Complementary Therapies in Medicine (2010) 18, 95103

available at www.sciencedirect.com

journal homepage: www.elsevierhealth.com/journals/ctim

Complementary alternative medicine (CAM) use in

Ireland: A secondary analysis of SLAN data
Patricia Fox a,, Barbara Coughlan a, Michelle Butler a, Cecily Kelleher b

a
UCD School of Nursing, Midwifery & Health Systems, Health Sciences Centre, Beleld, Dublin 4, Ireland
b
UCD School of Public Health & Population Science, Woodview House, University College Dublin, Beleld, Dublin 4, Ireland
Available online 1 March 2010

KEYWORDS Summary
Purpose: National prevalence studies on CAM use have been undertaken internationally, how-
Complementary
ever, to date no such studies have been performed in Ireland. The aim of this study was to
alternative medicine;
estimate the prevalence of CAM use among the general population in Ireland and to identify
CAM;
characteristics of typical Irish CAM users.
Ireland;
Methods: A descriptive, quantitative design was used. A secondary data analysis of the SLAN
Secondary analysis;
(National Survey of Lifestyles, Attitudes and Nutrition) 1998 (N = 6539) and 2002 (N = 5992) sur-
Prevalence;
veys was undertaken, allowing access to data from a representative cross-section of the Irish
Survey;
adult population. Use of CAM was determined by whether or not respondents had ever attended
Predictors;
a CAM practitioner. 2 test for independence of categorical variables and multivariate logistic
SLAN
regression analysis were used (stepwise function of SPSS software).
Results: The prevalence rate for visits to CAM practitioners increased from 20% in 1998 to 27%
in 2002. Similar to international ndings, Irish CAM users are more likely to be well educated,
afuent, middle-aged and employed. Self-employed persons in particular are more likely to
visit CAM practitioners (a nding not commonly reported internationally). Irish persons suffering
from pain, anxiety and depression are also more likely to use CAM.
Conclusions: Use of CAM is increasing among the Irish general population and predictors of CAM
use in this study are broadly similar to those found internationally. The prole constructed from
our study should assist health professionals to identify those persons who may wish to use CAM
so that appropriate verbal/written guidance may be provided.
2010 Elsevier Ltd. All rights reserved.

Contents

Introduction............................................................................................................... 96
Methods ................................................................................................................... 97
Data source and sample .............................................................................................. 97
Statistical analysis.................................................................................................... 97

Corresponding author. Tel.: +00135317166476.

E-mail address: patricia.fox@ucd.ie (P. Fox).

0965-2299/$ see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctim.2010.02.001
96 P. Fox et al.

Results .................................................................................................................... 97
The prevalence of CAM use in Ireland................................................................................. 97
The prole of Irish CAM users......................................................................................... 97
Socio-demographics............................................................................................ 97
Health status .................................................................................................. 99
Discussion ................................................................................................................ 101
Conclusion ............................................................................................................... 102
Acknowledgement........................................................................................................ 102
References ............................................................................................................... 102

