The relationship between experienced benefits and harms of using complementary and integrative health approaches and intention to maintain their use in Finland

doi:10.21203/rs.3.rs-4435651/v1

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Research Article

The relationship between experienced benefits and harms of using complementary and integrative health approaches and intention to maintain their use in Finland

https://doi.org/10.21203/rs.3.rs-4435651/v1

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Background

The estimated prevalence of the use of complementary and integrative health (CIH) approaches varies between 24–71% in adult populations worldwide. Little is known about the intention to maintain their use. This study aimed to examine whether the experienced benefits and harms of CIH use, and self-rated health (SRH) relate to the intention to use CIH in the future in current users.

Methods

A total of 1652 Finnish CIH users completed an online-survey in December 2022, out of which 58.8% intended to use CIH in the future. Binary logistic regression analyses were used to examine the relationship between the intention to use CIH, experienced benefits and harms of CIH use and SRH.

Results

Having experienced at least one type of benefit from CIH use compared to no experienced benefits was related to the intention to use CIH (OR = 19.3, 95%CI = 11.05 to 33.80). Conversely, having experienced at least one harm from CIH use compared to no harms was inversely related to the intention to use CIH (OR = 0.27, 95%CI = 0.20 to 0.35). Easing of pain or related ailment was found to be the most strongly related benefit to the intention to use CIH. SRH was not found to be statistically significantly related to the intention to use CIH.

Conclusions

This study highlights the importance of the benefits and harms CIH users experience on the continuation of CIH use. The intention to maintain use relates to everyday effectiveness of CIH experienced by users.

complementary and integrative health

complementary and alternative medicine

CIH

CAM

Finland

intention to use

self-rated health

Complementary and integrative health (CIH) approaches comprise a vast range of provider-led procedures, natural remedies, products and self-help practices, that are offered along with or outside of conventional healthcare worldwide ^1–4. Estimated prevalence of 12-month CIH use is found to vary between 24–71% depending on the study and country ⁵. Recognising the varying terminology ⁴, in this article the term CIH is used in referring to CIH approaches, and as a corresponding term to CAM (complementary and alternative medicine) and CAIM (complementary, alternative and integrative medicine).

The most commonly reported reasons for the use of CIH are the perceived benefits and safety of CIH, and dissatisfaction with conventional medicine ⁶. Reported benefits include management of pain ⁷, perceived improvement of physical and emotional health and well-being and quality of life ^6,8, as well as CIH being reported by users as helpful ^9,10. The use of CIH has been attempted to be explained by having value fit with CIH use¹¹ and by beliefs in magical concepts regarding health¹², or holistic health and healing beliefs ^13,14. Individuals with more modern health worries and paranormal beliefs have also been found more likely to find CIH as effective¹⁴. Reasons for the non-use of CIH include doubt of efficacy of and concerns about possible side-effects of CIH, and satisfaction with conventional medicine ⁶. Reported perceived harms or adverse effects from CIH use include temporary discomfort or pain and high cost of CIH treatments ^8,15,16.

Studies indicate that previous CIH use and having a positive attitude towards CIH ¹⁷, family influence ^17,18, and belief in positive outcomes following from CIH use ¹⁸ are associated with the intention to use CIH in the future. Furthermore, improvement of general well-being and CIH being used as an addition to conventional medical treatment ¹⁹ have been found to be connected to the intention to continue CIH use. A recent publication by Fournier and Varet ²⁰ included two vignette studies focusing on the intention to use conventional, complementary and alternative medicine during cancer treatment. Intention to use CIH was found positively correlated with conspiracy beliefs, and this correlation was found to be larger for the use of “unconventional medicine” as an alternative to chemotherapy, compared to complementary use²⁰.

Theoretical frameworks with which the intention to use CIH has been explained include the theory of planned behaviour ¹⁷ and the CIH-tailored consumer commitment model (CCM)^21,22. CCM conceptualises commitment to CIH within a psychological and behavioural frame based on one hand on CIH users' values and on the other the experiences gained from use of CIH. The model assumes that commitment to future use, i.e. intention of CIH users to continue the use, is related to utilitarian and symbolic values ^21,22. According to Sirois et al. ²¹, utilitarian values include positive outcomes of CIH use, containing physical, emotional and behavioural outcomes. Symbolic values refer to the perceived “fit” between the CIH user’s belief system and that of the CIH modalities they use, for example holistic health beliefs and emphasis on whole person treatments. In this article we conceptualise positive CIH outcomes as experienced benefits of CIH use, and negative CIH outcomes as experienced harms of CIH use.

