Open Access Open Badges Research article

How parents choose to use CAM: a systematic review of theoretical models

Ava Lorenc1, Yael Ilan-Clarke2, Nicola Robinson1 and Mitch Blair3*

Author Affiliations

1 Centre for Complementary Healthcare and Integrated Medicine, Thames Valley University, Paragon House, Boston Manor Road, Brentford, Middlesex, TW8 9GA, UK

2 Lifespan Research Group, Royal Holloway, University of London, 11 Bedford Square, London, WC1B 3RF, UK

3 River Island Paediatric and Child Health Academic Centre, Imperial College, Northwick Park Hospital Campus, Watford Road, Harrow, Middlesex HA1 3UJ, UK

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BMC Complementary and Alternative Medicine 2009, 9:9  doi:10.1186/1472-6882-9-9

Published: 22 April 2009



Complementary and Alternative Medicine (CAM) is widely used throughout the UK and the Western world. CAM is commonly used for children and the decision-making process to use CAM is affected by numerous factors. Most research on CAM use lacks a theoretical framework and is largely based on bivariate statistics. The aim of this review was to identify a conceptual model which could be used to explain the decision-making process in parental choice of CAM.


A systematic search of the literature was carried out. A two-stage selection process with predetermined inclusion/exclusion criteria identified studies using a theoretical framework depicting the interaction of psychological factors involved in the CAM decision process. Papers were critically appraised and findings summarised.


Twenty two studies using a theoretical model to predict CAM use were included in the final review; only one examined child use. Seven different models were identified. The most commonly used and successful model was Andersen's Sociobehavioural Model (SBM). Two papers proposed modifications to the SBM for CAM use. Six qualitative studies developed their own model.


The SBM modified for CAM use, which incorporates both psychological and pragmatic determinants, was identified as the best conceptual model of CAM use. This model provides a valuable framework for future research, and could be used to explain child CAM use. An understanding of the decision making process is crucial in promoting shared decision making between healthcare practitioners and parents and could inform service delivery, guidance and policy.