of Traditional medicine is about 3 to + billion 4inggit Malaysia every year. This is about 5'##(U6) million more compared with the value that they spent on western medicine that contribute only about 5&##(U6) 5&##(U6) million. $uring the last decade, traditional medicines as well as 2omplementary 2omplementary 7 Alternative Medicine (2AM) have been well accepted and increasingly used in the developing countries (8hang, +###).
Malaysia can be considered as one of the country that uses a variety of traditional medical systems which can be e/plained by the various ethnic diversity of its population. Traditional medical systems can be classified into several subgroups, which are Traditional 3
Malay medicine, Traditional 2hinese Medicine and also Traditional 1ndian Medicine. 1t can complement or can stand alone as an alternative to the modern medicines (2hen, 3*3). Traditional Traditional medicine can be considered considered as widely consumed by the local community community (2how, +##+).
Traditional medicine can be defined as 9the summation of knowledge, skills and also practices based on the theories, beliefs and e/periences e/ periences originally from the different cultures, whether reasonable or not to be used in maintaining our health also as a prevention, diagnosis, impro improvem vement ent as well well as to treat treat phy physi sical cal and and ment mental al illne illnesse sses: s: (WHO Global Global Atlas Atlas of Traditional, Complementary and Alternative Medicine , +##'). ;hile for many traditional
medicinal products, scientific evidence and well documented form of safety and efficacy is insufficient and limited, but still these products have been tested or used in a population for centuries< communities have learned as much as practical knowledge regarding this particular medicine medicine through the folklore which is the tradition of the culture and has been passed on by generations of healers (Timmermans, +##&). 1.2
Problem Statement
Most of the consumers practice the use of 2omplementary and Alternative Medicine (2AM) irresponsibly due to lack of knowledge about their medications. ;e need to ensure that proper education and information about 2AM can be implemented to the pharmacist as well as to the public. =ne of the most important types of 2AM is Traditional Malay Medicine (TMM). eople need to be e/posed to this type of medications in their education, especially for the university>s students. They need to be familiar with the term that we called TMM so that they can apply the knowledge in their daily life and give awareness to the public about the TMM therapies. 1t is important in order to prevent abuse or misuse of the medication. 4
6tudents especially, tend to use many alternative medications for many reasons and it is different between male and female instead of using conventional medicine. ?ven though they know the conventional medicine provided in the prescription from the physician is much safer to use and to treat the disease, but still most of them prefer to take any other supplements rather than focus on the drugs prescribed by the doctor. They maybe prefer to use the TMM products @ust to complement with the conventional medication or else as an alternative to it. As there is not much research regarding university students on the use of TMM and their knowledge, perception regarding this matter, thus this is a good platform and idea to conduct this research. This study aimed to describe the attitude, understanding, and also patterns of TMM used among students in UiTM uncak Alam 2ampus.
1.
Ob!ectives
To identify the use of TMM among students in UiTM uncak Alam campus. • •
To identify the basic knowledge regarding the safety and trends of TMM use. To analye the patterns of TMM used among each student in different faculties in UiTM uncak Alam 2ampus.
•
To identify this population>s attitude regarding the safety and trends of TMM use.
1. "ypothesis •
;e can briefly assume that most of the students from different courses in UiTM uncak Alam are not familiar with TMM.
5
•
They may prefer to use conventional medicine alone instead of using TMM because of
•
not much knowledge in this area. They are likely to have a negative attitude towards the safety and effectiveness of the TMM.
1.#
Si$ni%icance o% study
The effectiveness and uses of TMM in teenager, especially among students in the university nowadays are an issue because they do not know whether this medicine will give a therapeutic effect much more the same with conventional medicine or it only give more side effects to the people who used it. Actually, many studies had been conducted towards the public all around the world, but still every studies has it owns limitation and only a few have been focusing on TMM and its application among students. This study is conducted in order to know the attitude and knowledge of 2AM, especially on the uses of TMM therapies among the students primarily in UiTM uncak Alam campus where from this study possible outcome can be determined in order to increase the knowledge level and acknowledge the attitude of the students towards the safety and effectiveness of the TMM.
1.&
Research 'uestions
3. ;hat are the common factors that influence students in UiTM uncak Alam to use Traditional Malay Medicine instead of conventional medicineB
6
+. $o the non-medical students care much about the knowledge on TMM before they use the therapiesB &. 1s there is any difference in the pattern of use on TMM between the students from the different departmentB ". $o they have a positive attitude towards the TMM medicines rather than conventional medicinesB
CHAPTER 2
LITERATURE REVIEW
2.1
(raditional Medicine
;orld Cealth =rganiation (;C=) had already give a broader definition of traditional medicine that can be known as 9the summation of knowledge, skills and practices based on the theories, beliefs and e/periences of folklore which is a tradition in every different cultures, whether reasonable or not to be used in maintaining our health, as well as in the prevention, 7
diagnosis, improvement or treatment of physical and mental illnesses:. ;C= has stated that almost all of the population in both undeveloped and developing countries prefer to use a traditional complementary medicine respectively (Dodeker 7 =ng, +##'). Traditional Medicines including herbal medicines, has been used worldwide including in Malaysia (Ai 7 Tey, +##*).
Cerbal medicines, which includes herbs from plants, herbal preparations and herbal products, are the most common of traditional medicines (;orld Cealth =rganiation, +##'), and women are the most fre%uent users (Call et al., +#33< Murphy et al., 3***).Cerbal medicines have been used by women to treat several numbers of problem related to reproductive system such as menstrual problems, infertility, discomforts, labor, menopause and dysfunctions of pregnancy (Deal, 3**).
