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Table 2 Results and categorical grouping displaying the socio-demographic characteristics of CM users (1); Drivers of CM use (2); health service utilisation of CM users (3) and (4) CM use amongst health subpopulations

From: Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use

Author Method Target population Sample (n) Appraisal score Results Themes
1 2 3 4
Adams et al., 2003 [27] Longitudinal study Women 41,817 9 Higher CM use by non-urban women. CM use in older women used CM in conjunction with medication for chronic disease. >97 % consulted with a CM practitioner. X    X
Adams et al., 2005 [75] Longitudinal study Middle age women 11,202 8 15.7 % cancer patients consulted with a naturopath/herbalist. CM users consulted with both CM & conventional practitioners. CM users were more likely rural residents & have school education only (49 %). X   X X
Adams et al., 2007 [47] Longitudinal survey Middle aged women 11,202 9 8.7 % women consulted with a naturopath, 1.4 % consulted with an herbalist. CM users more likely in non-urban areas (63 %) compared to 37 % in urban areas. Women who used naturopath also used conventional practitioners more frequently. X   X  
Adams et al., 2011 [49] Longitudinal study Middle aged women 10,638 8 Women who consulted with a CM practitioner experienced more symptoms. Women with diploma or university education use CM more than non-CM users & more likely to reside in urban areas. No difference in consultation numbers between CM users & non-CM users for chiropractic, osteopathy, acupuncture & naturopathy. X   X  
Adams et al., 2012 [55] Longitudinal study Self-reported depression 7,164 6 62 % of women used both conventional practitioners & CM (chiropractor 18 %, osteopathy 7 %, massage therapy 44 %, acupuncture 9 %, & naturopath 22 %).    X X
Adams et al., 2013 [73] Longitudinal study Middle aged women 1,800 8 63.9 % consulted with a massage therapist, 43 % a chiropractor, & 22.9 % naturopath. Women in rural & outer regional areas used chiropractors more than women in cities who used osteopathy or yoga. X   X  
Alderman & Kiepfer, 2003 [86] Structured interviews Psychiatry patients 52 4 51.9 % used CM in preceding 6 months. High use of nutritional supplements (66.7 %), 18.5 % visited a chiropractor. Drivers for use CM surrounded its usefulness with conventional treatment, natural healing & believed in CM philosophy.   X X X
Basedow et al., 2014 [46] Cross sectional survey Osteoarthritis patients 435 7 Females were more likely to use CM & > 70 years with a school education. 69 % reported CM use for disease management. 67 % CM users stated CM to be safe & 33 % felt it was effective in pain management. X X   X
Braun & Cohen, 2011 [59] Cross sectional survey Cardiac patients 161 4 No significant difference in age, gender, income or education between CM users & non-CM users. 51 % reported CM use. 71 % used CM to improve health, 30 % disease management, 20 % disease prevention. X    X
Broom et al., 2012a [68] Longitudinal study Middle aged women 9,820 6 33 % consulted with a chiropractor & 40 % massage therapist. 63 % used CM & conventional practitioners. 2 % consulted with a CM practitioner only.    X  
Broom et al., 2012b [77] Longitudinal survey Middle aged women 10,492 6 42.4 % of women consulted with a CM practitioner. Women with back pain were more likely to use conventional therapy & CM (44.2 %). Women who consulted with a CM practitioner had better health compared to non-CM users.    X  
Brownie, 2006 [71] Cross sectional survey Elderly individuals 1,263 8 CM supplement use for arthritis, osteoporosis, hypertension & cardiovascular disease management. Females were more likely to report supplement use. X    X
Buchbinder et al., 2002 [72] Cross sectional survey Rheumatoid arthritis patients 101 6 CM users more likely female & > 60 years. 73.3 % used CM, with 31.7 % consulting with a CM practitioner. 25.7 % used CM & conventional therapy for disease management. X    X