In Finland, the use of most CIH modalities falls under consumer legislation, making consumer perspective within CIH research relevant. Unlike the neighbouring countries of Sweden and Norway, there is no national policy for traditional and complementary medicine in Finland ²³. There is a possibility for serious adverse effects for the use of some CIH modalities, for example via herb-drug interactions ²⁴, and the 2023 Finnish government programme aims to assess the patient safety of alternative therapies offered outside health care ²⁵. The prevalence of CIH use in Finland is relatively high ^2,10, making it paramount for the national CIH policy development that the reasons behind continued use are better understood. To the authors’ knowledge the association between experienced benefits and harms and the intention to use CIH have not been researched earlier.

CIH modalities are used for treatment of various health conditions, and for health promotion to maintain well-being ^26,27. Previous studies on the connection between self-rated health (SRH) and prevalence of CIH use offer inconsistent results ²⁸. Some studies report good SRH ¹⁹ and some poor SRH ² being associated with higher rates of current CIH use. To the authors’ knowledge, the relationship between SRH and intention of CIH users to maintain their CIH use has not been studied.

Aims

This study aimed to investigate whether the experienced benefits and harms of CIH use are related to the intention to maintain CIH usage in the future. Thus, the hypotheses are:

H1: Having experienced benefits from CIH use is related to the intention to maintain CIH use, and

H2: Having experienced harms from CIH use is inversely related to the intention to maintain CIH use.

In addition, CIH being used both for treatment of ailments and health promotion ^2,27, we explore whether there is an association between SRH and CIH users’ intention to continue CIH usage.

Sampling and recruitment

The data were collected from a commercial probability-based online panel (Kantar Public) in December of 2022 with an online survey questionnaire. A questionnaire was sent by email to 11507 randomly selected panellists aged 16 and above living in mainland Finland. A total of 3244 panellists completed the survey. This study was a part of a larger Finnish CIH research project. More details on sampling and recruitment are reported elsewhere ¹⁰.

Measures

Measures of respondent characteristics

Basic characteristics (gender, age, place of residence) were asked in the beginning of the survey. Age was calculated based on year of birth. Gender of the respondents was assessed via a categorical question (female; male). Residency was assessed by using the four designated NUTS (Nomenclature of Territorial Units for Statistics) level 2 areas of Finland (Helsinki-Uusimaa; South Finland; West Finland; North and East Finland).

Information on household yearly income was collected with a categorical question, the answers of which were merged into the following categories used in the final analysis: low (35.000€ and below), middle (35.001-50.000€), and high (50.001€ and above). Highest form of obtained education was collected with six categories, which were merged into the following categories for the final analysis: primary and lower secondary school; upper secondary education and vocational college education; Bachelor’s degree or higher vocational degree; Master’s degree or higher.

Use of CIH

The usage of CIH was assessed with the Finnish version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q; ²⁹). The survey includes modalities from three CIH categories: providers, natural remedies and self-help practices. The researcher-defined group of CIH users includes respondents who reported the usage of at least one CIH modality at least once within the 12 months prior to taking part in the survey. All modalities included in the definition are listed in Table 1. The process is detailed in Authors ¹⁰.

Table 1

CIH modalities included in the definition of CIH user^a in this study.
CIH providers and therapists	CIH Natural remedies	CIH self-help practices
Chiropractor	Herbs and herbal medicine	Meditation and mindfulness
Homeopath	Homoeopathic remedies	Yoga
Acupuncturist	Other supplements (not vitamins and minerals)	Tai Chi and Qigong
Phytotherapist		Relaxation techniques
Bone setter		Visualisation
Energy healer		Attending traditional healing ceremonies
Reflexologist		NLP^b
Aromatherapist
Massage therapist (other, non-conv.)
Naprapath
Osteopath
Art therapist
Cuppist
Hypnotherapist
TCM practitioner^b
Anthroposophic therapist
Ayurvedic practitioner
Other

^a Using one or more of the included modalities at least once in the 12 months preceding the survey.

^b TCM = Traditional Chinese Medicine, NLP = Neurolinguistic Programming.

