Socio-Cultural Perceptions and Health Literacy on Cupping Therapy: A Case Study of the Felda Jengka 8 Community

Socio-Cultural Perceptions and Health Literacy on Cupping Therapy: A Case Study of the Felda Jengka 8 Community

Md Hamzaimi Azrol Md. Baharudin, Nurshahira Ibrahim, Abu Bakar Jaafar, Wan Azmi Wan Ahmad, Muhammad Muzakkir Othman@Seman, Nurul Hidayah Che Hassan

Universiti Teknologi MARA Pahang, Malaysia

DOI: https://dx.doi.org/10.47772/IJRISS.2024.8120153

Received: 02 December 2024; Accepted: 09 December 2024; Published: 08 January 2025

ABSTRACT

This study explores the level of understanding and perceptions of cupping therapy within the rural Felda Jengka 8 community in Pahang. Cupping, a form of traditional medicine, remains integral to the local healthcare practices, deeply rooted in cultural and religious beliefs. However, the community’s understanding of the practice is inconsistent, largely shaped by informal knowledge rather than scientific evidence. A mixed-methods approach, combining surveys and interviews, was used to assess the socio-cultural factors influencing the community’s knowledge of cupping, including education and access to information. Findings reveal significant gaps in health literacy, particularly regarding the safety and efficacy of cupping, as well as a strong reliance on cultural narratives. These insights highlight the need for culturally tailored health education interventions to bridge the gap between traditional practices and modern medicine. The study recommended for integrating traditional therapies into formal healthcare frameworks to enhance health literacy in rural communities.

Keywords: cultural beliefs, cupping therapy, hijama, health literacy, rural communities and traditional medicine

INTRODUCTION

Cupping therapy, also known as hijama in Islamic contexts, is a traditional form of alternative medicine that has been practiced for centuries across various cultures, including in ancient Egypt, China, and the Middle East (Chen, Li, Liu, Guo, & Chen, 2018). It involves the application of cups to the skin to create suction, believed to stimulate blood flow, promote healing, and remove toxins from the body (Al-Bedah et al., 2019). In recent years, cupping has gained popularity globally, particularly among athletes and wellness enthusiasts, but in rural settings like Felda Jengka 8, it holds deeper cultural significance, intertwined with religious and traditional healing practices.

The global resurgence of interest in traditional and complementary medicine has sparked renewed attention to practices like cupping therapy. The World Health Organization (WHO) estimates that 80% of the world’s population relies on traditional medicine for primary healthcare needs, highlighting its significance in global healthcare systems (WHO, 2019). In Malaysia specifically, traditional medicine plays a critical role in complementing the modern healthcare system, especially in rural communities where access to conventional medical facilities may be limited or where cultural preferences influence healthcare choices.

Felda Jengka 8, located in Pahang, Malaysia, represents a unique intersection of traditional and modern healthcare practices. As one of the Federal Land Development Authority (FELDA) settlements, the community maintains strong cultural ties while experiencing gradual modernization. The practice of cupping therapy in this setting reflects broader patterns of traditional medicine use in rural Malaysia, where cultural knowledge is passed down through generations alongside increasing exposure to modern medical understanding.

However, the level of understanding of cupping practices, varies significantly among populations. While some view cupping as an effective therapeutic tool backed by centuries of traditional knowledge, others hold misconceptions or lack comprehensive knowledge about its benefits and risks. This variance in understanding creates potential challenges for healthcare providers and community health educators working to promote safe and effective healthcare practices. The community’s unique socio-cultural context, combined with varying levels of health literacy and access to medical information, creates a complex environment for healthcare delivery and education in the area.

However, the integration of traditional practices like cupping therapy into modern healthcare systems presents both opportunities and challenges. Therefore, the primary problem this study addresses is the gap between traditional knowledge of cupping therapy and scientific understanding, which can lead potential risks in its application in Felda Jengka 8. Several specific issues contribute to this research problem, including limited documentation of traditional cupping practices and their variations within the community, potential safety concerns arising from non-standardized application methods, the challenge of integrating traditional knowledge with modern medical understanding, and the need for culturally sensitive health education strategies that address both traditional beliefs and scientific evidence.