Introduction extensive process of harmonisation and development2 for

Consistent with Irish common law traditions, comple-
mentary alternative medicine (CAM) practitioners have
historically been free to practise their therapies in Ireland;
however, in 2001, the Government indicated their intention
to regulate the sector.1 Following a consultative process with
CAM practitioners and on the recommendations of an initial
report1 commissioned by the Minister for Health and Chil-
dren, a Working Group was established in 2003 to examine
and consider regulatory issues in this area.2 The Work-
ing Group concluded that the CAM community in Ireland
was a very disparate one with varying levels of exper-
tise, training and level of association with national and
international associations. In addition, when compared to
other countries, Ireland was at a slightly earlier stage of
developing robust systems of professional associations and
federations.2 Issuing its report in 2005, this Working Group
recommended statutory regulation for herbalists, acupunc-
turists and Traditional Chinese Medicine (TCM) practitioners
and a robust system of voluntary self-regulation for all
other CAM practitioners.2
When launching the report in May 2006, the Minister
indicated the Governments intention to initially support
voluntary self-regulation of the sector.3 Also, on the recom-
mendations of the Working Group, an information leaet4
was launched to safeguard and guide members of the public
who may wish to avail of the services of CAM practitioners.4
More specically, this information leaet advises that good
complementary practitioners will not dissuade patients
from attending their doctor or another CAM practitioner, and
they will not advise patients to stop taking their prescribed
medications. Potential CAM users are also recommended to
ask practitioners about their membership of professional
associations and qualications.4
While the reports which examined the regulation of
CAM noted that there has been a growing interest in and
use of CAM therapies,1,2 no prevalence studies of CAM use
have been conducted in Ireland. Although numerous inter-
national studies have been undertaken520 and the value
of their respective ndings is indisputable, data on Irish
CAM users is necessary to provide a clearer picture of the
extent of CAM use among the Irish population and more
importantly to construct a prole of a typical Irish CAM
user. Noting the general prole of Irish CAM users, con-
ventional providers will be better positioned to target the
aforementioned information leaets to those persons who
are most likely to use CAM. In addition, the ndings may
inform the work of the CAM sector as they continue with the
self-regulation.
The Survey of Lifestyles, Attitudes and Nutrition (SLAN) is
a representative survey of a cross-section of the Irish adult
population, rst conducted in 1998 and repeated in 2002.21
A secondary analysis of SLAN data was undertaken on 1998
and 2002 data to rstly, estimate the prevalence of CAM vis-
its among the general population of Ireland and secondly to
explore the characteristics of a typical Irish CAM user (no
data had been collected on self-prescribed CAM use in the
SLAN surveys). The purpose of this paper is to present these
ndings with particular emphasis on the socio-demographic
and health-related characteristics associated with CAM use
among the Irish population. Information on the type of CAM
practitioners visited was not accessible from the 1998 sur-
vey so the information presented pertains only to the 2002
survey. Prior to this, the ndings of international CAM preva-
lence surveys are briey discussed.
International prevalence studies conducted up to and
during the 1990s have been examined in two systematic
reviews published in 2000.19,20 Although 12 papers met the
respective inclusion criteria in both cases, only half the
surveys5,710 were common to both, an outcome most likely
due to different inclusion criteria with regard to sampling
and exclusion (or not) on the basis of language. According
to Ernst, the prevalence rates for CAM use varied from 9%
to 65% across the different countries surveyed (US, Canada,
Australia, Scotland, Austria, Germany, China) although the
highest estimate for one-year prevalence was 42%. The
considerable variance was attributed to the problem of
inconsistent denitions of CAM and different time-frames of
use. The author concluded that although the true prevalence
of CAM among the general population remains uncertain,
it is likely that the popularity of CAM is increasing.19 In
addition, the survey ndings were generally consistent with
respect to the typical prole of CAM users; that is, the sur-
vey authors primarily reported that CAM users were more
likely to be women, afuent, middle-aged, well educated
and Caucasian. The other systematic review undertaken
by Harris and Rees (2000) also concluded that it is most
likely that CAM is increasing in popularity with chiroprac-
tic and massage being the most popular therapies. Uptake
of CAM in the previous year across the different studies
ranged from 6% to 23% for visits to CAM practitioners and
25.1% to 48.5% for self-prescribed CAM.20 Of note, pre-
dictors of CAM use were not addressed in this systematic
review.
Surveys conducted subsequent to these systematic
reviews reported CAM prevalence in the previous year
Complementary alternative medicine (CAM) use in Ireland
ranging from 10% to 44.1%12,15,16 for visits to CAM prac-
titioners and 38% to 74.8%12,1518 for use of at least
one form of CAM. With respect to visits to CAM prac-
titioners, the most popular therapies were chiropractic,