Intention to use CIH

Intention to use CIH in the future was assessed with the question: “Do you intend to use any complementary treatments in the future?”. The answer options were combined into three categories: ”Yes” (”Yes”/”Probably yes”), ”No” (”No”/”Probably no”) and ”I do not know or want to answer”. For the final analysis, the answer options were grouped into two categories: ”Yes” (”Yes/Probably yes”) and ”No/Unsure” (”No/Probably no/I do not know or want to answer”).

Self-rated health (SRH)

SRH was assessed via a multiple choice question, ”What is your state of health like at the moment?”. Six answer options were provided. In the final analysis, the answer options were merged into four categories in order to highlight differences between dimensions of good and poor SRH: ”Poor” (Very poor/Somewhat poor), ”Average”, ”Good” (Very good/somewhat good) and ”I do not know or want to answer”.

Experienced benefits and harms of CIH use

Experienced benefits were assessed with the question: ”Which of the mentioned benefits have you experienced resulting from using CIH (visiting providers, using natural remedies and self-help practices) during the last 12 months?”. Experienced harms were assessed with the question: ”Which of the mentioned harms have you experienced resulting from using CIH (visiting providers, using natural remedies and self-help practices) during the last 12 months?”. The respondent could choose all the options which applied, which was analysed as a ”Yes” response. The options which the respondent did not choose were analysed as a ”No” response. If the respondents chose the option ”No benefits” in the case of benefits, “No harms” in the case of harms, or ”I do not know” in either case, all other response options were automatically excluded by the data collection programme. The included experienced benefits and harms are listed in Table 2.

Table 2

Answer options for experienced benefits and harms from using CIH.
Experienced benefits	Experienced harms
Eased pains, aches, tightness, or other ailments	Money was wasted, as I did not get help
Relieved stress, sleeplessness, depression, or anxiety	I was cheated
Increased mental well-being, energy, or everyday functionality	Pains, aches, or ailments became worse
Decreased medication use	I felt hurt or treated inappropriately
I felt heard and seen with my ailments and problems	Other, harm what?
Gave support, faith or hope in solving my problems	No harms^b
Other, benefit what?	I do not know^b
No benefits ^a
I do not know ^a

^a If chosen by the respondent, all other options for experienced benefits were automatically excluded by the data collection programme.

^b If chosen by the respondent, all other options for experienced harms were automatically excluded by the data collection programme.

The included benefits and harms were chosen based on earlier research ^6,30 to explore the experienced benefits and harms at the population level. The answer options were formulated and finalised by the research team. To decrease the time burden of the full questionnaire, experienced benefits and harms were assessed for general CIH use instead of assessing them for each individual CIH modality. The original Finnish answer options of both experienced benefits and harms are presented in the supplementary materials (Supplementary Table 1).

Open-ended ”Other, what?” responses for both experienced benefits (n = 53) and harms (n = 17) were read through by the research team. Most responses were classified as genuine answers (e.g., for benefits ”Maintaining mobility”; for harms ”The ailment eased only for a moment”). However, five respondents reported in their answers not having used CIH in the 12 months prior to taking part in the survey despite belonging to the researcher-defined CIH user-group, and thus were excluded from all of the following analysis.

Statistics

Data were weighted based on age, gender and region of residency. Between-group differences in respondent characteristics in relation to the intention to use CIH in the future were tested by using Pearson’s chi-square test (Table 3). Pearson’s correlations between experienced benefits and between experienced harms are presented in the supplementary materials (Supplementary table 2; Supplementary table 3).

Association between intention to use CIH (no/unsure; yes) and SRH (good; average; poor; ”I do not know”), experienced benefits (no experienced benefits; at least one experienced benefit; ”I do not know”), experienced harms (no experienced harms; at least one experienced harm; ”I do not know”), and the individual experienced benefits and harms (no; yes) are described with proportions and odds ratios (ORs) with their 95% confidence intervals (95%CI) (Table 4, Table 5).

