Onche et al.

BMC Complementary Medicine and Therapies (2024) 24:177 BMC Complementary

https://doi.org/10.1186/s12906-024-04429-x
Medicine and Therapies

RESEARCH Open Access

Knowledge, perception, attitude, and practice

of complementary and alternative medicine
by health care workers in Garki hospital Abuja,
Nigeria
Enole Jennifer Onche1, Mojisola Morenike Oluwasanu1* and Yetunde Olufisayo John-Akinola1

Abstract
Background Healthcare workers are currently making efforts to offer services that cater to the holistic care needs
of their patients. Previous studies have shown that some healthcare workers encounter challenges when advising
patients about Complementary and Alternative Medicine (CAM), even though its use is widespread. Many health
care workers may not have received formal education or training in CAM and consequently are unable to address
their patients’ questions about it. This study explored the knowledge, perception, attitude and practice of CAM by
healthcare workers in Garki Hospital, Abuja, Nigeria.
Methods This was an institution-based cross-sectional study, design and a convergent parallel, mixed methods
design was used for data collection. Five (5) healthcare workers were purposively selected as participants for the key
informant interviews, while two hundred and fifty (250) selected using a simple random sampling method completed
the questionnaire. The data collection instruments used were a key informant interview guide and a 35-item self-
administered questionnaire. Knowledge was assessed with a 4-item scale with a maximum score of 8. Perceptions and
attitudes were assessed using Likert scales with a maximum score of 45 and 20, respectively. Practice was assessed
with a 6-item scale with a maximum score of 18. Qualitative data was analysed using framework analysis. Quantitative
data was analysed using descriptive and inferential statistics. Data acquired from both methods were integrated to
form the findings.
Results The average age of respondents for the quantitative study was 34.0 ± 7.8 years, and they were predominantly
females (61.2%) with one to ten years of work experience (68.8%). The mean knowledge, perception and attitude
scores were 1.94 ± 1.39, 13.08 ± 2.34 and 32.68 ± 6.28, respectively. Multiple linear regression result showed that
knowledge (t = 2.025, p = 0.044) and attitude (t = 5.961, p = 0.000) had statistically significant effects on the practice of
CAM. Qualitative data revealed that the majority of the participants perceive CAM favourably, provided it is properly
introduced into mainstream medicine with evidence of safety and research to prove its efficacy.

*Correspondence:
Mojisola Morenike Oluwasanu
ope3m@yahoo.com
Full list of author information is available at the end of the article

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Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 2 of 11

Conclusion The study has shown the gaps in knowledge and the practices of CAM by conventional medical
practitioners. This has implications for their ability to counsel and refer patients who may require CAM therapies.
Policy, research and programmatic initiatives that seek to enhance their knowledge of CAM, and improve
collaboration with CAM practitioners are recommended.
Keywords Knowledge, Perception, Practice, Complementary and alternative medicine, Conventional health care
workers, Abuja, Nigeria

Background them the choice of using conventional medicine and/ or

Complementary and Alternative Medicine (CAM) is CAM.
“a system of complex medical and health care practices
and products that are not generally considered part of Methods
conventional medicine” and has been used since antiq- Study design
uity [1]. As centuries passed, the practice receded with This was an institution-based, cross-sectional study and
more emphasis on the practice of conventional medicine a convergent parallel, mixed methods design was used
[2]. Recently, CAM has gained increasing attention and for data collection. The quantitative approach was a
interest from healthcare workers and the general public cross-sectional study while the qualitative was key infor-
[3]. The use of CAM persists in local communities, espe- mant interviews. Both the quantitative and qualitative
cially in low-income countries [1]. Tertiary institutions in data were equally important and occurred concurrently.
some high-income countries have taken steps to integrate This approach was adopted to support the collection of
CAM curricula into their medical education system [2, complimentary data and enrich the interpretation of the
4]. The decision to recommend CAM therapy to a patient results. The qualitative and quantitative data were anal-
is related to the healthcare worker’s knowledge and train- ysed separately, and the results were integrated to gener-
ing [5]. ate conclusions.
The healthcare system in Nigeria will benefit from Data collection comprised key informant interviews
increased communication between conventional medi- and a descriptive cross-sectional survey among conven-
cine practitioners and CAM practitioners as both play tional healthcare workers in Garki Hospital, Abuja, Nige-
complementary roles in healthcare delivery, especially ria. The study assessed healthcare workers’ knowledge,
given community members’ favourable views on the perception, attitude and practice of CAM. The study also
accessibility and affordability of CAM [6–8]. Legally, identified factors [11, 12] that may influence the health-
the Medical and Dental Practice Act states that CAM care workers’ perception of CAM and its integration into
practitioners are not authorised to practice medicine the healthcare system [13].
and are liable to be punished [9]. However, special pro-
visions (that allow for the supervised, regulated practice Description of the study area
of CAM) are made for them under the National Primary Garki is an urban area located in Abuja, in the Federal
Health Care Development Agency (NPHCDA) Act, Capital Territory of Nigeria, and the main languages spo-
whose agency was set up to promote CAM’s relevance in ken are English and Hausa. However, people from many
the advancement of primary health care [9]. The recorded different ethnicities populate the area. The residents
efforts at integrating CAM into the health care system are engage in various economic activities ranging from bank-
selected training of CAM practitioners and public health ing, health care, civil service, public service, business and
campaigns with the purpose of training CAM practitio- telecommunications. The study was limited only to the
ners to adopt good agricultural practices and sound med- healthcare workers in Garki Hospital Abuja. Garki Hos-
ical practices [9]. These were conducted by the Federal pital Abuja is a tertiary hospital located in Garki Local
Ministry of Health and international development part- Government Area (LGA) of the Federal Capital Territory
ners such as the World Health Organisation [10]. Abuja Municipal Area Council.
Few studies have been conducted on CAM among con- The number of health workers in this institution was
ventional healthcare workers in Nigeria; all these were 500 as of the time of this study. These consist of 137
quantitative studies [6, 7]. This study explored the knowl- doctors (including consultants, senior registrars, regis-
edge, perception, attitude and practice of CAM by health trars and medical officers), 156 nurses, 21 pharmacists,
care workers in Garki Hospital Abuja, Nigeria. 20 medical lab scientists, six physiotherapists and oth-
The findings can contribute to the fulfilment of the ers including 82 patient care attendants, five preventive
Sustainable Development Goal (SDG 3) of Good Health medicine counsellors, 10 radiographers, nine medical lab
and Well-being by creating an enabling environment technicians, three optometrists, two embryologists, two
for patients seeking care for health problems by offering
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 3 of 11

