Table 7 Merging of survey and qualitative results, guided by framework for TM integration

Contextual characteristics

(psychosocial factors):

Contextual characteristics/psychosocial factors describe the historic use or trust associated with TM usage in a given society.

Trust in TM use

Significant use of TM among residents of Ashanti region. Key reason cited for high use of TM among participants was trust in TM due to its natural state and negligible side effects.

High usage of TM among participants:

Yes = 95.0%

No = 5.0%

I have much confidence in traditional therapies because you do not get any problems after taken them and it heals you completely, so I use them a lot.

[Participant 18, Nkenkaaso, Female, 24 years]

Consumer experience:

Consumer experience is influenced by health system accessibility – physical, financial, cultural [38]

Physical availability of healthcare

Participants narrated how healthcare is geographically available to them.

The majority of participants considered TM geographically accessible.

TM = 54.5%

Orthodox = 45.5%

The TM are very close. They take it around and if you want it, you just buy and use it. As for the orthodox medicine, no one will bring it to your shop or your work place. You have to look for pharmacy shop and buy. [Participant 1, Afrancho, Female, 49 years]

Culturally acceptable healthcare

Furthermore, TM appeared to be the traditionally acceptable health system among participants.

A considerable percentage of participants deemed TM as a culturally acceptable medical system:

TM = 98.5%

Orthodox = 1.5%

In the olden days…there were no hospitals and no clinics. Everything concerning our health was dependent on TM. When you are sick, they tell you that take traditional drugs and we are still using it. So, TM to me is culturally acceptable.

[Participant 20, Tarkwa Maakro, Male, 65 years]

Now, we have TM

Financial accessibility

Cost of care was dependent on nature of services delivered. In that, modernised TM practice was reported to expensive, while local TM services were deemed economical.

More than half of participants recounted TM to be less expensive:

TM = 56.7%

Orthodox = 43.3%

clinics and they have made it like the hospitals with their nurses and others…those TM clinics are expensive but if you visit an old woman in the house to prepare some TM for you, that one is less expensive.

[Participant 19, Nkenkaaso, Male, 20 years]

Consumer experience:

Consumer experience is impacted by satisfaction derived from utilising the various health systems as well as motivation for usage [38].

Satisfaction from health systems

Satisfaction from health systems was based on effectiveness of therapy.

More than three-quarters of the participants reported that they gain satisfaction from accessing TM because it is effective in treating ailments.

TM = 81.4%

Orthodox = 9.6%

Indifferent = 9.0%

The best medicine I can talk about is TM. If not for TM, I know I would not be alive by now. I was very sick. It was not easy for me at all but TM has saved my life.

[Participant 10, Asawase, Female, 80 years]

Consumer experience:

Consumer experience is influenced by knowledge about the integration process [38].

Knowledge about TM integration

Participants demonstrated their familiarity with the integration process. Knowledge about integration varied among sex of participants.

More males (76.5%) than females (54.9%) were aware of TM integration into the Ghanaian health system

p-value < 0.001

So yes, I have heard that TM has been integrated into our healthcare system. I am a man so I keep track of issues especially health related issues. Even our current president Nana Addo met some of the experts to find out from them how well they can implement that. So, I am aware of it.

[Participant 17, Kwadaso, Male, 50 years]

Knowledge about integration differed in terms of marital status of participants.

Participants who were not married (71.8%) exhibited more knowledge about TM integration than their ever married counterparts (58.5%)

p-value = 0.013

I know there are some pharmacies that sell TM products. When you visit such a facility, the TM provider will tell you to go to the hospital for the doctors to examine you before he starts treatment. That way, the provider will be sure of what you are suffering from and know the kind of drugs to give to you. I am young and single oo but I know a lot of things about health

[Participant 19, Nkenkaasu, Male, 20 years]

Participants’ residential status influenced their knowledge about TM integration.

A greater proportion of urban dwellers (75.3%) were more knowledgeable about TM integration than the rural residents (57.1%). Hence, being a city dweller was perceived to be advantageous.

p-value = 0.001

Oh yes, I have heard about TM integration on the radio, that is Peace FM. My brother, I feel lucky to be in the city because any new intervention starts from the city…They said that, now the hospitals have been made in such a way that when you visit the facility and you prefer TM, they will send you to a TM centre to be treated there. For instance, if you are suffering from malaria, they have some TM at the hospital that can treat malaria and they will prescribe that for you.

[Participant 16, Kwadaso, Male, 43 years]

The size of participants’ households influenced their knowledge about integration.

Participants with less than five household members (78.8%) were familiar with TM integration than those with five or more household members (57.6%).

p-value = < 0.001

Currently, there are people at KNUST who are learning TM. That is what they have gone to school to study. We are only two in this house, I told you one of my grandchildren is staying with me and he is the one who told me. He said it when I was sick and receiving care at a TM centre. Therefore, many facilities will have it (TM units) in few years to come.

[Participant 20, Tarkwa Maakro, Male, 65 years]

Consumer experience:

Consumer experience is shaped by people’s preference for integration [38].

Preference for TM integration

Larger household as a predictor of preference for TM integration. Participants with larger households were more likely to choose TM integration.

In comparison to household size less than 5, the likelihood of service users with household size five and above having preference for integration is

[0.47; 0.23-0.95]

p-value = 0.034

I support integration with all my heart because with integration people like me who have larger families can have access to good healthcare. I have a large family my sister! In all, we are nine that is wife, seven children and myself. So do you understand why I prefer integration?

[Participant 13, Asuosu, Male, 43 years]

Participants who had lower household monthly income have a high propensity to prefer integration.

The possibility that a participant who earned between 500 and 999 Ghana Cedis to prefer TM integration was lower than those who earned below GHC 500.

500-999:

[0.37; 0.18-0.75]

p-value = 0.006

1000-1499:

[0.44; 0.17-1.18]

p-value = 0.104

1500+:

[0.67; 0.20-2.31]

p-value = 0.528

I prefer integration because if I go to the hospital and they are unable to cure me, then I can get treatment from a qualified TM doctor without having to spend much. I do not earn much; I earn just 300Gh Cedis a month so through TM integration, even with my little income, I will get proper care and can patronise quality TM products and services when the need arises.

[Participant 14, Kobreso, Male, 38 years]