Accessible Requires Authentication Published by De Gruyter September 23, 2020

Factors determining choice of complementary and alternative medicine in acute and chronic diseases

Praheli Dhar Chowdhuri ORCID logo and Kaushik Kundu



Systematic analysis of the determinants of choice of a treatment modality aids to the understanding of decision process of healthcare utilization. The revealed preference of a single modality may differ according to the nature of disease. Existing studies have not integrated possible causal factors in a model with respect to diseases. This study identifies major determinants and formulates their integral effect on choice of a particular modality on acute and chronic diseases in accordance to socio-behavioural model.


A cross-sectional study on 300 samples using a 30-point questionnaire, developed in Likert scale and dichotomous scale. Possible determinants are tested on choice of CAM in case of acute disease and of chronic disease separately.


Revealed single modality treatment preference (of CAM) varies widely between acute disease (13%) and chronic disease (58.67%). Bivariate associations are significant for gender (For, overall CAM preference, p=0.001, acute disease, p<0.001, chronic disease, p=0.024), Disease burden (overall and chronic: p<0.001, acute: p=0.008) and previous CAM usage (overall and chronic: p<0.001, acute: p=0.016). Social factor individually has significant influence on choosing CAM both acute (OR=1.096, p<0.001) and chronic disease (OR=1.036, p<0.001). Ideation of philosophical need factor, guided by philosophical congruence with CAM (OR=1.047, p<0.001) is a novel finding of this study. While with multiple logistic regression male gender (p=0.03), social factor (p<0.001), perception of CAM efficacy (p=0.02) and negative ideation about CAM cost-effectiveness (p=0.002) are found to be important in Acute disease; choosing CAM in chronic disease is guided by female gender (p=0.001), making decision in-group (p=0.001), low disease burden (p<0.001), philosophical need factor (p=0.001), and perception of CAM efficacy (p<0.001).


Demographic, social, cognitive and philosophical factors are important determinants of choosing CAM as a treatment modality over conventional medicine, but they act differently on CAM preference in acute and chronic diseases.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


[1] Grad FP. The preamble of the constitution of the World Health Organization. Bull World Health Organ 2002;80:981–981. Search in Google Scholar

[2] Sigerist HE. Civilization and disease. NY: Cornell University Press, 2018. Search in Google Scholar

[3] Chandra S. Status of Indian medicine and folk healing: with a focus on integration of AYUSH medical systems in healthcare delivery. Ayu 2012;33:461. Search in Google Scholar

[4] Harris P, Rees R.The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature. Complement Ther Med 2000;8:88–96. Search in Google Scholar

[5] Spigelblatt L, Laîné-Ammara G, Pless IB, Guyver A. The use of alternative medicine by children. Pediatrics 1994;94:811–14. Search in Google Scholar

[6] Astin JA. Why patients use alternative medicine: results of a national study. Jama 1998;279:1548–53. Search in Google Scholar

[7] Sirois FM, Purc-Stephenson RJ. Consumer decision factors for initial and long-term use of complementary and alternative medicine. Complement Health Pract Rev 2008;13:3–19. Search in Google Scholar

[8] Hunt KJ, Coelho HF, Wider B, Perry R, Hung SK, Terry R, et al. Complementary and alternative medicine use in England: results from a national survey. Int J Clin Pract 2010;64:1496–502. Search in Google Scholar

[9] Wapf V, Busato A. Patients’ motives for choosing a physician: comparison between conventional and complementary medicine in Swiss primary care. BMC Complement Altern Med 2007;7:41. Search in Google Scholar

[10] McFadden KL, Hernández TD, Ito TA. Attitudes toward complementary and alternative medicine influence its use. Explore J Sci Heal 2010;6:380–8. Search in Google Scholar

[11] Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995;36:1–10. Search in Google Scholar

[12] O’Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in Health Care: shared decision making using patient decision aids: a review of the evidence base for shared decision making. Health Aff 2004;23:VAR-63. Search in Google Scholar

