Doctor of Philosophy
Sydney Business School
Thongruang, Charlee, The barriers to the adoption of Thai traditional medicine services in Thai community hospitals: a case study of community hospitals in Phitsanulok Province, Doctor of Philosophy thesis, Sydney Business School, University of Wollongong, 2014. http://ro.uow.edu.au/theses/4064
Thai traditional medicines (TTM) have been revived in Thailand’s health systems since 1977 in line with the WHO’s Alma-Ata Declaration and global trends toward the use of complementary and alternative medicine. Since then, the policies to promote their practices in hospitals have been incorporated in several national healthdevelopment plans. However, the literature suggests that their adoption in community hospitals progressed at a slow rate for more than 20 years before dramatically increasing in this decade. Although a large number of hospitals have adopted these policies, the literature relates some difficulties in both adoption and implementation. Delayed adoption of TTM policies in the initial stages and difficulties in their implementation reflect the existence of barriers to this process. These barriers and their causes have yet to be systematically investigated using multilevel samples.
This study aims to explore the barriers to the adoption of TTM policy in Thai community hospitals, and to formulate recommendations informing policy development to mitigate these barriers. It takes a qualitative approach to seeking data from multilevel stakeholders involved in the TTM policy process, including its adoption and implementation in hospitals. The research design consists of in-depth interviewing of 54 informants from seven multilevel groups relevant to TTM policy. Its theoretical framework follows the modified organisational innovation-adoption process of Everett M. Rogers (2003) to investigate knowledge, attitudes and practices based on informants’ experiences. Thematic analysis is conducted using the NVivo software package, complemented by further analysis using Leximancer analytic software.
The diffusion of innovation theory helps explain why TTM policy has been adopted irregularly in hospitals without the satisfactory accomplishment of Rogers's agendasetting and matching stages. Its adoption has faced difficulties from barriers emerging from external, internal and individual characteristics. Three barriers found in this study are disagreement between policy and budget from the government; a lack of knowledge of and confidence in TTM practices among clinicians; and the complexity of the Thai bureaucratic mechanism. Further, TTM's weaknesses negatively influence attitudes among both clinicians and patients.
Based on its findings, this study formulates three main recommendations to inform TTM policy development. They include encouraging agreement between policy and budget; developing knowledge, confidence and incentives for physicians practicing TTM; and improving TTM popularity and reliability. Five groups of possible strategies relevant to these recommendations have been proposed, including reforming the administrative, financial and institutional mechanisms concerning TTM policy and gaining strong political commitment; integrating TTM into current health systems; improving TTM knowledge and practice in both physicians and TTM practitioners’ training; developing TTM services and products for more reliability; and encouraging engagement from all stakeholders for TTM development. All recommendations and strategies need the contributions from all responsible agencies and other stakeholders to be achieved.
This study has made a significant contribution at the theoretical level in identifying the barriers regarding innovation-adoption contexts. It contributes to the body of knowledge about the negative impacts of the barriers to the adoption and implementation of the policy. Its novel and specific recommendations emerging from multilevel informants will permit the development of more relevant TTM policy, leading in turn to greater perception, more sustainable adoption and effective implementation.