Canaway & Manderson, 2013 [28] Mixed methods Diabetic patients with cardiovascular disease 2,766 9 CM users more likely to be > 50 years. 54.5 % reported consulting a CM practitioner & 45.1 % used CM regularly. 42.7 % believed in CM, 39.4 % believed CM was safe, 31.3 % used CM to control their health & 27.8 % preferred CM to other therapies. X X X X
Chatfield et al., 2009 [80] Cross sectional survey Ankylosing spondylitis patients 75 8 94.7 % CM users more likely female & have university education. 36 % CM users visited a massage therapist (81.5 %), acupuncture (6.7 %), naturopath (6.7 %) & homeopath (5.3 %). X   X X
Correa-Velez et al., 2003 [65] Interviews (design not-specified) Oncology patients 111 7 32 % were CM users with 56 % male & 44 % female, both with higher income. Most consulted practitioners were: reiki practitioner (33 %), a naturopath (27 %), or an integrative practitioner (27 %). 42 % used CM while participating in the study & 64 % CM use over last year. X   X X
Correa-Velez et al., 2005 [66] Interviews (semi-structured) Oncology patients 39 5 82 % of participants were regular CM users. Naturopathy (26 %), massage therapy (21 %) & integrative doctors (15 %) were the most common services used. CM used to survive cancer (67 %) & reduce cancer symptoms (33 %).   X X X
D’Onise et al., 2013 [31] Cross sectional survey General population 1,146 8 CM users were more likely to have a Bachelor degree, high gross household income, & full time employment. 32 % used CM products, 27 % used CM services. Individuals with chronic disease used CM products more than CM services 32.5 % vs 26.3 %. Services used were chiropractor (24.2 %), alternative therapy (5.4 %), & massage therapy (0.3 %). X   X X
Day, 2002 [82] Cross sectional survey Paediatric patients 92 4 No difference in age for CM users to non-CM users. 35.9 % used CM & 98.6 % were prepared to use CM. X X X  
Day et al., 2004. [39] Cross sectional survey Children with Inflammatory bowel disease 46 4 Mean age of CM users was 11 years with 72 % being CM users. CM drivers related to dissatisfaction with standard care & advice from others. Homeopathy, chiropractic & massage consultations were used by <4 participants. X X X X
De Visser et al., 2000 [56] Cross sectional survey HIV/AIDS patients 894 5 56 % used CM. 45 % use both CM & conventional therapy. Women were more likely to only use CM. No other gender differences in CM use. Majority of CM users used nutritional & herbal supplements & massage therapy. X X X X
Dunning, 2003 [38] Focus groups Diabetic patients & practitioners 10 4 80 % were CM users. CM used for non-diabetic reasons. All participants used CM & conventional care for diabetes. Naturopathy & massage services were more likely used.    X X
Edwards et al., 2014 [35] Cross sectional survey Oncology patients 639 5 Females had higher CM use (88.6 %). 82.9 % used CM during their cancer treatment with 56.3 % using manual therapies. CM users reported CM improved quality of life (42.6 %), supported health (33.6 %), managed cancer symptoms (26.2 %) & believe CM gave them hope. X X X X
Feldman & Laura, 2004 [44] Cross sectional survey University students 518 3 81.1 % used CM in the past 2 years. 82.5 % CM users female. Common treatments were relaxation techniques (41.7 %), massage therapy 38.2 %, herbal medicine (37.3 %), & art therapy (32.2 %). Drivers for CM were better results (34.5 %), lifestyle factors (33.1 %) & felt CM had fewer side effects (32.1 %). X X X  
Field et al., 2008 [57] Cross sectional survey Women with high breast cancer risk 892 7 55 % reported CM use. 13.7 % used acupuncture, 28.2 % massage therapy, 12.3 % naturopathy & 7 % osteopathy. CM use was noted more in tertiary education & >50 year old individuals who resided in a major city. X   X  
