In Norway, a national cross-sectional survey was carried out between April 28 and May 5 2020 using computer-assisted telephone interviews. The survey was conducted in collaboration with the marketing research company Ipsos A/S and had a target sample of 1000 people, representing the Norwegian population of 5.4 million inhabitants [13]. The sample was stratified by sex, age and region of residence and drawn from Norwegian residents aged 16 and above living in private households with a landline telephone or a cell phone using random quota sampling. Up to 7 attempts were made to reach the selected person. N=4,337 were unreachable after 7 calling attempts (figure 1). Individuals who were reached and refused participation (n=1,881) were considered non-respondents, leading to a response rate of 34.5%. The final sample contained 1008 individuals, 487 women and 521 men (figure 1).
Survey instrument
A COVID-19 adapted version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q) was used [11, 14] addressing COVID-19 related use in addition to use for acute illness, chronic illness, well-being and other, unspecified reasons. The survey consisted of three parts: The first part related to CAM use offered by CAM providers, the second part included questions regarding use of natural remedies and dietary supplements while the third part included questions related to self-help practices such as mindfulness, yoga, and relaxation techniques. In all parts, the questions referred to use during the last three months. Demographic characteristics collected were sex, age, level of education, household income and place of residence. All data were anonymously collected and reported.
Measures
Measures of personal characteristics
Age was obtained as an open question and assessed as a continuous variable as well as categorical after being devided into four groups; 16-24 years; 25-39; 40-59 years; and 60 year or more.
Level of education was collected using six categories: 1. Primary school up to 8 years; 2. primary school up to 10 years; 3. secondary school; 4. college/university less than 4 years; and 5. college/university 4 years or more. These were merged into primary school (1-2); secondary school (3); and college/university (4-5).
Household income was collected using the following categories (NOK <100,000, 100,000-199,000, 200,000-299,000, 300,000-399,000. 400,000-499,000, 500,000-599,000, 600,000-799,000, 800,000-999,000, 1000,000-1500,000 and more than NOK 1500,000). These categories were merged into low household income (<NOK400,000), middle household income (NOK 400,000-799,000) and high household income (NOK 800,000 or more).
Other personal characteristics included sex (female, male) and residence (merged into the Norwegian regions South-East, South, West, Mid (Trøndelag), and North).
CAM providers
The measure consultations with CAM providers were specified by visits to massage therapists, naprapaths, acupuncturists, coaches, healers, homeopaths, cupping therapists, herbalists, traditional healers, osteopaths, kinesiologists, and other CAM providers.
The respondents were asked whether they had consulted one or more CAM providers and if yes; reasons, benefit, and possible adverse effects of the treatments.
Natural remedies and dietary supplements
Use of natural remedies and dietary supplements were mapped by providing the respondents with a list of remedies organized as herbs (ginger, curcumin, garlic, green tea, herbal tea, cranberry, blueberry/blueberry extract, oregano, echinacea, chaga, and other), vitamins and minerals (vitamin B, vitamin C, vitamin D, magnesium, calcium, iron, zinc, selenium, and other vitamins and minerals), homeopathic remedies, Bach flower remedies, and dietary supplements (Omega 3, 6 or 9, protein shake, Q10, and other dietary supplements). The respondents were asked whether they had used one or more of these remedies, and if yes; reasons, benefit, and possible adverse effects of this use.
Self-help practices
Use of self-help practices were measured by specific questions regarding the use of meditation, yoga, qigong, tai chi, relaxation, visualization, mindfulness, lightning process, neuro-linguistic programming (NLP), participation in traditional healing rituals, and other self-help practices. The respondents were asked if they had used these self-help practices and further; why, whether they found it to be beneficial, and if they experienced adverse effects.
Over-all use of CAM
Over-all-CAM use was measured by calculating the total number of CAM users reported, combining the variables modalities provided by CAM providers, natural remedies and dietary supplements, and self-help practices.
Statistics
Descriptive statistics were carried out using Statistical Package for Social Sciences (SPSS) v. 26.0. Pearson’s chi-square tests, Fisher exact tests, and T-test were performed to identify differences in sociodemographic factors (age, education level, household income) between men and women and between CAM users and non-CAM users.