At present, the COVID-19 pandemic is still spreading all over the world, with constant mutation, which increases the difficulty of prevention and control. TCM has a long history in the prevention and treatment of acute infectious diseases and the experiences of TCM treatment have been recorded in the Shanghan Lun and Detailed Analysis of Epidemic Warm Diseases , which provided a new scheme for treating COVID-19 [23-27]. However, the willingness to accept TCM among asymptomatic COVID-19 patients was not reported in the literature.
The present study explored the acceptance of TCM and its independent predictors among asymptomatic COVID-19 patients and found that 91.53% of the patients were willing to accept TCM treatment, while 8.47% of the patients presented unwillingness to accept TCM. Demographic factors including gender, age, education level, income level, and residence were not significantly associated with TCM acceptance in the present study, which was different from the cross-sectional studies reported from other regions [28-31]. National Health Commission of the People’s Republic of China has repeatedly mentioned the promotion of TCM in the prevention and control of COVID-19, we put forward the following suggestions to accelerate the acceptance of TCM based on the results of this study.
4.1 Increasing the publicity of TCM is important to promote the acceptance of TCM
TCM is a significant part of Chinese cultural heritage, which ideas and practice methods contain the profound wisdom of Chinese philosophy . The multivariate logistic regression analyses indicated that participants who understood the culture of TCM was one of predictors for TCM acceptance, but more than half of the participants lacked an understanding of the culture of TCM regrettably, which is similar to surveys in other countries. A cross-sectional study in Australia reported that only 26% of dental students knew about CAM . In Hungary, 12.4% of the subjects showed a better understanding of CAM . In Bangladesh, nearly 45% of pharmaceutical students believed that lack of knowledge was the main obstacle to the application of CAM . Given that TCM theory is difficult for non-professionals to understand, straightaway propaganda is necessary.
Participants of the present study reported that the most important source of their TCM information was media (44.07%), followed by family members and friends (40.95%) and medical staff (38.09%). In India, the majority of dental practitioners (73.3%) reported that media (internet, newspapers, etc.) was their main source of knowledge about CAM . One study in Silesia, Poland, demonstrated that 60.8% of patients obtained information about CAM from the internet and 38.6% acquired information from television. These results indicated that appropriate media publicity is conducive to guiding and enhancing the public’s receptivity to TCM . This raises requirements for TCM practitioners in China. On the one hand, they should continue to strengthen publicity through the media, especially the emerging network media such as WeChat, microblog, and Zhihu, to generalize the advantages of TCM to the public. On the other hand, carrying out public welfare activities, such as “TCM enter communities”, “TCM enter school”, can help in increasing awareness about TCM.
4.2 Clarifying the impact of TCM is the premise of advocating TCM
According to the results of the present study, among the participants who were willing to accept TCM, 70.51% preferred Chinese herbal medicine, 62.79% chose Chinese patent medicine, and 34.96% favored massage treatment. A survey on Parkinson’s patients in China illustrated that herbal medicine, rehabilitation exercise, and acupuncture were the most commonly used TCM therapies . Compared to other TCM therapies, Chinese herbal medicine is the most popular treatment in China.
The safety and efficacy of the TCM is critical to controlling the COVID-19 and has caused widespread concern. Multivariate logistic regression analysis in the current study showed that safety and efficacy of the TCM were the independent predictors for willingness to accept TCM. These results were higher than data from others countries. A survey on diabetic patients in Jeddah Saudi Arabia showed that 54.2% patients believed CAM have no side effect. A study in Indonesia indicated that 68.31% of diabetic patients considered that CAM products were safe and 63.69% of diabetic patients considered that CAM products were effective.
However, considering TCM would delay the treatment was an important independent predictor for hesitation to accept TCM in this study. In fact, the clinical role of TCM in the management of COVID-19 has been verified by clinical trials in China [39,40]. Therefore, considering the willingness of asymptomatic COVID-19 patients to accept TCM and the effectiveness and safety of the TCM, clarifying the impact of TCM is the premise of advocating TCM for the patients. Inviting the recovering COVID-19 patients who were treated with TCM to give health lectures and broadcasting the clinical practice of TCM in the treatment of COVID-19 in the fangcang hospital may be the significant ways for asymptomatic COVID-19 patients to accept TCM treatment.
4.3 Active communication with attending doctors contribute to acceptance of TCM
Communication between doctors and patients plays an important part in healthcare activities , which can determine the patients’ self-management behavior and health outcomes . Our study indicated that informing the attending doctor before receiving TCM treatment is an important influencing factor for willingness to accept TCM treatment. A study conducted in Palestine from April 2018 to March 2019 exhibited that 64.0% of pregnant women believed that doctors should provide patients with advice on commonly used CAM therapies . In Saudi Arabia, 81.11% of the subjects intended to discuss the application of CAM with their doctors . According to the outpatient service in Iran, among 155 patients who accepted CAM voluntarily, 50 patients (32.2%) reported that they had disclosed the usage of CAM to their doctors . These results suggested that patients had a strong interest in receiving CAM with the advice of their physicians.
In the present study, when participants were asked the reason behind their willingness to accept TCM treatment, only 26.27% of the participants said that it was due to the recommendation by medical staff. When asked about their hesitation toward TCM treatment, 36.08% of participants replied that it had not been recommended by medical staff. Therefore, healthcare practitioners must have a certain understanding of CAM so that they can actively communicate with patients and recommend the most appropriate treatment according to the patients’ conditions. According to a survey in Germany, more than half of the patients expressed their interest in CAM consultation and more than 80% of patients expected their attending doctor to have a certain knowledge of CAM . In India, 57.5% of dental practitioners reported that health professionals should be able to provide patients with advice on commonly used CAM methods . Therefore, we also suggested attending doctors could recommend TCM and teach some gongfa of TCM (tai chi, qi gong, wuqinxi, etc.) to benefit patients in the fangcang hospital.
4.4 Larger surveys are helpful for better understanding the patients’ willingness
Recently, this is the first study all over the world to investigate the cognition, attitude, and willingness of asymptomatic COVID-19 patients to accept TCM, which can provide some reference for doctors to apply TCM in asymptomatic COVID-19 patients. However, it is worth noting that there are still some limitations in this study.
First of all, this study is a self-administered questionnaire-based cross-sectional study. Thus, the causality cannot be directly deduced and further longitudinal research is needed to verify the possible causal relationship. Secondly, the questionnaire was developed based on multiple questionnaires but it could not be verified in a large sample size due to time constraints. Thirdly, the sample had a low representation of the elderly (> 60 years old) owing to few admissions of participants of this age to the fangcang hospital. Fourthly, since our survey was just conducted in the largest fangcang hospital in Shanghai, it cannot fully represent the willingness of asymptomatic COVID-19-infected people in Shanghai and even in the world. Fifthly, as the world is urgently fighting against COVID-19, more outcomes of TCM treatment for COVID-19 will be published, which may affect the willingness of patients to accept TCM.