Elsevier

Complementary Therapies in Medicine

Volume 42, February 2019, Pages 347-354
Complementary Therapies in Medicine

Predictive factors of complementary and alternative medicine use in the general population in Europe: A systematic review

https://doi.org/10.1016/j.ctim.2018.12.014Get rights and content

Highlights

  • In practice many researchers distinguish among use of CAM products, CAM practices or consultation of a CAM practitioner.

  • The use of CAM practitioners is the most studied behaviour.

  • As predictive factors of CAM practitioner use, evidence is consistent for female sex & self-reported chronic disease only.

  • Predictive factors of CAM vs. classical practitioner use are note clearly different.

Abstract

Aim

To identify predictive factors of CAM use in the general population in Europe.

Methods

We performed a systematic review to summarize and analyse the published data on factors predictive of CAM use by the general population in Europe. The Cumulative Index to Nursing and Allied Health Literature, Google Scholar, PsycInfo, PubMed and the Web of Science databases were systematically searched up to August 2, 2018. We selected observational studies (case-control, cohort and cross-sectional) of adults conducted in Europe. Risk of bias was determined using the ROBINS-I tool recommended by the Cochrane Group.

Results

Over six thousand articles were identified of which 49 met our inclusion criteria. Twenty three studies investigated the consultation of CAM practitioners, five looked at the use of CAM products, one concerned CAM practices and twenty studied combinations of these. Female gender and self-reported chronic disease are predictive factors of CAM practitioner use. In contrast, marital status is not a predictive factor for consulting a CAM practitioner. Female gender is also a predictive factor of CAM product use. For all other factors investigated, no clear conclusions could be drawn.

Conclusion

We found no clear specificity of the use of CAM practitioners versus conventional health practitioners. Other directions of public health research should be explored, rather than assuming that there is specificity.

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.

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