Looking beyond the barriers: Practical and symbolic factors associated with disclosure of complementary and alternative medicine (CAM) use

Introduction: Research on disclosure of CAM use to physicians has focused more on barriers to disclosure than factors that promote disclosure. The purpose of this study was to test a new conceptual model of CAM disclosure which posits that disclosure of CAM use is motivated by both practical (positive CAM outcomes) and symbolic (sense of control, quality of the CAM provider relationship) factors that arise from the CAM treatment experience. Methods: Two general medical samples provider-based CAM consumers, undergraduates ( N= 226) and community-dwelling adults ( N= 128), completed a survey about their CAM use and disclosure, health-related control, CAM patient-centered care, and CAM outcomes. Results: Disclosure rates of CAM use to physicians were 65% among students and 69% among the community adults. Univariate analyses revealed that disclosure of CAM use was associated with provider patient-centered care in both samples, and perceived control over health in the student sample. In both samples positive CAM outcomes were associated with CAM disclosure. The multivariate logistic regression revealed that students who disclosed CAM use were more likely to report higher perceived control over health (OR = 1.5), patient-centered care (OR = 1.7), and positive behavioral CAM outcomes (OR = 1.4). However, the multivariate results for the community sample were non-significant. Conclusions: In a sample of student and community adult CAM consumers, the findings suggest that the benefits experienced from CAM treatments (practical factors) as well as the meaning of disclosing CAM use (symbolic factors) are associated with CAM disclosure, and underline the importance of the patient-CAM provider relationship for promoting client initiated coordination of care