psychologists, 10 renal technicians, one dietician and five Sampling procedure

mortuary attendants. The healthcare workers were stratified into the differ-
ent cadres of healthcare. The sample population was
Study population selected using a simple random method. The proportion-
The study population comprised medical doctors (phy- ate allocation method was applied in sample selection;
sicians and surgeons), nurses, pharmacists, medical lab the proportion of healthcare workers selected from each
scientists, physiotherapists and other healthcare workers subgroup was determined by their number relative to
working in Garki Hospital Abuja, Nigeria. The inclusion the entire population. The ratio used in the proportion-
criteria were at least one year of experience post-quali- ate allocation of health workers into the study is shown in
fication, complete registration with the appropriate pro- additional file 1.
fessional bodies and employment as permanent staff. Key Five healthcare workers who participated in the key
informant interviews were also conducted with heads of informant interviews were selected through a purposive
units of medicine, surgery, nursing, medical laboratory method. The decision to include them was based on their
science and pharmacy. position as heads of key service delivery units and their
level of experience.
Sample size determination
The sample size was calculated using the standard for- Study instruments
mula (derived from Cochran’s formula and Slovin’s for- A ten-item key informant interview guide (Additional
mula) [14]. file 2) was developed from previous studies [2, 15–19]
and used to gather information on the knowledge, per-
z 2 p (1−−p) ception, attitude, practice, challenges, and facilitators to
e2
n= 1+(z 2 ∗ p (1−−p) incorporating CAM and the recommendations for the
e2 N same. The interviewer -administered interviews were
conducted to illustrate the perspectives and opinions of
Where: experienced authority figures on their perception and
n = the required sample size. attitudes towards CAM.
z = 1.96 (95%) standard normal deviation at the Quantitative data was collected using a 35-item self-
required confidence interval. administered questionnaire (Additional file 3) developed
p = proportion of health care providers with a favour- from a literature review [2, 5, 7, 17–19]. This instrument
able attitude toward CAM. included sections covering the socio-demographic char-
q = 1 – p. acteristics, knowledge of CAM therapies [2, 5, 7], attitude
e = margin of error set at 0.05. and perception towards CAM therapies [17–19], and
p = 60.0% (proportion of physicians with a favour- practice [2, 19].
able attitude toward CAM in Lagos University Teaching
Hospital)7. Training of research assistants, pretesting of tools and data
N = known population of health care workers in Garki collection
Hospital that is 500. Before data collection, the researcher had a two-day ori-
n = 213. entation with two members of staff of Garki Hospital
A non-response rate of 10% of the minimum sample who had degrees in the social sciences, and they were
size was calculated to address possible cases of loss or engaged as research assistants in the study. The orienta-
incomplete completion of the questionnaire. tion focused on the study’s objectives, interview tech-
na = n x 1/1 – r. niques, procedures for data collection and ethical issues.
where: na is the adjusted sample size, n is the initial Soon after, the quantitative and qualitative research tools
sample size calculated using standard formula, r is the were pre-tested in a nearby hospital with similar char-
expected non-response rate (expressed as a decimal). acteristics to the study area and revised as appropriate
na = 213 × 1/1–0.1. before the conduct of the actual study.
= 213 × 1/0.9. Data collection was conducted between 12th Septem-
= 213 × 1.11. ber 2020 and 12th November 2020. For the quantitative
x2009;237 data, 250 respondents completed the self-administered
Therefore, the minimum sample size estimate for the questionnaire while interviews were held with five key
study is 237, which was increased to 250. informants by the researcher.
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 4 of 11

