Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use
BMC Complementary and Alternative Medicine volume 16, Article number: 176 (2016)
There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years.
A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia.
The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government.
This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.
Complementary medicine (CM) refers to a diverse collection of clinical practices (such as acupuncture, massage therapy and naturopathy) and treatments (such as herbal medicine and homeopathy) not traditionally associated with the conventional medical curriculum . Australia is one country in which CM use is particularly significant with some of the highest CM utilisation in the developed world . Coupled with high utilisation is a high CM practitioner population which outnumbers conventional medical providers in some areas .
The increasing use of CM services by the general population has gradually resulted in CM becoming an important subject amongst Australian primary health care professionals and policy makers. Most recently, the Federal Department of Health and Aging (DOHA) commissioned a review on the Australian Government Rebate on Private Health Insurance for Natural Therapies . In addition, Australia’s National Health and Medical Research Council (NHMRC) have published a statement to assist health consumers in Australia in making informed decisions regarding their health care including a close scrutiny of the evidence associated with CM . Whilst some CM professions and products are regulated by governing bodies in Australia, often at levels beyond that observed in other countries, most CM provision remains informal or unregulated, and is generally not integrated into conventional health care frameworks .
Alongside the attention given to CM by Australian policy makers, a number of other issues have been identified as significant concerns within the Australian health system. One such issue is the growing prevalence of chronic disease and the associated pressure this places on health spending in Australia , as highlighted in the National Health Priority Areas (NHPA) . Another issue is the need to strengthen primary health care services due to a number of concerns related to accessibility amongst high risk populations including individuals with chronic disease . Rurality is also a factor which attracts ongoing attention within Australian health policy due to the large rural and remote areas in Australia and the impact this has on the ability to provide timely and quality health care appropriate to the needs of the population .
International data from the USA, UK, Norway and Canada identifies key demographic and health related factors which have been recognised as independent predictors for CM use in the general population. Compared to non-CM users, CM users are: more likely to be female and middle-aged; [11–13] have higher levels of income and education; [12–14] have multiple health concerns or diseases ; and reside in a non-urban area . However the characteristics of CM users are not always consistent in all countries possibly due to local or regional political, social and economic factors . Various ‘push’ and ‘pull’ factors, defined as the positive or negative motivations regarding CM use respectively, have also been identified as influential in driving CM use in some populations. Examples of ‘pull factors’ include dissatisfaction with conventional care and concerns about the safety of pharmaceutical medication whilst ‘push factors’ include alignment with personal beliefs, attraction of the holistic principles of CM or desire for greater personal control of their wellbeing .
Given the growing prevalence of CM use in Australia, there is a need for policy makers and practitioners to respond meaningfully to this component of the Australian healthcare system . Developing a considered, co-ordinated response to CM use requires a clear understanding of the nature of CM use including the characteristics of users, the details of CM use and patients’ motivations for using CM. In response, this article reports findings from the first comprehensive and rigorous critical review of the current contemporary literature reporting original empirical research on the profile of Australian CM users, the CM services being used and the reasons for CM use amongst the Australian population.
A database search was conducted to identify peer-reviewed original research published from January 1 2000 to December 31 2014 investigating the nature of CM use amongst the Australian population. The search included the following databases: AMED; CINAHL; and PubMed. The search terms employed were: complementary medicine; alternative medicine; natural medicine; herbal medicine; complementary therapies; traditional medicine; holistic health; phytotherapy; naturopathy; supplements; acupuncture; massage; yoga; aromatherapy; homeopathy and Australia. The following search strategy was used within all search fields in PubMed: (Australia) AND [(complementary medicine) OR alternative medicine) OR aromatherapy) OR natural medicine) OR yoga) OR herbal medicine) OR supplements) OR acupuncture) OR naturopathy) OR massage) OR complementary therapies) OR holistic health) OR homeopathy) OR traditional medicine) OR phytotherapy)]. Manual searching was also conducted to ensure known relevant articles were included in the review. All articles were imported into Mendeley, a bibliographic management software system and analysed based on title, abstract and full text. Articles were included if they reported peer-reviewed original research findings from new empirical data collection reporting on CM use in Australia, whilst articles were excluded if they were commentaries, editorials or literature reviews and were non-English. The database search was supplemented by an internet search using the same search terms as above, to identify any additional items, and bibliographic searching of included materials was also used to identify additional material. One author conducted the search and downloaded the results into Mendeley. Two authors independently examined the title and abstract of each result to identify relevant studies for inclusion. This review employed a mixed methods approach .
Critical appraisal analysis
A critical appraisal quality research tool was used to examine the validity and worth of the selected articles. The critical appraisal tool was designed to compare and evaluate the studies based on a scoring system which identified three dimensions: the methodology, participant characteristics and definition of CM. The criteria listed is equally weighed with one point being allocated to each criteria. This appraisal score has been modified from previous mixed method reviews [19, 20] and has been designed to allow for different study designs to be compared equally based on their total score. This tool has been described elsewhere [19, 20]. Methodology assessment was based on representative sampling method, a sample size >500, response rate >75 % and a low recall bias. Critical evaluation of participant characteristics was appraised according to age, gender, residence location, socioeconomic status and health status (relating to CM use in chronic disease). Finally, studies were appraised for inclusion of the researcher’s definition of CM. Each aspect of the three dimensions were given 1 point if the paper identified the minimum requirement and a final score was tallied with a maximum potential score of 10.