acupuncture, osteopathy, and homeopathy, while non-
prescribed vitamins and herbal supplements appear to be
the most commonly used self-prescribed CAM.1114,16,18 In
general, the characteristics associated with CAM use have
remained consistent across the surveys conducted over
time. For the most part, CAM use is reported to be higher
in females,5,7,8,1014,1618 middle-aged persons,5,8,10,1215,17,18
those with higher incomes,5,7,8,10,13,16,17,18 and those who are
more educated.5,7,10,1118 Use of CAM has also been asso-
ciated with chronic health conditions 5,8,10,13,14,17 and poor
self- perceived health status.11,18 Importantly, over 50% of
CAM users have not discussed their use of CAM with their
doctors. 5,7,10,15,16
Methods
The purpose of this secondary analysis was to estimate the
prevalence of CAM visits among the general population of
Ireland and to explore the characteristics of a typical Irish
CAM user.
Data source and sample
In 1998, 6539 persons completed the SLAN survey while
5992 persons participated in 2002 giving a response rate of
53.4%.21 In both SLAN surveys, respondents were asked if
they had ever in their lifetime attended a CAM practitioner.
If they answered yes, they were asked to state what type
or types of practitioners they had visited. They were also
asked to indicate for what reason they attended the CAM
practitioner, whether it was for treatment for aches and
pains/muscle problems, stress, weight loss, ear, nose and
throat problems, skin problems, to help quit smoking, or
other problems. Survey participants were not asked about
self-prescribed CAM use.
Statistical analysis
The secondary analysis was carried out separately on the
1998 and 2002 SLAN data to examine CAM use in an Irish
population. A series of 2 tests were used to examine the
socio-demographic background and health status of those
who did and did not use CAM. The standard p < .05 level of
statistical signicance was used to identify signicant rela-
tionships in the groups. Where signicant relationships were
observed, those variables were then entered into a logistic
regression model to determine their predictive capability
using the stepwise function (forward LR) of SPSS software
(version 11). Tests of the multivariate models for 1998 and
2002 with all the predictors, against constant only mod-
els were statistically signicant 2 (45, N = 5640) = 848.053
p = .000, 2 (34, N = 5051) = 786.489, p = .000, respectively,
indicating that the predictors as a set reliably distin-
guished between CAM users and non-CAM users. In 1998,
the model correctly classied 81.6% of cases, a negligible
improvement over the constant only model, which correctly
97
classied 80% of cases. In 2002, the model correctly clas-
sied 74.7% of cases, in comparison to the constant only
model, which correctly classied 71.6% of cases. The Cox &
Snell and Nagelkerke R2 values provide an indication of the
amount of variation in the dependent variable explained by
the model.22 The Model summary for 1998 indicated that
between 14% and 22% of the variability for CAM use in 1998
is explained by the model; this gure is 1421% for the 2002
model.
Results
The prevalence of CAM use in Ireland
The overall prevalence rate for CAM use (visits to CAM prac-
titioners) in Ireland in 1998 was 20% increasing to 27% by
2002 (Table 1). The most popular therapies in 2002 were
acupuncture (7.8%), reexology (7%), homeopathy (6.2%),
chiropractic (3.3%) and osteopathy (1.2%).
The prole of Irish CAM users
For the purpose of this study, the prole of a typical Irish
CAM user was examined under two main headings (1) Socio-
Demographic and (2) Health Status. All signicant predictors
were used to build the prole of an Irish CAM user.
Socio-demographics
The Socio-demographic information from 1998 and 2002 is
presented in Tables 1 and 2. The rate of CAM use was greater
for females than for males. An increase in the numbers
of both sexes use of CAM providers was evident between
1998 and 2002 (Table 1). Individuals most likely to use CAM
were aged between 40 and 59 years, in both 1998 and 2002,
respectively (Table 1). In 2002, over one third of those aged
4059 years used CAM in contrast to one quarter of the
younger age group and less than one fth of the older age
group.
Married/cohabiting couples and separated or divorced
persons were more likely to attend a CAM practitioner than
widowed or single/never married persons (Table 1). In 2002,
a signicant relationship was evident between use of CAM by
separated or divorced persons and those who were widowed.
Respondents with no formal education/primary or some
secondary education had a much lower uptake of CAM than
those with third level education (Table 1). In 2002, less than
one fth of the less well-educated group used CAM in con-
trast to well over one third of those with higher educational
attainment. Self-employed persons were more likely to avail
of CAM than those who were homemakers, seeking work
for the rst time, unemployed, or retired for both years
(Table 1). In general, those with higher incomes were more
likely to avail of CAM than less well off persons in 1998 and
2002, respectively (Table 1). In 2002, those earning greater
than D 450 per week were more likely to use CAM than those
earning less than D 190 per week. Of interest, those who
earned more than D 760 per week were less likely to use CAM
than those earning between D 450 and D 760. Individuals in
possession of a medical card were less likely to visit a CAM
provider than those who did not have a medical card in 1998
and 2002, respectively (Table 1). On the other hand, those
98 P. Fox et al.