Analysis of quantitative and qualitative data description. Themes from the quantitative and qualitative
Responses in each questionnaire were coded using a cod- data sets were compared to identify areas of differences
ing guide developed by the research team. This coding or commonalities. The data from both sources were inte-
guide includes scores for variables to be analysed. The grated during final data interpretation using the weaving
variable, knowledge, was assessed using four questions, approach, which entails a narrative description and pre-
and the maximum score for knowledge was 8. For each sentation of both the qualitative and quantitative findings
question, If the respondent answered “Yes” with valid by themes [21].
examples, a score of 2 was given; “Yes” without correct
examples was assigned a score of 1 and responses that Results
were either “No” or “Don’t know” were given a score of Participants’ profile (key informant interviews)
0. Perception was assessed using four questions on a Lik- For the interviews, the participants’ ages ranged from 38
ert scale, and the score ranged from 0 to 20. Attitude was to 53 years. The results further showed that 60% of the
also assessed using nine (9) questions on a Likert scale participants were male. 40% were either Idoma or Igbo,
and the score ranged between 0 and 45. The knowledge, and the remaining 20% were Hausa. All participants
attitude and practice were reported using the mean and were Christian and had between two to thirteen years of
standard deviation. Practice was assessed using a 6-item experience in a supervisory role. The selected individu-
scale, and the questions included ever use of CAM by the als include a consultant physician, a consultant surgeon, a
health worker and counselling and referral of patients for senior nurse, a senior pharmacist and a preventive medi-
CAM services. The highest and lowest scores were 0 and cine counsellor working under the jurisdiction of the
18, respectively. Institute of Human Virology, Nigeria (IHVN).
Analysis of quantitative data was done using SPSS ver-
sion 26. Continuous variables were summarised using Socio-demographic characteristics of respondents
mean and standard deviation. Categorical variables such The results showed that the mean age was 34.0 ± 7.8 years
as age, knowledge, perception and practice were grouped and the highest age group proportion (81.2%) was for
into categories derived from the coding and scoring those aged 20 to 39 years. The results showed that the
guides. Independent t-test, one-way analysis of variance, majority (61.2%) of the respondents were female. Most
pearson correlation and multiple linear regression analy- of the respondents were either medical doctors 41.6% or
sis were used to determine associations and test statisti- nurses 29.6%. The data showed that the majority of the
cal significance at p < 0.05. respondents, 68.8% had between one to ten years of work
For the qualitative data, the audio recordings were experience. The results are shown in Table 1.
transcribed verbatim into Microsoft Word document and
analysed using framework analysis to identify common Knowledge of CAM
themes supported by normative quotes [20]. The results in Table 2 show the respondents’ knowledge
This involved a 5-step process: familiarisation with the of CAM. The mean knowledge score for the study popu-
data, development of a thematic framework, indexing, lation is 1.94 ± 1.39 with a range of 0 to 6 from a total pos-
charting, mapping and interpretation [20]. During the sible score of 8 points.
familiarisation process, members of the research team, Most (59.6%) had read materials on CAM. Respon-
read the transcripts to get acquainted with the data; after dents were then asked if they knew the names of alter-
that, there was a discussion of the data. A thematic cod- native/traditional medicines used by practitioners and to
ing framework was developed based on the discussion list at least three. The majority (65.2%) answered “No” or
during this phase. After that, portions of the transcripts “Don’t Know”, about one quarter (24.4%) answered “Yes,”
were indexed by identifying the themes and codes where and the remaining (10.4%) were able to list correct exam-
they belong. These were charted by arranging the infor- ples of the medicines that were asked. A high percentage
mation in a table according to the themes with the aid (70.4%) were aware of the risks associated with CAM use.
of Microsoft Word. Finally, the mapping and interpreta- According to the qualitative findings, most of the par-
tion were done by arranging and discussing the charted ticipants were unaware of changes within the health sys-
information on perception, attitude and factors influenc- tem, including government policies favouring the use
ing the utilszation of CAM. At this point, the research- of CAM or training sessions to instill the knowledge of
ers were interested in deducing explanations and patterns CAM though they acknowledge a few efforts by govern-
across the data. mental and non-governmental organizations to promote
There was integration and synthesis of the qualita- integration of CAM as illustrated in these quotes:
tive and quantitative data sets [21]. This helped deepen
“There have been efforts but everything has to go
understanding of CAM among conventional health-
through a process. It has been delayed. However,
care practitioners providing a more detailed qualitative
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 5 of 11

Table 1 Socio-demographic characteristics of respondents Table 2 Respondents’ knowledge of CAM