Categorical grouping of the identified articles was also conducted. This process involved reading and re-reading the articles and extracting relevant data to categorise common themes identified in the literature. A common theme was defined by the authors as a topic or characteristic that appeared consistently across a number of the selected articles. Other critical integrative reviews identify and develop themes in the same manner, by assessing their findings and identifying consistency on a particular topic or characteristic that holds relevancy to the research topic [19, 21–25]. Once themes were identified, articles were allocated to appropriate categories with each article allocated to as many categories as was relevant. Categorical grouping of themes allowed for contrast and comparison of reported findings within the identified articles.
Risk of bias assessment
All selected articles underwent a risk of bias assessment utilising an existing tool used to assess the risk of bias in prevalence studies. This tool identifies 4 main domains of bias including external validity, internal validity, measurement bias, and bias relating to analysis. The tool is comprised of 10 items and includes a summary assessment and is described elsewhere .
A total of 64 articles were selected for review between 2000 and 2014, with a majority published between 2007 and 2014. Of the selected articles, 56 employed quantitative which comprised of 17 longitudinal studies and 39 cross sectional surveys. Seven articles utilised qualitative research methods which included, two focus group studies, two structure interview studies, two semi-structured interview studies and one interview (design not-specified). Only one study utilised mixed methods. Figure 1 summarizes the7 literature search process.
Most studies were national (n = 23) in scope whilst others focused on specific geographic regions including South Australia (n = 8), Queensland (n = 4), Victoria (n = 14) and New South Wales (n = 15). The critical appraisal analysis recognised 9 articles with a score of 9. Significant gaps were identified in the selected articles with particular reference to the methodology of the studies, with approximately two thirds of the articles not reporting adequate representative sampling methods or a response rate of 75 % or above. A minority of articles provided a discrete definition of CM, which was defined as the definition of CM that was applied in their research. The minimum requirement to meet this criteria was that the researchers clearly stated what they meant by CM. In many cases such a definition was not provided. In particular, definitions where CM was only described as treatments not specifically recommended or prescribed by a doctor were considered to not to fulfil this criteria. An example of a CM definition used was: consultations with a CM practitioners [27–29]. However, the definition of CM was not consistent across articles or employed frequently enough to be of value. Results from the critical analysis tool is displayed in Table 1.
Articles reported four broad areas: the socio-demographic characteristics of CM users; health service utilisation of CM users; drivers of CM use and CM use in health subpopulations. Categorical grouping of the selected articles is presented in Table 2.
A number of significant gaps were identified from the risk of bias assessment. A large number of gaps were noted in the external validity criteria, particularly in relation to representativeness of the study to the national population, a true representation of the target population and the likelihood that nonresponse bias was minimal. Internal validity assessment highlighted gaps relating to inclusion of an appropriate prevalence period, appropriate parameters of the numerator and dominator of interest and inclusion of an overall risk of bias summary on the study. A majority of these gaps were identified from poor or inadequate reporting in the selected articles. Results from the risk of bias assessment is displayed in Table 3.
Sociodemographic characteristics of CM users
Correlation between adult CM use and gender was identified in a number of articles, reporting a higher rate of CM consumption amongst female CM users compared to male CM users in general population based studies [30–34]. In these studies, female CM users were more likely to be middle-aged, have a higher education level and a higher annual income, compared to female non-CM users. Ethnicity was also a key characteristic of CM use and was found to be higher in Caucasian populations [30, 33, 35–38]. In comparison there was no difference in age, gender or disease status of children who used CM products or CM services [39–42] however one study reported higher CM use by children whose parents had a higher education or a managerial occupation and used CM themselves .
Individuals residing in rural areas were more likely to utilise CM in general [37, 44] and in particular manual therapies [34, 45] when compared to individuals in urban localities. Individuals in remote, outer regional and inner regional areas are more likely to consult with chiropractors compared to individuals in major cities  with 55.3 % of the population in rural NSW reporting use of chiropractic services . The impact of locality on naturopathic consultations is not as clear with some studies reporting increased consultation rates in non-urban areas (63 %)  and others identifying lower consultation rates (15 %–31.4 %) in rural areas [46, 48].
