International Journal of ISSN: 2381-1803IJCAM

Complementary & Alternative Medicine
Research Article
Volume 1 Issue 1 - 2015
Knowledge base and Attitudes of University students towards Complementary and Alternative Medicine (CAM)
Rao G, Rao A, Pierce A, M Shakeel*, Trinidade A, Khan I and Ah-See KW
Department of otolaryngology-head and neck surgery, Aberdeen Royal Infirmary, UK
Received:January 18, 2015 | Published: March 17, 2015
*Corresponding author: M Shakeel FRCSED (ORL-HNS), Specialist Registrar, Otolaryngology-Head and Neck surgery, Ward 45, ARI, Aberdeen, AB25 2ZN, Tel: 00441224552100; Fax: 00441224554569; Email: @
Citation: Rao G, Rao A, Pierce A, M Shakeel*, Trinidade A, et al. (2015) Knowledge base and Attitudes of University students towards Complementary and Alternative Medicine (CAM). Int J Complement Alt Med 1(1): 00004. DOI: 10.15406/ijcam.2015.01.00004


Introduction: The use of complementary and alternative medicine (CAM) is increasing in all parts of the UK. Based on the published data, CAM use appears to be more prevalent among patients attending the otolaryngology outpatient department who are in higher education cohort.
Aim: This study aims to establish the CAM use by university students and also explore their beliefs and knowledge base about the CAM.
Methodology: Questionnaire based survey study.
Results: 450 questionnaires were distributed to students not studying medicine at Aberdeen University, of which 366 questionnaires were completed (81% response rate). The proportion of students currently using CAM was 30.9% and 18.9% had used CAM in the last year. The most common information source to find out about CAM was family or friends (52.2%; n=191); whilst 41.8% (n=153) would recommend CAM to others. 44.5% (n=163) spent £9 or less on CAM per week. The vast majority of students (82.2%; n=301), had not informed their GPs of their usage of CAM. Amongst the most common cited causes for CAM use was to help relieve exam stress.
Conclusion: CAM use is common amongst university students at our university and is likely to be the same in other institutions. Given the potential side effects of CAM and the possibility of drug-herb interaction, education on CAM should be made available on campus and students should be encouraged to report its use to their general practitioners.
Keywords: Complementary Alternative Medicine, University Students


The use of complementary and alternative medicine (CAM) is on the rise in the UK, and an estimated £1.6 billion is spent on it annually. Despite its escalating use, the distribution of CAM is still largely unregulated. This is partly due to the current legislation which does not require CAM therapies to go through the rigorous clinical testing that conventional medicines must do prior to marketing and merchandising to the public [1]. There are many possible concerns with respect to this. In one survey of the prescribing practices of 323 Scottish GP offices over a one year period, 60% of the practices were found to prescribe herbal medicines and 4% of patients had been administered herbal medicines known to interact with the patients’ current prescribed conventional drugs [2].

Our hospital is affiliated with the local university, and in out ENT Department, we noticed that many university students admitted to having used CAM at least once. It is often the perception of medical practitioners that only the ‘poorly educated’ would resort to CAM. To date we have been unable to find any previous studies from the United Kingdom that have looked at the consumer behavior and use of CAM by university students, who could be considered recipients of ‘higher education’ and therefore perhaps more enlightened to conventional medicine. The aim of our study was to establish the CAM use by university students and also explore their beliefs and knowledge base about the CAM.


This was a questionnaire-based survey study and was conducted over a 4-week period. The questionnaire was developed by the team based on previously published literature and was piloted before use in the current study. It included a brief definition of complementary and alternative medicine and highlighted therapies that come under this umbrella term (Appendix 1). Questionnaires were distributed to the university students with the exclusion of medical students. One of the researchers was always available to distribute and collect the questionnaire face to face to allow any queries to be answered if needed. A total of 450 questionnaires were distributed. Each responder completed the questionnaire only once. The questionnaires were distributed to the university students.
The data were entered into a prospective spreadsheet on Microsoft Excel 2007 and analyzed using SPSS 15. Descriptive statistics were calculated for the cumulative data on the whole sample for quantitative variables and frequencies.