1n 6outheast Asia, even though there are many conventional medicines have been produced and available for many purposes, the use of traditional medicine remains popular as access to modern medicine is widespread but not available to all (6hein, +##3). 1n fact, all member countries of the 6outheast Asian region, with the help of ;C=, start to developing and introducing the use of traditional medicine into their primary health care and also try to increase the access and strengthening them in that position (6hein, +##3< ;orld Cealth =rganiation, +##'), as this traditional medicine give more benefit to the population in being less e/pensive by providing low cost to them and readily available in natural form compared to the conventional medicines respectively(Delew, 3***).
8
A high prevalence use of alternative medicine has been reported among patients suffering from chronic disease such as arthritis. 1n fact, herbal therapies have always been regarded as effective and ancient or natural medical remedies to treat arthritis (Eestin, 3*'
2.2
(raditional Malay Medicine
Malay Traditional Massage Therapy (MTMT) is one of the e/amples of Malay Traditional Medicine, where the knowledge and also practices of this therapy is already synonyms to the Malay culture and it covers all aspects of health and healing practice from generations to generations. Malay massage therapy usually inherited via traditions among families, either in the verbal or written form. eople usually knew or called the MTMT practitioners as Tabib (healers).The aim of the treatment is to cure and also as a prevention of the diseases. Dasically, there are three methods involves in this massage therapy which are lumur (doubing), urut (massaging) and the last one is bekam (cupping) (=thman, Faroo%ui,
Hamina, 7 $in, +#3+).
1n Malaysia, MTMT has been practiced long time ago before the modern medicine has been established. From the previous studied, there is an evidence on the use of MTMT as an effective treatment for patients that have chronic diseases such as back pain, insomnia, osteo 9
related diseases for e/amples arthritis, @oint pain, knee pain, osteomyelitis, osteoporosis and others (Maurits et al., +##').There are an evidence regarding the statement that massage actually can reduce the intensity of the pain, improve the function of the body and also as the main treatment of pain. The originality of this therapy can be seen based on the ancient and earliest references on the uses of massage therapy that come from Dabylonia which is around *## D2, in 2hina (around +## D2), 1ndia (around 3'##-3+#D2), Ireece (Cippocrates "G#&D2, Asclepiades, Ialen) and 4ome (lato "+-&" D2) and also 6ocrates ("#-&**D2) (Eanemet, 3*').
There was a study conducted by 6agar et al. (+##) about the effectiveness of the massage therapy which can improve physiologic and also clinical outcome by giving a symptomatic relief of pain using physical and also for mental rela/ation. Massage techni%ues can actually gave local biochemical changes that will improve the blood flow and also blood circulation in the body by manipulating the affected muscle and gave o/ygen supply to the site of action. =ther than that, massage also can improve the fle/ibility of the muscle, give strength to the lymph movement and also loosen up the adherent connective tissues (Hee et al. 3**#).Unfortunately, the right and precise mechanism of the massage therapy to give a lot of therapeutic effects are still unknown (=thman et al., +#3+).0ot much evidence can be shown on the clinical efficacy of the therapy, fre%uently with the inade%uate used of the practical system (Drandmaier 7 ;alach, 3**< ?rnst 7 Fialka, 3**"< Jickers, 3**G). Mostly, all the randomied studies have used massage as a control group or others management of the therapeutic effects but there have no studies on the originality and in a broad version of massage, but they only used them as a placebo type that gives no therapeutic effects at all (Csieh et al., 3**+).
10
From the previous studied, we found out that MTT can be one of the modalities for the treatment of Hower Dack ain (HD). ?ven though the mechanism of action was not welldocumented but still the results of the treatment had gave a lot of benefits to the patients. The patients were much more comfortable with the traditional treatment procedures as it gave the lesser side effect to them and does not involve any surgical interventions. The patients> %uality of life which has improved is one of the evidence that MTT is effective to treat HD patients. Deside the low side effects and lower cost, as well as easy to be access make peoples to seek more for these traditional types of treatments (=thman, Faroo%ui, 7 Hamin, +#3&).
2.
)nderstandin$* +ttitudes , )ses o% (raditional Medicine amon$ students
harmacy students in Universiti Eebangsaan Malaysia (UEM) also give a positive attitudes and understanding towards the basic knowledge of Traditional 7 2omplementary Medicine (T72M). They also have the same opinion about the application of T72M in the curriculum of pharmacy program to help them gain more knowledge on the T72M therapy. Cowever, there are still not much evidence-based facts regarding the T72M that make them still unsure to apply it in their daily practices. The main issues are regarding the efficacy and effectiveness of T72M that make them unconfident to help their patients or clients on the use of T72M. Therefore, the students need to be e/posed more on the knowledge and educations related to the scientific evidence of the T72M and for sure need to be implemented in the pharmacy curriculum base. Many issues related to the %uality, safety and effectiveness need to 11
be focus and can be a main topic to be studied. Further study needs to be done regarding the knowledge and attitudes of the final year students in the faculty of pharmacy at other universities in Malaysia to prove the findings in this proposal (Kamal, araidathathu, 7 Ami, +#33).
=ther studies shown that there are only a small percentage (*.) of the students that still using the TMM treatment such as Malay herbs, like medicated hot oil (minyak panas ), medicated ointment originally from the sea cucumber or plant (ubat gamat ) , the blood cleaning procedure that used to get rid of the to/ic in the patient>s blood ( bekam), also the herb that derived from different parts of the shrub (jamu) and misai kucing with the scientific name as Clerodendrantusspicatus which is believed by the people as the treatment of diabetes mellitus while only 3*.' of the students had used TMM beforehand (Casan et al., +#33).