Table 1 Univariate associations between CAM use and demographic variables.

SLAN survey 1998, N = 6539 2002, N = 5992

Attended CAM Attended CAM

Gender
Female 23.2%, n = 752 p = .000 31.5%, n = 1077 p = .000
Male 16.2%, n = 460 22.2%, n = 531
Age
1839 yearsa 19.6%, n = 593 p = .000 25.2%, n = 561 p = .000
4059 years 23.4%, n = 425 35%, n = 789
60+ years 15.6%, n = 188 19.3%, n = 250
Educational status
None/primaryb 13.7%, n = 363 p = .000 17.7%, n = 374 p = .000
Completed secondary 20.7%, n = 272 30.1%, n = 398
Third level 27.5%, n = 477 36.5%, n = 668
Marital status
Married/cohabiting 22%, n = 719 p = .000 29.9%, n = 1017 p = .000
Widowed 14.9%, n = 63 18.7%, n = 77
Separated/divorced 21.3%, n = 50 38.2%, n = 94
Single/never married 17.4%, n = 363 23.5%, n = 404
Employment status
Homemakerc 16.7%, n = 345 p = .000 22.8%, n = 402 p = .000
Employee 21.3%, n = 529 30%, n = 756
Self-employed 26.7%, n = 148 35.9%, n = 230
Student 18.2%, n = 46 26.2%, n = 37
Sick/disabled/other 20.5%, n = 87 27.3%, n = 59
Location
Urban 22.7%, n = 612 p = .000 30.4%, n = 760 p = .000
Rural 18.3%, n = 529 25.6%, n = 778
Belong to a religion
Yes 26.2%, n = 1362 p = .000
No 40.5%, n = 226
Nationality
Irish 27%, n = 1467 p = .000
Other/no nationality 40.1%, n = 111
Afuence level
Low 15.1%, n = 217 p = .000
Medium 19.7%, n = 584
High 26.4%, n = 362
Net income per week: D 20.7%, n = 341 p = .000
<190 29.9%, n = 676
190450 34.8%, n = 406
>D 450
Medical card
Yes 12.9%, n = 218 p = .000 19.6%, n = 310 p = .000
No 22.9%, n = 951 30.8%, n = 1230
Private health insurance
Yes 33.4%, n = 1034 p = .000
No 21.2%, n = 505
a Age 1539 years in 2002.
b Education category (none, primary, some secondary).
c Employment category (homemaker, seeking work 1st time, unemployed, retired).
Complementary alternative medicine (CAM) use in Ireland 99

Table 2 Univariate associations between CAM use and health status variables.

SLAN survey 1998, N = 6539 2002, N = 5992

Attended CAM Attended CAM

Satisfaction with health

Dissatiseda 28.1%, n = 184 p = .000 35.9%, n = 221 p = .000
Neither 24.2%, n = 242 30.1%, n = 290
Satised/very satised 17.4%, n = 750 25.9%, n = 1091
Work limitb
Yes 29%, n = 215 p = .000 32.6%, n = 251 p = .001
No 18.8%, n = 944 27.2%, n = 1308
Prescribed pills taken
Yes 22.6%, n = 440 p = .001 28%, n = 614 p = .769
No 18.5%, n = 772 27.6%, n = 971
Tranquil/sedative taken
Never 27.6%, n = 1441 p = .001
Once or twice 43.4%, n = 36
3 or More 49.4%, n = 40
Anxiety
Yes 31.7%, n = 129 p = .001 43.5%, n = 206 p = .001
No 19%, n = 1094 26.2%, n = 1400
Depression
Yes 30.6%, n = 140 p = .001 44.2%, n = 254 p = .001
No 18.9%, n = 1083 25.8%, n = 1352
Pain
No pain 15.9%, n = 665 p = .000 24.3%, n = 913 p = .000
Moderate pain 29.5%, n = 475 35%, n = 547
Extreme pain 28.7%, n = 27 33.3%, n = 37
Able perform usual activity
No problems 18.3%, n = 931 p = .000 26.7%, n = 1227 p = .000
Some problem 30.4%, n = 217 35.4%, n = 255
Unable 17.9%, n = 15 24.4%, n = 22
a Dissatised/very dissatised with health.
b Work or daily activity limited by long term illness, health problem or disability.

