A prevalence of 63.4% for CAM use by patients with TBI was obtained in this study. This was similar to the rates reported for cancer patients in Turkey
, and pediatric cancer patients in Taiwan
. The prevalence rate was lower than the rates reported for the public in Japan
 and cancer patients in Taiwan
 but higher than those for cancer patients in the United States
 and the United Kingdom
. Differences in the definition of CAM and study population accounted for the wide variation of rates in the results of this study. Chinese medicine was the most frequently used CAM in this study. This is contrasting to the types of CAM use in other studies
[3, 7, 8]. This might have resulted from cultural differences and the convenience of use.
More than 90% of the patients continued using conventional medicine while using CAM. This is a typical Taiwanese pattern of mixing traditional Chinese medicine, conventional medicine, and folk therapies
. Similar findings have been reported in many developing countries
[16, 17]. Medical practices in Taiwan are generally categorized into three groups: conventional medicine, traditional Chinese medicine, and folk medicine. Each type of medicine consists of specific knowledge, skills and beliefs, and diverse approaches that coexist, in accordance to the definition of a “mixed” medical system or medical pluralism. Medical pluralism, which is the combination of conventional and traditional medical systems, is widespread in Asian countries. In many countries, the public believes that simultaneously applying CAM with conventional treatments improves overall health, which is consistent with beliefs regarding health and illness
[15, 18]. Chinese culture understands health regarding the concepts of yin and yang, emphasizing harmony and balance. This includes internal harmony of the body and harmony between the body and its environment. For example, food may be used as medicine to improve the internal harmony of the body
In our study, patients with TBI used CAM primarily to improve their overall health and, additionally, complement conventional medical treatment to restore health. Thus, TBI patients have used CAM mainly to preserve their health with the hope of strengthening the body, which is similar to findings from a study of the public in Taiwan
. Another major reason for using CAM was for psychological and spiritual support and to rebuild confidence in the ability of the patients to overcome illness. Half of the participants in our study believed that spiritual healing, the use of holy water, and reciting a Buddhist mantra strengthen the psychological domain, which reflects the concept that body and mind affect each other. Such psychological support can assist patients in coping with acute conditions or the long-term problems they must confront every day. Moreover, spiritual therapies may help people cope with the exigencies of daily life, as well as with special problems.
Most participants in this study (78.1%) did not inform their physicians on their CAM use, a finding that is similar to those of previous studies
[3, 19, 20]. For example, in Taiwan, Tseng et al.
 and Huang et al.
 found that 81.6% and 50% of CAM users, respectively, did not inform conventional health care personnel. Cheung et al.
 reported that reasons for not disclosing CAM use included “not being asked,” “didn’t think about it,” and “didn’t think it was important to my care.” However, not informing physicians on CAM use may increase the risk of health complications related to combined use of CAM and conventional medicine. Physicians must know enough about various forms of CAM to know which should be contraindicated with the treatments they are providing and which need not be. This reduces the risk of CAM modality in adversely affecting treatment plans designed by physicians.
Characteristics of CAM users differ according to culture, geography, and type of dominant health care system. Our study showed that CAM use in Taiwan is not associated with variables such as patient gender, educational level, or religious beliefs, and whether patients had used CAM in the past, which is similar to the results of most studies
[8, 9, 13, 19]. We found that younger patients who believe in CAM were more likely to use CAM. This was similar to the findings from other studies that reported a relationship between age and CAM use
[3, 4, 21]. Previous studies have shown that the response “had ever used CAM” was a critical predictive variable for current CAM use
[1, 8]. However, we found that most patients (85.1%) had never used CAM prior to TBI, which made the item “had ever used CAM” an irrelevant variable.
Questions on belief in CAM showed that more positive thoughts toward CAM resulted in a greater possibility that patients might choose CAM. Patients’ use of CAM is consistent with their attitudes toward CAM and health beliefs
. For instance, Chinese people generally regard Chinese medicine as being able to balance the qi of yin and yang. They also trust that it does not induce iatrogenic illness and nourishes the body with fewer side effects than conventional medicine does. Folk therapy is valued for its spiritual benefits, which relieve stress and enhance confidence
[11, 14]. CAM users also believe that CAM is holistic, natural, and associated with the spirit
. These varied beliefs affect the types and methods of medical treatment that patients use. In the view of patients, these different approaches to medicine are complementary, an attitude that reflects the concept of the yin-yang balance in Chinese culture. Our results show that most of the patients tended to use CAM and conventional medicine at the same time, suggesting that integrating traditional Chinese medicine and conventional medicine may become increasingly common in Taiwan’s health care system. Currently, in addressing the Taiwanese public’s preference for medical pluralism, some clinics integrated traditional Chinese and conventional medicine. We suggest that medical universities introduce scientifically approved CAM-related curricula, integrate CAM into programs that have previously used only conventional medicine, and provide opportunities for students to learn about complementary medical therapies.
This study had several limitations. Firstly, this study recruited only TBI patients who were scheduled for follow-up as outpatients; thus, information on those who did not need outpatient follow-up, those who lived outside the Taipei area and could not travel to the study hospital after discharge, and those who relied exclusively on CAM is limited, possibly causing a study sample bias. In addition, we used a convenience sample of patients attending an outpatient clinic who had received a single diagnosis at a single hospital. The limited sample size and homogeneity of patients, as well as the recalled bias of information in our study, limit the generalizability of the results. This study explored patients’ satisfaction with the efficacy of CAM based only on subjective perceptions and cannot provide evidence-based data on efficacy.