title: Bridging the gap: how traditional healers interact with their patients. A comparative study in Cameroon.
abstract: OBJECTIVE
  To compare traditional healers (TH) and Cameroonian representatives of Western medicine (Western providers (WP)) in terms of patient characteristics and communication patterns during the consultation in rural Cameroon.
  
  
  METHODS
  A facility-based comparative study was conducted. Seven TH were compared to eight WP in the same district. Patients (five per provider) provided detailed socio-demographic data. Recorded consultations were analysed with the Roter Interaction Analysis System (RIAS).
  
  
  RESULTS
  Patients were similar in socio-demographic characteristics except for age, where TH patients were on average 9 years younger (P < 0.05). Patients of TH travelled 2.5 times as far to their provider as did patients in the WP group (79 vs. 31 km; P < 0.05) and paid 12 times more for their treatment (123 vs. 10 Euros; P < 0.05). Consultations of TH were shorter (5.6 vs. 10.3 min, P < 0.01), had fewer utterances (100 vs. 166, P < 0.05) and the patient's share in the communication was smaller (P < 0.01). TH had a higher percentage of lifestyle and psychosocial information at the expense of medical information (P < 0.05) and communicated more emotionally (P < 0.001). They asked more frequently for their patients' opinion (P < 0.01) and explicitly discussed their patients' concept of illness (P < 0.001). Patients of TH responded with a higher percentage of active communication (P < 0.05) i.e. question asking (P < 0.01).
  
  
  CONCLUSIONS
  Our data contradict the idea that the lack of money or geographical access to Western health care in rural Africa is the main reason for people to consult traditional healers. Compared to WP, TH interacted very differently with their clients, using a more patient-centred communication style, to seek common ground with patients. This different type of interaction could be a relevant factor contributing to the popularity of traditional healers in Cameroon.
authors.affiliation: Department of Internal Medicine, Hôpital du Jura, Delémont, Switzerland. niklaus.labhardt@gmail.com
authors.forename: Niklaus D
authors.initials: ND
authors.lastname: Labhardt
authors.forename: Sabine M
authors.initials: SM
authors.lastname: Aboa
authors.forename: Engelbert
authors.initials: E
authors.lastname: Manga
authors.forename: Jozien M
authors.initials: JM
authors.lastname: Bensing
authors.forename: Wolf
authors.initials: W
authors.lastname: Langewitz
mesh_terms: D002163:Cameroon; D003142:Communication; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016488:Medicine, African Traditional / Q000379:methods / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D011369:Professional-Patient Relations; D012017:Referral and Consultation; D012423:Rural Health