Middlesex University Research Repository An open access repository of Middlesex University research http://eprints.mdx.ac.uk Thorburn, James (2020) A mixed methods sequential explanatory study of the utilisation and practice of traditional Chinese medicine by Chinese people in Hong Kong and Guangzhou. Masters thesis, Middlesex University. [Thesis] Final accepted version (with author’s formatting) This version is available at: https://eprints.mdx.ac.uk/33692/ Copyright: Middlesex University Research Repository makes the University’s research available electronically. Copyright and moral rights to this work are retained by the author and/or other copyright owners unless otherwise stated. The work is supplied on the understanding that any use for commercial gain is strictly forbidden. A copy may be downloaded for personal, non-commercial, research or study without prior permission and without charge. 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See also repository copyright: re-use policy: http://eprints.mdx.ac.uk/policies.html#copy Abstract Little is known about why traditional Chinese (TCM) continues to be used and practised by Chinese people despite the existence of evidence-based Western medicine (WM). This study aims to explore Chinese patients and TCM practitioners’ attitudes and beliefs towards the utilisation and practice of TCM and to determine if there are any differences in the way in which Chinese people use and practice TCM in different regions of China, in this study, Hong Kong and Guangzhou. A mixed-method, sequential explanatory study was undertaken that involved two phases. In the first phase, a structured questionnaire translated into Chinese was used to collect data from a convenience sample of Chinese patients attending outpatient clinics in Hong Kong and Guangzhou. A Chinese research assistant who could speak Cantonese and Mandarin distributed the questionnaires to patients attending the TCM outpatient clinics in Hong Kong and Guangzhou. Also, a random sample of Chinese medicine practitioners in Hong Kong was sent a questionnaire by post, as a list of Chinese medicine practitioners names, and clinic addresses in Hong Kong are available on the Chinese Medical Council’s Internet website. For TCM practitioners in Guangzhou, a Chinese research assistant distributed the questionnaire in-person to a random sample of TCM doctors working at the Guangzhou University of Traditional Chinese medicine in Guangzhou. In the second phase of the study, semi-structured interviews were conducted with patients and Chinese medicine practitioners in Hong Kong and patients and TCM practitioners in Guangzhou. Patients and TCM practitioners who took part in an interview were randomly selected from a list of patients and TCM practitioners who had previously filled out a questionnaire in the first phase of the study. A total of 1,200 patients and 400 TCM practitioners took part in the study, which comprised of 600 patients attending an out-patient TCM clinic in Hong Kong and 600 attending an out-patient TCM clinic in Guangzhou. The response rate for patients who took part was 81.4% (n= 505) and for Guangzhou 91.6% (n=550). For TCM practitioners, the response rate was 55% (n=110) for practitioners in Hong Kong and 61.5% (n= 123) for practitioners in Guangzhou. Patients’ mean age was 44.6 years, and the sample consisted of 41.2% males and 58.8% females. For TCM practitioners, the mean age was 45.4 years and the sample consisting of 66.1% males and 33.9% females. In the second phase of the study, semi-structured interviews were conducted with 16 patients and 16 TCM practitioners in Hong Kong and Guangzhou, respectively. The results showed that for patients in Hong Kong and Guangzhou the most common use of TCM was for the treatment of acute medical conditions, such as colds and flu and also for chronic medical conditions, such as rheumatism and diabetes. Also, patients in Guangzhou were found to use TCM to “recuperate” the body after taking Western medicines prescribed by WM doctors, or after suffering a chronic illness. Concurrent use of TCM and WM was found to be more common in patients in Guangzhou, than in patients in Hong Kong. The integration of TCM services in hospitals in Hong Kong is notably different from that of China. Unlike China, where TCM practitioners are permitted to treat in-patients inside state-run hospitals, in Hong Kong, TCM practitioners are only permitted to treat patients on an outpatient basis and not as in-patients. The results of this study contribute to the existing body of literature about the utilisation and practice of TCM by Chinese people in Hong Kong and Guangzhou. The study also provides unique information about the practice of TCM in Hong Kong since the implementation of the Chinese medicine Ordinance and the establishment of the Chinese Medicine Council of Hong Kong. Although the study contributes to the existing body of literature concerning the utilisation and practice of TCM by Chinese people and TCM practitioners ‘respectively, it does have several inherent limitations. Among the significant limitations is the fact that, as a cross-sectional survey design was used, therefore no “cause and effect” relationships can be drawn from the results. Furthermore, because statistical tests, in general, require a large sample size to ensure a representative distribution of the population being studied, the total number of patients and TCM practitioners who participated in the study is relatively small. A Mixed Methods Sequential Explanatory Study of the Utilisation and Practice of Traditional Chinese Medicine by Chinese People in Hong Kong and Guangzhou James Thorburn, MRes., BSc., PgCert., CSci., FRSB School of Health and Education Middlesex University, London, United Kingdom A Thesis Submitted to Middlesex University in Partial Fulfilment of the Requirements of the Master of Philosophy APRIL 2020 Dedication To Alex and all my friends and colleagues whose, moral support and kindness provided me with a source of energy and inspiration to undertake this research. i Acknowledgements Undertaking this PhD has been a truly life-changing experience for me, and it would not have been possible to do it without the support and guidance that I have received from different people. Firstly, I would like to thank my Director of Studies, Dr Celia Bell, for the help she gave me during my research. Besides my Director of Studies, I would like to express my very great appreciation to my two supervisor’s Dr Ming Cheng and Dr Linda Bell. Dr Ming Cheng put me in touch with two colleagues of his, Professor Shao Xiang Xian of the 1st Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, the People’s Republic of China and Professor Lin Zhi Xiu of the Department of Chinese medicine at The Chinese University of Hong Kong Dr Linda Bell provided me with immense support and advice during my research and also taught me a lot about qualitative research and mixed-methods studies. She also provided expertise and assistance whenever I needed her help. Special thanks also go to the TCM practitioners and students at the Asante Chinese Academy in London, UK, for undertaking pilot-testing the English versions of the patient and TCM practitioner questionnaires used in my research. Also, to Jerry Wing Fai Yeung, who during the time that I was conducting my research was himself a PhD student at The University Hong Kong. Jerry instrumental in helping me to pilot-test the Chinese versions of the patient and the TCM practitioner questionnaires used in my research. Several other people also helped me with this research, and these are the people who collected data and in the field for this study. In Guangzhou, Xi-wen Huang and Yang Ming-ye, two research assistants who were also doing their PhDs with Professor Shao Xiang Xian at the 1st Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, People’s Republic of China, distributed and collected questionnaires from patients and TCM practitioners in Guangzhou. While, in Hong Kong, Ellie Jun Zhi Yan, a registered TCM practitioner, collected data from patients attending an outpatient clinic and also interviewed TCM practitioners based in Hong Kong. Ellie also kindly accompanied me on a visit to Guangzhou, where her skills as an interpreter were indispensable. Finally, Chris Chak-hin Wong, another registered TCM practitioner undertook interviews with patients and TCM practitioners based in Guangzhou. During data collection, their contribution was invaluable to my research. ii Although I consider myself to be a reasonably proficient user of Microsoft Word, when it came to the mammoth task of undertaking the final formatting of my thesis, I found that my skills in using Microsoft Word were somewhat limited. Therefore, I would like to express great appreciation to Usama for his skill and expertise in formatting my PhD thesis. Last but not least, my thanks go to my partner Alex who has been by my side throughout this PhD, living every single minute of it, and without whom I would not have had the determination to embark on this journey in the first place.