Development and psychometric evaluation of the belief and attitude about herbal medicine inventory among iranian patients with cardiovascular disease

Authors

1 Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran

2 Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Background: Over-the-counter use of herbal products puts patients with cardiovascular diseases (CVDs) at risk for drug interactions. Belief and attitude have significant effects on behavior. Objectives: This study was conducted to develop and evaluate the psychometric properties of the Belief and Attitude about Herbal Medicine Inventory (BAHMI). Methods: In this methodological study, the BAHMI draft was developed based on the approach of Waltz and colleagues and using the existing instruments and the three main theory of planned behavior subscales. After face and content validity assessment, BAHMI construct and concurrent validity were assessed. Accordingly, 200 patients with CVD were consecutively recruited from a heart clinic in Kashan, Iran, 2018. BAHMI reliability was also assessed through the internal consistency and the test–retest methods. Results: The BAHMI draft included 40 items. Seven items were excluded during psychometric evaluation phases. Exploratory factor analysis revealed a five-factor structure for BAHMI which explained 42.636% of the variance of its total score. The correlation coefficient between the scores of BAHMI and Hashem-Dabaghian and colleagues' questionnaire was –0.7 (P < 0.0001). BAHMI mean score was significantly different among patients with different levels of agreement on herbal product use (F = 19.16, P < 0.0001). Cronbach's alpha, intraclass correlation coefficient, standard error of measurement, and smallest detectable change of BAHMI were 0.864, 0.888, ±13.46, and 10.2, respectively. No participant obtained the minimum and maximum possible BAHMI scores. Conclusion: The 33-item BAHMI is a valid and reliable instrument for the assessment of belief and attitude about herbal medicine among patients with CVD. The findings of this study can be used for health policy-making and planning.

