Use of traditional and complementary medicines among first- and second-generation Norwegian Pakistanis: a cross-sectional survey

Abstract

Traditional and complementary medicine (T&CM) is widely used in Pakistan for health maintenance and illness management, and Pakistani immigrants continue using T&CM after migration. Although various T&CM modalities have been identified, their prevalence and reasons for use remain unclear. This study aims to investigate T&CM use among Pakistani immigrants in Norway, including self-reported purposes, perceived benefits, associated harms, as well as gender and generational differences in T&CM use. An online cross-sectional survey using an adapted version of the I-CAM-Q questionnaire was conducted between February and August 2024, with 488 first-generation and 445 second-generation Pakistani immigrants aged ≥ 18 years. Proportional stratified random sampling was employed to ensure adequate representation across gender, generation, and age groups. Pearson’s chi-square and Fisher’s exact tests were used to examine associations between categorical variables. Logistic regression models were used to assess the relationship between the use of T&CM modalities and sociodemographic variables. Non-parametric tests were used to identify differences in the use of natural products and in overall T&CM use. A total of 99.8% of participants reported using T&CM in the past year, including natural products (99.3%), religious self-care practices (75.7%), self-care activities such as yoga and meditation (35.1%), and visits to T&CM providers (27.8%). First-generation women reported the highest use of T&CM modalities (median = 16, IQR = 23). Women were more likely than men to engage in self-care practices after adjusting for other variables. Visiting T&CM providers was significantly associated with older age, higher income, and chronic disease after adjustment. Several participants visited T&CM providers abroad. T&CM was mainly used for well-being and illness prevention, while 42.7% used natural products for acute conditions. Although most participants found T&CM beneficial, some reported adverse effects, mainly from natural products (23.8%). This study confirms the widespread use of T&CM among Pakistani immigrants in Norway, reflecting a culturally rooted, holistic approach to health. The reliance on natural products and the use of modalities received from T&CM providers abroad highlight the need for open communication about T&CM and culturally sensitive healthcare approaches to ensure patient safety.