According to the research conducted among the pharmacy students in Cong Eong, they stated that one out of three students there had been using traditional medicine previously at least once in the past year and mostly all of them have ever tried T72M. From the entire sample, only 3 of the students stated that they have negative attitudes towards T72M. 6o we can say that T72M is well accepted by the pharmacy students. These findings are in concurrence with other studies which found that medical and non-medical students still in doubt about the safety and effectiveness of the T72M but they still have a positive attitude towards this therapy because they are likely to have not much concern about the scientific and therapeutic evaluation of this treatment (Con et al., +##")
12
2omplementary and Alternative Medicine (2AM) has been accepted among the people by showing the great demand towards this interdisciplinary nature of the care that can increased the health-related %uality of life (C4LoH) outcomes (Eelleher, +##&). =ne of the therapies involved in 2AM is MTMT and it is the main choice for some Malay people in Malaysia as their alternative treatment or complement to the conventional medicine to improve their %uality of life (LoH) (Cassan et al., +#3#). 2AM is the main treatment that has been used in Malaysia and it is %uite popular among the population there (Faroo%ui et al., +#3+< Cassan et al., +#3#) however the well documented evidenced of this information is still limited regardless of the increasing use of 2AM practices. Ministry of Cealth Malaysia currently recently had recognied the important role of 2AM in Malaysia health care system and they had been providing an opportunity to the patients to make use of the 2AM therapies with full confidence and without any doubt or afraid of making a wrong decision in choosing this type of treatment. Decause of the initiatives made by the ;orld Cealth =rganiation (;C=) in recogniing the effectiveness and the usefulness of 2AM in national health care system, in the early year of +###, Malaysia is one of the country that developed and implemented their own policies on Traditional and 2omplementary Medicine (T72M) therapies (=thman et al., +#3+).
13
CHAPTER 3
METHODOLOGY
.1
Study -esi$n
A cross sectional study was conducted at UiTM uncak Alam 2ampus which was located about G# km from the city of Euala Humpur and appro/imately &' km from the UiTM main campus of 6hah Alam. UiTM uncak Alam 2ampus consisted of " different faculties which were Faculty of harmacy, Faculty of Cealth 6cience, Faculty of Cotel 7 Tourism Management and Faculty of =ffice Management 7 Technology. This study was conducted for a period of one month, which was from Kanuary till February +#3". A set of finalied %uestionnaire werw distributed to the students of each faculty. They were briefly introduced about the research before they started answering the %uestionnaire. !Appendi" A# Map of $iTM %uncak Alam Campus&
.2
Study Sample
The sub@ects of this research study were selected from undergraduate students from each faculty which involved final year students only. Doth male and female were involved in this study. There were &' out of "## were successfully answered by the respondents. The %uestionnaires were distributed by using convenient sampling method.
14
.
-ata Collection
The data collection tool was a set of %uestionnaire. 1t had been answered by the respondents itself according to their perception and also their knowledge. A pilot study was conducted at the end of the +#3++#3& academic session to 3# respondents and they were e/cluded in the final survey. The %uestionnaire consisted of + parts! (i) sociodemographic part and (ii) 4esearch %uestions part. There were ' %uestions in sociodemographic part and +' %uestions on the research %uestions part. 4esearch %uestions part was subdivided into + sections which are about the knowledge, attitude and also uses of the Traditional Malay medicine. The %uestions were designed in several different types to be answered by the respondents. Multiple choice answers had been provided. There were also close-ended %uestions with yes and no answers as well as the Hikert scale type had been used in several sections of the %uestions. !Appendi" '# (uestionnaire&
.#
-ata +nalysis
$ata was collected and analyed by using 6tatistical ackage for 6ocial 6ciences (666) software version +#.#. 2hi N s%uare test and Eruskal ;allis test were used to analye the data. 6ignificance level was set at pO#.#' with the confidence interval of *'. $ata was collected and summaried using tables and has been shown in the results of the findings.
15
CHAPTER 4
RESULTS
#.1
Sociodemo$raphic variables o% study participants
The total number of respondents involved in this study were *.+' (n&') out of 3## (n"##) %uestionnaires that have been distributed. According to the result analyed by using the 666 software that was shown in Table 3.", from the total respondents involved, there were #.& (n+'3) female students and +*.(n3#G) male students. Most of the respondents were between the range of ++-+" years old (GG.", n+&) followed by range of 3*-+3 years old (&3.&, n333), +'-+ years old (3., nG), +-&# years old (#.G,n+) and the least was above &# years old (#.&, n3). There were four different courses that involved in this study which were harmacy that mostly contributed +.' (n*) students followed by Cotel Management (+G.&,n*"), Dusiness Management (+'.',n*3) and lastly Cealth 6cience students which were +#. (n"). As the %uestionnaires were distributed using convenient samplings, the percentage of the respondent>s year of study were slightly different which '&.' of them from Pear + only while others were from Pear & and Pear 3 with +"." and ++.3' respectively. Dased on the respondents> educational background, most of them were from a diploma background ('.', n+#*) followed by matriculation background (+3.#, n') and foundation background (3*.G, n#) as well as others background which was degree that only contributed about #. (n&) respondents. (able #.1 6ocio-demographic variables of study participants
Jariables
Fre%uency (0)
ercentage () 16
Gender Male Female
1/0 2&1
2. /.
Age 3*-+3 ++-+" +'-+ +-&# Above &#
111 2 0 2 1
1. 00.# 1. /.0 /.
