The use of and out-of-pocket spending on complementary and alternative medicine in Qassim province, Saudi Arabia
2013; King Faisal Specialist Hospital and Research Centre; Volume: 33; Issue: 3 Linguagem: Inglês
10.5144/0256-4947.2013.282
ISSN0975-4466
AutoresAbdullah M.N. AlBedah, Mohamed Khalil, Ahmed Tawfik El-Olemy, Abdullah Al Mudaiheem, Sulaiman Al Eidi, Omar A. Al-Yahia, Saleh A Al-Gabbany, Basem Y. Henary,
Tópico(s)Ethnobotanical and Medicinal Plants Studies
Resumooriginal articleThe use of and out-of-pocket spending on complementary and alternative medicine in Qassim province, Saudi Arabia Abdullah M. N. AlBedah, Mohamed K. M. Khalil, Ahmed T. Elolemy, Abdullah A. Al Mudaiheem, Sulaiman Al Eidi, Omar A. Al-Yahia, Saleh A. Al-Gabbany, and Basem Yousef Henary Abdullah M. N. AlBedah National Center for Complementary and Alternative Medicine, Riyadh Saudi Arabia and Professor of Public Health, Tanta University, Egypt , Mohamed K. M. Khalil National Center for Complementary and Alternative Medicine, Riyadh Saudi Arabia and Professor of Public Health, Tanta University, Egypt , Ahmed T. Elolemy National Center for Complementary and Alternative Medicine, Riyadh Saudi Arabia and Professor of Public Health, Tanta University, Egypt , Abdullah A. Al Mudaiheem National Center for Complementary and Alternative Medicine, Riyadh Saudi Arabia and Professor of Public Health, Tanta University, Egypt , Sulaiman Al Eidi National Center for Complementary and Alternative Medicine, Riyadh Saudi Arabia and Professor of Public Health, Tanta University, Egypt , Omar A. Al-Yahia Qassim Health Affairs, Training and Research Center, Qassim, Saudi Arabia , Saleh A. Al-Gabbany Qassim Health Affairs, Training and Research Center, Qassim, Saudi Arabia , and Basem Yousef Henary Liver Institute – Epidemiology, Cairo, Egypt Published Online:6 Jun 2013https://doi.org/10.5144/0256-4947.2013.282SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutAbstractBACKGROUND AND OBJECTIVES: The current picture of the Saudis' use of complementary and alternative medicine (CAM) has not yet been developed. The aim of this study was to assess the feasibility of using the international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q) in Saudi Arabia to evaluate the use of and out-of-pocket spending on CAM.DESIGN AND SETTINGS: It was a cross-sectional study, conducted in 2011, in primary health care centers in Qassim.METHODS: In a multistage sampling technique, 12 primary health care centers were selected randomly in the Al-Qassim province in Saudi Arabia. From each center, 100 attendants were interviewed for a total of 1160 completed questionnaires.RESULTS: A total of 74% of subjects had visited CAM providers in 12 months before the survey. This percentage decreased to 47.6% when spiritual healers were excluded. The specific CAM providers who were visited were spiritual healers (26.7%), herbalists (23.2%), providers of honeybee products (14.9%), and hijama (wet cupping; 13%). Chronic illnesses were the main reason for the visits. A total of 50% of subjects were satisfied with their visit. Physicians were the providers of CAM for 11.3% of the participants. More than 75% of the subjects used herbs in the previous 12 months for medical and health reasons, while only 25% used vitamins or minerals. Self-help was used in 26% of the participants. Relaxation (10.3%) was the most common self-CAM practice followed by meditation (6.7%). The subjects spent 350 000 (US$) on CAM visits and 300 000 (US$) purchasing CAM products.CONCLUSIONS: I-CAM-Q can be used in different populations and cultures in the East including Saudi Arabia after customization to overcome its limitations, as the questionnaire was developed in Western societies.IntroductionThe field of complementary and alternative medicine (CAM) is very broad and constantly changing. Accordingly, defining CAM is difficult. Historically, CAM has been defined as "all practices not regularly taught