Fong & Fong, 2002 [43] Cross sectional survey Paediatric inpatients 120 3 33 % used CM. Massage therapies used by 17 %, 46 % naturopath, 29 % chiropractor & 10 % herbalist.   X X  
Forster et al., 2006 [70] Cross sectional survey Pregnant women 588 8 36 % used herbal medicine during pregnancy. No identification of CM services used. X    
Frawley et al., 2013 [29] Longitudinal survey Pregnant women 1,835 9 CM users were more likely to have a university degree, full time employment & higher income compared to non-CM users. 48.1% of women consulted with CM practitioners & 52 % used a CM product during pregnancy. Massage therapy was the most used 34.1 %, followed by chiropractic 16.3 %, acupuncture 0.6 %, naturopathy 7.2 %, osteopathy 6.1 % & doula services 1.4 %. X   X X
George et al., 2004 [60] Cross sectional survey Chronic obstructive pulmonary disease patients 173 4 41 % were CM users, mean age of 70 years. 55 % of CM users were male. CM used to promote health, reduce side effects & reduce disease progression. X X   X
Gollschewski et al., 2004 [87] Cross sectional survey Menopausal women 886 8 82.5 % CM users. CM users were middle aged (<55 years) & married. 66.8 % of women used nutritional supplements for menopausal management. X    
Heath et al., 2012 [81] Cross sectional survey Palliative care in children with cancer 96 5 No significant difference in CM usage in terms of age, family income or education. 30 % used CM at end of life stage. 44 % reported using more than 1 CM therapy. X    X
Hunter et al., 2014 [37] Cross sectional survey Radiotherapy patients 152 6 45.4 % CM users. Higher CM use in females & Caucasians. Young individuals more likely to use CM. CM users more likely to have secondary education & lower income. 2.9 % used acupuncture, 17.39 % chiropractor, 26.09 % massage therapy, 2.9 % osteopathy, 5.8 % naturopathy, 2.9 % Chinese Medicine & 1.45 % homeopathy. CM use was more likely in individuals diagnosed with breast, rectum, kidney, endometrium & skin cancers. X   X X
Klafke et al., 2012 [36] Cross sectional survey Male cancer patients 403 7 No difference in sociodemographic factors between CM users & non-CM users. 61.5 % used CM while undergoing cancer treatment. X    X
Kremser et al., 2008 [53] Cross sectional survey Breast cancer patients 367 5 87.5 % used CM with 65.7 % CM users resided in NSW. CM use related to improving physical health (86.3 %), improving emotional health (86.3 %), supporting immune system (68.8 %), reducing side effects (49.2 %) and reducing the return of breast cancer (39.9 %). 41.4 % used massage therapy, 13.7 % acupuncture and 4.4 % naturopathy. X   X X
Leong et al., 2009 [84] Cross sectional survey Multiple sclerosis (MS) patients 428 5 66.3 % female & 60.3 % male participants used CM. Higher use in rural areas (70.4 %). 72.1 % used CM & conventional therapy for disease management. X    X
Lim et al., 2005 [42] Cross sectional survey Children 503 6 51 % of children reported CM use with no difference in gender. Most common CM practitioners included 7 % chiropractic, 7 % aromatherapy, 5 % naturopathy, 5 % dietary & 5 % massage. X   X  
MacLennan et al., 2006 [34] Longitudinal study General population 3,015 7 CM users were more likely 35–44 years. 29.3 % of women used CM services compared to males (23.6 %). 52.2 % used CM over the last year. Common practices included chiropractic 16.7 % & naturopathy 5.7 %. CM consultation higher in rural areas (29.4 %). X   X  
Magin et al., 2006 [63] Interviews (semi-structured) Individuals with skin complaints 26 4 Most CM users were female. CM users felt CM was more efficacious than conventional medicine. Consultations were commonly with naturopaths & herbalists. X X X  
Mak & Faux, t2010 [52] Cross sectional survey Osteoporotic patients 202 6 CM users were more likely female & 67 years old with post-secondary education. 51.5 % used CM for disease management. 19 % consulted with an acupuncturist, 12 % chiropractor/osteopathy, 6 % naturopathy & 2 % massage therapy. Drivers for CM used were holistic (53 %), reducing pain (29 %) & control over health (8.1 %). X X X X
