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

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