3 # # 1
2.& 2/. 20. 2&.&
)ear of study Pear 3 Pear + Pear &
11 3
22.1 &.& 2#.#
*ducational 'ackground Matriculation Foundation $iploma =thers
& / 2/
21./ 1.0 &3.& /.3
Course harmacy Cealth 6cience Cotel Management Dusiness Management
#.2
Knowled$e on (raditional Malay Medicine 4(MM5
17
According to Table ".+, ma@ority of the respondents agreed that herbal therapy, massage and bekam (cupping) were the e/amples of TMM with a percentage of *.G (n&+#) and same goes to the knowledge about the safety use of TMM which contribute about &.+ of the total respondents. Calf of the respondents about '." agree that TMM therapies are risk free to the general public and "+.G of the respondents based on their knowledge do not agree with that statement. Most of the respondents stated that they agree with the %uestion provided e/cept for the knowledge on the amount of herbs in TMM among different brand names with the ma@ority of G". did not agree with it. (able #.2 Enowledge on TMM among the different students 'uestion
Herbal terapy, massage and bekam!cupping& are e"ample of TMM Pes 0o TMM is used because it is safe and fe+ side effects Pes 0o TMM terapies are risk free to te general public Pes 0o All TMM products must carry te labeling, Tis product not intended to diagnose, treat,cure or prevent disease-
Pes 0o
6re7uency 485
&+#
Percenta$e 495
&
+* G#
+#'
3'+
*.G 3#."
&.+
3G.
'."
"+.G
+" &
G. +&.+
Te amount of erbs in TMM product is te same among different brand names.
Pes 0o
3+G +&3
&'.&
G".
/ufficient evidence e"ists +ic supports te use of TMM
Pes 0o
++' 3&+
G&.# &.# 18
Healtcare practitioners sould be able to advise teir patients about commonly used TMM
#.
Pes 0o
&3'
"+
.+
33.
+ttitudes towards (MM
The results regarding the attitudes of the respondents towards TMM are tabulated in the Table ".& below. Most of them agree that TMM must be scientifically proven to be safe before it is marketed and sold in our country with a percentage of "3.. =ther than that, half of them not sure and the others agree that it may be dangerous to take TMM with some prescription medications with percentage of +*.3 and &".' respectively. About &.' of the respondents slightly agree that TMM have fewer side effects than medicines prescribed by the doctors. Ma@ority of them agree that TMM like massages, medicinal plants, and bekam (cupping) are the treatment that save and very effective for our health with the percentage of &.*, whereas TMM is useful as a complementary to the conventional medicine ("+.*) and TMM products that are not tested in a scientific manner should be discouraged with the percentage of '&. respectively.
Cowever, most of the respondents have doubt regarding TMM, whether it should be used for minor ailments or for the treatment of more serious illnesses with the percentage of &&.& .They also not sure if most of people often take TMM to improve their health or to help them stay healthy with the percentage of &.#. Desides, they agree that most of the people should inform pharmacist when they use TMM to complement with prescription medications (".*) and people always seek an advice from pharmacist before using any TMM with a percentage of &+.' respectively. 19
(able #. Attitude towards TMM among different students Statement
TMM must be scientifically proven to be safe before it is marketed and sold in our country
Scale F(%)
/trongly disagree
0isagree
1ot sure
Agree
/trongly agree
+* (.3)
&# (.")
"3 (33.')
3# (&#.&)
3"* ("3.)
1t may be dangerous to take TMM with some prescription medications
+ (.G)
"G (3+.*) 3#" (+*.3)
3+& (&".')
' (3G.#)
TMM has fewer side effects than medicine prescribed by doctor
+' (.#)
&& (*.+)
3&3 (&G.)
3&" (&.')
&" (*.')
Massages, medicinal plants, and bekam (cupping) are the TMM that save and very effective for our health
+ (.)
G# (3G.)
' (+3.#)
3&* (&.*)
'' (3'.")
TMM is useful as a complementary to the conventional medicine
++ (G.+)
GG (3.')
# (++.")
3'& ("+.*)
&G (3#.3)
TMM products that are not tested in a scientific manner should be discouraged
" (3.3)
3+(&.")
& (+&.+)
3*+ ('&.)
GG (3.')
TMM should be used for minor ailment and not for treatment of more serious illnesses
3 (#.&)
+* (.3)
33* (&&.&)
33" (&3.*)
*" (+G.&)
eople often take TMM to improve their health or to help them stay healthy
3 (#.&)
&3 (.)
3&+ (&.#)
3&# (&G.")
G& (3.G)
eople should inform pharmacist when they use the TMM to complement with prescription medications.
3 (#.&)
(+.#)
3 (3*.*)
33 (".*)
3# (&#.#)
20
eople always seek an advice from pharmacist before using any TMM
#.#
+*(.3)
'* (3G.')
*# (+'.+)
33G (&+.')
G& (3.G)
)ses o% (MM
According to the Table "." below, almost all of the respondents already had or currently use one or more than one of TMM listed in the %uestionnaire. Most of them (&G.") prefer to use medicated oil followed by massages (+3.") as compared to other TMM listed below. A hundred and si/ty (++.') respondents prefer to take TMM for their health maintenance and hundred forty si/ (+#.') used TMM to promote general health. Ma@ority of 21
the respondents have no symptoms (G'.*, n+"&) prior to the long term use of the TMM. There is no specific time for most of the respondents which is '." (n+G*) prior to the daily usage of the TMM. Most of the respondents (+.", n3&3) use to get or buy their TMM at the pharmacy followed closely by traditional healers (+G., n3+&) and grocery shop (+&.*, n33#).
Almost half of the respondents ("*.*, n&3#) get the information or sources about TMM from their family members and friends and others used to know it from many other resources like mass media, magaines, online and flyers or advertisements with a percentage of 3&., 3+.+, 33. and 3#.' respectively. =ut of three hundred and fifty seven, almost all of them ('.+, n&#") have stated that their family members also had used TMM before or currently use it in their daily life.