with private health insurance were more likely to visit a CAM
practitioner than those without private insurance (Table 1).
Urban dwellers were more likely to avail of CAM than
rural dwellers in 1998 and 2002, respectively (Table 1). Ques-
tions regarding nationality and religion were not asked in
the 1998 survey, therefore, the following results pertain to
2002 only. CAM use was more common among respondents
who described themselves of non-Irish nationality (Table 1).
Of this group, two fths used CAM in contrast to CAM use
in just over one quarter of Irish respondents. Those who
belonged to a religious group were less likely to visit a CAM
practitioner than those who declared no religious afliation.
The demographic variables that were predictive of CAM
are presented in Tables 3 and 5. For both years self-
employed status and higher education were found to be
predictive of CAM use. Other variables predictive of CAM
use included afuence level and non-possession of a med-
ical card in 1998 (Table 3), while age group 4059 years,
private health insurance and non-membership of a religious
group were predictive of use in 2002 (Table 5).
In summary, CAM users in Ireland are by in large women
aged between 40 and 59 years, third level educated, afu-
ent, urban dwellers and in possession of private health
insurance. Increased utilisation of CAM was also identied
among separated or divorced persons, the self-employed
(relative to other groups) and those who declare no religious
afliation.
Health status
Health Status was explored under the headings of (1) physi-
cal health and (2) mental health respectively.
Physical health. Those who reported being dissatised
with their physical health were more likely to use CAM than
those who were satised with their health in 1998 and 2002,
respectively (Table 2). In 2002, over one third of those who
reported being dissatised with their health admitted to
using CAM in contrast to CAM use among one quarter of those
who reported being satised with their health status. Those
respondents who reported that their work or daily activ-
ity was limited by health problems were more likely to use
CAM than those who reported no limitations for both years
(Table 2). Similarly, when asked about performance of usual
activity in 2002, those who reported some problems in this
100 P. Fox et al.

Table 3 1998 Multivariate analysis demographic variables.

Demographics n Sig. Odds ratio 95% CI 95% CI

a
Employment 345/2066 .000
Employee 529/2488 .110 1.172 .965 1.425
Self-employed 148/554 .000 2.000 1.520 2.633
Student 46/253 .686 .922 .623 1.366
Sick/disabled/other 87/425 .448 1.131 .823 1.556
Educationb 363/2644 .000
Secondary 272/1311 .012 1.303 1.060 1.603
Third level 477/1733 .000 1.717 1.406 2.096
Location
Rural 529/2892 .018
Urban 612/2700 .191 1.109 .950 1.294
Afuence
Low 217/1440 .032
Medium 584/2961 .161 1.150 .946 1.397
High 362/1371 .005 1.366 1.098 1.700
Gender
(Male) 460/2842 .014
Female 752/3248 .075 1.189 .983 1.439
Medical card
No 951/4161 .000
Yes 218/1696 .000 .579 .472 .711
Predictive variables are shown in bold.
a Employment category (homemaker, seeking work 1st time, unemployed, retired).
b Education category (none, primary, some secondary).

regard were more likely to use CAM than those who reported
no problems or those who were unable to perform their daily
activity (Table 2).
Persons experiencing both moderate and severe pain
were more likely to visit a CAM practitioner in contrast to
those with no pain for both years (Table 2). In 2002, one
third of those with severe pain and those with moderate pain
used CAM in contrast to less than one quarter of those with
no pain. In 1998, where prescribed medicines were taken,
there was a greater likelihood that those persons would visit
a CAM practitioner in contrast to those not taking prescribed
medicines (Table 2). However, no signicant relationship was
observed in 2002.
Mental health. In relation to mental health, respondents
complaining of anxiety were signicantly more likely to
use CAM than those who were not diagnosed with anxi-
ety (Table 2). Individuals with a history of depression were
also much more likely to avail of CAM than those who
were not depressed (Table 2). Regarding the medical treat-
ment of mental health problems in 2002, there was a
signicant relationship between the taking of prescribed
tranquillisers/sedatives and use of CAM (this question was
not asked in 1998). Of respondents who had taken tranquil-
lisers/sedatives on three or more occasions in the previous
year, almost half visited a CAM practitioner in contrast
to just over one quarter of those who had not taken

Table 4 1998 Multivariate analysis health status variables.