in biomedical schools," which does not apply to countries already including CAM in the medical school curriculum.1,2 According to the National Center for Complementary and Alternative Medicine in the United States, CAM is defined as a group of diverse medical and health care interventions, practices, products, or disciplines that are not presently considered part of conventional medicine.3,4 Complementary interventions are used together with conventional treatments, whereas alternative interventions are used instead of conventional medicine.The term "CAM" often refers to a broad set of health care practices that are not part of a country's own tradition, while the term "traditional medicine" (TM) is a comprehensive term used to refer both to TM systems such as traditional Chinese medicine, Indian Ayurveda, and Arabic Unani medicine and to various forms of indigenous medicine.5Studies performed in different parts of the world have established that the use of CAM is very common and varies among populations. WHO has reported that approximately two thirds and 50% to 80% of the population of developed and developing countries, respectively, have used alternative and complementary medicine.6The results from the 2002 National Health Information Survey (NHIS) in the USA showed that 36% of adults use CAM, and if prayer is included, this figure jumps to 62%.7 In 2007, almost 4 out of 10 adults had used CAM therapy in the past 12 months.8 The use of CAM is common among patients with certain illnesses, especially chronic diseases.9–11In Saudi Arabia, the current, detailed, and comprehensive picture of the Saudis' use of CAM has not yet been developed, although published data show that CAM is widely used. In 2000, a study in the capital city Riyadh showed that 46% of the population used CAM, and 19% of them used CAM in the previous year.12 In 2008, a household survey study conducted in the Riyadh region found that 73% of the population had previously used CAM, and 67% used it in the previous 12 months. In addition, 42% had consulted a CAM provider, and 72% kept at least 1 traditional therapy item at home.13 Prayers, herbs, wet cupping, and honey bee products are the most common CAM modalities used by the Saudi population. The methods belong to the indigenous traditional practices common in the Arab and Islamic countries. The majority of those practices are grouped under the term "Prophetic medicine," where clerics, rather than physicians, advocate the traditional medical practices in the days of the Prophet of Islam.12,13The use of CAM has been extensively studied globally among different populations. However, it is difficult to compare findings across studies and across countries because of differences in the way the use of CAM was measured, including differences in study design and methodological limitations.14 In 2006, a workshop was convened by the National Research Center in Complementary and Alternative Medicine (NAFKAM), University of Tromsø, Norway, to develop a common questionnaire that could be used across populations and countries.15 The questionnaire is called the "international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q)." The question "Can we use this questionnaire internationally across developed and developing countries with different cultures?" remains unanswered.The aim of this study was to measure the use of CAM and out-of-pocket spending on CAM in the Qassim region, Saudi Arabia, by using I-CAM-Q.METHODSOverall designFace-to-face interview survey targeting primary health care (PHC) attendants aged 18 years and older from both genders and any nationality. A total of 1167 participants were included in the study using a multistage sampling technique. The study was conducted from the beginning of May to the end of June 2011, targeting attendants of PHC centers in the Qassim region aged 18 years and older from both genders and any nationality.SampleA multistage sampling technique was