Barriers to acceptance: an exploratory study of complementary/alternative medicine disuse

N Jain, J A Astin
Journal of Alternative and Complementary Medicine: Research on Paradigm, Practice, and Policy 2001, 7 (6): 689-96

BACKGROUND: Previous research indicates wide use of complementary and alternative medicine (CAM). While understanding this trend is certainly important, an equally meaningful although largely unexamined research question is: why do the majority of patients and individuals fail to avail themselves of such therapies? Understanding these factors may be particularly important given the increasing evidence suggesting that certain of these therapies may be efficacious.

METHODS: A two-page survey that examined demographic characteristics, attitudes toward CAM, and rates of use of specific CAM therapies was mailed to a randomly selected sample of 1680 Stanford University alumni. A total of 601 responses were received (response rate, 35.8%). Multiple regression analyses were carried out to examine predictors of general CAM disuse and disuse of specific therapies.

RESULTS: The following variables predicted disuse of CAM in general (p < 0.05): (1) being male (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.44-0.98); (2) being healthy (OR 0.95; 95% CI 0.91-0.99); (3) lack of physician support for CAM use (OR 1.82; 95% CI 1.42-2.29); and (4) believing CAM treatments are ineffective or inferior (OR 0.27; 95% CI 0.19-0.38). Lack of knowledge about CAM approached significance (p = 0.068). With regards to specific therapies, the following patterns were seen: disuse of massage was associated with being male and younger; lack of physician support predicted disuse for all treatments except acupuncture and homeopathy; the belief that CAM treatments in general are ineffective predicted disuse of all therapies except chiropractic while the belief that chiropractic was ineffective predicted its disuse; the perception that CAM produced negative side-effects predicted disuse of chiropractic; lack of knowledge of CAM predicted disuse of herbs, chiropractic, and homeopathy; positive health status was associated with disuse of chiropractic; and finally, the perception that providers were not in accessible locations predicted disuse of all CAM therapies except homeopathy and meditation.

CONCLUSIONS: Study findings indicate people are less likely to use CAM if they are male, are in good health, believe that the therapies are in general ineffective or inferior to conventional methods, perceive that conventional medical doctors are not supportive, and to a lesser extent feel they do not have adequate knowledge of CAM. Specifically, avoidance of chiropractic is associated with concerns for safety and side-effects. For treatments that are more provider-based as opposed to self-care based, lack of accessibility-to providers may explain disuse. As researchers continue to demonstrate the clinical efficacy of CAM therapies, these preliminary findings deserve attention because they highlight potential reasons why patients and physicians may be biased against or unable to avail themselves of such therapies.

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