Why do patients turn to complementary and alternative medicine? A health psychology perspective

Complementary and alternative medicine (CAM) includes a wide range of practices which do not fit within the dominant biomedical model of health care and are not usually provided within conventional medicine settings.  In the UK some of the more established forms of CAM include acupuncture, chiropractic, homoeopathy, hypnotherapy, medical herbalism, and osteopathy.  CAM can also be incorporated into self-treatment regimes through the use of ‘medicinal’ products such as nutritional supplements, flower essences and herbal remedies that are readily available over the counter. 

Why does it matter why people use CAM?

Research on why people use CAM is relevant to a substantial proportion of the general population.  While people who use CAM are in the minority, this minority is growing, as is the availability and accessibility of CAM.  46% of the UK population can be expected to use one or more CAM therapies in their lifetime and 10% visit a CAM practitioner each year (Thomas & Coleman, 2004; Thomas, Nicholl, & Coleman, 2001).  This situation is broadly similar in other western countries including the United States, Canada and Australia. Research into CAM use can inform us about current delivery and use of different types of health care. 

On an academic level, understanding CAM use has the potential to improve our models of healthcare particularly those that concern the factors influencing people’s uptake and maintenance of a variety of health behaviours.  On a practical level, understanding CAM use has implications for conventional medicine, doctor-patient communication and integrated healthcare. 

Conventional medicine

The current popularity of CAM can be seen as somewhat puzzling given the recent advances within conventional medicine.  From this perspective, the popularity of CAM might signal an opportunity for change in conventional medicine.  Patients might be turning to CAM to fulfil identifiable needs that are currently unmet; conventional medicine could adapt in order to satisfy those needs. 

Doctor-patient communication

The majority of patients who use CAM do so alongside conventional medicine.  This creates the potential for interactions between herbs, nutritional supplements and conventional drugs; hence the need for disclosure and open discussion between doctors and patients about CAM.  Understanding why patients use CAM can facilitate such conversations.

Integrating CAM and conventional medicine

For integrated medicine to be successful, patients’ perspectives must be understood and respected.  If we understand why people use CAM, we can ensure that those characteristics of CAM that are valued by patients are preserved in any attempt to integrate it with conventional medicine.

Why do people use CAM?

Researchers suggest that people use CAM either because they are dissatisfied with conventional medicine and/or because they are attracted to CAM.  Vincent and Furnham (1996) term these push and pull factors respectively. 

'Push factors'

Some CAM users do so out of a sense of dissatisfaction with conventional medicine.  This notion has proved popular in the literature, and most studies have consistently found that people who use CAM are more likely to be dissatisfied with one or more aspects of conventional medicine.  People who seek CAM out of dissatisfaction with conventional medicine can be dissatisfied with either technical and/or interpersonal aspects of their care. 

These aspects include: lack of treatment effect; negative side-effects from (invasive/toxic) conventional treatments; perceived lack of hope for future; and a poor doctor-patient relationship and communication.  It is important to remember that despite being dissatisfied with conventional medicine the vast majority of people who use CAM do so alongside conventional medicine.  Furthermore, dissatisfaction with conventional medicine is only a partial explanation of why people use CAM, factors which attract people to CAM must also be incorporated. 

'Pull factors'

In a recent systematic review of the literature we examined 94 published studies of CAM use that analysed why people are pulled towards CAM (Bishop, Yardley, & Lewith, 2007).  We found that four main themes help to explain why people are attracted to CAM. 

Patient participation

CAM offers opportunities for patients to gain control over and participate in treatment.  Qualitative studies suggest that people who use CAM are attracted to and value the opportunities it affords them to regain a sense of control over their illness and treatment.  Similarly patients value the participatory therapeutic relationships that are usually fostered by CAM practitioners.  There is limited quantitative evidence that CAM users are more likely than non-users to desire control over and participation in their treatment.  Much of this evidence comes from studies in cancer and HIV; the relationship between control and CAM use needs to be tested in other illness groups.

Belief in mind-body connection

People who use CAM tend to believe that psychological factors such as stress and emotions have a causal role in illness.  Other aspects of illness perceptions (e.g. people’s beliefs about how long their illness might last, and how serious its consequences are) might also be related to CAM use but have rarely been studied in this context.

‘Natural’ medicine

CAM tends to be perceived as holistic and/or natural, characteristics which are valued by people who use CAM.  This reflects the emphasis in CAM on treating the whole person (not just the symptoms) and using natural remedies or methods (not processed medicines).  The extent to which CAM users value holistic and natural treatments appears to vary across different type of CAM, although further research is needed to clarify the extent to which preferences for holistic and natural treatments predict the use of specific CAM therapies.  Qualitative studies also suggest that some patients mistakenly equate ‘natural’ with ‘safe’, a practice which needs to be challenged by both CAM and conventional clinicians. 

Unconventional belief systems

Some people who use CAM share other, broader, belief systems.  Astin (1998) found that CAM users were more likely to be unconventional and committed to causes such as feminism, environmentalism, spirituality, personal growth and a love of the foreign and exotic.  There is also a small amount of evidence suggesting that people who use CAM (particularly mind-body therapies such as meditation) are likely to score highly on measures of spirituality; religious beliefs are inconsistently associated with CAM use.

Conclusions

People use CAM in part because they are pushed away from conventional medicine and in part because they are pulled towards CAM.  The research to date suggests that elements of CAM that are valued by patients (such as holistic and patient-centred care) might be incorporated into conventional medicine. However, this account of CAM use is far from complete, and the evidence that supports it is limited.  To improve our understanding of why people use CAM, future research must address: 

• The likely differences between people who chose different CAM therapies and people who chose practitioner-based CAM compared with self-treatment
• The different approaches that patients have to managing their use of CAM in relation to their use of conventional medicine.
• The differences between people who use CAM to treat an illness compared to people who use CAM to enhance wellbeing. 
• The relationship over time between people’s beliefs and their experiences of CAM.

If we can address these issues through high quality research, then we can better understand why people use CAM and start to use this knowledge to inform the design and delivery of an integrative medical service. 

References

Astin, J. A. (1998). Why patients use alternative medicine.  Results of a national study. Journal of the American Medical Association, 279, 1548-1553.
Bishop, F. L., Yardley, L., & Lewith, G. T. (2007). A systematic review of beliefs involved in the use of complementary and alternative medicine. Journal of Health Psychology, 12, 851-867.
Thomas, K. J. & Coleman, P. (2004). Use of complementary or alternative medicine in a general population in Great Britain. Results from the National Omnibus survey. Journal of Public Health, 26, 152-157.
Thomas, K. J., Nicholl, J. P., & Coleman, P. (2001). Use and expenditure on complementary medicine in England:  a population based survey. Complementary Therapies in Medicine, 9, 2-11.
Vincent, C. & Furnham, A. (1996). Why do patients turn to complementary medicine?  An empirical study. British Journal of Clinical Psychology, 35, 37-48.
Felicity L Bishop  14th November 2007

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