NAFKAM monitors the Norwegian population's usage of CAM on a regular basis. This article provides information on the structure of and methodology for these surveys.
The survey consists of a one-time anonymous interview by phone, of minimum 1,000 persons aged 18 years or older. The field work takes place every second year in the week overlapping November and December.
Respondents are called after their phone number has bee randomly chosen by machine, weighted in the process to gain representativeness in respondents' gender and place of residence (by region).
The questionnaire and manuscript used by the interviewers is prepared by NAFKAM. The interviewers are hired by an agency specializing in telephone interviews. After the field work the agency delivers the raw data to NAFKAM together with a simple report. On average, each interview takes about 8 minutes, and the response rate has varied between 9-11%.
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 shared with NAFKAM nor stored by the agency. Respondents are informed that no information that can match their identity with their answers, is stored. They are informed that their anonymous response will be part of a summary regarding respondents' age, gender, usage or non-usage of complementary and alternative medicine (CAM) etc). The summary will be made publically available 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 practitioner, 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 the practitioner was listed in the public Register of Practitioners or not,
- if they had used other CAM therapies other than the 9 predefined ones, and about the names of any such.
Since respondents may have consulted more than one provider, and/or been treated with 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).
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 NAFKAM does not consider ordinary use of dietary supplements (in line with the supplement's declaration) for maintaining one's health as CAM - but because NAFKAM has a specific assignment from the health authorities to monitor the population's use of supplements. For pratcical purposes, this is included 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:
All answers to the question about "Other CAM therapies used, than the predefined ones" are 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 covered the Norwegian Act no 64 about Alternative treatment. In most of NAFKAM's surveys, massage therapy has been listed among the most used CAM therapies. In early editions of the survey, asked additional follow-up questions to the users of massage therapy whether they had used massage for health-related purposes or for improving well-being or relaxation. Most massage users stated that theyu had used it for health-related purposes. To date, we see no reason to believe that these purposes have changed.
The cost figures in NAFKAMs public reports from these surveys have not been adjusted for CPI (consumer price index).
The figures have not been corrected for possible cases of outliers (responses of extremely high use and/or costs).
The lower age limit for being interviewed has been changed in the surveys, from the age of 15, 16 to the current 18 years. The latter ensures that the respondents have formal consent competence and the right to decide to make treatment choices for their own health. To increase the possibilities for comparisons over time; the data presented in the from the 2012-2020 surveys have been re-analyzed according to this. Thus, these reports are based on fewer interviews than 1,000.
Questions regarding the NAFKAM national CAM survey can be directed to Ola Lillenes (link to contact info on uit.no)