(able #.# atterns of use of TMM among students 'uestions
6re7uency 8
Percenta$e 495
0o you use any of te follo+ing TMM2
Medicinal plants Massages 'ekam (cupping) Medicated oil 3amu Cerbal bath =thers
& 3"3 "" +"# '" &' +#
3+.G +3." G. &G." .+ '.& &.# 22
0one at all
"+
G."
4eason!s& +y you use TMM2 romote general health Hose weight revent illness Cealth maintenance 4elease stress $ietary supplement ?nergy booster =thers 0o specific reasons
3"G '* 33' 3G# " '* " 3# &#
+#.' .& 3G.+ ++.' 33. .& G. 3." ".+
0uring te time you are using TMM5 do you e"perience anyof te follo+ing symptom!s&2 0ausea 7 Jomiting 4ashes1tching Cair loss $iarrhea Allergies $iiness =thers 0one at all
+ +& * +' 3* +# & +"&
.& G.+ +." G. '.3 '." #. G'.*
Ho+ fre6uently are you taking your TMM eac day2 =nce daily + N & times daily " N ' times daily 0o specific time
+ 3 + +G*
Were do you buy7get your TMM2 harmacy =nline Irocery shop Traditional healers =thers
3&3 3* 33# 3+&
+." ".3 +&.* +G. 3G.*
8rom +ere did you kno+ about te TMM2 Friends 7 Family Magaines =nline Mass media FlyersAdvertistement =thers
&3# G & ' G' 3+
"*.* 3+.+ 33. 3&. 3#.' 3.*
.G ". #.G '."
0oes any of your family members use TMM2
Pes
&#" '&
'.+ 3". 23
0o
#.&
Comparison o% understandin$ about (MM amon$ di%%erent courses
The results regarding the knowledge of respondents towards the uses of TMM are tabulated in the table ".' below. Almost all of the pharmacy students agree that, bekam (cupping) and herbal therapy are the e/ample of TMM. All of them agree that TMM is used because it is safe and has fewer side effects. =ther than that there is a significant difference between each course. There is a significant difference (p #.#+3) between each course about their understanding on the herbal therapy, massage and bekam (cupping) as the e/ample of TMM. harmacy students have slightly more knowledge and almost all of them agree (*".*) on the statement. Dusiness Management students surely agree (#.&) that TMM 24
therapies are risk free to the general public. There is a significant difference (p #.#+3) between the answer of each different courses. (able #.& Understanding towards TMM among students. Statement
Herbal terapy, massage and bekam!cupping& are e"ample of TMM Pes 0o TMM is used because it is safe and fe+ side effects Pes 0o TMM terapies are risk free to te general public Pes 0o All TMM products must carry te labeling, Tis product not intended to diagnose, treat,cure or prevent diseasePes 0o Te amount of erbs in TMM product is te same among different brand names. Pes 0o
Pharmac y 8495
"ealth Science 8495
"otel Mana$ement 8495
usiness Mana$ement 8495
*&(*".*) '('.3)
#(*".G) "('.")
3(G.+) 3&(3&.)
G(&.') 3'(3G.')
3(+.) 3(3.&)
G3(+.") 3&(3.G)
+(.+) 3+(3+.)
&(#.+) 3(3*.)
'3('+.#) "(".#)
&G(".G) &('3.")
'"('.") "#("+.G)
G"(#.&) +(+*.)
#(3.G) 3(3.")
'3(G.*) +&(&3.3)
+(.+) 3+(3+.)
G3(G.#) &#(&&.#)
+G(+G.') +(&.')
+'(&&.) "*(GG.+)
""("G.) '#('&.+)
&+(&+.) GG(G.&)
""('*.') &#("#.')
&40.5 4.15
01432.#5 3#43.#5 141.05 1/41/.05
&3(&".3) G#(G'.*)
/ufficient evidence e"ists +ic supports te use of TMM
Pes 0o
&(.) +3(++.&)
G(&.') 3'(3G.')
Healt care practitioners sould be able to advise teir patients about commonly used TMM
Pes 0o
&432.#5 1041.05
25
harmacy students show that almost all of them had knowledge on the re%uirement of TMM products that must carry labeling of the product that it is not intended to treat, diagnose or cure any disease without complementary to the conventional medicine and scientifically proven with the significant difference of (p#.##+). There is a slightly different argument about the same amount of herbs in TMM product among different brand names which most of the pharmacy students &.' do not agree with the statement more than the others and there is a significance difference (p#.#&3) between each courses. There is a significant difference (p#.###) between each group regarding the statement on the evidence of the use of TMM and most of the pharmacy students G stated that there is not much evidence e/ist to support the use of TMM.
All of them agreed that health care practitioners must be able to counsel their patients about commonly used TMM with the percentage of the harmacy student (*G.*), Cotel Management are *.", and +." of Cealth 6cience and Dusiness Management students but there is a significant difference between each courses where pharmacy students more agree to that statement (p#.##').
(able #.0 Total percentage and significance p-value of knowledge on TMM. 'uestions Herbal terapy, massage and bekam!cupping& are e"ample of TMM TMM is used because it is safe and fe+ side effects TMM therapies are risk free to the general public All TMM products must carry te labeling,Tis product not intended to diagnose, treat
Pes 0o
(otal 8495 &+# (*.G) &(3#.")
P value #.#+3
Pes 0o Pes 0o Pes 0o
+* (&.+) G#(3G.) +#' ('.") 3'+ ("+.G) +" (G.) &(+&.+)
#.G&+ #.#+3 #.##+
26
,cure or prevent diseaseTe amount of erbs in TMM product is te same among different brand names. /ufficient evidence e"ists +ic supports te use of TMM Healtcare practitioners sould be able to advise teir patients about commonly used TMM
#.0
Pes 0o
3+G(&'.&) +&3(G".)
