This is a repository copy of Consumer decision factors for initial and long-term use of
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Version: Accepted Version
Article:
Sirois, F.M. and Purc-Stephenson, R.J. (2008) Consumer decision factors for initial and
long-term use of complementary and alternative medicine. Journal of Evidence-Based
Complementary & Alternative Medicine, 13 (1). 3 - 19. ISSN 1533-2101
https://doi.org/10.1177/1533210107310824
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CAM decision factors
1
RUNNING HEAD: CAM decision factors
Please cite as:
Sirois, F. M., & Purc-Stephenson, R. J. (2008). Personality and consultations with
complementary and alternative medicine practitioners: A five-factor model investigation
of the degree of use and motives. Journal of Alternative and Complementary Medicine,
14(9), 1151-1158. doi:10.1089/acm.2007.0801
Consumer decision factors for initial and long-term use of complementary and alternative
medicine
Fuschia M. Sirois, Ph.D., BSc., Rebecca J. Purc-Stephenson, M.A.
Department of Psychology
University of Windsor
a
Portions of this paper were presented at the 114
th
Annual Convention of the American
Psychological Association, 2006, New Orleans, LA.
Correspondence concerning this article should be addressed to Fuschia M. Sirois, PhD,
Department of Psychology, University of Sheffield, 309 Western Bank, Sheffield, S10 2TP,
United Kingdom. Email:
f.sirois@sheffield.ac.uk
CAM decision factors
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.Abstract
Guided by the conceptual framework of the consumer decision-making model, the present study
compared the factors associated with initial and long-term use of complementary and alternative
medicine (CAM) providers. A survey was completed by 239 people recruited from the offices of
physicians and CAM practitioners. Conventional medicine clients (n = 54), new/infrequent (n =
73) and established CAM clients (n = 112) were compared to identify the decision factors for
initial and long-term CAM use. Consistent with the components of this model, we found support
for the roles of external influences (age, social recommendations), decision process factors
(symptom severity, egalitarian provider preference) and post-decision factors (dissatisfaction
with conventional care) depending on whether the pattern of CAM use was new/infrequent, or
established. Overall, this study provides preliminary support for the utility of the consumer
decision-making model as an integrative framework for understanding the roles of correlates of
CAM use.
Abstract word count: 148
KEYWORDS: Alternative Medicine; Patient-Provider Relationship; Consumerism; Health-care
Decision Making
CAM decision factors
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Consumer decision factors for initial and long-term use of complementary and alternative
medicine
Complementary and alternative medicine (CAM) includes a diverse group of healing
therapies (e.g., chiropractic, homeopathy, massage therapy, and acupuncture) not currently
considered an integral part of conventional medical practice (National Institutes of Health, 2002).
Interest in and use of these therapies has continued to rise over the past two decades (Barnes,
Powell-Griner, McFann, & Nahin, 2004) prompting research into the reasons why health-care
consumers choose CAM. Although a multitude of factors (e.g., sociodemographics, beliefs, and
health status) have been suggested, how these factors may operate together in CAM decisions
remains unexplained. One reason may be the lack of a clear and unifying conceptual framework
from which to situate these decision factors and the processes through which they may direct
different types of CAM decisions.
Indeed, much of the research on CAM decisions to date has been atheoretical with
predictors simply classified as “push” or “pull” factors (Boon, Brown, Gavin, & Westlake,
2003a; Furnham & Smith, 1988) without an explanation of how these determinants may work
with other predictors to actually result in the decision to use CAM. Among the few studies that
have employed a conceptual framework to explain the roles of CAM decision factors, the health
self-management model (Grzywacz et al., 2005), the self-regulatory model (Cameron, Leventhal,
& Leventhal, 1993), and the socio-behavioral model (Andersen & Newman, 1973) have been
applied (Bishop, Yardley, & Lewith, 2006; Sirois & Gick, 2002). The latter model in particular
has been used most often to organize the predictors of CAM use and specifically CAM
consultations (Hendrickson, Zollinger, & McCleary, 2006; Hildreth & Elman, 2007; Kelner &
Wellman, 1997; Sirois & Gick, 2002). According to this model, health-care decisions follow
CAM decision factors
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from a sequence of conditions initiating with predisposing factors (e.g., beliefs,
sociodemographic variables), the ability to secure health services (e.g., income), and medical
need. Predisposing variables such as health beliefs influence health-care use indirectly, whereas
medical need is the most immediate cause of health service use (Andersen & Newman, 1973).
Although this model provides a general guide for delineating the sequence of factors that may
result in a decision to use CAM, it does not sufficiently account for the more complex and non-
linear processes that may be involved, or how and why decisions among subgroups of CAM
users may differ.
Although it has been suggested that patients, and CAM users in particular, are becoming
more consumer-minded in their health-care choices (Kelner & Wellman, 1997), models of
consumer decision making have not been applied to this increasingly popular health-care choice.
Such models may be useful not only to understand how diverse correlates of CAM use are linked
to decision making, but also to understand the different decision processes among different sub-
groups of CAM users. For example, in contrast to initial or trial use, long-term CAM use is
thought to involve more enduring motivations and factors that are distinct from those for initial
CAM use (Sirois & Gick, 2002; Vincent & Furnham, 1996). Yet few studies have compared the
factors associated with initial CAM use to those for long term CAM use, or employed a
conceptual framework to explain how and why they may differ.
The present study had two main objectives. First, we applied and tested the efficacy of
the Consumer Decision-Making model (Kanuk and Schiffman, 2000) for understanding the
relative roles of several factors that have been implicated in the decision to use CAM.
Specifically we examined how socio-demographic factors, medical needs, social relationships,
dissatisfaction with conventional treatment, and patients’ role expectations for health-care