The response rate was 81% (366/450). Most students were undergraduates (n=295) and there was a slightly higher number of females overall (n=200, 56%). Most students were aged 20 to 21 (n=120, 33.9%) (Table 1). The most commonly used non-herbal CAM was massage (n=44, 15%), followed by aromatherapy and counseling (Table 2). With respect to herbal CAM, energy drinks were most commonly used (n=133, 45.2%) followed by vitamins and aloe vera (Table 3). The most common reasons to use herbal treatments were to provide energy boost, aid in exercise and exams and to increase concentration. At the time of study, approximately 31% of students (n=113) were currently using some form of CAM. Almost one third of students had never tried CAM (n=114, 31%) (Table 4). Most students gained information about CAM from family and friends (n=191, 52%), whilst the media and the internet also proved popular (Figure 1). Up to almost 18% of students (n=64) had received advice on CAM from a healthcare professional (Table 4). Despite its level of use in the student population, most students (n=195, 53%) were unsure of its effectiveness and its safety (n=207, 57%), (Figures 2 & 3) but only 65 students admitted that their GPs knew about their CAM usage and almost 42% (n=153) would recommend its use to others nonetheless. Sixty students (16%) were also on prescribed medications. Of those who bought CAM, most would not spend more than £10 on it (n=163, 45%), whilst 2 students admitted to spending over £50 (Table 4).
Participants characteristics
n (number of participants)
Percentage (%)
Total 366 100
Male 166 44.2
Female 200 55.8
Level of university course
Undergraduate 295 81
Post graduate 71 19
<19 110 30.4
20-21 120 33.9
22-23 60 16.2
>24 76 19.5

Table 1:Study sample characteristics

Non-Herbal Therapy n (%) Reasons
Massage 44 (15) Musculoskeletal pain, Relaxation, Stress
Aromatherapy 36 (12.2) Relaxation, Sleep, Stress
Counselling 21 (7.1) Depression, relaxation, exams
Meditation 21 (7.1) Relaxation, Stress, Family advice
Acupuncture 16 (5.4) Musculoskeletal pain, cold
Bach Therapy 15 (5.1) Exams, Stress, Anxiety
Chiropractor 12 (4.1) Musculoskeletal pain, relaxation
Spiritual healing 6 (2) Headache, psychological help
Reflexology 5 (1.7) Family advice, Stress, Relaxation
Osteopathy 3 (1) Musculoskeletal pain, Stress
Kinesiology 3 (1) Musculoskeletal pain, Headache
Shiastu 3 (1) Musculoskeletal pain, Stress
Kinesiology 3 (1) Musculoskeletal pain, Headache
Kinesiology 3 (1) Musculoskeletal pain, Headache
Anthrophilosophical Medicine 1 (0.3) None mentioned

Table 2:Reasons for use of Non-herbal CAM by university students

Herbal Therapies n (%) Reasons
Energy Drinks 133 (45.2) Energy boost, Exercise, Increase concentration, Exams
Vitamins 120 (40.8) Nutritional support, Boost immunity, General health, Constipation
Alovera 52 (17.7) Skin problems(eczema, sunburn, rash), Hair/nail treatment, General health
Echinacea 26 (8.8) Cold/flu/fever, Boost immunity, General health
Cranberry Juice 32 (10.9) General health, prevent infection (urine infection in particular), gastro-intestinal symptoms
Protein Supplements 31 (10.5) Exercise, Weight gain, Exams
Garlic 28 (9.5) Cold/flu, Boost immunity, General health
Homeopathy 19 (6.5) Cold/flu, Skin problems(eczema, sunburn, rash), Musculoskeletal pain
Herbal Vitamins 21 (7.1) Nutritional Support, General Health, Cold/flu
Ginseng 12 (4.1) Energy boost, Exams, General health, Nutritional support
Primrose Oil 12 (4.1) Menstrual symptoms, Menopausal symptoms, General health, Skin problems(eczema, sunburn, rash)
Minerals 20 (4.8) Nutritional support, General health
Chinese Herbal Medicine 18 (6.1) Cold/flu, General health, sleep
Creatine 18 (6.1) Exercise, Exams, Nutritional support
Weight loss products 18 (6.1) General health, Weight loss
Gym Enhancer 15 (5.1) Exercise, General Health, Musculoskeletal pain
St John Warts 10 (3.4) Stress, Depression
Ginkgo 9 (3.1) Increase memory, Exams, Energy boost
Glucosamine 8 (2.7) Musculoskeletal pain, Exercise
Ayurvedic Medicine 6 (2) General health, Constipation, Gastro-intestinal symptoms
Glutamine 4 (1.4) Musculoskeletal pain, Exercise, Psychological help
Melatonin 4 (1.4) Psychological help, Sleep
Kava 2 (0.7) Enjoyment, Family advice
Ephedra 1 (0.3) Exercise, To stay awake
Eastern Medicine 1 (0.3) Enjoyment
Naturopathy 1 (0.3) Relaxation