Drivers of CM use
Over half of the selected articles identified various ‘push’ and ‘pull’ factors as drivers behind CM use. Patient interactions and experiences with the conventional health system appear influential with unsatisfactory results from conventional therapy [38, 47, 49–52], and the desire to further reduce symptoms or side effects from conventional therapy [27, 38, 41, 50, 51, 53, 54] both being reported as popular drivers of CM use. Patients were also drawn positively to CM for a number of other reasons including: attraction to the perceived notion of CM as a holistic method of health care [55, 56]; the ability to use CM as a preventive therapy [27, 50, 53, 57, 58]; and the therapeutic value of CM as an adjunctive therapy to conventional medicine [50, 53]. Other drivers amongst patients using CM centred on the perceived alignment of CM with the individual’s personal belief system , the perception of CM as safe , the ability for CM to provide hope  or a sense of patient control over their treatment [50, 62, 63], and a perception that CM practitioners are more supportive towards their health compared to other health professionals [27, 64]. Within subpopulations with chronic health conditions, CM use was linked to reducing side effects from conventional medicine, dissatisfaction with standard care and to assist in disease management [28, 39, 41, 46, 53, 56, 61, 65, 66].
Use of health services by CM users
CM users were identified as accessing multiple health services from a wide variety of conventional and CM disciplines. CM users appear to be higher users of conventional medical care, with several articles reporting CM users as visiting general practitioners more frequently than non-CM users [32, 44, 47, 49, 67]. The majority of CM services used for a diversity of conditions were chiropractic, massage therapy, naturopathy and acupuncture [29, 30, 33, 34, 42, 44, 45, 48–50, 53, 55, 57, 63–66, 68–78]. Results indicate that chiropractors and massage therapists are the most commonly consulted CM disciplines, with chiropractor consultations reported up to 55.3 % , with a higher use by rural residents [33, 79] and male CM users . Massage therapy consultations were reported by up to 81.5 %  amongst those with musculoskeletal complaints. Rates of acupuncture consultations were reported to range from 6.7 % and 32.2 %, with a higher rate of use amongst pregnant women  and increased frequency of use in fertility clinic patients . The least commonly consulted CM practitioner across all populations were homeopaths [46, 68].
CM use amongst health subpopulations
CM use was reported in a number of chronic diseases including those identified as Australian NHPA. Patients accessed CM to assist in the management of a number of chronic diseases including: cancer [53, 65, 75, 81]; musculoskeletal diseases (rheumatoid arthritis, osteoporosis, osteoarthritis and ankylosing spondylitis) [44, 46, 49, 52, 72, 80]; digestive disease (inflammatory bowel disease) [39, 82]; asthma [58, 61]; cardiovascular diseases ; multiple sclerosis ; diabetes mellitus [28, 38, 83]; mental health [32, 44, 47, 49, 55, 85, 86]; and HIV . CM use for chronic disease management was associated with users reporting poorer health compared to non-CM users  and evidence of utilising both CM and conventional professionals . Alongside individuals with chronic health conditions, pregnant women also used CM concurrent to conventional maternity care with almost half of pregnant women consulting specifically with a CM practitioner for pregnancy-related complaints . In addition, two studies reported high CM use (53.8 %–82.5 %) by women experiencing menopause-associated symptoms [50, 87].
This is the first critical review of a large body of research which has explored the contemporary nature of CM use in Australia. This review identifies high use of CM in line with international sociodemographic trends including the predominance of females  and those with tertiary education qualifications [30, 37]. A number of reasons to explain the association between education level and CM use have been suggested to include: higher levels of health literacy and access to resources [32, 88]; potential for self-determination ; and greater disposable income to spend on healthcare . If these reasons apply to Australian CM users, it may suggest such users are potentially conducting their own research to inform self-determined health choices. The relationship between CM use and level of education is of particular interest in Australia given the past and current concerns about CM use by the peak scientific body  which appear to go unheeded by members of the population with higher education. Exceptions to the identified relationship between higher education level and CM use is apparent amongst older adults where post-secondary education is less prominent . This difference may be explained by the higher rates of chronic disease in this population , however, less is known about the factors which influence this group . As such, more research is needed to better understand health decision-making amongst older adults with chronic disease.
Our review identifies individuals with chronic diseases or co-morbidities, and a lowered quality of life, have a higher reported CM health service utilisation when compared with non-CM users. Many of the mentioned chronic diseases, such as cancer, musculoskeletal diseases, mental health and diabetes, are identified as NHPA by the Australian Government due to their high mortality and morbidity rates in the population . Given the priority focus on these diseases, the higher rates of CM use by individuals with these conditions requires further research and policy attention. Despite the trends identified in this review, very little is known about CM use and users within chronic disease subpopulations. In particular a more detailed description of the specific CM used by individuals with chronic disease including the reasons for use, their concurrent use of conventional treatments, and the effectiveness and safety of CM as part of their overall health care is urgently needed. Alongside this, the interprofessional dynamics between CM and conventional health professionals providing care to the same individual is an important area requiring further research focus, given that amongst chronic disease subpopulations CM users are also more likely than non-CM users to have an increased frequency of consultations with their general practitioner and/or allied health professional [27, 47, 49, 55, 68].
This review identified key differences in CM services in rural and non-urban areas, compared to urban populations. In particular, the use of manual therapies such as consultations with a massage therapist or chiropractor were more common amongst rural populations. These geographical insights suggests there may be other more specific drivers or influences of CM use in rural areas . It has been proposed that access to both CM and conventional health services and overall CM workforce distribution may be influential in the differences in CM use in rural areas when compared with urban populations . In addition, rural CM users are more likely to have a lower household income compared with their urban counterparts . The reasons underpinning this economic characteristic require further clarification. Overall, the higher rate of CM use and contrasting profile of users of CM in rural areas deserves close research and policy attention given the important challenges facing rural health care at a federal and state government level [93, 94] in Australia.