#.#&3
Pes 0o
++'(G&.#) 3&+(&.#)
#.###
Pes 0o
&3' (.+) "+(33.)
#.##'
Comparison o% +ttitude towards (MM amon$ di%%erent courses
From the table below, we can see that almost all of the mean value for each statement shows that there is a significant difference (p O #.#') between each group of students and mostly pharmacy students with the mean of ".3' agree with the statement that TMM must be scientifically-proven to be safe before it is marketed and sold in our country. Doth of the pharmacy and health science students are more likely to agree that TMM is useful as a complementary to the conventional medicine with the mean of &. and &.&" respectively. =ther than that, pharmacy students (&.G) tend to be more concerns on the safety, and efficacy of the TMM treatment followed by health science students with the mean of &." while the other two groups of students slightly agree with the statement. There is an e/ception for the last statement with shown that there is no significant difference (p #.&G) because all students from each course slightly agree and some of them not sure whether people always seek an advice from the pharmacist before using any TMM products or therapies.
(able #. 2omparison of Attitude on TMM among students.
Statement
Mean (SD)
p-value
27
Pharmac y
"ealth Scienc e
"otel Mana$ement
TMM must be scientifically-proven to be safe before it is marketed and sold in our country
".3' (3.+#")
&.* (3.+&" )
&.'& (3.+G)
1t can be dangerous to take TMM with some prescription medications
&.G (3.3&3)
&." (3.#G )
&.3 (3.3'3)
&.& (3.3+)
#.###
TMM has fewer side effects than medicine prescribed by doctor
&.'# (#.*33)
&.'" (#.*+ )
&.#+ (3.##')
&.&& (3.#3#)
#.##&
Massages, medicinal plants, and bekam (cupping) are the TMM that save and very effective for our health
&.*3 (#.*+#)
&.G3 (3.#"")
&.#& (3.+3&)
&.& (3.3G&)
#.###
TMM is useful as a complementary to the conventional medicine
&. (#.+#)
&.&" (3.#G )
&.&+ (3.#)
#.###
TMM products that are not tested in a scientific manner should be discouraged
".3G (#.'G)
&.*& (#.+ )
&.' (#.*')
#.###
TMM should be used for minor ailment and not for treatment of more serious illnesses
".#* (#.'3)
&. (#.*'#)
&.G (#.*"")
#.###
&.3& (3.##)
&.+ (#.G*")
&.G (#.')
usiness Mana$ement
&.* (3.+G+)
#.##3
28
eople often take TMM to improve their health or to help them stay healthy
&.& (#.*')
&.' (#.G&)
&.G& (#.3G)
&.G& (#.#)
#.###
eople should inform pharmacist when using TMM to complement with prescription medications.
"."3 (#.G3)
".3G (#.'*)
&.' (#."+)
".#' (#.')
#.###
People always see; an advice %rom pharmacist be%ore usin$ any (MM
.22 41.35
.# 41.1/15
.# 41./0&5
.& 41.13#5
#.
/.0
Comparison on Patterns o% )se o% (MM amon$ di%%erent courses
Dased on the Table ". below, there are significant difference (pO#.#') on the patterns of use of TMM which are medicinal plants (p#.#&G) and jamu (p#.#3G) among different students in each course respectively. =verall results stated that massages and medicated oils are the TMM products that are more preferred by pharmacy students (#.") and health science students (".G).
There is a significant difference (p#.##*) based on the reasons they are using the TMM. Most of the pharmacy students followed by hotel management students prefer to use TMM to maintain their health. All of them slightly agree (p#.#'') that the reasons of them using TMM is to release stress. There is no significant difference (pQ#.#') for other reasons of using TMM. harmacy students ('.) mostly preferred to use TMM products and therapies
29
because of no symptoms that occur prior to the usage of them (p #.#3*). Calf of the other respondents have no symptoms when using the TMM treatment.
(able #.3 2omparison on atterns of Use of TMM among students. 'uestions
0o you use any of te follo+ing TMM2 Medicinal plants Massages 'ekam (cupping) Medicated oil 3amu Cerbal bath =thers 0one at all 4eason!s& +y you use TMM2 romote general health Hose weight revent illness Cealth maintenance 4elease stress $ietary supplement ?nergy booster =thers 0o specific reasons
Pharmacy 8 495
"ealth Science 8 495
"otel Mana$ement 8 495
usiness Mana$ement 8 495
(otal 4p5
&+(3+.) &+(&+.) (.+)
3(+".&) &G(".G) (*.')
3*(+#.+) "#("+.G) 3G(3.#)
3"(3'.") &&(&G.&) 3&(3".&)
#.#&G #.3'+ #.++"
G*(#.") (.+) (.3) "(".3) 3"(3".&)
'(.#) 3#(3&.') *(3+.+) &(".3) "('.")
'G('*.G) +&(+".') 3#(3#.G) (.") 3G(3.#)
'(G&.) 3&(3".&) *(*.*) G(G.G) (.)
#.#& #.#3G #.+& #.G" #.##
"G('".)
&'('#.#)
&&("+.&)
&+(&.G)
#.#G3
33(3&.3) +*(&".') "*('.&)
3#(3".&) +("#.#) &*(''.)
+#(+'.G) &#(&.') "+('&.)
3(+3.) +(&&.) &#(&G.3)
#.#' #.+G+ #.##*
3G(3*.#) +3(+'.#)
+"(&".&) 3+(3.3)
+"(&#.) 3+(3'.")