Table 3:Reasons for use of Herbal (CAM) Therapies by university students

Use of CAM
University students n (%)
113 (30.9)
Yes, <1 year
69 (18.9)
Yes, > 1 year
54 (14.8)
114 (31.1)
Information Source on CAM
81 (22.1)
Health care professional
64 (17.5)
191 (52.2)
27 (7.4)
68 (18.6)
Perceived effectiveness of CAM
Not Effective
13 (3.6)
Less Effective
18 (4.9)
Not sure
195 (53.3)
Very Effective
128 (35)
Extremely Effective
12 (3.3)
Perceived safety of CAM
Very unsafe
4 (1.1)
Quite unsafe
12 (3.3)
Not sure
207 (56.6)
Quite safe
108 (29.5)
Very safe
35 (9.6)
Recommend CAM use to others
153 (41.8)
Exercise Routine
Less than 4 times
61 (16.7)
2-4 times
136 (37.2)
Less than 2 times
106 (29)
63 (17.2)
Use of CAM for exercise
88 (24.0)
GP knowledge about CAM use
65 (17.8)
Money spent on CAM
169 (46.2)
<9 GBP
163 (44.5)
10-19 GBP
25 (6.8)
20-49 GBP
7 (1.9)
>50 GBP
2 (0.5)
Administration of Prescribed Medicine
60 (16.4)

Table 4:Exploration of students’ attitude towards CAM.

Figure 1: Sources of information on Complementary and Alternative Medicine consulted by university students.
Figure 2: Perceived effectiveness of Complementary and Alternative Medicine by university students.
Figure 3:Perceived safety of Complementary and Alternative Medicine by university students.


It is clear from our research that CAM use is prevalent amongst our local university student population, a finding that is likely to be translatable to university student populations at large. There are several possible reasons for this. People’s therapy choice may be influenced by an adoption of a healthy living regime. Many feel that CAM therapies offer a more natural option which more fits in to this ‘healthier’ lifestyle when compared to more conventional therapies. Another theory of consumer behavior regarding CAM have shown that many people turn to using alternative therapies once they have already tried conventional medical therapy. Factors influencing their choices included severity of symptoms, consumer age, and dissatisfaction with conventional care [3].

It is patients with chronic conditions such as arthritis, malignancies and dementia that are most commonly quoted as using CAM. This differs from our results with almost two-thirds of our group being aged 22 or below and therefore having a lower prevalence of chronic illness. Overall, when comparing these students to a non-medical, non-student population previously studied Shakeel et al. [1] we found that the students were as likely to have found CAM effective and also as likely overall to recommend CAM use to others. These finding add to the hypotheses that university students and the public are similar in their views and usage of CAM despite the perception of them being ‘more highly educated’. Similar high CAM usage was found in university students in the USA and Canada [4,5].

The findings of this study correlate well with previous studies that have looked into the differences between the sexes and use of CAM [6]. Our study also highlights the cost of using CAM within the student population. We found that almost half of participants regularly spent money on CAM, most spending £9 or less a week. This shows that CAM usage is not necessarily reserved for those who are ‘well-off’.

It is interesting that despite the prevalence of students using CAM, most were unsure of both its effectiveness and its safety. Yet most would still recommend its use and very few made their GP aware that they were using it. This highlights the misconception that CAM is generally safe to use, a misconception that has probably kept its distribution largely unregulated until recently. In general we found that knowledge of the potential side effects and drug-herb interactions was lacking amongst the student population. As a result, most did not think it important to tell their GPs of its usage, despite many using prescribed medications.


CAM use is common amongst university students at our university and is likely to be the same in other institutions. Given the potential for unaccounted for side effects and the possibility of drug-herb interaction, education on CAM should be made available on campus and students should be encouraged to report its use to their general practitioners.


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