The NAFKAM national CAM survey

Redaksjonen | | 27. Feb 2023

We monitor Norwegians' usage of complementary and alternative medicine (CAM) on a regular basis. This summary provides information on the structure of and methodology for these surveys, as well as links to the reports from the different editions of the survey.

Methodology

The survey consists of a one-time anonymous interview by telephone, of minimum 1,000 persons aged 18 years or older. From 2012-22, the field work has taken place every second year, in the week overlapping November and December.

Respondents are called after their phone number has been randomly chosen by machine; weighted in the process to achieve representativity in gender and place of residence (by region).

The questionnaire and manuscript used by the interviewers is prepared by us at NAFKAM. The interviews are carried out by agencies specializing in telephone interviews. After the field work, the agency delivers the raw data to us together with a simple report about the field work. From these, we know that over time, each interview takes approximately 8 minutes, and the response rate has varied between 9-11% through the different editions of the survey.

Respondents' anonymity

Answers to questions about usage of treatment for health-related outcomes is considered sensitive information. Yet, the interviewers do not ask of the respondent's name or other information that may identify the person called. The phone number used, is neither stored by the agency nor delivered to NAFKAM.

The respondents are informed that no information that can match their identity with their answers, is stored. They are informed that their anonymous answers will be part of a summary regarding 1.000 respondents' age, gender, usage or non-usage of CAM and supplements, etc), and that this will be made publically available in a report on NAFKAMs website.

What questions are asked?

In the survey, all respondents are initially asked a set of common demographic questions; about age, gender, place of residence, marital status, level of education and household annual gross income.

Regarding CAM, all respondents are asked whether they once or more; in the last 12 months; with a therapeutic intent (to prevent, alleviate or cure a specific health problem), have

received one or more therapies which according to Norwegian law are considered CAM (such as acupuncture, homeopathy, reiki healing or the like) from a professional provider, within or outside the public healthcare system, and/ or
used herbs/natural remedies (such as ginger, ginseng, garlic or the like), and/or
used self-help techniques (yoga, meditation, mindfulness or the like)

Those who answer that they have received a CAM therapy from a provider, are asked follow-up questions about

which of a total of 9 predefined therapies they were treated with,
if they had used other CAM therapies other than the 9, and about the names of any such
if the practitioner was listed in the public Register of Practitioners or not

As the respondents may have consulted more than one provider, and/or have used more than one therapy, the percentages for these proportions cannot be summed to 100%.

CAM users' costs and experiences

Everyone who answer that they had used one or more of the above three forms of CAM is also asked:

to estimate their yearly costs for this
if they experienced that the CAM they used improved their state of health; if it worsened their condition; and if they had experienced any adverse effects from the treatment

Health, chronic illness and use of the public health service

All respondents are also asked:

how they generally rate their own health, on a scale from very good to very bad.
if they have a long-term (chronic) illness or disorder that has been diagnosed by a MD/ GP.
how many times during the last 12 months they have consulted the public healthcare system (a MD/ GP, emergency room, physiotherapist, hospital or similar), and their possible costs for this (consultation, medicines, materials/equipment etc).

Dietary supplements

All respondents are also asked whether they have used dietary supplements (cod liver oil, vitamins/minerals, trace elements etc) in the past year, and about their possible costs for this.

This is done, even if ordinary use of dietary supplements (in line with the supplement's declaration) for maintaining one's health is not considered CAM - but due to NAFKAMs specific assignment from the health authorities to monitor the population's use of supplements. For practical purposes, we include this in our CAM survey.

The above questions and topics form the core of NAFKAM's population survey.

These are asked routinely and in the same way in each edition of the survey, so that we can track changes in the population's use over time.

In addition, there is a variable part, with different questions on different topics that vary from time to time. For example, we have asked about the respondents' lifestyle and habits, shape, mood and satisfaction, and their perceptions of various factors for quality of life.

NB/ take note:

The figures have not been corrected for possible cases of outliers (responses of extremely high use and/or costs).
When comparing cost data from the different editions, please be aware that the costs have not been adjusted for CPI (consumer price index).
From 2020, the lower age limit for being interviewed and included in the survey is 18 years, which corresponds with the official Age of majority in Norway. This increases the probability that the respondents have full formal consent competence and rights to make treatment choices for their own health. However, we do not check if the age stated is correct.

In earlier editions, the lower age limit was 15 and 16 years. To increase the possibilities for comparisons over time; the data presented from the 2012-2020 surveys have been re-analyzed according to this. Thus, the reports from these editions are based on slightly fewer interviews than 1,000.
All answers to the question about "Other CAM therapies used, than the predefined ones" are quality-checked by NAFKAM if they can be classified as CAM or not. This ensures that the figures for total usage of CAM and costs to it, are corrected before further analysis is done.
Massage therapy is classified as CAM via the Norwegian Act no 64 about Alternative treatment and in most of NAFKAM's surveys it has been listed as one of the most used CAM treatments. Yet, users' purposes (well-being or health-related) has been questioned.

In the early editions of the survey, we therefore included follow-up questions to those who stated having used massage therapy; whether their purpose of this was mainly health-related or to increase their well-being/relaxation. Most of them stated that their purpose was mainly health-related. If we remove those who stated well-being/relaxation as their purpose, the proportion who used massage therapy was reduced by approximately 2 percentage points in the 2012, -14 and -16 editions of the survey. We see no reason to believe that this has changed significantly since then.

Contact

Questions regarding the NAFKAM national CAM survey can be directed to Ola Lillenes (link to contact info on uit.no)