Review limitations and future areas of research
A number of gaps in the reviewed literature were identified in relation to study quality and findings. Study quality could be improved by using a representative sampling method of the general population in order to gain a greater view of CM use in the general population. As a number of studies were conducted in individual states, additional data from other states is needed to provide a more complete picture of CM use in Australia. In addition the gaps identified in the risk of bias assessment may pose as an issue for the strength of the results descripted in this review.
As mentioned, CM users are more likely to be female and in line with this more studies have been conducted to explore female CM users and use in Australia. Studies targeting male-specific populations and CM use are recommended for future studies. An additional priority area is a thorough examination of effectiveness, economics, and safety of the CM being used to manage chronic disease. To adequately address all of these identified areas comprehensive research designs which examine CM within the context of chronic disease is paramount.
Heterogeneity in research design and methodology may limit the ability to draw broader conclusions about CM use from this review. Of significance is the absence of definition for CM across the contemporary literature. This is an important issue due to widely recognised need for a uniform definition of CM and a lack of clarity regarding which professions and practices fit under the umbrella term. Nevertheless, this review does provide the first summative critical review of research examining the nature of CM use in Australia providing important insights for both health services research as well as practice and policy development around CM use in Australia.
CM use is substantial across contemporary Australia and all involved in managing, organising, providing and using health care services in Australia need to be cognisant of CM use, especially as concurrent to conventional medicine use and consultation with conventional health care providers. Further research examining a range of identified areas around CM use in Australia will help contribute to wider practice and policy development and attempts to provide effective, safe and coordinated health care for all Australians.
CM, Complementary medicine; DOHA, Department of Health and Aging; HIV, Human Immunodeficiency Virus; NHMRC, National Health and Medical Research Council; NHPA, National Health Priority Areas; NSW, New South Wales; UK, United Kingdom; USA, United States of America
Zollman C, Vickers A. What is complementary medicine? BMJ (Clinical research ed). 1999;319(7211):693–6.
Andrews G, Adams J, Segrott J, Lui C. The Profile of Complementary and Alternative Medicine Users and Reasons for Complementary and Alternative Medicine Use. In: Adams J, Andrews G, Barnes J, Magin P, Broom A, editors. Traditional, Complementary and Integrative Medicine: An International Reader. London: Palgrave Macmillan; 2012.
Wardle J, Adams J, Magalhães Soares R, Sibbritt D. Distribution of complementary and alternative medicine (CAM) providers in rural New South Wales, Australia: a step towards explaining high CAM use in rural health? Aust J Rural Health. 2011;19(4):197–204.
Department of Health. The Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies. Australian Government Department of Health and Ageing. 2015. http://www.health.gov.au/internet/main/publishing.nsf/Content/phi-natural-therapies. Accessed 11 May 2015.
National Health and Medical Research Council. Complementary medicines 2015. http://www.nhmrc.gov.au/health-topics/complementary-medicines. Accessed 4 Mar 2015.
Wardle J, Weir M, Marshall B, Archer E. Regulatory and legislative protections for consumers in complementary medicine: lessons from Australian policy and legal developments. European Journal of Integrative Medicine. 2014;6(4):423–33.
Parliament of Australia. Terms of Reference. 2015. http://www.aph.gov.au/Parliamentary_Business/Committees/House/Health/Chronic_Disease/Terms_of_Reference. Accessed 30 Oct 2015.
Australian Institute of Health and Welfare. National health priority areas 2015. http://www.aihw.gov.au/national-health-priority-areas/. Accessed 14 May 2015.
National Health Priority Action Council. National Chronic Disease Strategy. Canberra: Australian Governement Department of Health and Ageing; 2006.
Australian Institute of Health and Welfare. Impact of rurality on health status. 2015. http://www.aihw.gov.au/rural-health-impact-of-rurality/. Accessed 30 Oct 2015.
Thomas K, Coleman P. Use of complementary or alternative medicine in a general population in great Britain. Results from the national omnibus survey. Journal of public health (Oxford, England). 2004;26(2):152–7. doi:10.1093/pubmed/fdh139.
Bishop FL, Lewith GT. Who uses CAM? a narrative review of demographic characteristics and health factors associated with CAM use. Evidence-based complementary and alternative medicine : eCAM. 2010;7(1):11–28. doi:10.1093/ecam/nen023.
Laiyemo MA, Nunlee-Bland G, Lombardo FA, Adams RG, Laiyemo AO. Characteristics and health perceptions of complementary and alternative medicine users in the United States. The American journal of the medical sciences. 2014. doi:10.1097/MAJ.0000000000000363.
Chao MT, Wade CM. Socioeconomic factors and women’s use of complementary and alternative medicine in four racial/ethnic groups. Ethnicity & disease. 2008;18(1):65–71.