Table 3

Distribution of respondent characteristics in CIH users (n = 1652).
		n (%) of total n = 1652	%Intends to use CIH	p
Age In years	Mean age in years (SD)	46.2 (18.3)
Age	16–29 years	366 (22.1)	45.4	< .001
	30–59 years	836 (50.6)	63.5
	60 years and above	450 (27.3)	61.0
Gender	Female	967 (58.5)	64.9	< .001
	Male	685 (41.5)	50.1
Income ^a	Low	482 (29.2)	54.8	< .001
	Middle	278 (16.8)	65.1
	High	648 (39.2)	59.6
	I do not know	241 (14.6)	57.9
Highest obtained education^b	Primary and lower secondary school	112 (6.8)	54.5	.778
	Upper secondary and vocational college education	814 (49.3)	59.1
	Bachelor’s degree or higher vocational degree	409 (24.8)	57.5
	Master’s degree or higher	302 (18.3)	62.6
Place of residence	Helsinki-Uusimaa	512 (31.0)	54.1	.080
	South Finland	317 (19.2)	61.2
	West Finland	423 (25.6)	59.2
	North and East Finland	399 (24.1)	62.6

^a 2 respondents (0.1%) did not respond to the item asking about their income.

^b 15 respondents (0.9%) responded “Other” or did not report their educational information.

Table 4

Results of the logistic regression analyses with unadjusted odds ratios (ORs) and 95% confidence intervals (CI95%).
		n	%	%Intends to use CIH	OR	CI95%	p
SRH							.018
	Good	876	53.0	60.2	1.00
	Average	511	30.9	59.6	0.97	0.78 to 1.21
	Poor	248	15.0	53.6	0.76	0.57 to 1.01
	I do not know or want to answer	17	1.0	25.0	0.24	0.08 to 0.70
Experienced Benefits							< .001
	No	137	8.3	10.2	1.00
	Yes, at least one	1320	79.9	69.3	19.3	11.05 to 33.80
	I do not know	194	11.7	21.1	2.31	1.21 to 4.41
Experienced Benefits, individual items (No / Yes)
	Eased pains, aches, tightness, or other ailments	872/780	52.8/47.2	38.4/81.5	7.06	5.63 to 8.85	< .001
	Relieved stress, sleeplessness, depression, or anxiety	1013/638	61.3/38.7	48.4/75.2	3.23	2.60 to 4.02	< .001
	Increased mental well-being, energy, or everyday functionality	951/701	57.6/42.4	47.5/74.0	3.15	2.55 to 3.89	< .001
	Decreased medication use	1445/205	87.6/12.4	55.5/82.0	3.72	2.56 to 5.40	< .001
	I felt heard and seen with my ailments and problems	1471/180	89.1/10.9	55.7/83.4	4.04	2.69 to 6.07	< .001
	Gave support, faith or hope in solving my problems	1392/260	84.3/15.7	55.0/78.8	3.05	2.23 to 4.19	< .001
	Other, what?	1603/48	97.1/2.9	58.7/62.5	1.18	0.65 to 2.13	.589
Experienced harms							< .001
	No	1176	71.2	69.7	1.00
	Yes, at least one	248	15.0	37.9	0.27	0.20 to 0.35
	I do not know	227	13.8	24.7	0.14	0.10 to 0.20
Experienced Harms, individual items (No / Yes)
	Money was wasted, as I did not get help	1537/115	93.0/7.0	61.2/26.1	0.22	0.15 to 0.34	< .001
	I was cheated	1594/54	96.7/3.3	59.8/27.8	0.27	0.15 to 0.49	< .001
	Pains, aches, or ailments became worse	1592/59	96.4/3.6	58.8/58.3	0.99	0.58 to 1.67	.966
	I felt hurt or treated inappropriately	1602/50	97.0/3.0	59.5/36.0	0.39	0.22 to 0.71	.002
	Other, what?	1638/14	99.1/0.9	58.7/64.3	1.26	0.42 to 3.76	.681

Adjusted ORs for SRH were computed with binary logistic regression analyses. Gender, age, income, education and place of residence were used as adjusting variables. Backwards binary logistic regression analyses were used for both experienced benefits and harms, with SRH, gender, age, income, education and place of residence used as adjusting variables. Backwards selection was used to find the strongest indicators (experienced benefits and harms) related to the intention for future CIH use. P-value > 0.01 was used to reject variables from the models.

All results reported in the Results-section (see below) are based on weighted data. The data were analysed using IBM SPSS Statistics (version 28).

Basic respondent characteristics

Out of the 3244 respondents who completed the survey, 1657 (51.1%) were categorised as CIH users, whereas 1587 (48.9%) were categorised as non-users. Five respondents, who were categorised as CIH users but who explicitly stated otherwise in their answers for open-ended questions, were excluded from the analysis (see: Experienced benefits and harms of CIH use in Methods). In the final CIH user group used in all analysis (n = 1652), women constituted 58.5% of the respondents. The mean age was 46.2 years (SD = 18.3) (Table 3).