Variables Frequency (N) Percent (%) Variable Frequency (%)
(N = 250) (N = 250)
Age (in years) Read CAM Materials
20–29 77 30.8 Yes 149 59.6
30–39 126 50.4 No 101 40.4
≥ 40 47 18.8 Know the names of CAM used by practitioners
Gender Yes, with correct examples
Male 97 38.8 Yes 26 10.4
Female 153 61.2 No 61 24.4
Religion 163 65.2
Christian 214 85.6 Aware of CAM therapies listed by NAFDAC
Islam 30 12 Yes, with correct examples
Traditional African Religion 2 0.8 Yes 15 6
None 4 1.6 No 16 6.4
Profession 219 87.6
Medical Doctor 104 41.6 Aware of risks associated with CAM
Nurse 74 29.6 Yes
Pharmacist 13 5.2 No 176 70.4
Medical Lab Scientist 9 3.6 74 29.6
Physiotherapist 3 1.2
Paramedical 47 18.8 but has not seen the light of day due to the problem
Ethnicity of effecting policies in Nigeria.” – Key informant.
Hausa 26 10.4
Igbo 83 33.2
Yoruba 46 18.4 Perception of complementary and alternative
Idoma 13 5.2 The results in Table 3 show the respondents’ perceptions
Others 82 32.8 of CAM. The mean perception score of the respondents is
Years of Experience 13.08 ± 2.34 with a range of 4 to 19, out of a total possible
1–10 172 68.8 score of 20.0. Less than half, 47.2%, of the respondents,
11–20 59 23.6 disagree with the statement that healthcare systems
21–30 15 6 should rely on conventional medicine alone. Less than
31–41 4 1.6 two-thirds (56.2%) of the respondents either agree or
Paramedical professions include Optometrists, Embryologists, Radiographers, strongly agree with the statement that healthcare systems
Dieticians, Renal Technicians and Psychologists
should provide conventional medicine and CAM at the
there are NGOs and other private bodies that are patients’ discretion. A similar percentage (55.2%) agreed
readily advocating for CAM to be used in the pro- or strongly agreed with the statement that healthcare sys-
fessional health system. But it has not yet been tems should provide conventional medicine and CAM at
approved.” Key informant. the healthcare providers’ discretion. The majority of the
“In the past, there probably were efforts to bring respondents (73.2%) agree or strongly agree that health-
CAM into the mainstream (conventional medicine) care systems should provide conventional medicine and
evidence-based CAM as integrative medicine.

Table 3 Perception of the respondents on the future of CAM

Perception Statement Strongly Agree Neither Disagree Strongly Total
Agree N (%) agree nor N (%) disagree N
N (%) disagree N (%) (%)
N (%)
Healthcare systems should rely on conventional medicine alone 9 (3.6) 42 (16.8) 52 (20.8) 118 (47.2) 29 (11.6) 250
(100)
Healthcare systems should provide conventional medicine and CAM at the 29 (11.6) 114 (45.6) 47 (18.8) 46 (18.4) 14 (5.6) 250
patient’s discretion (100)
Healthcare systems should provide conventional medicine and CAM at the 21 (8.4) 117 (46.8) 55 (22.0) 45 (18.0) 12 (4.8) 250
healthcare provider’s discretion (100)
Healthcare systems should provide conventional medicine and evidence-based 45 (18.0) 138 (55.2) 43 (17.2) 19 (7.6) 5 (2.0) 250
CAM as integrative medicine (100)
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 6 of 11

According to the qualitative findings, the majority of of the respondents agree or strongly agree that medi-
the participants thought that CAM can be appropriately cal practitioners should be more educated in the use of
introduced into mainstream medicine provided there is CAM.
evidence and a lot of research channelled along that path According to the qualitative findings, some of the
to make sure it is beneficial for patients as shown in this potential adverse effects of CAM, which all the partici-
quote: “If [CAM is] properly introduced into mainstream pants expressed, include concerns that it will affect con-
medicine and there is evidence and a lot of research chan- ventional medicine practice leading to interferences
nelled along that path to make sure CAM is beneficial for when a patient decides to explore and use both CAM and
patients, I am totally for it.” – Key informant. conventional medicine causing harm to the patient as
In addition, there were concerns expressed by most of illustrated in this quote:
the participants that some CAM practitioners may not
“There will be interferences because a patient will
understand the biological or pharmacological basis for
decide to explore and try both CAM and conven-
the efficacy of their products and the National Agency for
tional medicine. This may be harmful to the patient.
Food and Drug Administration and Control (NAFDAC)
In terms of our unit (HIV unit managed by the Insti-
may not approve the use of some CAM products due to
tute of Human Virology of Nigeria), we try to make
this issue as illustrated in this quote:
our patients understand the repercussions of doing
“Hardly will NAFDAC give CAM practitioners both (CAM and conventional medicine).” – Key
license to practice. Some practitioners cannot defend informant.
[do not know the pharmacological basis for the effi-
cacy of their products] what they are giving out. It
Another concern expressed by some participants was
(CAM practice) will only be done well if it is done
potential resistance by healthcare providers to accept and
the right way.” – Key informant.
provide care using CAM since they were not trained on
it. This could hinder acceptability by the health workers,
as shown in this quote:
Attitude towards complementary and alternative
“We still have a long way to go because the training
Table 4 shows the respondents’ attitude toward CAM.
in conventional medicine has made us believe that
The mean attitudinal score of the respondents is
if it is not conventional, it shouldn’t be accepted.” –
32.68 ± 6.28 with a range of 9 to 45, out of a total possible
Key informant.
score of 45 points. Almost half (48%) of the respondents
strongly agree or agree with the statement that practis-
ing with knowledge of CAM and Conventional Medicine The positive effects expressed by all the participants
is superior to practising with only the knowledge of con- include that CAM would be cheaper than conventional
ventional medicine. The majority (95%) of the respon- medicine, and in a low-income country like Nigeria, it
dents agree or strongly agree that research on the efficacy would help people access care at a cost they can afford.
and safety of CAM should be performed. Most, (76.8%) Also, it would lead to greater patient acceptability