Wardle J, Lui CW, Adams J. Complementary and alternative medicine in rural communities: current research and future directions. J Rural Health. 2012;28(1):101–12. doi:10.1111/j.1748-0361.2010.00348.x.
Bishop FL, Yardley L, Lewith GT. A systematic review of beliefs involved in the use of complementary and alternative medicine. J Health Psychol. 2007;12(6):851–67. doi:10.1177/1359105307082447.
Adams J, Sommers E, Robinson N. Public health and health services research in integrative medicine: an emerging, essential focus. European Journal of Integrative Medicine. 2013;5(1):1–3. http://www.sciencedirect.com/science/article/pii/S1876382012011225.
Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91–108. doi:10.1111/j.1471-1842.2009.00848.x.
Steel A, Frawley J, Adams J, Diezel H. Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review. Health & social care in the community. 2014. doi:10.1111/hsc.12112.
Steel A, Lucke J, Adams J. The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review. BMC Women’s Health. 2015;15(1):14. doi:10.1186/s12905-015-0165-6.
Steel A, Lucke J, Adams J. The prevalence and nature of the use of preconception services by women with chronic health conditions: an integrative review. BMC Women’s Health. 2015;15(1):1–12. doi:10.1186/s12905-015-0165-6.
Adams J, Barbery G, Lui C-W. Complementary and alternative medicine use for headache and migraine: a critical review of the literature. Headache. 2013;53(3):459–73. doi:10.1111/j.1526-4610.2012.02271.x.
Adams J, Lui CW, Sibbritt D, Broom A, Wardle J, Homer C, et al. Women’s use of complementary and alternative medicine during pregnancy: a critical review of the literature. Birth. 2009;36(3):237–45. doi:10.1111/j.1523-536X.2009.00328.x.
Peng W, Adams J, Sibbritt DW, Frawley JE. Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication. Menopause. 2014;21(5):536–48. doi:10.1097/GME.0b013e3182a46a3e.
Solomon D, Adams J. The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review. J Affect Disord. 2015;179:101–13.
Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9. doi:10.1016/j.jclinepi.2011.11.014.
Adams J, Sibbritt DW, Easthope G, Young AF. The profile of women who consult alternative health practitioners in Australia. The Medical journal of Australia. 2003;179(6):297–300.
Canaway R, Manderson L. Quality of life, perceptions of health and illness, and complementary therapy use among people with type 2 diabetes and cardiovascular disease. J Altern Complement Med. 2013;19(11):882–90. doi:10.1089/acm.2012.0617.
Frawley J, Adams J, Sibbritt D, Steel A, Broom A, Gallois C. Prevalence and determinants of complementary and alternative medicine use during pregnancy: results from a nationally representative sample of Australian pregnant women. Aust N Z J Obstet Gynaecol. 2013;53:347–52.
Xue CCL, Zhang AL, Lin V, Da Costa C, Story DF. Complementary and alternative medicine use in Australia: a national population-based survey. Journal of alternative and complementary medicine (New York, NY). 2007;13(6):643–50. doi:10.1089/acm.2006.6355.
D’Onise K, Haren MT, Misan GMH, McDermott RA. Who uses complementary and alternative therapies in regional South Australia? Evidence from the Whyalla Intergenerational Study of Health. Australian health review : a publication of the Australian Hospital Association. 2013;37(1):104–11. doi:10.1071/AH11130.
Wilkinson JM, Simpson MD. High use of complementary therapies in a New South Wales rural community. The Australian journal of rural health. 2001;9(4):166–71.
Wilkinson JM, Jelinek H. Complementary medicine use among attendees at a rural health screening clinic. Complement Ther Clin Pract. 2009;15(2):80–4. doi:10.1016/j.ctcp.2008.12.005.
MacLennan AH, Myers SP, Taylor AW. The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004. The Medical journal of Australia. 2006;184(1):27–31.
Edwards GV, Aherne NJ, Horsley PJ, Benjamin LC, McLachlan CS, McKay MJ, et al. Prevalence of complementary and alternative therapy use by cancer patients undergoing radiation therapy. Asia-Pacific journal of clinical oncology. 2014;10(4):346–53. doi:10.1111/ajco.12203.
Klafke N, Eliott JA, Wittert GA, Olver IN. Prevalence and predictors of complementary and alternative medicine (CAM) use by men in Australian cancer outpatient services. Annals of oncology : official journal of the European Society for Medical Oncology/ESMO. 2012;23(6):1571–8. doi:10.1093/annonc/mdr521.
Hunter D, Oates R, Gawthrop J, Bishop M, Gill S. Complementary and alternative medicine use and disclosure amongst Australian radiotherapy patients. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2014;22(6):1571–8. doi:10.1007/s00520-014-2120-8.
Dunning T. Complementary therapies and diabetes. Complementary therapies in nursing & midwifery. 2003;9(2):74–80. doi:10.1016/S1353-6117(02)00143-9.
Day AS, Whitten KE, Bohane TD. Use of complementary and alternative medicines by children and adolescents with inflammatory bowel disease. J Paediatr Child Health. 2004;40(12):681–4. doi:10.1111/j.1440-1754.2004.00510.x.
