Predictive factors of complementary and alternative medicine use in the general population in Europe: A systematic review
Introduction
The term “complementary and alternative medicine” (CAM) is usually applied to a heterogeneous set of scientifically controversial products, therapies and practices. This set typically include homeopathic products,1 some services provided by various health practitioners such as chiropractors,2 medical traditions (e.g., ayurveda3), some diets (e.g., alkaline diet4), or even certain religious practices (e.g., prayer5).
Thus, any attempt to assess a general prevalence of CAM use is dependent on researchers' classification criteria.6 In Europe, prevalence studies of CAM use by the general population provide results ranging from 0.3% to 86% for use of any type of CAM at any time.7 Outside the European Union, studies on the prevalence of CAM use over the past 12 months in the general population have also shown a wide range in results from 9.8% to 76%.8
It is essential that healthcare professional provide their patients with reliable information about CAM therapies.9 In addition, raising and discussing the issue of CAMs with patients might increase visit satisfaction for both, patient and professional.10 However, almost 77% of patients do not spontaneously disclose their use of CAM to their general practitioner.11 Among the reasons for this non-disclosure, 20% of patients think that the physician will not understand them.12 In addition, physicians would like to be better informed about CAMs before addressing the issue with their patients.13 In order to engage in discussion of the subject and to construct communication tools about CAMs, it is necessary to understand why patients use them.
One aspect of understanding the use of CAMs is to identify factors predicting the use of these therapies.14 While there are several systematic reviews of studies of CAM use by specific populations (e.g., asthmatics15 or cancer patients16), to date, there is no such review of predictive factors of CAM use by the general population in Europe. Thus, the aim of this systematic review was to identify predictive factors of CAM use in the general population in Europe.
Section snippets
Method
This systematic review was registered in PROSPERO, the international prospective register of systematic reviews (CRD42018086474) and the report follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Selection of studies
Of the 6006 article titles identified by our main and complementary search procedures, 49 articles meet the inclusion criteria. A list of the excluded studies along with reasons for exclusion is provided in Supplementary File S4. The flow diagram of the study selection process is shown in Fig. 1.
Characteristics of included studies
Table 1 and Supplementary File S5 shows the characteristics of the 49 included studies. The design for all studies was cross-sectional. Most studies were conducted in Israel (n = 9)19, 20, 21, 22, 23, 24
Summary of findings
In Europe most of the published studies concerned the consultation of a CAM practitioner. Female gender and self-reported chronic disease are consistently the two characteristics predictive of such consultations. Being a woman is also a positive predictive factor for resorting to other forms of CAM behaviours. There is also strong evidence against marital status as a predictive factor for consulting a CAM practitioner. For all other factors, no clear conclusion can be drawn.
The problem with the “use of CAM” category
Some studies have
Conclusions
Within the category “use of CAM”, in practice many researchers distinguish among use of CAM products, CAM practices or consultation of a CAM practitioner. The latter is currently the most studied category of behaviour. Female gender and self-reported chronic disease are the two factors that are significantly predictive of CAM practitioner use and for which the evidence is consistent. There is also strong evidence against any particular marital status being a predictive factor of CAM
Conflict of interest
All authors declare no competing interests.
Source of funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethical approval
Not applicable.
Acknowledgements
We thank Camille Riboud and Fanny Daragon for their contribution to the selection of articles and data extraction. We also thank Dr. Alison Foote from the “Publication in English” service of Grenoble-Alpes University Hospital for critically editing the manuscript.
References (84)
- et al.
How far can complementary and alternative medicine go? The case of chiropractic and homeopathy
Soc Sci Med
(2006) - et al.
Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits
Patient Educ Couns
(2016) - et al.
Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies
Complement Ther Med
(2004) - et al.
A systematic review of complementary and alternative medicine for asthma self-management
Nurs Clin North Am
(2013) - et al.
Are people who use “natural drugs” aware of their potentially harmful side effects and reporting to family physician?
Patient Educ Couns
(2004) - et al.
Use of unconventional therapies by primary care patients–religious resources vs. complementary or alternative medicine services
Complement Ther Med
(2013) - et al.
Characteristics of visitors to practitioners of homeopathy in a large adult Norwegian population (the HUNT 3 study)
Homeopathy
(2012) - et al.
Characteristics of visitors to homeopaths in a total adult population study in Norway (HUNT 2)
Homeopathy
(2008) Determinants of complementary alternative medicine (CAM) use
Complement Ther Med
(2004)- et al.
Adaptive coping strategies and attitudes toward health and healing in german homeopathy and acupuncture users
Explore
(2010)
Factors related to regular use of complementary/alternative medicine in Turkey
Complement Ther Med
Characteristics of patients consulting their regular primary care physician according to their prescribing preferences for homeopathy and complementary medicine
Homeopathy J Fac Homeopathy
Complementary alternative medicine (CAM) use in Ireland: a secondary analysis of SLAN data
Complement Ther Med
Alternative medicine in a sample of 655 community-dwelling elderly
J Psychosom Res
Is there a geography of alternative medical treatment in The Netherlands?