Table 4 Respondents’ attitude toward CAM

Variable Strongly Agree Neither Disagree Strong- Total
Agree N (%) agree nor N (%) ly N (%)
N (%) disagree disagree
N (%) N (%)
Practising with knowledge of CAM and Conventional Medicine is superior to 35 (14.0) 85 (34.0) 55 (22.0) 55 (22.0) 20 (8.0) 250 (100)
practising with only knowledge of conventional medicine
Incorporation of CAM therapies can result in increased patient satisfaction 22 (8.8) 121 (48.4) 54 (21.6) 42 (16.8) 11 (4.4) 250 (100)
CAM therapies can assist in fighting illness 27 (10.8) 121 (48.4) 76 (30.4) 21 (8.4) 5 (2.0) 250 (100)
Medical Practitioners should be more educated in the use of CAM 54 (21.6) 138 (55.2) 30 (12.0) 22 (8.8) 6 (2.4) 250 (100)
I would support the incorporation of CAM in the undergraduate curriculum of 34 (13.6) 117 (46.8) 55 (22.0) 36 (14.4) 8 (3.2) 250 (100)
my previous course of study
Incorporation of CAM therapies into the health care systems would enhance 29 (11.6) 110 (44.0) 74 (29.6) 26 (10.4) 11 (4.4) 250 (100)
patient care
I would support CAM being introduced in a drug formulary 29 (11.6) 119 (47.6) 59 (23.6) 35 (14.0) 8 (3.2) 250 (100)
Research on the efficacy and safety of CAM should be performed 129 (51.6) 101 (40.4) 14 (5.6) 5 (2.0) 1 (0.4) 250 (100)
Provision of wellness centers using CAM and conventional medicine would 37 (14.8) 128 (51.2) 60 (24.0) 21 (8.4) 4 (1.6) 250 (100)
benefit patients
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 7 of 11

because most of their clients are raised within the tra- Practice of CAM
ditional Nigerian setting, and a lot still believe in it. In The mean practice score of the respondents is 9.1 ± 2.6
addition, compliance will be enhanced; patient load and with a range of 4 to 18, out of a total possible score of 20
satisfaction will increase, as illustrated in these quotes: points. It was shown that 82.4% of the respondents had
a poor score on CAM utilisation and outcomes (prac-
“It will make health care delivery much more afford-
tice) while 17.6% had a good score on the same. The
able, and the health of many Nigerians will be taken
result presented in Table 5 shows that the majority of
care of, meaning cheaper and less resource intensive.”
the respondents (70.0%) had not used or recommended
– Key informant.
CAM. In comparison, 26.0% of the respondents and 48%
were likely to refer their patients to a CAM practitioner if
"> available at the institution. Only 10.4% of the respondents
had ever referred their patients to a CAM practitioner
“It would lead to greater patients’ acceptability
while 83.2% had not done so. The majority of the respon-
because most of our clients are raised within the tra-
dents (69.6%) had discussed the possible benefits of CAM
ditional Nigerian setting, and a lot still believe in it.”
therapy with 0–25% of their patients, while 33.2% of the
– Key informant.
respondents had discussed the possible harmful out-
comes of the same with 0–25% of their patients. Almost
Table 5 Practice of CAM half (49.6%) of the respondents said that their patients are
Variable Frequency Percent the ones to initiate discussion of the benefits and risks of
(N) (%) CAM therapy. In contrast, the following proportions said
Used/recommended complementary and Alternative it was either themselves (21.2%) or a third party (23.2%).
Medicine
Yes 65 26.0 Potential barriers and facilitators to the incorporation of
No 175 70.0 CAM into the Hospital practice
Don’t Know 10 4.0 A barrier expressed by some of the participants to the
Likely to refer a patient to a CAM practitioner (if available incorporation of CAM into Hospital practice includes
at institution) for treatment of an ailment health care workers not readily aligning with CAM
Extremely likely 22 8.8 because the institution they work in has not made provi-
Somewhat likely 98 39.2 sions for it as reflected in these quotes:
Neither likely nor unlikely 45 18.0
Somewhat unlikely 47 18.8 “People [Health workers] will not want to accept it at
Extremely unlikely 38 15.2 first because they do not understand it. Garki Hospi-
Ever referred a patient to a CAM practitioner tal has an already established conventional medical
Yes 26 10.4 practice.” – Key Informant.
No 207 93.2 “Garki Hospital is located in an urban area. The
No Response 17 6.8 management will not look too kindly on anything
Percentage of patients that health worker has discussed that will decrease patient patronage. Practitioners
The possible benefits of using CAM therapies themselves will not readily align with considering
0–25% 174 69.6 CAM.” – Key informant.
26–50% 35 14.0
51–75% 30 12.0
76–100% 11 4.4
A potential facilitator identified by one of the participants
Percentage of patients that health worker has discussed
was the availability of financial resources which must be
possible harmful outcomes of using CAM therapies
channeled to the conduct of research to prove that these
0–25% 83 33.2 therapies are beneficial and not as harmful.
26–50% 54 21.6 Another facilitator identified was education. Spe-
51–75% 72 28.8 cifically, a two-pronged approach was emphasised that
76–100% 41 16.4 includes patient education and practitioner education to
Individual who usually initiates discussion of the benefits and improve the acceptability of CAM as stated in the quotes
risks of below:
CAM therapy
“We need to develop a two-pronged approach con-
Self 53 21.2
sisting of patient education and practitioner ………
Patient 124 49.6
Third-party 58 23.2
which will improve acceptability of CAM.” –Key
No response 15 6.0
informant.
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 8 of 11