Health status n Sig. Odds ratio 95% CI 95% CI

a
Satisfaction with health 184/655 .009
Neither 242/1000 .815 1.032 .792 1.344
Satised/very satised 750/4311 .083 .809 .636 1.028
Pain: none 665/4172 .000
Moderate 475/1611 .000 2.617 2.204 3.108
Extreme 27/94 .000 3.472 1.955 6.168
Depression
Yes 140/457 .000 1.575 1.228 2.019
Predictive variables are shown in bold.
a Dissatised, very dissatised.
Complementary alternative medicine (CAM) use in Ireland 101

Table 5 2002 Multivariate analysis demographic variables.

Demographic variables n Sig. Odds ratio 95% CI 95% CI

Gender (female) 1077/3421 .338 1.681 .580 4.867

a
Employment 402/1766 .000
Employee 756/2517 .110 1.165 .966 1.405
Self-employed 230/640 .000 1.864 1.455 2.388
Student 37/141 .758 .931 .590 1.470
Sick/disabled/other 59/216 .965 1.009 .679 1.498
Age Group 1539 years 561/2229 .000
4059 789/2253 .000 1.796 1.530 2.108
60+ years 250/1295 .111 1.221 .955 1.562
Educationb 374/2115 .000
Complete secondary 398/1323 .000 1.584 1.300 1.931
Third level 668/1828 .000 1.809 1.481 2.211
No religion 226/558 .007
Belongs to religious group 1362/5189 .003 .716 .576 .891
No private insurance 505/2385 .002
Has private insurance 1034/3093 .000 1.320 1.132 1.538
Predictive variables are shown in bold.
a Employment category (homemaker, seeking work 1st time, unemployed, retired).
b Education category (none, primary, some secondary).

Table 6 2002 multivariate analysis health status variables.

Health status variables n Sig. Odds ratio 95% CI 95% CI

No pain 913/3750 .000

Mod pain 547/1561 .000 2.122 1.806 2.495
Extreme pain 37/111 .000 2.848 1.716 4.725
No depression 1352/5234 .000
Depression 254/575 .000 1.783 1.428 2.225
No anxiety 1400/5335 .014
Anxiety 206/474 .014 1.352 1.062 1.721
Predictive variables are shown in bold.