Markovic et al., 2006 [51] Cross sectional survey Women with gynaecological cancers 53 4 17 % of women used CM. Most CM users were low income. Acupuncture was the only service used. X X X X
Murthy et al., 2014a [74] Longitudinal study Older aged women 1,310 9 Women in rural areas were more likely to use massage therapist. 76.4 % had a CM consultation with 41.4 % consulting with a massage therapist, 37.3 % chiropractor, 13.3 % acupuncture & 8.8 % osteopathy. X   X  
Murthy et al., 2014b [95] Longitudinal study Older aged women 1,310 9 Sociodemographics were not associated with CM use. 75.2 % used self-prescribed CM products. Women were more likely to use CM treatments & a conventional practitioner. X   X  
O’Callaghan & Jordan, 2003 [96] Cross sectional survey University students 171 4 CM used more likely female (77 %) & mean age of 29 years. 36.3 % CM users. 72 % consulted with a naturopath, 33 % aromatherapy & 31 % acupuncture. X X X  
Patching van der Sluijs et al., 2007 [50] Cross sectional survey Menopausal women 1,296 5 53.8 % used CM services or products. 20.3 % consulted with a CM practitioner (7.2 % naturopath & 4.8 % acupuncture, were the most common). X   X  
Rayner et al., 2009 [54] Focus groups Fertility clinic patients & practitioners 15 3 CM used for infertility due to a negative experience from assisted reproductive technologies or participants having a positive experience with CM.   X   X
Sarris et al., 2010 [76] Cross sectional survey Middle & older aged women 511 5 48 % consulted with a CM practitioner. Higher use of CM in 40–64 year olds (56.2 %). Older women consulted with a massage therapist or naturopath. Women who consulted with a practitioner had more health conditions. X   X  
Shenfield et al., 2002 [58] Structured interviews Asthmatic children 174 2 51.7 % used CM in past year. 62.1 % currently use CM. 71.2 % used CM for preventative reasons & 17.5 % to improve asthma symptoms. 32 % visited a homeopath & 32 % a naturopath.   X X X
Shorofi & Arbon, 2010 [45] Cross sectional survey Hospitalised patients 353 5 90.4 % used CM, with women more likely to use CM. Services used were massage therapy (45 %), chiropractic (39.7 %), herbal medicine (38.2 %), & acupuncture (19.8 %). Rural CM users were more likely to use manual therapies compared to urban users who used biologically based therapies. X X X  
Sibbritt et al., 2006 [79] Longitudinal study Middle aged women 11,143 9 16 % CM users consulted with a chiropractor &/or osteopathy were mid-aged. CM users were more likely rural residents & with school education only. Users were more likely to use CM with conventional medicine. X   X  
Sibbritt et al., 2013 [62] Longitudinal survey Middle aged women 10,287 8 8.6 % of women used Chinese medicine. Users were more likely to have school education, born in Australia & live in rural or remote areas. Users were also more likely to frequently visit a doctor & Chinese medicine practitioner. Users also used other CM professionals including massage therapy (54 %), naturopathy (50 %), chiropractor (19 %), osteopathy (8 %) & acupuncture (47 %). X   X  
Sinha & Efron, 2005 [40] Cross sectional survey Children with attention deficit hyperactivity disorder 75 4 67.6 % used CM for Attention deficit hyperactivity disorder. 58 % found CM helpful. CM use was associated with reducing side effects (67.4 %), hoping for a cure (66.7 %), reducing symptoms (88.9 %) & additional treatment to conventional therapy (69.7 %). 20 % visited a chiropractor. X X X  
Skouteris et al., 2008 [97] Cross sectional survey Pregnant women 321 5 Sociodemographics were not different between CM users & non-CM users although CM users reported poorer health. 73.2 % reported CM use of which 29 % used CM for pregnancy related symptoms. 49.5 % consulted with a massage therapist & 5.9 % a naturopath X   X X