Table 6 Relationship between the socio-demographic Table 7 Relationship between the socio-demographic
characteristics of the respondents and perception of CAM characteristics of the respondents and the practice of CAM
Variable Perception of ANOVA/ T-test (F/T) P Variable Practice of CAM ANOVA/ P
N = 250 CAM (Scores) N = 250 (Scores) T-test
Age Mean SD 0.001 0.979 Age Mean SD 2.410 0.122
20–29 13.25 2.34 20–29 8.58 2.70
30–39 13.01 2.34 30–39 9.38 2.41
≥ 40 13.02 2.34 ≥ 40 9.78 2.6
Gender 1.212 0.272 Gender 0.080 0.777
Male 13.29 2.34 Male 9.15 2.79
Female 12.11 2.33 Female 9.05 2.48
Years of Experience 0.739 0.391 Years of Experience 0.762 0.383
1–10 13.04 2.34 1–10 8.98 2.60
11–20 13.03 2.34 11–20 9.27 2.43
≥ 21 12.74 2.33 ≥ 21 8.85 3.14
Ethnicity 0.210 0.647 Ethnicity 0.124 0.725
Hausa 12.38 2.34 Hausa 9.50 2.97
Igbo 13.31 2.33 Igbo 8.84 2.77
Yoruba 13.5 2.34 Yoruba 9.11 2.85
*Others 12.87 2.33 *Others 8.85 2.38
Religion 5.707 0.018 Religion 0.293 0.034
Christian 11.55 2.31 Christian 9.10 2.54
Islam 12.2 2.32 Islam 9.17 2.61
Traditional African 14 2.34 Traditional African 12.00 8.49
Religion Religion
None 11.25 2.30 None 7.00 1.15
Profession 0.741 0.390 Profession 0.178 0.027
#
Medical Doctors 12.83 2.32 Medical doctors 8.54 2.38
Nurses 13.58 2.34 Nurse 9.86 2.86
Pharmacists 14.46 2.35 Pharmacist 9.46 2.47
**Paramedical 12.61 2.31 **Paramedical Professions 9.54
Professions *Other ethnicities include Idoma, Igala, Edo/Ishan, Ebira, Tiv, Ibibio, Efik, Urhobo,
*Other ethnicities include Idoma, Igala, Edo/Ishan, Ebira, Tiv, Ibibio, Efik, Urhobo, Ijaw, Bini, Tarok, Yala, Boki, Akwa Ibom, Angas, Mwaghavul, Clip, Isodas, Nupe,
Ijaw, Bini, Tarok, Yala, Boki, Akwa Ibom, Angas, Mwaghavul, Clip, Isodas, Nupe, Ebekwara, Ron, Dogmak, Kanuri, Annane, Delta, Oron, Anang, Bassa and Bajju
Ebekwara, Ron, Dogmak, Kanuri, Annane, Delta, Oron, Anang, Bassa and Bajju ** Paramedical professions include Medical laboratory scientists,
#
Surgeons and physicians Physiotherapists Optometrists, Embryologists, Radiographers, Dieticians, Renal
Technicians and Psychologists
** Paramedical professions include Medical laboratory scientists,
Physiotherapists, Optometrists, Embryologists, Radiographers, Dieticians, ***Significant p (< 0.05)
Renal Technicians and Psychologists
***Significant p (< 0.05)
Association between the socio-demographic
“Mainstream conventional medicine took several characteristics of respondents and their practice of CAM
years to be accepted so factors such as education, There is no relationship between the respondent’s age,
education, education! It is important to educate gender, ethnicity, years of experience and their prac-
people on the positive side (of CAM).” – Key infor- tice of CAM. The exceptions are religion and profession
mant. (P ≤ 0.05). The result of this finding is shown in Table 7.

