Understanding adherence and the impact of consultations in complementary and alternative medicine

Student thesis: Doctoral ThesisDoctor of Philosophy


Complementary and Alternative Medicine (CAM) is used by approximately half of the population in the United Kingdom, yet little is known about why people adhere to it. Adherence is defined as the extent the actions of a patient correlate with the advice that was agreed upon with their health professional. It is an important issue in conventional health care because the rate of medication adherence is estimated to be around 50%, meaning patients may not be experiencing the full benefit of their treatment. If more could be understood on the matter, from the CAM perspective, an intervention can potentially be developed to improve adherence with all types of medicine.

A systematic review of attitudes and beliefs towards CAM that affect adherence to provider-based CAM in adults was conducted. Positive attitudes and beliefs in treatment efficacy were associated with adherence to CAM. The effect of CAM practitioners was also highlighted in the studies.

The effect was then investigated further through a grounded theory study of patients and Traditional Chinese Medicine (TCM) practitioners. The TCM Consultation Model for Adherence emerged. The core driver of adherence was patients feeling cared for, which TCM practitioners achieved through building a therapeutic relationship.

In order to test the applicability of the model beyond TCM, a survey was developed and administered online to CAM patients. From the TCM Consultation Model for Adherence, patients feeling supported in the management of their health, patients trusting in their practitioner as well as patients having a therapeutic relationship with their practitioner were found associated with overall adherence to CAM.

As a few behaviours within the model were correlated with adherence, one was chosen for development into an intervention to improve adherence. This resulted in the proposal of a positive psychology intervention, which could be applicable to all health professionals so patients can ultimately have better health.

It was through understanding the CAM perspective that the intervention was able to be developed for such an important issue, showing the benefit of integrating CAM with conventional medicine.
Date of Award1 Nov 2020
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorVivian Auyeung (Supervisor) & Jignesh Patel (Supervisor)

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