Keywords


1. Mc  Namara  K, Alzubaidi  H, Jackson  JK. Cardiovascular
disease as a leading cause of death: How are pharmacists
getting involved? Integr Pharm Res Pract 2019;8:1-11.
2. Sarrafzadegan N, Mohammmadifard N. Cardiovascular disease
in Iran in the last 40  years: Prevalence, mortality, morbidity,
challenges and strategies for cardiovascular prevention. Arch
Iran Med 2019;22:204-10.
3. Abolbashari  M, Macaulay  TE, Whayne  TF, Mukherjee  D,
Saha  S. Polypharmacy in cardiovascular medicine: Problems
and promises! Cardiovasc Hematol Agents Med Chem
2017;15:31-9.
4. Behnood-Rod A, Afzali Poor Khoshkbejari M, Pourzargar P,
Hassanzadeh M, Moharamzad Y, Foroughi F. Complementary
and alternative medicine use among Iranian patients attending
urban outpatient general practices. Complement Ther Clin
Pract 2018;30:58-63.
5. Liperoti  R, Vetrano  DL, Bernabei  R, Onder  G. Herbal
medications in cardiovascular medicine. Am Coll Cardiol
2017;69:1188-99.
6. Grant SJ, Bin YS, Kiat H, Chang DH. The use of complementary
and alternative medicine by people with cardiovascular disease:
A systematic review. BMC Public Health 2012;12:299.7. Zafarghandi N, Pirasteh A, Khajavi K, Bateni F. Knowledge,
attitude and behaviors of people referred to health centers of
Tehran about Iranian traditional medicine. Alborz Univ Med J
2012;1:65-70.
8. Roozbeh  J, Hashempur  MH, Heydari  M. Use of herbal
remedies among patients undergoing hemodialysis. Iran J
Kidney Dis 2013;7:492-5.
9. Azizi-Fini  I, Adib-Hajbaghery  M, Gharehboghlou  Z. Herbal
medicine use among patients with type 2 diabetes in Kashan,
Iran, 2015. Eur J Integr Med 2016;8:570-5.
10. Hashem-Dabaghian  F, Abdollahi  Fard  M, Shojaei  A,
Kianbakht S, Zafarghandi N, Goushegir A. Use and attitude
on herbal medicine in a group of pregnant women in Tehran. J
Med Plants 2012;11:22-33.
11. Onder  G, Liperoti  R, Foebel  A, Fialova  D, Topinkova  E,
van  der  Roest  HG, et  al.; SHELTER Project. Polypharmacy
and mortality among nursing home residents with advanced
cognitive impairment: Results from the SHELTER study. J Am
Med Dir Assoc 2013;14:450.e7-12.
12. Gómez  C, Vega-Quiroga  S, Bermejo-Pareja  F, Medrano  MJ,
Louis  ED, Benito-León  J. Polypharmacy in the elderly:
A marker of increased risk of mortality in a population-based
prospective study (NEDICES). Gerontology 2015;61:301-9.
13. Tagharrobi  Z, Mohammadkhan  Kermanshahi  S,
Mohammadi  E. Clinical nurses’ perceptions of the
opportunities for using complementary therapies in Iranian
clinical settings: A  qualitative study. Complement Ther Clin
Pract 2016;24:11-8.
14. Hall  H, Brosnan  C, Frawley  J, Wardle  J, Collins  M,
Leach  M. Nurses’ communication regarding patients’ use
of complementary and alternative medicine. Collegian
2018;25:285-91.
15. Rocha  V, Ladas  EJ, Lin  M, Cacciavillano  W, Ginn  E,
Kelly KM, et al. Beliefs and determinants of use of traditional
complementary/alternative medicine in pediatric patients who
undergo treatment for cancer in South America. J Glob Oncol
2017;3:701-10.
16. Gupchup  GV, Abhyankar  UL, Worley  MM, Raisch  DW,
Marfatia  AA, Namdar  R. Relationships between Hispanic
ethnicity and attitudes and beliefs toward herbal medicine use
among older adults. Res Social Adm Pharm 2006;2:266-79.
17. Ajzen  I. The theory of planned behavior: Frequently asked
questions. Hum Behav Emerg Technol 2020;2:314-24.
18. Kamel  FO, Magadmi  RM, Hagras  MM, Magadmi  B,
AlAhmad  RA. Knowledge, attitude, and beliefs toward
traditional herbal medicine use among diabetics in Jeddah
Saudi Arabia. Complement Ther Clin Pract 2017;29:207-12.
19. Bharucha  DX, Morling  BA, Niesenbaum  RA. Use and
definition of herbal medicines differ by ethnicity. Ann
Pharmacother 2003;37:1409-13.
20. Rashidi S, Farajee H, Jahanbin D, Mirfardi A. Evaluation of
knowledge, belief and operation of Yasouj people towards
pharmaceutical plants. J Med Plants 2012;11:177-84.
21. Bakhtiari  Z. The assessment of patient’s satisfaction about
medicinal plants in Isfahan. J Med Herbs 2010;1:37-9.
22. Hozni S, Azmiyan Moghadam F, Yeganeh M, Haghshenas S.
Evaluation of demographic characteristics and attitudes about
traditional medicine among patients referred to a clinic. J
Guilan Univ Med Sci 2015;24:72-9.
23. Kashani L, Hassanzadeh E, Mirzabeighi A, Akhondzadeh S.
Knowledge, attitude and practice of herbal remedies in a group
of infertile couples. Acta Med Iran 2013;51:189-94.
24. Waltz CF, Strickland OL, Lenz ER. Measurement in Nursing
and Health Research. 5th ed. New York: Springer Publishing
Company; 2017.
25. Ajzen I. TPB Questionnaire Construction. 2019. Available from:
https://people.umass.edu/aizen/pdf/tpb.measurement.pdf. [Last
accessed on 2021 Oct 15].
26. Taghizadeh Z, Ebadi A, Montazeri A, Shahvari Z, Tavousi M,
Bagherzadeh  R. Psychometric properties of health related
measures. Part 1: Translation, development, and content and
face validity. Payesh 2017;16:343-57.
27. Polit  DF, Yang  F. Measurement and the Measurement
of Change: A  Primer for the Health Professions. China:
Philadelphia, PA: Wolters Kluwer; 2016.
28. Kyriazos TA. Applied psychometrics: Sample size and sample
power considerations in factor analysis (EFA, CFA) and SEM
in general. Psychology 2018;9:2207-30.
29. Polit DF, Beck CT. Nursing Research: Generating and Assessing
Evidence for Nursing Practice. 10th ed. China: Lippincott
Williams & Wilkins; 2017.
30. Mao JJ, Palmer SC, Desai K, Li SQ, Armstrong K, Xie SX.
Development and validation of an instrument for measuring
attitudes and beliefs about complementary and alternative
medicine (CAM) use among cancer patients. Evid Based
Complement Alternat Med 2012;2012:798098.
31. LoBiondo-Wood  G, Haber  J, Titler  MG. Evidence-Based
Practice for Nursing and Healthcare Quality Improvement. 9th
ed. China: Elsevier Health Sciences; 2018.
32. Ebadi A, Taghizadeh Z, Montazeri A, Shahvari Z, Tavousi M,
Bagherzadeh  R. Translation, development and psychometric
properties of health related measures-Part 2: Construct validity,
reliability and responsiveness. Payesh 2017;16:445-55.