used. Twelve PHC centers were selected randomly from 140 PHC centers in the Qassim region. From each center, 100 attendants were recruited; 1167 agreed to participate. Of those, 1160 participants were able to complete the questionnaire.QuestionnaireWe used a modified version of the I-CAM-Q developed originally by the National Research Center in Complementary and Alternative Medicine (NAFKAM) of the University of Tromsø, Norway.15 After receiving the permission from the original authors, the questionnaire passed through the following steps: (a) Translation (English-Arabic) and back translation. (b) Modification: questions were added to calculate out-of-pocket spending on the use of CAM therapy and CAM products. Questions regarding CAM products such as bracelets, books, or other materials were also added. Questions were added to collect demographic information, as the original questionnaire did not include demographic questions. (c) Testing the questionnaire through workshops (national and international) and in the field on a small number of participants.RESULTSOut of the 1200 targeted subjects, 1167 agreed to participate, and 1160 completed the questionnaire. The mean age was 40.69 years (SD 13.9). The ages ranged from 18 to 90 years, and 58% of the subjects were males. Saudis represented 93.6% of the participants. Regarding education, 26.4% of the participants were illiterate or could only read and write, 39.5% had intermediate and secondary education, and 32.2% were educated at the university level and above. Other demographic characteristics are shown in Table 1.Table 1 Sample characteristics.CharacteristicsFrequency (1160)Percent (100.0%)Age (y)<3026723.130–<4029425.440–<5029825.850–<6018516.060+1139.8Missing system30.3SexMale67958.5Female47941.3Missing system2.2EducationIlliterate or read and write30626.4Intermediate and secondary45839.5University and above37432.2Missing system221.9OccupationProfessional201.7Intermediate18315.8Skilled nonmanual1139.7Partly skilled21018.1Unskilled453.9Armed forces353.0Inadequately described403.4Students, no occupation, housewives51444.3NationalitySaudi108693.6Non-Saudi726.2Missing system2.2Total1160100.0The overall use of CAM through CAM providers (one or more visits) in the last 12 months was 74.3% (862/1160; 95% CI, 71.7–76.8) including prayer or spiritual healings. When we excluded prayer, the proportion decreased to 47.8% (554/1160; 95% CI, 44.9–50.7). This compared to 83.4% (967/1160) of the subjects who visited physicians in the same period. The proportions are not mutually exclusive, as participants can visit both physicians and CAM providers.Spiritual healers (26.7%), herbalists (23.2%), providers of honeybee products (14.9%), and hijama (cupping) therapists (13%) were the providers most commonly visited in the last 12 months (Table 2).Table 2 Visits to CAM providers.CAM practicesDid you visit CAM provider in the last 12 mo?Number of visits in the last 3 moReason (Last visit)Satisfaction (last visit)Yes95% CIN%X (SD)Acute illnessChronic illnessWell-beingVerySomewhatNot at allSpiritual healer308/115526.724.229.48.67 (20.63)671594718891627.0%56.4%16.6%65.96%31.9%2.11%Herbalist269/116023.220.825.84.91 (11.41)8315210158692033.9%62.0%4.1%64.%27.9%8.1%Honeybee products172/116014.912.917.16.01 (12.12)17945612530610.2%56.3%33.5%77.6%18.6%3.73%Hijama151/116013.011.215.11.66 (0.92)20109118346914.3%77.9%7.9%60.2%33.3%6.52%Cauterization109/11609.47.811.31.02 (0.74)194814418428%70.6%1.5%66.7%27.3%6.06%Chiropractic48/11594.13.15.53.21 (2.61)102772815222.7%61.4%15.9%62.2%33.3%4.4%Acupuncture25/11582.21.83.32.44 (1.34)31931212012%76.0%12%50%50%0%Homeopath1/11570.10.010.610101000%100%0%100%0%0CAM: Complementary and alternative medicine.The number of visits to CAM providers in the last 3 months ranged from 1 to 6. Spiritual healers (8.6 [20.6] visits), therapists with camel milk and urine (7.6 [13.6] visits), honeybee-product therapists (6 [12.1] visits), and herbalists (4.9 [11.4] visits) were the most frequently visited practices in the last 3 months; Table 2.The main reason for visiting a CAM provider was chronic illness. For chronic illness, the practice-specific percentages ranged from 76% (19/25) for acupuncture to 54% (94/172) for honeybee products.More than 50% were satisfied with the outcome of the last visit. For the CAM practices, the percentage of participants who were "very satisfied" ranged from 51.8% for cautery to 72.7% for honeybee products. Those who were "not at all satisfied" ranged from 2 to 8% for all listed practices in Table 2.Table 3 shows the common CAM provider visits (spiritual healer, herbalist, honeybee-product therapists, hijama (cupping) provider, and cautery provider) by sociodemographic characteristics. The middle-age group (30–<50 years) visited herbalists (P=.019), hijama (cupping; P=.0001), and cautery providers (P=.018) significantly more frequently than other age groups. Age did not affect visits to spiritual healers. Females were significantly more likely to visit CAM providers (P=.001) except for hijama (cupping). Highly educated (university and above) persons visited honeybee-product therapists (P=.0001) and hijama (cupping; P=.0001) significantly more frequently than others. Illiterate participants visited spiritual healers and cautery providers significantly more frequently than others. Regarding occupation, the jobless particiapants, housewives, and unskilled workers were significantly more likely to visit spiritual healers (P=.01). Except for hijama (cupping), Saudi nationals were significantly more likely to visit spiritual healers, herbalists, honey-product therapists and cautery providers. Both Saudis and non-Saudis visited hijama (cupping) providers equally.Table 3 Demographic characteristics and CAM visits.CharacteristicsSpiritual healing (308) (26.7%)Herbal (269) (23.2%)Honeybee products (172) (14.9%)Hijama (cupping) (151) (13.0%)Cauterization (109) (9.4%)Age (y)<30 (267)61 (22.85)52 (19.48)15 (5.62)14 (5.24)8 (3.00)30–<40 (294)93 (31.63)77 (26.19)40 (13.61)26 (8.84)11 (3.74)40–<50 (298)80 (26.85)84 (28.19)33 (11.07)46 (15.44)24 (8.05)50–<60 (185)49 (26.49)38 (20.54)12 (6.49)23 (12.43)16 (8.85)60+ (113)24 (21.24)18 (15.93)4 (3.54)17 (15.04)6 (5.31)P.107.019a.001a.001a.018aSexMale (679)131 (19.29)103 (15.17)80 (11.78)99 (14.58)51 (7.51)Female (479)176 (36.74)165 (34.45)91 (19.00)52 (10.86)58 (12.11)P.001a.001a.001a.064.008aEducationIlliterate or read and write (306)102 (33.33)75 (24.51)25 (8.17)31 (10.13)40 (13.07)Intermediate and secondary (458)118 (25.76)106 (23.14)58 (12.66)48 (10.48)47 (10.26)University and above (374)84 (22.46)85 (22.73)86 (22.99)71 (18.98)17 (4.55)P.005a.852.001a.001a.001aOccupationProfessional (20)3 (15.0)3 (15.0)4 (20.0)4 (20.0)0 (0.0)Intermediate (183)44 (24.04)52 (28.42)67 (36.61)41 (22.40)28 (15.30)Skilled nonmanual (113)20 (17.70)12 (10.62)16 (14.16)15 (13.27)14 (12.39)Partly skilled (210)50 (23.81)40 (19.05)58 (27.62)37 (17.62)12 (5.71)Unskilled (45)12 (26.67)7 (15.56)7 (15.56)1 (2.22)6 (13.33)Armed forces (35)8 (22.86)11 (31.43)8 (22.86)12 (34.29)7 (20.0)Inadequately described (40)6 (15.0)7 (17.5)5 (12.5)8 (20.0)6 (15.0)Students, no occupation, housewives (514)165 (32.10)137 (26.65)74 (14.4)57 (11.09)80 (15.56)P.01a.002a.001a.001.011aNationalitySaudi (1086)297 (27.35)264 (24.31)168 (15.47)144 (13.26)107 (9.85)Non-Saudi (72)11 (15.28)5 (6.94)3 (4.17)7 (9.72)2 (2.78)P.024a.001a.008a.388.046aaThere is a statistical significant difference.CAM: Complementary and alternative medicine.Physicians providing CAMOf the 1160 participants, 131 (11.3%) visited physicians providing CAM therapy in the previous 12 months before the survey. Of the 1160 participants, the CAM therapies provided by physicians were herbal medicine (5.7%), spiritual healing (3.8%), manipulation (1.4%), and acupuncture (0.4%).Self-help practicesSelf-help was used by 26% (302/1160) of the participants. Relaxation (10.3%) was the