The study also, examines how cultural, educational, and socio-economic factors shape the understanding and practice of cupping therapy within the Felda Jengka 8 community. By investigating these factors, the research aims to contribute to the development of more effective health education strategies that respect cultural heritage while promoting evidence-based healthcare decisions. Understanding community perceptions and practices around cupping therapy is crucial for healthcare providers and policymakers working to integrate traditional medicine safely and effectively into modern healthcare systems. Through this research, we seek to bridge the knowledge gap by examining how various factors influence the community’s understanding and practice of cupping therapy, ultimately contributing to the development of more effective and culturally appropriate healthcare interventions.

Research Objectives

1. To assess the community’s knowledge of cupping therapy, focusing on their understanding of its mechanisms, safety, and efficacy.
2. To identify the socio-cultural factors that influence the acceptance and practice of cupping in the community.

LITERATURE REVIEW

Cupping therapy, a traditional healing practice, has been used for thousands of years in cultures across the world, including the Middle East, Asia, and Africa (Al-Bedah et al., 2019). It involves the application of suction cups on the skin, intended to enhance blood circulation, alleviate pain, and promote healing in the body. The practice is well-documented in ancient medical texts, particularly in traditional Chinese medicine and Islamic medical traditions (Zhao et al., 2013). In the Arabic context, cupping is known as al-Hijama, a term that refers to the process of drawing out impurities and restoring balance to the body. In Islam, cupping is not only viewed as a therapeutic treatment but is also regarded as a sunnah (tradition) of the Prophet Muhammad, further enhancing its cultural and religious significance among Muslim populations (Syahruramdhani et al., 2021). The practice, in its various forms, has continued to be an integral part of healthcare in many regions, particularly in rural areas where traditional medicine remains a cornerstone of health practices.

Globally, cupping therapy is divided into two main types: dry cupping and wet cupping. Dry cupping involves the use of suction cups applied to the skin to draw out blood to the surface without making incisions, and is commonly practiced in East Asian countries such as China. Wet cupping, on the other hand, includes small incisions made on the skin before suction is applied, a practice popular in the Middle East and Eastern Europe (Ernst & Lee, 2016). Both methods aim to increase blood flow, relieve muscle tension, and reduce pain. The use of cupping for pain relief, particularly musculoskeletal pain, fatigue, joint issues, and even high blood pressure, has been highlighted in many studies. Research suggests that cupping may improve symptoms of chronic pain, especially in the neck, shoulders, and lower back, as well as offer relief for conditions like headaches and migraines (Al-Bedah et al., 2019). Despite these benefits, there is still a lack of consensus in the scientific community regarding the efficacy of cupping therapy. Many clinical trials have been criticized for methodological flaws, leading to inconclusive results about its therapeutic value. Some studies suggest that cupping’s effects may be largely attributed to placebo, and there is a call for more rigorous and large-scale trials to determine its true effectiveness (Al-Bedah et al., 2019; Ernst & Lee, 2016).

Despite the scientific debate about its medical benefits, cupping therapy continues to be widely practiced, particularly in rural areas and among religious communities where cultural traditions and beliefs play a significant role in shaping health practices. In Malaysia, for example, cupping is commonly practiced alongside modern medicine, with rural communities often relying on traditional therapies due to their accessibility, affordability, and cultural significance (Ibn Razali et. al., 2021). This reliance on traditional treatments is particularly evident in the Felda settlements, where rural populations tend to trust traditional healing methods, including cupping, due to cultural familiarity and the belief in their efficacy (Hashim & Abdullah, 2020). In many cases, cupping is used not as a substitute for modern medicine, but as a complementary practice. However, challenges arise when individuals are unaware of the potential risks associated with cupping therapy, particularly when practitioners lack proper training or hygiene practices are inadequate. Minor side effects such as bruising, light-headedness, and discomfort are common with cupping, and while they are generally not harmful, wet cupping, in particular, can lead to more serious complications like infections if not performed in hygienic conditions (Mohamed & Zahari, 2017).