Hypothesis 1 There is no significant relationship

Association between the socio-demographic between the healthcare provider’s knowledge of CAM
characteristics of respondents and their perception of CAM and their likelihood of incorporating it into their practice.
Table 6 shows there is no relationship between the The results of the findings are shown in Table 8. The
respondent’s gender, years of experience, ethnicity, pro- table shows that there is a positive correlation between
fession and their perception towards CAM. The excep- the respondents’ knowledge of complementary and alter-
tion is religion (P < 0.05). native medicine and the likelihood of incorporating it
into their practice (r=.206, p = .001). Therefore, the null
hypothesis is rejected.
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 9 of 11

Hypothesis 2 There is no association between the health- Table 8 Pearson correlation analysis
care provider’s attitude toward CAM and their likelihood Knowledge Attitude Perception Practice
of incorporating it into their practice. Knowledge 1 0.216 0.100 0.206
(P < 0.005) (P < 0.005) (P = 0.001)
There is a positive correlation between the attitude of
Attitude 0.216 1 0.465 0.428
the respondents towards CAM and their likelihood of (P < 0.005) (P < 0.005) (P = 0.000)
incorporating it into their practice (r=.428, p = .000). The Perception 0.100 0.465 1 0.215
result of this finding is shown in Table 8. This means that (P < 0.005) (P < 0.005) (P = 0.001)
the attitude of the respondents towards complementary Practice 0.206 0.428 0.215 1
and alternative medicine has a significant influence on (P = 0.001) (P = 0.000) (P = 0.001)
their likelihood of incorporating it into their practice.
Therefore, the null hypothesis is rejected. Table 9 Multiple linear regression analysis of the factors
influencing practice of CAM
Hypothesis 3 There is no significant relationship Variable Partial Stan- Standardized t P
between the healthcare provider’s perception of CAM regression dard partial regres-
and their likelihood of incorporating it into their practice. coefficient error sion coefficient
(B) (SE) (beta)
The results of the findings are shown in Table 8. The
Knowledge 0.222 0.109 0.119 2.025 0.044
table shows that there is a positive correlation between
Attitude 0.163 0.027 0.392 5.961 0.000
the respondents’ perception of complementary and alter-
Perception 0.024 0.072 0.021 0.332 0.740
native medicine and the likelihood of incorporating it
Constant 3.040 0.953 3.191 0.002
into their practice (r=.215, p = .001). Therefore, the null
hypothesis is rejected.
The results showed that the multiple linear regression medical doctors, and this can be implemented through
model was statistically significant (F = 20.067, P = 0.000, the introduction of CAM courses in medical education
adjusted R2 = 0.187); knowledge (t = 2.025, p = 0.044) and institutions [25, 26] or through in-service training [27].
attitude (t = 5.961, p = 0.000) had statistically significant Conversely, the majority of the respondents had a posi-
effects on the practice of CAM as shown in Table 9. tive perception and attitude towards CAM. Studies in the
North West and South West regions of Nigeria have also
Discussion documented a positive attitude towards CAM among
Findings from this study revealed that the healthcare physicians [6, 7]. Respondents in this study expressed
workers had poor knowledge about CAM and this had that conventional medical practitioners should be more
implications on practice. This aligns with finding in the educated on the use of CAM including its possible inclu-
North West [6] and South West [7] regions of Nigeria sion in the undergraduate curriculum of their previ-
which showed that the knowledge of CAM is low and ous course of study. This finding is similar to what was
related to the healthcare providers’ years of experience. obtained in studies by Hilal et al., and Yurtseven et al. [5,
Most had read CAM materials but the majority did 28].
not know the products. In addition, the majority were Majority of the respondents expressed their reluc-
unaware of therapies listed/approved by the National tance to refer their patients to a CAM practitioner due
Agency for Food and Drug Administration and Control to concerns about the safety and efficacy of the drug.
and only a tenth knew the name of CAM used by prac- This is similar to findings of a study conducted among
titioners. Several studies among conventional health- physicians in Lagos, Nigeria which revealed that despite
care practitioners in different regions of the world have a good knowledge of the commonly used herbal prepa-
documented poor knowledge about CAM [5, 22–24]. rations, skepticism remained about the value of CAM.
This finding can be attributed to the fact that many of the Most indicated that they would discourage patients from
respondents may not have been taught CAM during their taking these therapies [7]. Reasons for this were insuffi-
training nor had they come across such knowledge in the cient research conducted on CAM therapies with a lack
years since graduation. The poor knowledge of CAM has of data on efficacy and safety of the same. Similar find-
grave implications for the competencies of healthcare ings were reported in Sokoto [8] where the respondents
workers to counsel, address concerns and provide proper showed a high degree of concern about the safety of
guidance to the increasing number of patients who may CAM.
be contemplating using CAM therapies or integrative The majority of respondents in this study had never
medicine [5]. This is essential because patients form their used nor referred patients to CAM practitioners, nor
health beliefs largely on the advice of the health care pro- had they discussed the benefits of using CAM thera-
vider [5]. This finding underscores the need for further pies. These echo the findings from a study conducted in
education for this cadre of health workers, particularly Sokoto, Nigeria, among healthcare workers [6]. This is an
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 10 of 11