most common self-CAM practice followed by meditation (6.7%).More than 75% (95% CI, 72.4–77.5) of the subjects used herbs in the previous 12 months for medical and health reasons. Al Murrah (Commiphora myrrha) was the most common (33.3%) followed by Yanson (Anise, Pimpinella anisum) (15.4%) and Helba (Trigonella foenum-graecum) (12.8%).Almost 1 quarter of our sample used vitamins and or minerals in the 12 months before the study. Most of them used multivitamins (13.4%) followed by iron (5.8%), folic acid (4.2%), and vitamin B complex (3.6%).Out-of-pocket spending on CAM visitsTable 4 shows the average cost of the last visit and the average cost for the last 3 months for each CAM provider. The average cost per visit (last visit) ranged from 186 Saudi Riyals (SAR) (50 US$) for the herbalist to 472 SR (125 US$) for the acupuncturist. Regarding the traditional CAM practices (excluding acupuncture and chiropractic services), the cost per visit ranged from 186 SAR (50 US$) for the herbalist to 297 SAR (80 US$) for the hijama therapist. Regarding the average cost per practice in the last 3 months, the cost of therapy with honey bee products was the highest at 704 SAR (188 US$).Table 4 Costs of visits to CAM providers.Frequency of useAverage cost (SR) last visitAverage cost (SR) last 3 moNo%χSDTotalχSDTotalPhysiciansa967b83.4739.701839.58125010.01059.882168.43179120.0Chiropractors484.1232.03329.387425.0393.87314.4912210.0Acupuncturists252.2472.50687.179450.0609.0885.9212180.0Herbalists26923.2186.10212.9142431.0318.27379.9672565.0Spiritual healers30826.7250.62655.7415288.0268.10451.7716354.0Hijamah15113.0297.12131.0337730.0512.97281.5255335.0Cauterization1099.4217.43138.8817180.0276.22184.8618000.0Camel milk and urine625.3210.1489.818915.0397.35132.0817205.0Honeybee products17214.9252.08220.5242862.0704.54457.20111741.0Massage453.9211.26183.568560.0333.43138.9412380.0Total cost of CAM189841.00327970.00CAM: Complementary and alternative medicine.aCosts for visiting physicians, not providing CAM therapies, were not included.b781 did not pay for their visits (visiting governmental health care facilities).Total out-of-pocket spending on CAM visitsThe total cost (out-of-pocket spending) on CAM visits in the last 3 months was 327 970 SAR. From this figure we can estimate that the out-of-pocket spending in the last year for our sample of 1160 individuals was (327 970×4)=1 311 880 SAR (349 834 US$; 1 US$=3.75 SAR). This did not include spending on self-CAM therapies or purchasing CAM products.Out-of-pocket spending on herbs, vitamins, supplements, and other CAM productsOut-of-pocket spending for purchasing herbs, vitamins, supplements, and other CAM products in the previous 3 months was as follows: honey (147 399 SAR), herbs (90 677SR), vitamins/minerals (15 855 SAR), other supplements (23 674SR), and other products (3320 SAR).The total out-of-pocket spending on purchasing CAM products was 280 925 SAR in the previous 3 months. In the previous year, the participants spent an estimated 1 123 700 SAR (≈300 000 US$) purchasing CAM supplements and products.Total out-of-pocket spending on CAMTherefore, the total out-of-pocket spending on CAM was 2 435 580 SAR (≈650 000 US$) per year for our study participants, including 350 000 US$ on CAM visits and 300 000 US$ purchasing CAM products.DISCUSSIONPublished studies have shown that CAM has been in creasingly accepted worldwide.16–19 The lifetime prevalence of CAM therapy use in the United States has increased steadily since 1950.20This increasing trend cannot be applied to the situation in Saudi Arabia, where traditional indigenous medicine rather than CAM is prevalent. CAM providers are mainly traditional healers. Only 11% (131/1160) of CAM visits were provided by physicians. The proportion of CAM users in our study is comparable to other published studies in Saudi Arabia, although they were conducted in other regions.12,13The most common practices used in the previous 12 