Smith & Eckert, 2006 [67] Cross sectional survey General population 2,985 7 18.4 % of children used CM. Most common consultations were chiropractic 34 %, massage therapy 21 %, & homeopathy 10.7 %. CM was used for preventing illness (39 %). X   X  
Smith et al., 2013 [85] Cross sectional survey Female family planning patients 221 6 Younger women had less CM use compared to older women. 83 % of women report CM use, 33 % had consultations with a CM practitioner including chiropractic 12.4 %, acupuncture 11 % & 9.5 % naturopathy. CM users (49 %) viewed CM as having more natural benefit, (44 %) better alternative to conventional treatment, (38 %) as effective treatment & (36 %) gives individual control. X X X X
Spinks et al., 2014 [83] Cross sectional survey Diabetic patients with cardiovascular disease 2,915 8 Females were more likely to use CM & have a higher education & higher income. Chronic disease was associated with increased CM use. Women consulted with acupuncturists, naturopaths, nutritionists, chiropractors, & massage therapists. X   X X
Stankiewicz et al., 2007 [48] Cross sectional survey Infertility clinic patients 97 4 66 % CM users, 26 % used CM with conventional medicine. 48 % used CM services, most commonly acupuncture (9 %), naturopathy (17 %) & chiropractic (14 %). X   X X
Steel et al., 2012 [64] Longitudinal study Pregnant women 1,835 8 49.4 % consulted with a CM practitioner (massage therapy 34.1 %, 16.3 % chiropractor were more common). 22.2 % consulted with both a CM & conventional practitioners.    X X
Steel et al., 2014a [98] Longitudinal survey Pregnant women 1,835 9 Women in non-urbans areas were more likely to consult a chiropractor. Women felt CM promoted holistic health & reduced conventional side effects. 53 % of women who used non-pharmacological pain management used a CM practitioner or products (49 %). X X X X
Steel et al., 2014b [99] Longitudinal survey Pregnant women 2,445 9 Chiropractor users were more likely located in non-urban areas & have permanent employment. 49.4 % consulted with a CM practitioner. 74.4 % used non-pharmacological pain management. 60.7 % used CM products or services. 80.7 % consulted with a practitioner. CM users believed CM had fewer side effects & was more natural & offered more control compared to conventional treatment. X X X X
Trutnovsky et al., 2001 [78] Cross sectional survey Sexual health clinic patients 63 4 59 % – 96 % CM use, depending on condition. CM users more likely to be female. X   X  
Wadhera et al., 2011 [41] Cross sectional survey Children 98 6 No difference between CM users & non-CM users regarding age, gender & illness. 67 % used CM previously or currently. 70 % used CM for disease management. Drivers for use surrounded dissatisfaction with conventional treatment, belief in CM, reduce side effects & lack of suitable conventional treatment. X X X  
Wilkinson & Simpson, 2001 [32] Cross sectional survey Rural residents 300 7 Females were more likely to consult & use CM products. 62.7 % consulted with a CM practitioner. 70.3 % use some form of CM. 68.7 % used CM products. Chiropractors consulted 55.3 %. 56.2 % felt CM improved quality of life. X X X  
Wilkinson & Jelinek, 2009 [33] Cross sectional survey Rural residents 102 5 There was no difference in gender & CM services used. 78 % used CM therapies, 66 % consulted with a CM practitioner (15 % naturopathy, 17 % massage, 17 % chiropractic). Drivers with CM use were positive attitudes towards CM, holism, anti-science, individual responsibility & rejection to authority. X X X  
Xue et al., 2007 [30] Cross sectional survey General population 1,067 8 71.2 % were CM users & identified as females, higher income earners & having a higher education. 16.4 % visited a clinical nutritionist, 73.7 % massage therapy, 29.1 % Western herbal medicine & 90.6 % chiropractor. X   X