+#(+".3) 3"(3G.*)
#.#'' #.3&
3'(3.*) &(&.G) (.&)
3#(3".&) +(+.*) G(.G)
3&(3G.) +(+.G) (*.#)
3#(3+.#) &(&.G) 3#(3+.#)
#.+&' #.&+" #.+GG
0uring te time you are using TMM5 do you e"perience anyof te follo+ing symptom!s&2 30
0ausea 7Jomiting 4ashes1tching Cair loss $iarrhea Allergies $iiness =thers 0one at all
Ho+ fre6uent are you taking your TMM eac day2 =nce daily +N& times daily "N' times daily 0o specific Time Were do you buy7get your TMM2 harmacy =nline Irocery shop Traditional healers =thers 8rom +ere did you kno+ about te TMM2 Friends 7 Family Magaines =nline Mass media Flyers Advertistement =thers 0oes any of your family members use TMM2 Pes 0o
G(.3)
'(.3)
(3#.&)
(*.G)
#.++
(.&) 3(3.+) "(".) &(&.G) &(&.G) # +('.)
"('.) +(+.*) '(.3) G(.G) '(.3) +(+.*) 'G(#.#)
(*.#) &(&.) *(33.') &(&.) '(G.") 3(3.&) '*('.G)
'(G.#) &(&.G) (.") (.") (.") # 'G(G.')
#.+G& #.+& #.3' #.3+G #.+#+ #.# #.#3*
*(*.+) "(".3) # 3(+.")
G(.3) +(+.) # G+(&.)
G(G.") G(G.") # GG(#.+)
G(G.G) '('.') +(+.+) #(G.*)
#.+"3
&&(&*.&) '(G.#) +(&&.&) &G("+.*)
+*("3.") # +(&.G) +G(&.3)
&"("&.G) (3#.&) +(&".G) &&("+.&)
&'("+.+) G(.+) +(&&.) +(&&.)
#.&++ #.#+ #.+*# #.3*#
3*(++.G)
+G(&.3)
3"(3.*)
3*(++.*)
#.#3*
(*.)
GG(*.+)
3(G.+)
'(+.")
#.""#
+'(+'.') 3*(3*.") +(+.G) +#(+#.")
3G(+3.G) 3G(+3.G) 3(+&.#) 3"(3.*)
3G(3.#) +3(++.&) ++(+&.") 3*(+#.+)
3*(+#.*) 3(3.) 3(3*.) 3+(3&.+)
#.''G #.*3G #.'' #.'""
&(&.3)
&(".3)
&(&.+)
&(&.&)
#.*G
&432.#5 1041.05
/.1//
/41.35 343.25
0#430.&5 1/41.&5
&4.35 142/.25
31
6eventy one (+.") respondents from pharmacy department have no specific time using their TMM treatment while others also have no differences (p#.+"3) which is si/ty two from health science (&.), si/ty si/ from hotel management (#.+) and seventy from business management (*.G) students also use it within no specific time daily.
There is a significance differences between the students on the sources of getting or buying the products where some of them prefer to buy online (p#.#+) and also getting it from the family members as well as the traditional medicine (p#.#3*), and most of them have the same choices to get the TMM from pharmacy (p#.&++), traditional healers (p#.3*#) and grocery shops (p#.+*#).
All of the respondents have no significant difference (pQ#.#') in term of knowing the information about TMM where they usually get the information from the family members and friends (p#.""#), magaines (p#.''G), online (p#.*3G), mass media (p#.'') and also flyers and advertisements (p#.'""). Most of the respondents from each courses agreed that they have one or more of family members that use TMM with the p-value of (p#.3#).
32
CHAPTER 5
DISCUSSION
&.1
This study was conducted to focus on the understanding, attitude and the patterns of use of TMM among the students of UiTM uncak Alam. All of them are Malay students and according to the Malaysia statistic department, Malays are the main population in Malaysia (Arif 7 Deng, +##G). ;e want to know the distribution of the students that using TMM in their basic daily life. Desides comparison among the variables also have been done in order to know in detail about the relationship between each variable with the different students from different area of study. The findings reported that there were some significant among the variables that have been tested. Cowever, no research has been carried out on the patterns of TMM use among Malay students from medical and non-medical courses.
&.2
Sociodemo$raphic variables o% study participants
Most of the respondents were between the range of ++-+" years old because most of them from Pear + students. There were four different courses that involved in this study, which were pharmacy students that mostly contributed about +.' followed by Cotel 33
Management +G.&, Dusiness Management +'.' and lastly Cealth 6cience students which were +#.. There is no significant difference between the gender and traditional medicine use and this can be supported by the previous study conducted in Malaysia which showed that the result also not significant between the gender and the traditional and complementary medicine use (Cassan et. al., +##*).
&.
Knowled$e on (MM amon$ the students %rom di%%erent courses
Most of the respondents from each course have the same level of knowledge regarding on the use of TMM. harmacy students show more knowledge about TMM treatment compared to other students. This was similar to the study conducted by Kamal at UEM which stated that the Traditional medicine has been offered as one of the elective course to almost all the pharmacy students with the bachelor degree program. Almost all of them agreed that this course will enhance their knowledge to be applied and beneficially practical for them in the future. Unfortunately, there is also lack e/posure for those who did not attend the course (Kamal et al., +#33).
harmacy students show that almost all of them had knowledge on the re%uirement of TMM products that must carry the labeling of product that not intended to be used for treating, diagnosis or cure any chronic diseases, and they know that the traditional medicine is the complementary treatment with the conventional medicine. The study population from previous researcher considered that the use of traditional medicine along with conventional medicine as a complementary rather than alternative of it (Casan at. al., +##*).