months in our study were prayer, herbal medicine, wet cupping, and honeybee products. These practices are part of the traditional "Prophetic medicine" prevalent in Saudi Arabia. Chiropractic, homeopathy, and acupuncture were rarely used according to our study. Although prayers and herbs are part of TM/CAM in any country, other practices differ from one region to another.Acupuncture and homeopathy are used more often in European countries than in the United States and Canada. In 2005, the World Health Organization's Global Atlas of Traditional, Complementary, and Alternative Medicine revealed that chiropractic manipulation, homeopathy, phytotherapy/herbal medicine, and massage were the most commonly used therapies. 21 If prayer had been considered, it would certainly be among the most commonly used therapies. When the study authors examined the use of prayer, it was in at least the top 3 most commonly used therapies and usually showed the highest prevalence.The use of CAM was more common among females and middle-age groups in our study. This trend is similar to published studies in Western countries. However, there was no consistent relationship between education or jobs and the use of CAM. While the use of CAM was higher in the highly educated and high-income population in the USA, this applied only to certain CAM therapies in our studies, such as wet cupping and honeybee therapies, but not to spiritual healings and cauterization.22 The relationship between education and the use of CAM is more complex and may interact with other factors such as race.23Chronic diseases was the most common reason for visiting a CAM provider in our study, and it is also a common reason in other countries. CAM users are more likely to be females with chronic illnesses.24 However, in Western countries, the number of male and female adults visiting CAM practitioners increased from 1997 to 2008. The most prominent change was that younger people of both genders with more limited complaints increased CAM visitation.25 The reasons for CAM utilization are complex and include the costs of traditional therapies, a desire for a more holistic approach to treatment, and dissatisfaction with current therapies.26The Qassim population is estimated to be 1.2 million (2012 projection); 50 % of them are <20 years of age. We can estimate that the Qassim people are spending ≈650 million SR (175 million US$) per year on CAM visits and ≈560 million SR (150 million US$) on CAM products. These figures indicate a total spending of ≈1.2 billion SR (≈325 million US$).If 1.2 million people living in Qassim are spending 325 million US$ per year, what can be estimated for the total population in Saudi Arabia? The total population of Saudi Arabia is now 28 million; if we assume that the CAM pattern in Qassim is applicable to all the regions in Saudi Arabia, this makes the total spending an estimated 8.2 billion US$ per year in Saudi Arabia.27In most countries, CAM is not covered by national insurance systems, and users pay almost all costs out of pocket. This willingness to pay reflects the public's general acceptance of CAM and also suggests that CAM therapies have benefits that outweigh their costs. Eisenberg et al22 reported that the estimated expenditures for alternative medicine professional services increased by 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997 with at least $12.2 billion paid out-of-pocket. This amount exceeded the 1997 out-of-pocket expenditures for all hospitalizations in the United States. A national health survey in 2007 revealed that more than $34 billion is spent on CAM annually in the United States. In Germany, where some forms of CAM are covered by insurance, costs for alternative therapies in 2000 accounted for approximately one tenth of expenditures on general medical treatments.28Approximately half of the Australian population uses CAM, and they spent an estimated $2.3 billion on CAM in 2000, which is nearly 4 