Intention to use CIH

In the CIH user group, 58.8% of the respondents intended and 26.6% did not intend to use CIH in the future. Respondents who answered ”I do not know” constituted 14.6% of the CIH user group. In the non-user group, 24.7% intended and 56.3% did not intend to use CIH in the future. Respondents who answered ”I do not know” constituted 19.0% of the non-user group. All of the following analysis were conducted by using the CIH user respondents (n = 1652).

The association between intention to use CIH, SRH, and experienced benefits and harms

Out of the CIH user respondents, 53.0% reported being in good health, 30.9% in average health, 15.0% in poor health, and 1.0% responded ”I do not know or want to answer” (Table 4). Logistic regression analyses were conducted for the association between CIH users’ intention to maintain CIH use and SRH. Unadjusted ORs showed SRH to be associated with intention to use CIH (p = .018), which was due to the difference between the respondents who chose the "I do not know or want to answer" option and the other respondents. However, based on the adjusted ORs SHR was not found to be statistically significantly associated with intention to use CIH in the future (p = .070) (Table 5).

Respondents who reported having experienced at least one of the included benefits comprised 79.9% of the total CIH users (Table 4). The rest of the respondents reported not having experienced any (8.3%) or were unsure about having experienced benefits from CIH use (11.7%). When asked about experienced harms, 15.0% of the respondents reported having experienced at least one, 71.2% reported not having experienced any harms, and 13.8% were unsure about experiencing harms from CIH use.

Logistic regression analyses were conducted for the association between CIH users’ intention to maintain CIH use, and experienced benefits and harms relating to CIH use. Unadjusted ORs and confidence intervals were calculated between the intention to use CIH, and experienced benefits and harms (Table 4). Overall, having experienced at least one type of benefit from CIH use was related (OR = 19.3, 95%CI = 11.1 to 33.8) to the intention to use CIH in the future compared to those who had not experienced any benefits. Having experienced at least one type of harm from CIH use was inversely related (OR = 0.27, 95%CI = 0.20 to 0.35) to intention to use CIH in the future compared to those who had not experienced any harms.

Out of the included experienced benefits, all but “Other, what?” were found to be associated to the intention to use CIH in the future. Experienced benefit “Eased pains, aches, tightness, or other ailments” (OR = 7.06, 95%CI = 5.63 to 8.85) had the strongest association to the intention to use CIH in the future. Three out of the included harms were found to be inversely associated to the intention to use CIH in the future. The strongest inverse association to the intention to use CIH in the future was with the experienced harm ”Money was wasted, as I did not get help” (OR = 0.22, 95%CI = 0.15 to 0.34).

[Table 4 HERE]

Adjusted ORs and confidence intervals were calculated between the intention to use CIH and experienced benefits and harms (Table 5). Out of the included experienced benefits, four were found to be statistically significantly associated with the intention to use CIH in the future. The benefit with strongest association was “Eased pains, aches, tightness or other ailments” (OR = 5.96, 95%CI = 4.67 to 7.61). Out of the included harms, only one (“Money was wasted, as I did not get help”; OR = 0.26, 95%CI = 0.17 to 0.40) was found to be statistically significantly associated with the intention to use CIH in the future.

Table 5

Results of the logistic regression analyses with adjusted odds ratios (ORs) and 95% confidence intervals (CI95%).
		OR	95%CI	p
a) ^a	SRH			.070
	Good	1.00
	Average	0.93	0.74 to 1.17
	Poor	0.74	0.55 to 0.99
	I do not know	0.35	0.11 to 1.08
b) ^b	Experienced benefits
	Eased pains, aches, tightness or other ailments			< .001
	No	1.00
	Yes	5.96	4.67 to 7.61
	Relieved stress, sleeplessness, depression or anxiety			< .001
	No	1.00
	Yes	2.67	2.04 to 3.49
	Increased mental well-being, energy or everyday functionality			< .001
	No	1.00
	Yes	2.31	1.79 to 2.97
	Gave support, faith or hope in solving my problems			.002
	No	1.00
	Yes	1.82	1.24 to 2.67
c) ^b	Experienced harms
	Money was wasted, as I did not get help			< .001
	No	1.00
	Yes	0.26	0.17 to 0.40

^a ORs adjusted for gender, age, place of residence, income and education.