34
There is a slightly different argument about the same amount of herbs in TMM product among different brand names which most of the pharmacy students know that the amount of the herbs is different with different brand names and the other respondents have not enough knowledge regarding this matter. As compared to other courses, harmacy students, mostly known that there is not much evidence e/ists to support the uses of TMM. The traditional and complementary medicine products and practice have been accepted among the local people and also worldwide, but most of the Malaysian herbal products and traditional practices are not scientifically evidenced-based and some of them also illegally marketed (Kamal, +##G).All of them agreed that healthcare practitioners should be able to advise their patients about commonly used TMM where pharmacy students are mostly agree with the statement. Dasic knowledge regarding the traditional medicine is beneficial to the student to make a right decision and give a proper advice to the other people that using TMM.
Almost all of the harmacy students agree that massage, medicinal plants and cupping are the e/ample of TMM. All of them agreed that TMM is used because it is safe and has few side effects. 6tudy that already done before stated that some differences e/ist where only a few of the respondents believed that traditional medicine was free from side effects (Eumar, Da@a@, 7 Mehrotra, +##G). harmacy students have slightly more knowledge about the different type of TMM available compared to the others. They have lacked knowledge regarding the safety use of TMM to the general public. 6tudy done before showed some differences were only a few of the respondents believed that traditional medicine was free from side effects (Eumar, Da@a@, 7 Mehrotra, +##G).
The traditional and complementary medicine and practice has been accepted among the local people and also worldwide, but most of the Malaysian herbal products and
35
traditional practices are not scientifically evidenced-based and some of them also illegally marketed (Kamal, +##G). Dasic knowledge regarding the traditional medicine is beneficial to the student to make a right decision and contribute to the community health care.
&.#
+ttitudes towards (MM amon$ students %rom di%%erent courses
=verall of the respondents have positive attitudes towards the uses of TMM. Almost all of them, especially pharmacy students have agreed that TMM must be scientifically proven to be safe before it is marketed and sold in our country and this is likely the same with the previous study that traditional medication still have a high interest in the population even though it has some evidence based issue related to the safety and efficacy of the treatment (=thman, Faroo%ui, 7 Hamin, +#3&).
Doth of pharmacy and health science students are more likely to agree that TMM is used as a complementary to the conventional medicine. This can be supported by the study conducted by (Eamil and Ehoo, +##G), which shows that both modern and traditional medicine treatments are believed to complement each other and the incorporation of T2M with conventional medicine in Malaysia is the positive support from the community.
=ther than that, pharmacy students tend to be more concerns about the safety, and the efficacy of the TMM treatment followed by health science students while the other two groups of students tend to be less concern about it. The result is %uite similar with previous study conducted by (Casan et. al., +##*) that more than half of the respondents (GG.&) have a positive attitude towards the %uality and also the safety of 2AM. They have a positive attitude about the role of pharmacists in providing advices regarding the use of TMM treatment. 6ince traditional and complementary medicine had gained popularity worldwide , 36
so it is important for the health practitioners e/plore the role of traditional treatment to educate patients about the potential benefit despite of the limited scientific-based evidence of effectiveness of 2AM towards an integrated model of health care provision (Eumar, Da@a@, 7 Mehrotra, +##G).
&.&
Patterns o% use o% (MM amon$ students %rom di%%erent courses
Almost all of the students have use the TMM treatment and they mostly prefer to use medicated oil and massages. A previous study showed that traditional medicines, which includes herbal medications has been used increasingly over the world including Malaysia. 1t stated that herbal medications are the common uses of traditional medicine in Malay respondents which is si/ times higher than other races (Ai 7 Tey, +##*). 1n addition to this, usage of others TMM like bekam (cupping), herbal bath and medicinal plants was also used by the respondents interchangeably and it is supported by the previous study that the impact of Traditional Malay Massage is not significant for each group of respondents ( ?rnst, +##*).
There are many differences regarding the patterns of use of TMM among different students in each course. Massages and medicated oils are the most preferable by the pharmacy students and health science students. There are many reasons they are using the TMM. Most of the pharmacy students followed by hotel management students prefer to use TMM to maintain their health. All of them slightly agree that the reasons of using TMM are to release stress. The other reasons of using TMM only applied to the rest of the population. ;C= has stated that traditional and complementary treatment play an important role in the prevention and health promotion to the population (6iti et al., +##*). harmacy students mostly prefer to use the TMM medicine and therapies because of no symptoms that occur prior to the usage of
37
the TMM. 6ome of the students from different department develop some mild symptoms when using the TMM treatment such as nausea and vomiting.
All of the respondents from each department agreed that they have no specific time on the usage of TMM treatment. There are some of the students prefer to buy or get their medication mostly from online, the traditional medicine shop and from other family members and most of them have the same choices to get the TMM from the pharmacy, traditional healers and grocery shops.
All of the respondents usually get the information about TMM from the family members and friends. They tend to be influenced by their friends and family member regarding the uses of TMM. Most of the respondents from each courses agreed that they have one or more of the family members that use TMM. The previous study also stated that friends (&+.') followed by family members (+#.+) as the main source to use 2AM. The other study also supported that friend and relatives were the main sources of knowledge about traditional medicine (Eumar, Da@a@, 7 Mehrotra, +##G).
&.0
=imitation
There were several limitations in this study. Firstly, it was a cross-sectional study, which is sub@ected to recall bias and error in the collection of data. 6econdly, convenient sampling also can give some bias to the results because this method used to recruit respondents to answer the %uestionnaire. 0ot all of the population is involved. Time restriction is also the ma@or limitations in this study because the %uestionnaires have to be distributed to each student from four different courses and different schedule between each group of students give some difficulty in meeting them to collect the %uestionnaires. 38