times the public contribution to all pharmaceuticals.29The significance of these numbers indicates that CAM is attracting more and more attention within healthcare systems. More research would support the further integration of CAM into conventional medicine as the benefits of these therapies are continually identified and published in scientific journals.I-CAM-Q was used in studies in Western societies, 24,30,31 but this is the first time it has been used in developing or Eastern countries, where TM rather than alternative medicine is common. As the questionnaire was designed for Western societies, the top CAM practices in the questionnaire were not the most common practices in Saudi Arabia. A new design should be constructed and customized for each region; however, we can keep the basic questions for the international comparison.CAM therapies are widely used in the Qassim province, and this may reflect the situation in Saudi Arabia. Practices common in Saudi Arabia are related mainly to Islamic Medicine and include spiritual healings, herbs, hijama, and honeybee products. The out-of-pocket spending also reflects the high demand for CAM therapies. Accordingly, a consideration of the safety, effectiveness, and legal and economic issues appears to be warranted. Further national studies should be conducted to assess the comprehensive current situation of the use of CAM. Uniform nomenclatures, definitions of CAM, and therapy protocols would provide better transparency and understanding.ARTICLE REFERENCES:1. Wardwell WI. "Alternative medicine in the United States" . Soc Sci Med. 1994; 38(8):1061-8. Google Scholar2. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. "Unconventional medicine in the United States. Prevalence, costs, and patterns of use" . N Engl J Med. 1993; 328(4):246-52. Google Scholar3. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/whatiscam/#1Accessed June 26, 2012. Google Scholar4. National Center for Complementary and Alternative Medicine. Expanding horizons of healthcare: Strategic plan 2005–2009Available from: http://nccam.nih.gov/about/plans/2011/introduction.htmAccessed on March, 2012. Google Scholar5. WHO. "General guidelines for methodologies on research and evaluation of traditional medicine" . WHO/EDM/TRM/2000.12000. Google Scholar6. Legal status of traditional medicine and complementary/alternative medicine: a worldwide review. Geneva: WHO. WHO/EDM/TRM/2001.22001. Google Scholar7. "A new portrait of CAM use in the United States" . Complementary and Alternative Medicine at the NIH. 2004; 11(3):1-4. Google Scholar8. Barnes PM, Bloom B, Nahin RL. "Complementary and alternative medicine use among adults and children: United States, 2007" . Natl Health Stat Report. 2008Dec 10(12):1-23. Google Scholar9. Chong CA, Diaz-Granados N, Hawker GA, Jamal S, Josse RG, Cheung AM. "Complementary and alternative medicine use by osteoporosis clinic patients" . Osteoporos Int. 2007; 18(11):1547-56. Google Scholar10. Millar WJ. "Use of alternative health care practitioners by Canadians" . Can J Public Health. 1997; 88(3):154-8. Google Scholar11. Ai AL, Bolling SF. "The use of complementary and alternative therapies among middle-aged and older cardiac patients" . Am J Med Qual. 2002; 17(1):21-7. Google Scholar12. Al-Faris EA. "The pattern of alternative medicine use among patients attending health centers in a military community in Riyadh" . J Family Community Med. 2000; 7(2):17-25. Google Scholar13. Al-Faris EA, Al-Rowais N, Mohamed AG, Al-Rukban MO, Al-Kurdi A, Balla Al-Noor MA, et al. "Prevalence and pattern of alternative medicine use: the results of a household survey" . Ann Saudi Med. 2008; 28(1):4-10. Google Scholar14. Peltzer K. "Utilization and practice of traditional/complementary/alternative medicine (TM/CAM) in South Africa" . Afr J Tradit Complement Altern Med. 2009Mar7 6(2):175-85. Google Scholar15. Quandt SA, Verhoef MJ, Arcury TA, Lewith GT, Steinsbekk A, Kristoffersen