Patient expectations of 'effectiveness' in health care: an example from medical herbalism.

Aims And Objectives: The study explored people's experiences of medical herbalism, with the aim of enhancing understanding about the use of herbalism in the context of contemporary UK health care.

Background: The popularity and use of complementary and alternative medicine in westernised societies is now well documented, and medical herbalism, in particular, is enjoying a particularly strong revival of interest. Despite this, the reasons for its sustained popularity remain unclear.

Design: The study was underpinned by Gadamerian hermeneutic phenomenology.

Method: Nineteen adult clients of medical herbalists were interviewed about their experiences. The processes of data collection and data analysis were informed predominantly by van Manen's phenomenological framework and by Kvale's framework for interview-based studies.

Results: Herbalism more closely met participants' expectations of effective health care. The themes 'dealing with illness causation', 'patient-practitioner collaboration' and 'provision of authentic evidence' were fundamental to achieving effectiveness but were perceived as more easily attainable in the context of medical herbalism.

Conclusions: Health care is more likely to meet the expectations of patients when its purposes, methods and goals are negotiated and made explicit, from the perspectives of both patient and health care professional. Medical herbalism has the potential to contribute usefully to participants' healthcare, especially when used selectively and in conjunction with conventional health care.

Relevance To Clinical Practice: The continued popularity of complementary and alternative medicine amongst the general public makes its acknowledgement in conventional health care more important than ever. In the context of the integrative health movement, it is therefore essential that health care professionals develop their understanding about patient practices and preferences, if a responsive health care system is to be maintained. Nurses are in a prime position to influence the knowledge base and future direction of integrative health care, especially in relation to the patient perspective.