Health Place
Prevalence surveys: to be taken with a pinch of salt
Complement Ther Clin Pract
Complementary and alternative medicine in an integrated health care delivery system: users of chiropractic, acupuncture, and massage services
Perm J
Complementary and Alternative Medicine: A Cross-Sectional Observational Study in Pediatric Inpatients
J Evid-Based Integr Med
Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice
Anticancer Res
Comparing complementary and alternative medicine use with or without including prayer as a modality in a local and diverse united states jurisdiction
Front Public Health
Use of complementary and alternative medicine among patients: Classification criteria determine level of use
J Altern Complement Med
CAM use in Europe–The patients’ perspective. Part I: a systematic literature review of CAM prevalence in the EU
Final Rep CAMbrella Work Package
Prevalence of complementary and alternative medicine (CAM) use by the general population: a systematic review and update
Int J Clin Pract
Advising patients who seek alternative medical therapies
Ann Intern Med
Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey
Ann Intern Med
Physicians want education about complementary and alternative medicine to enhance communication with their patients
Arch Intern Med
A critical review of the sociology of alternative medicine: research on users, practitioners and the orthodoxy
Health (N Y)
Complementary and alternative medicine (CAM) use in advanced cancer: a systematic review
J Support Oncol
Legal status and regulation of complementary and alternative medicine in Europe
Forsch Komplementarmedizin
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
BMJ
Health behavior in a kibbutz population: Correlations among different modalities of healthcare utilization
Isr Med Assoc J IMAJ
Who uses complementary and alternative medicine in Israel?
J Altern Complement Med
Change and stability: use of complementary and alternative medicine in Israel: 1993, 2000 and 2007
Eur J Public Health
Are users of complementary and alternative medicine sicker than non-users?
Evid-Based Complement Altern Med ECAM
Satisfaction with family physicians and specialists and the use of complementary and alternative medicine in Israel
Evid Based Complement Alternat Med
Complementary and alternative medicine: Beyond users and nonusers
Complement Ther Med
Use of complementary and alternative medicine in Israel: 2000 vs. 1993
Isr Med Assoc J
The co-use of conventional drugs and herbs among patients in Norwegian general practice: a cross-sectional study
BMC Complement Altern Med
Continuity of GP care is associated with lower use of complementary and alternative medical providers: a population-based cross-sectional survey
BMC Health Serv Res
Characteristics of female and male visitors to practitioners of acupuncture in the HUNT3 study
Am J Chin Med (Gard City N Y)
Socio-demographic characteristics and health perceptions among male and female visitors to CAM practitioners in a total population study
Forsch Komplementärmedizin Res Complement Med
Changes among male and female visitors to practitioners of complementary and alternative medicine in a large adult Norwegian population from 1997 to 2008 (the HUNT studies)
BMC Complement Altern Med
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Impact of socioeconomic and health-related factors on consumption of homeopathic and natural remedies in Spain in 2006, 2011 and 2017
2022, Journal of Integrative MedicineCitation Excerpt :Kemppainen et al. [9], using data from the European Social Survey 2014, found that 25.9% of the European population stated that they had taken some form of CAM in the preceding 12 months, figures going from 9.5% in Hungary, where insurance coverage is limited to massage, acupuncture, manual medicine, and neural therapy [10] to 39.5% in Switzerland, where CAM products, registered by Swiss Agency for Therapeutic Products are reimbursed by the federal health insurance, whereas others are reimbursed due to individual contracts according to private health insurance [10], and 39.5% in Germany, where the state insurance companies reimburse partly acupuncture, homeopathic and anthroposophic treatment performed by contracted qualified medical doctors, but patients must pay for medicines [10]. In addition to CAM regulation and insurance coverage, it is possible that the use of CAM and type of use are also influenced by sociodemographic and economic determinants through which we could identify characteristics of patients with greater or lesser trend to use CAM [7,11]. If we consider that the Spanish National Health System offers universal coverage and reimburses a percentage of the prescribed drugs depending on employment situation and income level and that CAM is not part of the catalog of free benefits, it could be thought that the consumer’s purchasing power could condition CAM use and furthermore, that in times of economic recession CAM use may be modified.
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A pragmatic case series of clients living with medically diagnosed migraines self-referred to reflexology
2020, Complementary Therapies in Clinical PracticeCitation Excerpt :All the participants were female, this may be a consequence of the fact that three times as many women as men live with migraine [1] possibly due to the effect of oestrogen [4]. The bias towards female participants may also come from the general bias within complementary therapies as a whole, that female gender is predictive of the use of Complementary and Alternative Medicine (CAM) [34]. The positive effects of this study could be explained by knowledge gained from discriminative and affective touch.
Does dissatisfaction with physicians lead patients to alternative practitioners?
2020, Complementary Therapies in Clinical PracticeCitation Excerpt :In these circumstances, analyses using logistic regression are precise and less biased than the propensity score estimates [23]. Therefore, covariates for multivariate logistic regression were selected based on two systematic reviews, the first on the determinants of recourse to CAM practitioners [24], and the other on the determinants of patient satisfaction [25]. To reduce the risk of confusion bias, we chose the co-variables associated with both patient satisfaction and the use of CAM practitioners.
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