AE, et al. "Development of an international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q)" . J Altern Complement Med. 2009; 15(4):331-9. Google Scholar16. Harris P, Rees R. "The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature" . Complement Ther Med. 2000; 8(2):88-96. Google Scholar17. Fisher P, Ward A. "Complementary medicine in Europe" . BMJ. 1994Jul9 309(6947):107-11. Google Scholar18. Hartel U, Volger E. "Use and acceptance of classical natural and alternative medicine in Germany--findings of a representative population-based survey" . Forsch Komplementarmed Klass Naturheilkd. 2004Dec 11(6):327-334German. Google Scholar19. MacLennan AH, Wilson DH, Taylor AW. "The escalating cost and prevalence of alternative medicine" . Prev Med. 2002Aug 35(2):166-73. Google Scholar20. Kessler RC, Davis RB, Foster DF, Van Rompay MI, Walters EE, Wilkey SA, et al. "Long-term trends in the use of complementary and alternative medical therapies in the United States" . Ann Intern Med. 2001Aug21 135(4):262-8. Google Scholar21. Bodeker G, Ong CK, Grundy C, Burford G, Shein K. Kobe, Japan: World Health Organization; 2005. Google Scholar22. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. "Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey" . JAMA. 1998Nov11 280(18):1569-1575. Google Scholar23. Bains SS, Egede LE. "Association of health literacy with complementary and alternative medicine use: a cross-sectional study in adult primary care patients" . BMC Complement Altern Med. 2011Dec30 11:138. Google Scholar24. Steinsbekk A, Rise MB, Bishop F, Lewith G. "Predictors for adolescent visits to practitioners of complementary and alternative medicine in a total population (the Young-HUNT Studies)" . PLoS One. 2011; 6(10):e25719Published online 2011 October 7 doi: 10.1371/journal.pone.0025719. Google Scholar25. Steinsbekk A, Rise MB, Johnsen R. "Changes among male and female visitors to practitioners of complementary and alternative medicine in a large adult Norwegian population from 1997 to 2008 (The HUNT studies)" . BMC Complement Altern Med. 2011Aug11 11:61. Google Scholar26. Frass M, Strassl RP, Friehs H, Müllner M, Kundi M, Kaye AD. "Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review" . Ochsner J. 2012; 12(1):45-56. Google Scholar27. Central Department of Statistics and Information. Census statisticsAvailable from: http://www.cdsi.gov.sa/2010-07-31-07-00-05/cat_view/31/138----/300----1431-2010/310-------1431-2010-----Updated2011Accessed July 2012. Google Scholar28. Marstedt G, Moebus S. Gesundheitsberichter-stattung des Bundes: Inanspruchnahme alternativer Methoden in der Medizin 9:9-27Robert Koch Institut, Statistisches Bundesamt, Berlin; Germany, 2002. Google Scholar29. MacLennan AH, Myers SP, Taylor AW. "The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004" . Med J Aust. 2006Jan2 184(1):27-31. Google Scholar30. Jay EM, Thorn B. "Spiritual/religious values and attitudes regarding complementary and alternative medicine" . The University of Alabama McNair Journal. 2011;45-73. Google Scholar31. Quandt SA, Ip EH, Saldana S, Arcury TA. "Comparing Two Questionnaires for Eliciting CAM Use in a Multi-Ethnic US Population of Older Adults" . Eur J Integr Med. 2012Jun1 4(2):e205-e211Epub 2012 Jan 20. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 33, Issue 3May-June 2013 Metrics History Published online6 June 2013 AcknowledgmentsInvestigators acknowledge with thanks the contribution of the following PHC physicians in Qassim for their contribution in the study: AlSayed AbdelMageed Ahmed, Awad AlKareem Ahmed Musa, Mohamed Awad ElNoby, Khaled AbdelHameed Abunawas, Hassan AlAmeen AbdelKareem, Ezat AbdelRahman AbuHashem, Manal Ibrahim AbdelMutaleb, Motaz Ahmed Mohamed, Khaled Abdulla Hamed, Nadia Hassan Abdullah Ali, and Mahmoud Mohamed Ahmed Bundok.InformationCopyright © 2013, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download
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