expected finding because most healthcare workers have and professional associations should implement policy,
not been trained on CAM and must follow the ethics research and programmatic initiatives that enhance CAM
of their profession and rely on evidence-based research and improve collaboration with CAM practitioners.
[13] to guide their practice. From this study, some factors
Abbreviations
affecting the perception of CAM are the respondent’s CAM Complementary and Alternative Medicine
religion and profession. This is similar to the findings of FMOH Federal Ministry of Health
a study conducted among healthcare workers in Trinidad HOD Head of Department
IHVN Institute of Human Virology, Nigeria
and Tobago [17]. LGA Local Government Area
Potential barriers and challenges to the acceptance of NAFDAC National Agency for Food and Drug Administration and Control
CAM were highlighted. Most respondents believe that NANTMP National Association of Nigeria Traditional Medicine Practitioners
NPHCDA National Primary Health Care Development Agency
healthcare workers are more likely not to accept CAM NIPRD Nigerian Institute of Pharmaceutical Research and Development
because they are under the authority and follow the eti- SPSS Statistical Package for the Social Sciences
quette of sound medical practice in the institution [10]. TCAM Traditional Complementary and Alternative Medicine
WHO World Health Organisation
Another barrier is that patients using the hospital are
well-educated; some will not even consider its use. Oth-
ers cited a lack of standardisation of CAM practice as Supplementary Information
a reason why it would be difficult to incorporate it into The online version contains supplementary material available at https://doi.
org/10.1186/s12906-024-04429-x.
their hospital practice [11]. All these potential barriers
and challenges must be considered, especially for patients Supplementary Material 1
who may desire to utilise CAM services [12].
Supplementary Material 2
The implications of these findings are that there is
Supplementary Material 3
need for effective integration of CAM into practice that
will lead to overcoming communication challenges with
patients, addressing potential safety issues and skepti- Acknowledgements
The authors express gratitude to all the respondents and participants who
cism about CAM efficacy. Addressing these implica- participated in the study. The authors also acknowledge the support and
tions requires ongoing education and training to improve contributions of all the academic staff in the Department of Health Promotion
healthcare workers’ understanding and approach to and Education including Professors O. Oladepo, A.J. Ajuwon, Oyedunni S.
Arulogun and the late Dr. F. O. Oshiname. Doctors O.E. Oyewole, M Titiloye,
CAM, enabling them to provide more comprehensive I.O. Dipeolu, Adeyimika T. Desmennu and Mr. John Imaledo. The following
and patient-centered care. individuals are appreciated for their immense support throughout the
conduct of this study; Mrs. O.J. Onche, Abraham I. Onche, Mr. Adole Onche, Dr.
F. Ogedegbe, Dr. D Igbinovia and the late Dr. G. Etudoh.
Limitations
There are two main limitations to this study. The first is Author contributions
that nurses and healthcare assistants make up the major- EJO conceptualised the study and conducted the interviews. EJO analysed
the qualitative and quantitative data under supervision and wrote the
ity of healthcare workers in Garki Hospital and the pro- draft manuscript. MMO provided leadership for the conduct of the study,
portional allocation in the initial sampling reflected this. supervised the design of the protocol and tools, quantitative and qualitative
However, the response rate for these cadres was very data collection and analysis. MMO and YOJ also critically reviewed the
manuscript and performed extensive edits. All authors read and approved the
low prompting the researchers to administer more ques- final manuscript.
tionnaires to the medical doctors to achieve the sample
size. The second is that this study was carried out among Funding
The research was funded in full by the authors.
healthcare workers in one tertiary hospital in Abuja the
capital city of Nigeria. Data availability
Further studies could consider including healthcare All qualitative and quantitative data generated during and/or analysed during
the current study are currently not publicly available but are available from the
workers in different hospitals to cut across the primary, corresponding author on request. This can only be used for non-commercial
secondary and tertiary healthcare facilities in Nigeria. purposes which ensures that participants’ confidentiality is protected.
This will ensure the results can be generalised.
Declarations
Conclusion
Ethical approval
This study investigated healthcare workers’ knowledge, The research ethics application for conducting this study was reviewed and
perception, attitude and practice towards CAM. The approved by the Health Research Ethics Committee of the Federal Capital
findings have shown the gaps in knowledge and the poor Territory Administrations board in Abuja, Nigeria. The reference number is
FHREC/2020/01/03/04-02-20 and the research was conducted following
utilisation or referral for CAM services by conventional the guidelines and regulations of the National Health Research Committee,
medical practitioners. Other potential barriers and chal- Nigeria. All participants provided written informed consent to participate in
lenges which may hinder the acceptance of CAM were the study.
highlighted. Therefore, the relevant government agencies
Onche et al. BMC Complementary Medicine and Therapies (2024) 24:177 Page 11 of 11

Consent for publication healthcare practitioners in Accra, Ghana: implications for integrative health-
Not Applicable. care. J Integr Med. 2016;14(5):380–8. pubmed.ncbi.nlm.nih.gov/27641609.
13. Umar M, Jimoh A, Adamu I, Adamu A, Yunusa A. Toward integration of
Competing interests herbalism into orthodox medical practice: perception of herbalists in Sokoto
The authors declare no competing interests. Northwest Nigeria. Int J Health Allied Sci. 2016;5(4):253–. http://www.ijhas.in/
article.asp?. issn = 2278344X;year = 2016; volume = 5; issue = 4; spage = 253;
Author details epage = 256;aulast = Umar.
1
Department of Health Promotion and Education, Faculty of Public 14. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in
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Received: 30 June 2022 / Accepted: 7 March 2024 ian Mainstream Health System: voices from within. Qual Health Res.
2021;31(10):1847–60.
16. Appiah B, Amponsah IK, Poudyal A, Mensah ML. Identifying strengths and
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