[13] Singh V, Raidoo DM, Harries CS. The prevalence, patterns of usage and people’s attitude towards complementary and alternative medicine (CAM) among the Indian community in Chatsworth, South Africa. BMC Complement Altern Med 2004;4:3. Search in Google Scholar

[14] Ryan M, Johnson MS. Use of alternative medications in patients with neurologic disorders. Annals Pharmacother 2002;36:1540–5. Search in Google Scholar

[15] Evans M, Shaw A, Thompson EA, Falk S, Turton P, Thompson T, et al. Decisions to use complementary and alternative medicine (CAM) by male cancer patients: information-seeking roles and types of evidence used. BMC Complement Altern Med 2007;7:25. Search in Google Scholar

[16] Eisenberg DM, Post DE, Davis RB, Connelly MT, Legedza AT, Hrbek AL, et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine 2007;32:151–8. Search in Google Scholar

[17] Egede LE, Ye X, Zheng D, Silverstein MD. The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care 2002;25:324–9. Search in Google Scholar

[18] Cochran WG. Sampling techniques, 3rd ed. New York: John Wiley & Sons, 1977:374. Search in Google Scholar

[19] Taylor SL, Cosenza RM. A conceptual choice model for hospital services. J Marketing Theory Practice 1999;7:20–32. Search in Google Scholar

[20] Ranstad K, Midlöv P, Halling A. Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden. Scand J Prim Health Care 2014;32:99–105. Search in Google Scholar

[21] Fouladbakhsh JM, Stommel M. Comparative analysis of CAM use in the US cancer and noncancer populations. J Complement Integ Med 2008;5. Article 19. Search in Google Scholar

[22] Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat report 2008;10:1–23. Search in Google Scholar

[23] Shere-Wolfe KD, Tilburt JC, D'Adamo C, Berman B, Chesney MA. Infectious diseases physicians’ attitudes and practices related to complementary and integrative medicine: results of a national survey. Evid Based Complement Alternat Med 2013;294381:1–8. Search in Google Scholar

[24] Sparber A, Wootton JC.Surveys of complementary and alternative medicine: part V. Use of alternative and complementary therapies for psychiatric and neurologic diseases. J Altern Comp Med 2002;8:93–6. Search in Google Scholar

[25] Guendelman S. Health care users residing on the Mexican border. What factors determine choice of the US or Mexican health system? Med Care 1991;29:419–29. Search in Google Scholar

[26] Wolinsky FD, Johnson RJ. The use of health services by older adults. J Gerontol 1991;46:S345–S357. Search in Google Scholar

[27] Lim MK, Sadarangani P, Chan HL, Heng JY. Complementary and alternative medicine use in multiracial Singapore. Complement Ther Med 2005;13:16–24. Search in Google Scholar

[28] MacLennan AH, Myers SP, Taylor AW. The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004. Medl J Au 2006;184:27. Search in Google Scholar

[29] van der Sluijs C, Lombardo FL, Lesi G, Bensoussan A, Cardini F. Social and cultural factors affecting complementary and alternative medicine (CAM) use during menopause in Sydney and Bologna. Evid Based Complement Alternat Med 2013;836234:1–6. Search in Google Scholar

[30] Shim JM. The influence of social context on the treatment outcomes of complementary and alternative medicine: the case of acupuncture and herbal medicine in Japan and the US. Global Health 2015;11:17. Search in Google Scholar

[31] Zörgő S, Purebl G, Zana Á. A qualitative study of culturally embedded factors in complementary and alternative medicine use. BMC Complement Altern Med 2018;18:25. Search in Google Scholar

[32] Flynn KE, Smith MA, Vanness D. A typology of preferences for participation in healthcare decision making. Soc Sci Med 2006;63:1158–69. Search in Google Scholar

Received: 2019-04-15
Accepted: 2019-09-27
Published Online: 2020-09-23

© 2020 Walter de Gruyter GmbH, Berlin/Boston