Sinha D, Efron D. Complementary and alternative medicine use in children with attention deficit hyperactivity disorder. J Paediatr Child Health. 2005;41(1–2):23–6. doi:10.1111/j.1440-1754.2005.00530.x.
Wadhera V, Lemberg DA, Leach ST, Day AS. Complementary and alternative medicine in children attending gastroenterology clinics: usage patterns and reasons for use. J Paediatr Child Health. 2011;47(12):904–10. doi:10.1111/j.1440-1754.2011.02100.x.
Lim A, Cranswick N, Skull S, South M. Survey of complementary and alternative medicine use at a tertiary children’s hospital. J Paediatr Child Health. 2005;41(8):424–7. doi:10.1111/j.1440-1754.2005.00659.x.
Fong DPS, Fong LKS. Usage of complementary medicine among children. Aust Fam Physician. 2002;31(4):388–91.
Feldman, Robert LR. The use of complementary and alternative medicine practices among Australian university students. Complement Health Pract Rev. 2004;9:173.
Shorofi SA, Arbon P. Complementary and alternative medicine (CAM) among hospitalised patients: an Australian study. Complement Ther Clin Pract. 2010;16(2):86–91.
Basedow M, Runciman WB, March L, Esterman A. Australians with osteoarthritis; the use of and beliefs about complementary and alternative medicines. Complement Ther Clin Pract. 2014. doi:10.1016/j.ctcp.2014.08.002.
Adams J, Sibbritt D, Young AF. Consultations with a naturopath or herbalist: the prevalence of use and profile of users amongst mid-aged women in Australia. Public health. 2007;121(12):954–7. doi:10.1016/j.puhe.2007.03.007.
Stankiewicz M, Smith C, Alvino H, Norman R. The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: a prospective survey. The Australian & New Zealand journal of obstetrics & gynaecology. 2007;47(2):145–9. doi:10.1111/j.1479-828X.2007.00702.x.
Adams J, Sibbritt D, Lui CW. The urban–rural divide in complementary and alternative medicine use: a longitudinal study of 10,638 women. BMC Complement Altern Med. 2011;11:2. doi:10.1186/1472-6882-11-2.
van der Sluijs CP, Bensoussan A, Liyanage L, Shah S. Women’s health during mid-life survey: the use of complementary and alternative medicine by symptomatic women transitioning through menopause in Sydney. Menopause (New York, NY). 2007;14(3):397–403. doi:10.1097/01.gme.0000236937.36078.f4.
Markovica M, Manderson L, Wraya N, Quinn M. Complementary medicine use by Australian women with gynaecological cancer. Psycho-Oncology. 2006;15(3):209–20.
Mak JCS, Faux S. Complementary and alternative medicine use by osteoporotic patients in Australia (CAMEO-A): a prospective study. Journal of alternative and complementary medicine (New York, NY). 2010;16(5):579–84. doi:10.1089/acm.2009.0425.
Kremser T, Evans A, Moore A, Luxford K, Begbie S, Bensoussan A, et al. Use of complementary therapies by Australian women with breast cancer. Breast (Edinburgh, Scotland). 2008;17(4):387–94.
Rayner J, McLachlan HL, Forster DA, Cramer R. Australian women’s use of complementary and alternative medicines to enhance fertility: exploring the experiences of women and practitioners. BMC Complement Altern Med. 2009;9(1):52.
Adams J, Sibbritt D, Lui C-W. Health service use among persons with self-reported depression: a longitudinal analysis of 7,164 women. Arch Psychiatr Nurs. 2012;26(3):181–91. doi:10.1016/j.apnu.2011.10.002.
de Visser R, Ezzy D, Bartos M. Alternative or complementary? Nonallopathic therapies for HIV/AIDS. Altern Ther Health Med. 2000;6(5):44–52.
Field KM, Jenkins MA, Friedlander ML, McKinley JM, Price MA, Weideman P, et al. Predictors of the use of complementary and alternative medicine (CAM) by women at high risk for breast cancer. European journal of cancer (Oxford, England : 1990). 2008;45(4):551–60. doi:10.1016/j.ejca.2008.09.023.
Shenfield G, Lim E, Allen H. Survey of the use of complementary medicines and therapies in children with asthma. J Paediatr Child Health. 2002;38(3):252–7.
Braun LA, Cohen M. Use of complementary medicines by cardiac surgery patients; undisclosed and undetected. Heart, lung & circulation. 2011;20(5):305–11. doi:10.1016/j.hlc.2011.01.013.
George J, Ioannides-Demos LL, Santamaria NM, Kong DCM, Stewart K. Use of complementary and alternative medicines by patients with chronic obstructive pulmonary disease. The Medical journal of Australia. 2004;181(5):248–51.
Sibbritt D, Adams J, Lui C-W. A longitudinal analysis of complementary and alternative medicine use by a representative cohort of young Australian women with asthma, 1996–2006. The Journal of asthma : official journal of the Association for the Care of Asthma. 2011;48(4):380–6. doi:10.3109/02770903.2011.560323.