^b Logistic regression analysis with backwards selection. Model includes experienced benefits/harms with p < 0.01. ORs adjusted for SRH, gender, age, place of residence, income and education.

Additionally, to further assess the robustness of the findings, all the analyses detailed above were conducted with the respondents who chose the “I do not know or want to answer” option excluded. The results of these analyses are presented in the supplementary materials (Supplementary table 4; Supplementary table 5).

This study sought to investigate the association between the intention to use CIH in the future and SRH, experienced benefits, and experienced harms of CIH use in a sample of Finnish CIH users. As hypothesised, having experienced at least one type of benefit from CIH use was associated with the intention to maintain CIH usage, whereas having experienced at least one type of harm was found to be inversely related to the intention to use CIH in the future. SRH was found not to be associated with the intention to use CIH in the future.

The results show that the majority (58.8%) of the CIH users surveyed intended to maintain their CIH use regardless of their SRH status. Moreover, the continuation of CIH use was more likely to be associated with the experienced benefits and harms of CIH use than SRH of the user. The finding that SRH was not associated with continuation of CIH use could be explained by earlier research suggesting that CIH is used not only for treating illnesses or related symptoms ^2,27 but also for non-medical reasons such as improving general well-being ^10,19,27. Using CIH for this type of ”health self-management” ²² thus encompasses more than using CIH for strictly medical purposes, possibly partly explaining why no clear association between SRH and intention to use CIH in the future could be found in this study. As the survey which was used in the current study focused on prevalence of use of CIH, health-related information was not collected with more detail (e.g., presence of chronic disease). Future research needs to detail further the association between health status and intention to use specific CIH modalities.

Overall, having experienced at least one type of benefit from CIH use was strongly related to intention to continue CIH use compared to those who had not experienced any benefits. The most remarkable association was found for the experienced benefit ”Eased pains, aches, tightness or other ailments”, indicating that the intention to maintain CIH use was related to the CIH users´ strive for alleviation of pain and other physical ailments. The experienced benefit related to relieved stress, sleeplessness, depression or anxiety was also found to be related to intent to use CIH, whereas money going to waste due to CIH use being unhelpful was found to be inversely related to the intention to maintain CIH use. As shown in earlier studies, the perceived effectiveness or lack thereof seems an important factor in whether or not someone intends to maintain their CIH usage ^17,18,21. These experienced benefits and harms highlight the importance of the experienced everyday effectiveness of CIH. In line with CCM ²¹, it seems that the respondents of this study base their intentions of CIH use maintenance at least partly on everyday outcomes of CIH.

Our results showed how intention to maintain CIH use was related to experienced benefits of increased mental well-being, everyday functionality and CIH use giving support, faith and hope in solving one’s problems. In the current study, increased well-being and everyday functioning was the second most commonly reported experienced benefit (42%) after easing of pain or related ailment (47%). These results highlight the wide range of the experienced benefits of the respondents, as intention to use CIH in the future was not only found related to reduction of a symptom or an ailment. The benefits of increased well-being and getting support could be seen as resembling the symbolic values presented in CCM, particularly the idea of emphasising whole person treatments mentioned by Sirois et al. ^21,22. Examining continued CIH use through a health consumer lens in the case of the current study is suitable, as our results show that experiencing CIH as effective and not a waste of money is associated to the intention to maintain its use. Overall, our results offer indirect yet clear support to the usage of CCM in explaining the maintenance of CIH use.

In our study 15% of the respondents reported having experienced at least one type of harm relating to their CIH use. In future studies it would be important to explore whether some CIH modalities are more likely to cause harm to its users than others. Most CIH modalities are not currently incorporated into the health care system in Finland, yet its users report helpfulness of the used modalities ¹⁰ and as according to our findings, 58.8% of CIH users intend to use CIH in the future. Thus, the possibilities of applying evidence-based CIH modalities for health promotion and pain management, and to limit the harm caused by CIH use should be further explored. Moreover, the finding that experienced everyday effectiveness of the used modalities of CIH has such a strong association with the intention to use CIH, suggests that both the economic and health consequences of CIH use deserve attention in public health research.

