Abstract:

Background:
The KAP surveys are conducted to collect data on the knowledge (information through learning or experience), attitudes (thoughts, beliefs) and practices (behaviours) about a health-related topic regarding a particular population. The theme in the reported study is complementary and alternative medicine (CAM) education. The targeted communities are students (medicine, pharmacy) and primary healthcare professionals (general practitioners-GPs and pharmacists).
CAM is a distinct concept in medical sociology encompassing medical systems (like Ayrveda, homeopathy, Anthroposophic medicine), products (like herbs), and practices (like acupuncture, apitherapy) that are not part of conventional medicine.
The rise of CAM is a healthcare phenomenon but still an educational challenge. The World Health Organisation (WHO) has created training benchmarks in some CAM practices. This can facilitate governments to establish standards for undergraduate and postgraduate CAM education to support conventional healthcare providers. CAM is culturally specific and WHO encourages the national level studies of CAM including the context of education.
The aim of this regional KAP study was to assess the needs regarding CAM education in Bulgaria. The vision is to identify the required capacity of knowledge for students and healthcare professionals to advise on CAM competently.

Methodology:
This KAP study was the second phase of a postdoctoral project at the Medical University of Varna. The instruments were self-administrated questionnaires designed to gather quantitative and qualitative data from the defined target groups. The respondents were invited to participate through formal students’/professionals’ online platforms within a concrete time period (May-Oct. 2021).

Results:
The study included a sample of 208 students from all the years of study (≥18 years old; medicine/n=145; pharmacy/n=63) and 185 professionals from Varna region (GPs/n=114; pharmacists/n=71).
The accumulated data is presented regarding the three components of the KAP framework.
1) Knowledge:
Generally, students and professionals are informed about CAM. However, high proportions of all the groups want more information regarding CAM (57% of the students and 71% of the professionals). Among the popular CAM modalities are homeopathy, yoga, fasting and Schussler salts therapy. The narratives include examples from Bulgarian folk medicine, animal therapy etc.
2) Attitudes:
The students share their support to include CAM in their regular curriculum (75%), mostly as elective disciplines. Successful examples are the introduction of homeopathy courses as electives and acupuncture as postgraduate courses. The professionals believe that practical seminars and congresses are the most important sources of information. The students trust practical seminars as well but also online sources.
3) Practices:
Personal use of CAM is reported by 69% of the students and 93% of the professionals. Most of the GPs and pharmacists prescribe or recommend CAM and would like to be trained scientifically about CAM. There are no national guidelines for the inclusion of CAM in the medical curriculum.

Conclusions:
The KAP survey provides real world data about the need of practice-based curriculum changes. The existence of high-quality educational CAM-standards can contribute to patient safety, which is a central value of our healthcare. Universities’ curriculum should keep pace with the rising CAM-needs.

Keywords:

Complementary and alternative medicine (CAM), integrative medicine, integrative healthcare, Bulgaria, KAP survey, higher education, postgraduate training.