Sibbritt D, Adams J, Murthy V. The prevalence and determinants of Chinese medicine use by Australian women: analysis of a cohort of 10,287 women aged 56–61 years. The American journal of Chinese medicine. 2013;41(2):281–91. doi:10.1142/S0192415X13500201.
Magin PJ, Adams J, Heading GS, Pond DC, Smith W. Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients’ experiences and perceptions. Journal of alternative and complementary medicine (New York, NY). 2006;12(5):451–7. doi:10.1089/acm.2006.12.451.
Steel A, Adams J, Sibbritt D, Broom A, Gallois C, Frawley J. Utilisation of complementary and alternative medicine (CAM) practitioners within maternity care provision: results from a nationally representative cohort study of 1,835 pregnant women. BMC pregnancy and childbirth. 2012;12:146. doi:10.1186/1471-2393-12-146.
Correa-Velez I, Clavarino A, Barnett AG, Eastwood H. Use of complementary and alternative medicine and quality of life: changes at the end of life. Palliat Med. 2003;17(8):695–703.
Correa-Velez I, Clavarino A, Eastwood H. Surviving, relieving, repairing, and boosting up: reasons for using complementary/alternative medicine among patients with advanced cancer: a thematic analysis. J Palliat Med. 2005;8(5):953–61. doi:10.1089/jpm.2005.8.953.
Smith C, Eckert K. Prevalence of complementary and alternative medicine and use among children in South Australia. J Paediatr Child Health. 2006;42(9):538–43. doi:10.1111/j.1440-1754.2006.00918.x.
Broom AF, Kirby ER, Sibbritt DW, Adams J, Refshauge KM. Back pain amongst mid-age Australian women: a longitudinal analysis of provider use and self-prescribed treatments. Complementary therapies in medicine. 2012;20(5):275–82. doi:10.1016/j.ctim.2012.05.003.
Heath JA, Oh LJ, Clarke NE, Wolfe J. Complementary and alternative medicine use in children with cancer at the End of life. J Palliat Med. 2012;15(11):1218–21.
Forster DA, Denning A, Wills G, Bolger M, McCarthy E. Herbal medicine use during pregnancy in a group of Australian women. BMC pregnancy and childbirth. 2006;6:21. doi:10.1186/1471-2393-6-21.
Brownie S. Predictors of dietary and health supplement use in older Australians. The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation. 2006;23(3):26–32.
Buchbinder R, Gingold M, Hall S, Cohen M. Non-prescription complementary treatments used by rheumatoid arthritis patients attending a community-based rheumatology practice. Intern Med J. 2002;32(5–6):208–14.
Adams J, Sibbritt D, Broom A, Loxton D, Wardle J, Pirotta M, et al. Complementary and alternative medicine consultations in urban and nonurban areas: a national survey of 1427 Australian women. J Manip Physiol Ther. 2013;36(1):12–9. doi:10.1016/j.jmpt.2012.12.010.
Murthy V, Sibbritt D, Adams J, Broom A, Kirby E, Refshauge KM. Consultations with complementary and alternative medicine practitioners amongst wider care options for back pain: a study of a nationally representative sample of 1,310 Australian women aged 60–65 years. Clin Rheumatol. 2014;33(2):253–62. doi:10.1007/s10067-013-2357-5.
Adams J, Sibbritt D, Young AF. Naturopathy/herbalism consultations by mid-aged Australian women who have cancer. European journal of cancer care. 2005;14(5):443–7. doi:10.1111/j.1365-2354.2005.00610.x.
Sarris J, Robins Wahlin T-B, Goncalves DC, Byrne GJ. Comparative use of complementary medicine, allied health, and manual therapies by middle-aged and older Australian women. Journal of women & aging. 2010;22(4):273–82. doi:10.1080/08952841.2010.518876.
Broom AF, Kirby ER, Sibbritt DW, Adams J, Refshauge KM. Use of complementary and alternative medicine by mid-age women with back pain: a national cross-sectional survey. BMC Complement Altern Med. 2012;12:98.
Trutnovsky G, Law C, Simpson J, Mindel A. Use of complementary therapies in a sexual health clinic setting. Int J STD AIDS. 2001;12(5):307–9.
Sibbritt D, Adams J, Young AF. A profile of middle-aged women who consult a chiropractor or osteopath: findings from a survey of 11,143 Australian women. J Manip Physiol Ther. 2006;29(5):349–53. doi:10.1016/j.jmpt.2006.04.013.
Chatfield SM, Dharmage SC, Boers A, Martin BJ, Buchanan RRC, Maksymowych WP, et al. Complementary and alternative medicines in ankylosing spondylitis: a cross-sectional study. Clin Rheumatol. 2009;28(2):213–7. doi:10.1007/s10067-008-1029-3.
Heath JA, Oh LJ, Clarke NE, Wolfe J. Complementary and alternative medicine use in children with cancer at the end of life. J Palliat Med. 2012;15(11):1218–21. doi:10.1089/jpm.2012.0150.
