The wide range of utilization of CAM among the population may be because of the lack of consensus in defining CAM, but the findings suggest that a high proportion of the population uses CAM. In general, the average prevalence of CAM was 32.2%. Because the studies were heterogeneous, the average was only calculated to give a rough estimate of proportions. The follow-up studies in particular found a steady increase in CAM use. Eisenberg et al2
stated that between 1990 and 1997 the use of CAM increased from 33.8% to 42%. In 2002, a review by Germany's Robert Koch Institut9
—the central federal institution responsible for disease control and prevention—presented findings from standardized surveys conducted by the Institut für Demoskopie Allensbach in 1970, 1997, and 2002. The surveys show a steady increase of CAM utilization since 1970. In 1970 about 14% of respondents had used some form of CAM over the past 3 months; this amount doubled to 28% in 1997 and ascended to 34% in 2002. Wolf et al32
reviewed the situation in Switzerland and found that the average prevalence of CAM was 49%, and Kessler et al1
stated that 67.7% of their American sample had used at least one form of CAM in their lifetime.
Additionally, these studies and the review by the Robert Koch Institut revealed that acupuncture and homeopathy are used more often in European countries than in the United States and Canada. Additional research comes from the World Health Organization's Global Atlas of Traditional, Complementary and Alternative Medicine
This atlas is a review-based overview of the CAM situation across the world and is at present one of the most reliable studies on CAM. The atlas substantiates the findings that chiropractic manipulation, homeopathy, phytotherapy/herbal medicine, and massage were the most used therapies. If prayer had been considered in the present study, it would certainly be among the most used therapies. When study authors examined the use of prayer, it was in at least the top 3 and most times showed the highest prevalence. Also relevant was the sparse research on energy medicine methods; few studies examined their prevalence. Therefore, little is known about utilization. It is difficult to provide an explanation for this lack of interest, but whenever one of these methods was examined, it ranked among the least used.
A closer look at the follow-up studies by Eisenberg et al2
showed an increase in the usage of nearly every therapy. Specifically, this increase applied to herbal medicine, massage, megavitamins, self-help groups, folk medicine, energy healing, and homeopathy. Referring to the studies undertaken by MacLennan et al,8
Eisenberg et al stated, “there has been a steady increase in use of CAM therapists by the South Australian public over the past 10 years.” Although prevalence rates for the utilization of CAM therapists between 2000 and 2002 () were declining, the authors found an increase in visits over the past 10 years to herbal and other therapists (prevalence for the Other Therapists group: 1.8% , 1.2% , and 4.8% ). shows that prevalence rates increased over the past 10 years. Additionally, Crivelli et al13
…a higher utilization of a CAM therapy is related to: a healthy and health preventive lifestyle (sports, abstinence of alcohol); lack of a general physician; no use of prescribed medications and vitamins over the last week; no medical treatment concerning rheumatism, heart disorders, allergic coryza or other allergies as well as mental breakdown or depression over the last 12 months; no physical or psychological problem since over 12 months; no headache, facial pain, general weakness or fatigue over the last 4 weeks; complete abandonment of influenza vaccination; a good up to very good self reported health status. In general users of a CAM therapist seem to be in a better health than users preferring a physician as their CAM provider.
Ozcakir et al25
found a lack of education in CAM: 96.5% of the physicians they studied had received no education in CAM. However, 74.4% of these physicians wanted some education on the subject. Although knowledge levels were low, about half of physicians (51%) believed in the efficacy of CAM. DeKeyser et al,26
Newell et al,27
Münstedt et al,28
and Wahner-Roedler et al29
also found a lack of education and knowledge about CAM. Perkin et al30
claimed that “in each group a majority felt that alternative medicine should be taught as a topic course during a medical student's training (medical students 84%, GPs 75%, hospital doctors 60%).”
Similarly, the Richardson et al31
study examined the reasons for communication gaps between physicians and patients about CAM and found that patients and physicians had different reasons for nondisclosure. “Physicians believed patients felt CAM discussions were unimportant and physicians would not understand, discontinue treatment, discourage or disapprove of the use. Patients attributed nondisclosure to their uncertainty of its benefit and never being asked about CAM.” This finding was consistent with the results of Wahner-Roedler et al29
who noted that “more than half the physicians (63%) stated that the patient initiated the discussion about benefits and risks of CAM therapy.”
Prevalence findings by Crivelli et al,13
Thomas et al,18
and MacLennan et al8
are based on CAM provided by therapists. Studies undertaken by Bachinger et al,11
Barnes et al,4
Haertel et al,7
Hanssen et al,12
McFarland et al,20
Menniti-Ippolito et al,17
Ock et al,21
and Ni et al14
did not differentiate between self-care and the use of a CAM therapist. Eisenberg et al2
distinguished between use under the supervision of a practitioner of alternative therapy and use without such supervision.
Because all of the studies allowed multiple answers in the study methodology, a recalculation was not possible. Therefore, the best overall prevalence with prayer included can only be specified for Barnes et al4
: 62%. Compared to the findings without prayer, this figure demonstrates an increase in utilization of 26%. Both follow-up studies2
found an increase in prevalence rates. Eisenberg et al2
reported an increase of 8.3% in CAM utilization between 1990 and 1997. MacLennan et al16
showed a continuing rise of CAM prevalence among the Australian population between 1993 and 2004 (1993: 20.3%, 2000: 23.3%, and 2004: 26.5%).
The identification of a user profile was another key question of the present study. Studies on general utilization found similar results. The most predictive factors for CAM utilization were sex, age, and education. The majority of the publications we reviewed showed a significantly higher utilization of CAM among women. Also, users tended to be middle aged and better educated. These findings are common to the results of several other authors34
and therefore might be the most predictive factors of CAM utilization. Also, several studies found that higher income levels were associated with a higher utilization of CAM, while the impact of marital status and health status was inconclusive. Although separation and poor health tend to be associated with a higher CAM utilization, these factors might be weak predictors.
Astin et al42
investigated other possible predictors of alternative healthcare use. The authors found that membership in the so-called cultural creatives—people at the leading edge of cultural change and characterized by their commitment to causes such as feminism, environmentalism, spirituality, personal growth, and a love of the foreign and exotic—predicted CAM utilization. In a review of the literature on beliefs involved in the use of CAM, Bishop et al43
found CAM users to have more active coping styles and to be more interested in making treatment decisions. Personal characteristics such as personality and coping skills were also reported by Honda et al,44
Huber et al,45
Spadacio et al,46
and Kersnik et al.36