The Association Between the Use of Complementary and Alternative Medicine (CAM) with Health-Related Quality of Life (HRQOL) and Anthropometric Indices Among University Staff

Authors: [Authors as listed in MJPHM]

Affiliations: Faculty of Health Sciences, Universiti Kebangsaan Malaysia; Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia

Published: 2017  |  Malaysian Journal of Public Health Medicine, 2017; Special Volume (2)

Last reviewed: March 2026

Background

Complementary and alternative medicine (CAM) encompasses a broad range of healthcare practices, products, and systems that exist outside conventional Western medicine. In Malaysia, CAM use is deeply rooted in the country’s multicultural heritage, drawing from traditional Malay medicine (perubatan Melayu), traditional Chinese medicine (TCM), Ayurvedic practices, and various indigenous healing traditions. The Malaysian government has recognised the importance of CAM through the establishment of the Traditional and Complementary Medicine Division within the Ministry of Health, and through the Traditional and Complementary Medicine Act 2016.

Despite growing institutional recognition, the relationship between CAM use and health outcomes among the general working population remains insufficiently studied. Health-related quality of life (HRQOL) is a multidimensional concept that captures an individual’s perceived physical, mental, and social wellbeing. Understanding how CAM use relates to HRQOL—and whether this association is confounded by or interacts with anthropometric health indicators—provides valuable insights for health promotion planning.

University staff represent an interesting study population because they typically have higher educational attainment, which is associated with greater health literacy and more informed health decision-making, but also with higher rates of CAM use in many populations. This study investigated the association between CAM use, HRQOL, and anthropometric indices among university staff in Malaysia.

Study Design and Methods

This cross-sectional study was conducted among staff at Malaysian universities. Data were collected through structured questionnaires that assessed CAM use patterns, HRQOL, and sociodemographic characteristics. Anthropometric measurements including body mass index (BMI), waist circumference, and waist-to-hip ratio were obtained through standardised protocols.

CAM use was categorised into major modality groups: herbal products and dietary supplements (including traditional herbal preparations, vitamins, minerals, and health foods), traditional medical practices (traditional Malay, Chinese, or Indian medicine consultations), mind-body therapies (yoga, meditation, tai chi, qigong), and manual therapies (massage, reflexology, chiropractic). HRQOL was assessed using a validated instrument that captured physical functioning, emotional wellbeing, social functioning, and general health perception domains.

Results and Analysis

Prevalence and Patterns of CAM Use

A notable proportion of university staff reported using at least one CAM modality. Herbal products and dietary supplements were the most commonly used CAM category, consistent with national and international trends showing that natural health products are the most popular form of CAM across diverse populations. Traditional medical practices and mind-body therapies also had substantial usage rates among the study population.

CAM Use and HRQOL

The relationship between CAM use and HRQOL was complex and not uniformly positive. Some CAM modalities were associated with differences in specific HRQOL domains, while others showed no significant associations after adjusting for potential confounders. The cross-sectional design makes it challenging to determine the direction of this relationship: individuals with lower HRQOL may seek CAM as a complementary approach to improving their wellbeing, or alternatively, certain CAM practices may genuinely influence perceived quality of life.

Anthropometric Indices

The study also examined whether CAM use was associated with anthropometric health indicators. Body mass index and waist circumference are well-established markers of cardiometabolic risk, and any association between CAM use and these measures could have implications for chronic disease prevention strategies. The analysis explored whether CAM users and non-users differed in their anthropometric profiles and whether anthropometric factors modulated the CAM-HRQOL relationship.

Discussion

The findings of this study contribute to the growing body of evidence on CAM use among Malaysian populations and its relationship with health outcomes. The high prevalence of CAM use among university staff aligns with previous Malaysian studies and with international research showing that higher educational attainment is associated with greater CAM utilisation.

The complex relationship between CAM use and HRQOL observed in this study mirrors findings from other countries. Research consistently shows that CAM users tend to report poorer health status than non-users, which likely reflects the fact that health concerns motivate CAM-seeking behaviour rather than indicating harmful effects of CAM itself. However, certain mind-body practices such as yoga and meditation have established evidence for improving specific aspects of quality of life, particularly emotional and psychological wellbeing.

The Malaysian context adds additional complexity due to the widespread cultural acceptance of traditional remedies and the blurred boundary between food, supplement, and medicine categories in traditional healing systems. Many Malaysians use traditional preparations not as alternatives to conventional medicine but as health maintenance practices integrated into daily life—a pattern that may not be well captured by standard CAM use questionnaires.

Public Health Implications

University administrators and workplace health promotion programmes should consider the high prevalence of CAM use among staff when designing wellness initiatives. Rather than ignoring or discouraging CAM use, evidence-based information about the safety, efficacy, and potential interactions of commonly used CAM modalities should be incorporated into health education programmes. This approach respects cultural health practices while promoting informed decision-making.

Healthcare providers serving university communities should routinely inquire about CAM use during consultations, as concurrent use of herbal products and conventional medications poses potential risks for drug-herb interactions. The integration of reliable CAM information into occupational health services could improve the quality of care for university staff and contribute to more comprehensive health promotion strategies that acknowledge the pluralistic healthcare-seeking behaviours of Malaysian populations.

Limitations

The cross-sectional design precludes causal inferences about the relationship between CAM use, HRQOL, and anthropometric indices. Self-reported CAM use may be subject to recall bias and social desirability effects. The study was conducted among university staff, who may have higher health literacy and different health behaviours compared to the general population, limiting generalisability. The broad categorisation of CAM modalities may mask important differences between specific therapies. Future research should employ longitudinal designs to track changes in HRQOL among CAM users over time and should examine specific CAM modalities rather than treating CAM as a homogeneous category.