The integration of cupping therapy into formal healthcare systems has met with resistance from some sectors of the medical community, primarily due to the lack of rigorous scientific evidence supporting its therapeutic claims. Healthcare professionals in many countries, including Malaysia, express concerns that cupping may be used in lieu of proven medical treatments, potentially delaying the proper diagnosis and treatment of serious conditions (Ali et al., 2017). This skepticism is compounded by the lack of standardization in cupping practices, which vary widely between cultures and individual practitioners. Furthermore, the potential for cupping to be misused or misunderstood is particularly high in areas with limited access to modern healthcare or health education. In many rural communities, particularly in Southeast Asia, health literacy is a significant issue, with limited access to medical information and resources. This gap in knowledge can lead to unsafe practices, such as over-reliance on cupping therapy or its improper use (Mohamed & Zahari, 2017). The influence of cultural beliefs further complicates this issue, as cupping may be seen not only as a physical remedy but also as a spiritually or religiously significant practice, particularly in Muslim communities where it is associated with the Sunnah of the Prophet Muhammad (Syahruramdhani et al., 2021). As a result, there is a need for targeted health education interventions that address both the cultural significance of cupping and the practical aspects of its safe use.

A critical aspect of improving the use of cupping therapy in these settings is enhancing health literacy, particularly in rural areas where traditional medicine is still the dominant form of healthcare. Studies have shown that the lack of access to credible medical information often leads people to rely on anecdotal evidence or misinformation about the benefits and risks of cupping therapy (Mohamed & Zahari, 2017). Health literacy campaigns that educate the public about the scientific evidence (or lack thereof) supporting cupping, as well as its safe application, are crucial to ensuring that traditional practices complement, rather than undermine, modern healthcare. In Malaysia, for instance, public health initiatives that provide education about cupping’s benefits, risks, and appropriate use could significantly improve health outcomes, especially in communities like Felda Jengka 8, where cupping is widely practiced.

In conclusion, while cupping therapy remains an important part of cultural and religious practices in many regions, its integration into modern healthcare systems presents both opportunities and challenges. The lack of scientific evidence, combined with concerns about safety and health literacy, highlights the need for further research and education on the practice. This review underscores the importance of understanding the cultural context and public perceptions of cupping therapy, particularly in rural areas, to develop educational interventions that promote safe practices and inform individuals about the potential risks and benefits of traditional therapies.

METHODOLOGY

This study employs a mixed-methods research design to comprehensively examine community perceptions of cupping therapy. The quantitative component consists of a structured survey aimed at assessing the general public’s knowledge and attitudes toward cupping therapy, while the qualitative component involves semi-structured interviews with key informants to explore cultural, medical, and religious perspectives. By integrating both approaches, the study seeks to provide a holistic understanding of cupping therapy perceptions in the community (Creswell & Plano Clark, 2017).

A purposive sampling technique was used to select 50 participants from the Felda Jengka 8 community, Malaysia, aged 18 and above. This sample includes individuals with varying levels of education and experience with cupping therapy, ensuring diverse viewpoints are captured (Etikan, Musa, & Alkassim, 2016). The study also involves 10 key informants, such as healthcare providers, religious leaders, and traditional healers, chosen based on their involvement with cupping therapy or health-related practices in the community (Guest, Namey, & Mitchell, 2013). This sampling strategy is designed to gain a deeper understanding of both general and expert perspectives on the practice.

The data collection process involves two primary methods. The survey includes 15 structured questions to assess participants’ knowledge of cupping therapy, its purported benefits, risks, and mechanisms, along with demographic information such as age, education level, and healthcare access. The survey was administered both in person and online to ensure a representative sample (Fink, 2013). Semi-structured interviews were conducted with the 10 key informants to explore the cultural and medical significance of cupping therapy and its integration with modern medical practices. The interviews were audio-recorded, transcribed, and analyzed thematically. The semi-structured format allows flexibility for the informants to share their perspectives while ensuring that the conversation remains focused on relevant topics (Mohd Yusof & Mohd Ali, 2017).

