Abstract
The use of herbal medicine (HM) dates to the history of human life when human beings sought a tool in nature to address their health issues. Within the South African context, cultural beliefs, the inadequacy of the health care system, the high cost of conventional medicine, and their side effects contribute to HM's high usage. Many patients seek alternative treatments that are not currently offered through primary healthcare (PHC) facilities, which they are often reluctant to disclose to their healthcare providers (HCPs). Herbal products are made up of different active ingredients that many consumers are not aware of, which may increase the possible herb-drug interactions (HDIs). In this context, this study aimed to develop an empowerment programme with a particular focus on patients who co-administer HM with conventional medicine and risk getting possible HDIs. The study was guided by a modified intervention mapping framework to develop, implement, and evaluate the programme. An exploratory, partially mixed-method sequential design was used to collect data. This study was conducted in PHC clinics in three provinces (Gauteng, Free State, and Mpumalanga). The first phase of the study was a qualitative method where interviews were conducted with (i) patients who visit PHC clinics and were admitted using HM and conventional medicine at the same time, and (ii) primary healthcare nurses who worked at PHC clinics. Secondly, the results that were found in the interviews were used to develop the empowerment programme. Thereafter, the programme was evaluated using four hours of the workshop and pre-and post-knowledge questionnaires. A focus group discussion was conducted for the triangulation of results. The situation analysis showed that there is a lack of effective communication between patients and HCPs, even though some PHC nurses mentioned that they do ask patients about HM. This finding was confirmed by the results from the quantitative method where 73.1% of participants mentioned that their HCPs never gave them clear instruction on how to use HM, 57.7% mentioned that their doctor or nurse never ask if they had questions or concerns about HM for their conditions, and only 10.3% mentioned that their doctor or nurse ask them about HM use. The results showed that the reason why PHC nurses do not enquire about HM is due to their insufficient knowledge of HM and HDIs. The results also showed that patients do not disclose the use of HM voluntarily. This was supported by the results from the qualitative results where 85.9% of participants mentioned that they do not tell their HCPs about their use of HM. The results after the intervention showed that participants had improved knowledge about HM, they agreed that HM can interact with their doctors’ medication, and more than 50% of the participants still
vii
believe that they can take HM with doctors’ medicine at the same time. These results showed that an empowerment programme is necessary to educate patients about the dangers of HDIs. The evaluation of the programme was piloted by two participants and the results showed that participants managed to initiate the communication about HM without fear and the PHC nurses allowed for the conversation.