BACKGROUND: The number of visits to
alternative medicine practitioners in this country is estimated
at 425 million, which is more than the number of visits to allopathic
primary care physicians in 1990. Patients' use of St. John's Wort
(SJW) has followed this sweeping trend. The purpose of our study
was to examine the reasons people choose to self-medicate with
SJW instead of seeking care from a conventional health care provider.
METHODS: We used open-ended interviews with key questions to elicit
information. Twenty-two current users of SJW (21 women; 20 white;
mean age = 45 years) in a Southern city participated. All interviews
were transcribed, and descriptive participant quotes were extracted
by a research assistant. Quotes were reviewed for each key question
for similarities and contextual themes. RESULTS: Four dominant
decision-making themes were consistently noted. These were: (1)
Personal Health Care Values: subjects had a history of alternative
medicine use and a belief in the need for personal control of
health; (2) Mood: all SJW users reported a depressed mood and
occasionally irritability, cognitive difficulties, social isolation,
and hormonal mood changes; (3) Perceptions of Seriousness of Disease
and Risks of Treatment: SJW users reported the self-diagnosis of "minor" depression,
high risks of prescription drugs, and a perception of safety with
herbal remedies; and (4) Accessibility Issues: subjects had barriers
to and lack of knowledge of traditional health care providers and
awareness of the ease of use and popularity of SJW. Also of note
was the fact that some SJW users did not inform their primary care
providers that they were taking the herb (6 of 22). Users reported moderate effectiveness
and few side effects of SJW. CONCLUSIONS: SJW users report
depression, ease of access to alternative medicines, and a
history of exposure to and belief in the safety of herbal remedies.
Users saw little benefit to providing information about SJW to
primary care physicians.
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