Data analysis for the quantitative component involves descriptive statistics, such as frequencies and percentages, to summarize participants’ knowledge and attitudes towards cupping therapy. The analysis will use SPSS (version 26), with cross-tabulations to examine how different demographic factors (e.g., age, education level) influence perceptions of cupping therapy (Field, 2013). For the qualitative component, the interview data will be analyzed using thematic coding to identify recurring themes related to cultural beliefs, health literacy, and the interaction between traditional and modern medicine. Thematic analysis will be conducted following a constant comparative method, with data compared across participants to identify patterns and group similar responses into themes (Braun & Clarke, 2006). To enhance the credibility of the findings, member checking will be employed, allowing participants to review and confirm the accuracy of the themes identified (Lincoln & Guba, 1985).

RESULTS

Understanding of Cupping Therapy

The results from the survey indicate a wide range of understanding among the respondents regarding cupping therapy. As shown in Table 1, 25% of participants were classified as “well-informed,” demonstrating a clear understanding of the benefits and potential risks of cupping therapy. However, 50% of participants were only “somewhat informed,” often basing their knowledge on anecdotal evidence or cultural beliefs rather than scientific research. A further 25% admitted to having minimal or no understanding of the practice, often citing confusion or misinformation regarding its efficacy and safety.

Table 1: Level of Understanding of Cupping Therapy Among Respondents

  Source: questionnaires

Social-Cultural Factor Influencing the Acceptance and Practice of Cupping In The Community

Cultural Factors

The qualitative interviews revealed that cultural and religious beliefs play a significant role in shaping the community’s perceptions of cupping therapy. For many participants, cupping is not merely a health practice but a religious obligation, seen as part of the sunnah (Prophetic tradition). This religious endorsement provides a powerful incentive for the practice, with 68% of respondents citing religious significance as a key reason for their acceptance of cupping therapy (Table 2).

Table 2: Cultural Influences on Perceptions of Cupping Therapy

Source: questionnaires

Despite this strong cultural endorsement, many participants expressed concerns about hygiene and safety, particularly regarding the qualifications of practitioners and the sterility of the equipment used. Only 29% of respondents had a clear understanding of the scientific principles behind cupping, highlighting a gap between cultural acceptance and scientific literacy.

The survey results shown in Table 3, indicated that individuals with higher levels of education were more likely to be well-informed about the practice and its potential risks. Conversely, those with limited formal education often relied on traditional narratives passed down through family or community, which may not always align with modern medical evidence.

Table 3: Education Level and Understanding of Cupping Therapy

Source: questionnaires

DISCUSSION

The findings of this study underscore the complex relationship between cultural beliefs, health literacy, and the practice of traditional medicine in the Felda Jengka 8 community. While cupping therapy remains widely accepted and practiced due to its cultural and religious significance, there is a clear gap in scientific understanding and awareness of potential risks. This is particularly evident among participants with lower levels of education, who tend to rely on informal sources of knowledge, such as family traditions and religious teachings, rather than scientific research or medical advice.

The results align with previous studies that highlight the role of cultural context in shaping healthcare decisions in rural communities (Wong & Chen, 2021). However, this study also reveals the need for targeted health education programs that can bridge the gap between traditional practices and modern medical knowledge. By integrating culturally sensitive educational initiatives, healthcare providers can promote a more balanced understanding of cupping therapy, ensuring that community members can make informed health decisions without undermining their cultural beliefs.

CONCLUSION

This study provides valuable insights into the level of understanding of cupping therapy within the Felda Jengka 8 community. The findings reveal significant knowledge gaps, particularly in relation to the scientific principles and potential risks of the practice. These gaps are largely influenced by cultural and religious beliefs, as well as varying levels of education and access to reliable health information. To address these issues, it is essential to develop culturally tailored health education programs that respect traditional knowledge while promoting evidence-based healthcare practices.

Future research should explore the feasibility of integrating traditional medicine into formal healthcare frameworks in rural areas, ensuring that communities can benefit from both traditional and modern medical practices. Additionally, further studies are needed to assess the impact of educational interventions on improving health literacy and reducing misconceptions about traditional therapies.

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