any prescribed tranquillisers/sedatives in the previous year
(Table 2).
The health status predictors of CAM use are presented
in Tables 4 and 6 for 1998 and 2002 respectively. The pres-
ence of moderate and severe pain was a signicant predictor
of CAM use in both years, as was depression. Anxiety was
found to be a signicant predictor of CAM use in 2002 only
(see Table 6). In summary, CAM users were more likely to
have some health problems either physical and/or mental
which interfere with daily activities and required medication
(Tables 4 and 6).
Discussion
While the results of this study are based lifetime use of CAM,
a prevalence rate of 27% is nonetheless notable consider-
ing it only includes visits to CAM practitioners. Numerous
studies10,12,13,16,18 indicate that most CAM users do not attend
practitioners and are more likely to self-prescribe CAM and
it is reasonable to assume that similar patterns exist in Ire-
land. As such, it is likely that our ndings underestimate
lifetime use of CAM in Ireland.
Similar to international research, this study has found
an increasing trend in CAM use in Ireland. The CAM practi-
tioners most frequently visited (acupuncture, reexology,
homeopathy, chiropractic and osteopathy) are similar to
those identied in other studies 7,12,15,16 although visits to
herbalists/naturopaths are more likely to be reported in
some US5,10 and Australian studies.7,12,16 Socio-demographic
predictors of CAM use in an Irish Population are education,
employment, afuence level, health insurance, age group
and religion. This study ndings of increased use of CAM
among the afuent also reects the ndings of other studies.
5,7,8,10,13,1618
Increased use of CAM among those with pri-
vate health insurance in contrast to those holding a medical
card adds weight to the argument that nancial resources
are inuential in this area and also supports international
ndings.13,16,23
The age group most likely to use CAM in Ireland also
supports the ndings of many international prevalence
studies5,8,10,1215,17,18 although Maclennan et al.7 found that
102
CAM uptake was greater among their younger respondents.
The increased uptake of CAM among the self-employed,
which is less likely to gure in international prevalence stud-
ies, may point to a desire by these individuals to stay healthy
as illness carries a much bigger nancial risk for this group.
While gender was not a signicant predictor of CAM
use, this study does support the international literature
nding that females are more frequent users of CAM than
males.5,7,8,1014,1618 The results of this study also support the
ndings of Barnes et al.13 and Ock et al.18 who reported that
urban dwellers were more likely than rural dwellers to use
CAM possibly due to increased availability of CAM practition-
ers in urban areas, although MacLennan et al.7,12 observed
greater CAM use among rural dwellers in Australia.
From a health status perspective, pain, anxiety and
depression were found to be signicant predictors of CAM
use. Dissatisfaction with health, daily activities affected by
health and the ingestion of medications were all associ-
ated with, although not predictive of CAM use. As already
identied by the SLAN surveys21 and the international
literature5,10,13,14,16 CAM is frequently used to treat prob-
lems such as chronic back and neck pain. CAM is also
frequently used for treatment of psychological illnesses such
as anxiety10,13,24 and depression.10,13,25 While our study did
not elicit if CAM was used for these conditions, it did high-
light the increased use of CAM among people with anxiety
and depression relative to those without mental health prob-
lems. With the exception of vitamins and minerals, CAM
remedies are used more frequently by women who perceived
their health as poor compared to those who do not.11,26
In a study of CAM use among American women, poorer
health status was also associated with increased CAM use.23
Our study concurs with international ndings regarding self-
perceived health status. Thorne et al.27 posit that those
with chronic illness choose CAM not out of some irrational
decision-making or unrealistic expectation of cure, rather
they choose it as one aspect of complex self-care manage-
ment. In essence, such individuals are taking responsibility
for their own health and aiming for an improved quality of
life despite their illness.
A major strength of the data on CAM uptake in the SLAN
studies is that they were collected from a large nation-
ally representative sample of Irish adults, which facilitates
determination of CAM use for a wide variety of subgroups.
The large sample size also allows for investigation of the
association between CAM use and socio-demographic and
health status variables.
Another strength of the study is that the ndings
maintained remarkable consistency over both time-points
thereby increasing condence in the prole constructed.
Limitations of the study include the use of secondary
data to determine prevalence of CAM which is likely to
underestimate the true prevalence as it does not address
self-prescribed CAM use as this was not available from the
primary data; this also limits comparison with some inter-
national studies. In addition, lifetime prevalence in contrast
to one-year prevalence limits comparison with many inter-
national studies.
As already noted, international data indicates that over
half of CAM users have not discussed their use of CAM with
their doctors. 5,7,10,15,16 This is of particular concern in the
context of greater use of CAM by individuals who have a
P. Fox et al.
physical and/or mental illness and are receiving conven-
tional treatment as evident in our results. While this study
presented ndings for CAM visits only, it is most likely that
patterns of self-prescribed CAM are similar to those found
internationally. Given the potential for complications arising
from using CAM and conventional treatments simultaneously
and most particularly in the context of the slightly ear-
lier stage2 of development of CAM services in Ireland, it is
essential that health professionals encourage their patients
to discuss their use of and/or interest in using CAM. The pro-
le constructed from our study ndings should assist health
professionals in this undertaking with a view to providing
verbal and written guidance4 to those who wish to use CAM.
This prole may also be of value to the CAM community as
they endeavour to develop and unify standards in the process
of self-regulation.
Importantly, further research is warranted to address
self-prescribed use of CAM products in Ireland. Finally if we
accept the study ndings that over a quarter of Irish people
have used CAM and that CAM use is on the increase in Ireland
similar to trends seen internationally, then it follows that
health professionals particularly doctors and nurses need to
increase their knowledge of CAM in order to provide quality,
evidence-based information on CAM to patients.
Conclusion
Similar to international ndings, CAM use appears to be
increasing in Ireland and Irish CAM users are also more likely
to be well educated, afuent, middle-aged and employed.
In this study, self-employed persons in particular were more
likely to visit CAM practitioners (a nding not commonly
reported in international studies). Irish persons suffering
from pain, anxiety and depression are also more likely to
use CAM.
Acknowledgement
We would like to thank the Irish Cancer Society who pro-
vided funding for a larger research study which included this
particular project.
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