Our study included 27 distinct CIH modalities, and an earlier study on the same data showed that the most important reason for use depended highly on the CIH modality in question ¹⁰. The results of this study suggest that benefits experienced from CIH use seem strongly associated with continued use of CIH. It remains for future research to assess the associations between the experienced benefits and harms of specific CIH modalities and the intention to continue their use.

Limitations

The results of this study are not without limitations. It was outside of the scope of the survey to detail the experienced benefits and harms for each of the included CIH modalities. There are still clear difficulties in determining a ”CIH user”, as the definitions of which modalities are included into the umbrella term of CIH are dynamic. In this study, the researcher-defined “CIH user” could have excluded people who perceived themselves as CIH users but had not used CIH in the 12-months prior to taking the survey. Similarly, as evident from the open-ended answers to experienced benefits and harms, some people who were defined as CIH users did not perceive themselves as such. Additionally, the current study did not assess ethnicity, yet this should be considered in future CIH-use related studies in Finland. For example, more attention should have been paid to Sámi representation in designing the survey, as the survey did not detail any modalities of Sámi traditional medicine which differ from the surveyed CIH modalities (e.g., traditional helper)³¹. Lastly, recall bias might have influenced respondents’ answers in which CIH modalities they had used ³² or the benefits and harms they had experienced.

This study examined the relationship between CIH users’ intent to use CIH in the future, and SRH, experienced benefits and harms from CIH use in Finland. Having experienced benefits from CIH use was related to intention to maintain CIH usage, whereas having experienced harms was inversely related to the intention. Easing of pain or related ailment was found to be the most strongly related benefit to the intention to use CIH in the future, whereas money being wasted on CIH was found to be inversely related to the intention. CIH was used by both respondents of poor and good SRH. The intention to continue CIH use was not found to be associated to SRH, possibly due to CIH being used both for treatment of various health conditions, and for health promotion to maintain well-being. Our results suggest that the intention to use CIH is related to the experienced everyday effectiveness of the used CIH modalities. The results provide information for planning CIH policy and legislation in Finland.

Acknowledgements. We acknowledge Kantar Public for collecting the data.

Authors’ contributions PA, SA and KH conceived the study and translated the I-CAM-Q questionnaire from English and Norwegian to Finnish. MPy and MPa performed the initial and final analyses. MPy and PA drafted the initial version of the paper and all authors reviewed subsequent versions and read and approved the final manuscript.

Funding The data collection of this study has been funded by Lapsi ja Luonto Säätiö (Child and Nature Fund), Helsinki, Finland. No further funding was received.

Competing interests The authors have no competing interests.

Availability of data and materials The dataset this paper has been based on has not been deposited in any repository. All dataset and materials are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate. An informed consent to participate in the survey was obtained from each respondent. This study does not cause any potential risks or harm to survey respondents, and it meets the ethical requirements of research with human participants according to The Finnish National Board on Research Integrity guidelines. The ethical approval was deemed unnecessary by the Academic Ethics Committee of the Tampere region. According to a statement from the Academic Ethics Committee of the Tampere region, ethical review is to be carried out prior to gathering data only if the research contains one or more of the following factors: 1) Participation in the research deviates from the principle of informed consent (participation is not, for example, voluntary, or the subject is not given sufficient or correct information about the research), 2) The research involves intervening in the physical integrity of research participants, 3) The focus of the research is on minors under the age of fifteen, without separate consent from a parent or carer, or without informing a parent or carer in a way that would enable them to prevent the child’s participation in the research, 4) Research that exposes participants to exceptionally strong stimuli, 5) Research that involves a risk of causing mental harm that exceeds the limits of normal daily life to the research participants or their family members or others closest to them, 6) Conducting the research could involve a threat to the safety of participants or researchers or their family members or others closest to them. Our research does not contain any of the aforementioned factors.

Consent for publication Not applicable.

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No competing interests reported.

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You are reading this latest preprint version

The relationship between experienced benefits and harms of using complementary and integrative health approaches and intention to maintain their use in Finland

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Abstract

Background

Methods

Results

Conclusions

Background

Aims

Materials and methods

Sampling and recruitment

Measures

Intention to use CIH

Self-rated health (SRH)

Experienced benefits and harms of CIH use

Statistics

Results

Basic respondent characteristics

Intention to use CIH

The association between intention to use CIH, SRH, and experienced benefits and harms

[Table 4 HERE]

Discussion

Limitations

Conclusions

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1