Results from this study indicate that women were generally more likely to use CAM at all levels. For both men and women, poor health was associated with CAM utilization at all levels. Moreover, younger age was associated with the use of CAM at all levels for women. Household income in women and university education in men were not associated with the use of CAM at any level.
Many studies report use of CAM in populations. However, the study population, time frame in use and definition of CAM vary . Emphasizing comparability between studies, we have chosen to compare our study to a limited selection of other studies.
The most comparable study is the HUNT 3 study conducted in the county of Nord-Trøndelag, Central Norway in 2008. They found similar use at CAM level 2 as shown in the results from our study .
The previous Tromsø study (the 5th Tromsø study), conducted in 2001/2002 reported lower use of CAM at level 2 compared to results from our group six years later (13.5% in women and 4.8% in men without cancer or coronary heart disease) . The higher use of CAM in this study might be due to a general increase in the use of CAM between 2002 and 2008 [6, 23]. The pre-prepared list regarding the CAM providers might have improved the recall and clarified what to consider as CAM, and thereby increased the reported rate of CAM use .
The findings of 33.3% use at CAM level 3 are in accordance with a recent review that found 32.2% prevalence of use in the 16 studies included . The findings from our study are also in accordance with findings from the UK and the US presented in another recent review . However, our data report a lower prevalence of use than findings from Australia and South Korea . The reason for this might be that South Korea has a stronger tradition of using traditional medicine, and that Australia is more influenced by traditional Eastern medicine due to geographical proximity.
The findings of a strong association between CAM use and being a young/middle age women with higher education and poor health, is in line with other studies [1, 24–26]. That women in this study used CAM more often than men at all levels was also in line with previous research, showing that women tend to be more active in their own health promotion and are more concerned about health issues and caring compared to men [13, 27]. Throughout the Western world women more often undertake health care visits [28–30], are more frequent utilizers of psychological support groups [31, 32] and of health advice on the Internet , and the typical reader of a self-help book is a woman. The presence of a gender bias in health care, which can lead to a neglect of women’s health care needs , might also contribute to women turning away from conventional patterns of care towards CAM providers and products.
Recent in-depth studies among Norwegian women using CAM support the findings that the public healthcare system in Norway may be unable to meet all the needs of female patients. The results illustrate subjectively experienced barriers related to the communication, understanding, and treatment of illness. Women diagnosed with breast cancer and multiple sclerosis express unmet needs with regard to their individual health care goals. They strongly emphasize the importance of CAM as a health care system that enables them to take active part in decision-making processes and treatment and, thereby, contribute to positive health outcomes for themselves. They not only relate to scientific, medical knowledge but also to experience-based knowledge (e.g., bodily experiences) [34, 35] as an important basis for their treatment decisions. By the decision to use CAM, and even in some cases to delay or decline conventional treatment, female CAM users differ from the expected patient behavior and challenge the rationality of medical advice which traditionally has been defined and provided by men [34, 35].
However, another reason for the higher use in women might be the fact that women generally utilize more health services than men [13, 36]. Together with the potential implications gender bias in healthcare has for women , this would explain why generally more women feel the need to seek alternatives to conventional care.
Women’s widespread use of CAM in Western countries has also been suggested as an expression of traditional gender roles and dominant discourses of femininity, as being “help-seeking” and adhering to the “patient role” is more in coherence with a traditional femininity than masculinity [37, 38]. The lower use of CAM among men may be explained by the fact that men adapt to preconceptions about a masculine behavior with little room for showing weakness and a need for help and support , and potentially the fact that their health care needs are better met within the public health care . Another explanation is related to ideas about men perceiving their body and health as being more “mechanical” than women, and that they, therefore, are less attracted to CAM where wholeness, communication and personal relation are more pronounced than the detailed biological mechanism .
The higher education among women using CAM was expected to correlate with the younger age. Analyzes adjusted for age, however, still show significant associations related to education. Women with higher education might be more able to find relevant information about CAM and to afford such treatment use. It can be speculated, that the higher educational background of women with a university education leads to higher self-confidence especially since even in modern Norway, it is not entirely the rule that women and men have the same education, in particular not for all of the age groups in this sample. It is not unlikely that this higher self-esteem makes females less apt to accept terms and conditions of treatment that they do not feel entirely comfortable with.
The lack of income differences between the users and non-users of CAM is in line with several other studies . Recent studies suggest that CAM no longer is a phenomenon restricted to unique segments enjoying high family income .
Despite the large sample size, the response rate (65.7%) could have influenced the generalizability of our findings as the non-responders differed from the responders concerning age and sex. Men in the oldest and youngest age groups and women in the oldest age group had the lowest response rate. However, the non-responders in these groups consist of only 391 responders. Therefore, even though these groups would have been expected to use CAM to a lesser degree, the number of non-responders in these groups is so low that the likelihood of substantially influencing the final results is small.
The generalizability was also influenced by the 1,878 respondents that were excluded from the study due to missing response to the CAM questions. Generally, non-response to a CAM question is more likely to mean no use leading to an overestimated use of CAM in the analysis . A non-responder-analysis, however, where the non-responders to the CAM questions are assumed to not having used CAM, showed that the tendencies are the same, though the significant level varies slightly.
The 12-month recall period concerning the use of CAM, might result in inaccuracies regarding the report of use. However, this factor is equally distributed between men and women.
One of the three questions regarding CAM asked for the use of herbal or “natural medicine” without defining this further. This could constitute an over- or underreporting of such use depending on how each participant defined their use. Moreover, young and old participants, men and women, might define this in different ways.
Traditional healing and CAM therapies might have different prevalence and associations for use. Both are combined in the same question, which makes a differentiation between associations for CAM and traditional healing, difficult.