Day AS. Use of complementary and alternative therapies and probiotic agents by children attending gastroenterology outpatient clinics. J Paediatr Child Health. 2002;38(4):343–6.
Spinks J, Johnston D, Hollingsworth B. Complementary and alternative medicine (CAM) use and quality of life in people with type 2 diabetes and/or cardiovascular disease. Complementary therapies in medicine. 2014;22(1):107–15. doi:10.1016/j.ctim.2013.11.007.
Leong EM, Semple SJ, Angley M, Siebert W, Petkov J, McKinnon RA. Complementary and alternative medicines and dietary interventions in multiple sclerosis: what is being used in South Australia and why? Complementary therapies in medicine. 2009;17(4):216–23. doi:10.1016/j.ctim.2009.03.001.
Smith CA, Bateson DJ, Weisberg E. A survey describing the use of complementary therapies and medicines by women attending a family planning clinic. BMC Complement Altern Med. 2013;13:10.1186/1472-6882-13-224.
Alderman CP, Kiepfer B. Complementary medicine use by psychiatry patients of an Australian hospital. Ann Pharmacother. 2003;37(12):1779–84. doi:10.1345/aph.1C179.
Gollschewski S, Anderson D, Skerman H, Lyons-Wall P. The use of complementary and alternative medications by menopausal women in South East Queensland. Women’s health issues : official publication of the Jacobs Institute of Women’s Health. 2004;14(5):165–71. doi:10.1016/j.whi.2004.08.001.
Keleher H, Murphy B. Understanding health: a determinants approach. Oxford, England: Oxford University Press; 2004.
Spinks J, Hollingsworth B. Policy implications of complementary and alternative medicine use in Australia: data from the National Health Survey. J Altern Complement Med. 2012;18(4):371–8. doi:10.1089/acm.2010.0817.
Robinson A, Chesters J, Cooper S. People’s choice: complementary and alternative medicine modalities. Complement Health Pract Rev. 2007;12(2):99–119. doi:10.1177/1533210107302436.
Caughey GE, Vitry AI, Gilbert AL, Roughead EE. Prevalence of comorbidity of chronic diseases in Australia. BMC Public Health. 2008;8(1):221.
Hall AK, Bernhardt JM, Dodd V. Older Adults’ use of online and offline sources of health information and constructs of reliance and self-efficacy for medical decision making. J Health Commun. 2015;20(7):751–8. doi:10.1080/10810730.2015.1018603.
Armstrong BK, Gillespie JA, Leeder SR, Rubin GL, Russell LM. Challenges in health and health care for Australia. Med J Aust. 2007;187(9):485.
Australian Institute of Health and Welfare. In: AIHW, editor. Rural, regional and remote health Indicators of health status and determinants of health. Canberra ACT: Australian Institute of Health and Welfare; 2008.
Murthy V, Sibbritt D, Adams J, Broom A, Kirby E, Refshauge KM. Self-prescribed complementary and alternative medicine use for back pain amongst a range of care options: results from a nationally representative sample of 1310 women aged 60–65 years. Complement Ther Med. 2014;22(1):133–40. doi:10.1016/j.ctim.2013.11.013.
O’Callaghan FV, Jordan N. Postmodern values, attitudes and the use of complementary medicine. Complementary therapies in medicine. 2003;11(1):28–32.
Skouteris H, Wertheim EH, Rallis S, Paxton SJ, Kelly L, Milgrom J. Use of complementary and alternative medicines by a sample of Australian women during pregnancy. The Australian & New Zealand journal of obstetrics & gynaecology. 2008;48(4):384–90. doi:10.1111/j.1479-828X.2008.00865.x.
Steel A, Adams J, Sibbritt D, Broom A, Frawley J, Gallois C. The influence of complementary and alternative medicine use in pregnancy on labor pain management choices: results from a nationally representative sample of 1,835 women. Journal of alternative and complementary medicine (New York, NY). 2014;20(2):87–97. doi:10.1089/acm.2013.0171.
Steel A, Adams J, Sibbritt D, Broom A, Gallois C, Frawley J. Determinants of women consulting with a complementary and alternative medicine practitioner for pregnancy-related health conditions. Women & health. 2014;54(2):127–44. doi:10.1080/03630242.2013.876488.
The authors wish to acknowledge the support from Office of Research at Endeavour College of Natural Health (Brisbane, Australia) who awarded RR and AT the Endeavour College Student Summer Research Program Scholarship.
RR and AT received the Endeavour College Student Summer Research Scholarship.
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RR and AS conceptualised the review. RR conducted the data search, critically analysed the selected articles and drafted the manuscript. JW conducted the internet search. AS, JA, JW and AT contributed to revising and finalising the draft manuscript. All authors have read and approve the final manuscript.
Co-authors JA and JW are associate editors to Patterns of use, knowledge and attitudes at BMC Complementary and Alternative Medicine.
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Reid, R., Steel, A., Wardle, J. et al. Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use. BMC Complement Altern Med 16, 176 (2016). https://doi.org/10.1186/s12906-016-1143-8