Attitudes and beliefs that affect adherence to provider-based complementary and alternative medicine: A systematic review

Introduction: Although a systematic review on the beliefs involved in the use of complementary and alternative medicine (CAM) has been conducted, there is research indicating that these findings may not be applicable to adherence. Thus, a systematic review was undertaken with the aim to identify the attitudes and beliefs towards CAM that affect adherence over time to provider-based CAM in adults. Methods: A literature search was conducted in the default fields on the variations of 'adherence', 'compliance' and 'concordance'. They were combined with "complementary medicine", "complementary therapy", "alternative medicine" and "alternative therapy", and their plural forms. The search was executed in PubMed, Embase, IPA, PsycINFO, CINAHL, BNI, CENTRAL, AMED and OpenGrey. Inclusion criteria were applied, along with a modified Downs and Black Instrument. Narrative synthesis was performed on the data extracted. Results: The search returned with 9387 records. Of these, seven studies were reviewed. Despite the lack of consistency in reporting and Downs and Black scores of 9-18, the findings overall appear to show that a positive attitude or belief in therapy as well as appreciation of the CAM is associated with adherence. To provide a framework of understanding, the factors extracted in this review can be mapped to the capability, opportunity, motivation and behaviour model which is applicable to conventional medication adherence. Conclusion: Positive attitudes and the belief in treatment effectiveness were generally associated with adherence to provider-based CAM in the adult population studied within this review.