Methodological Challenges in Creating CAM Modalities: Findings from the 2002 National Health Interview Survey

The National Center for Complementary and Alternative Medicine (NCCAM) has created five domains of complementary and alternative medicine: (1) alternative medical system, (2) mind-body interventions, (3) biologically based treatments, (4) manipulative and body-based methods, and (5) energy therapies. These domains define CAM at its current state within the United States. The purpose of this article is to examine how well the NCCAM created modalities work methodologically and statistically when applied to large national data. Data for this study were obtained from the 2002 National Health Interview Survey. In 2002 the supplemental section was on the use of CAM. The total sample size was 22,870 adults, aged 18 years and older. Using LISREL, factor loadings were obtained for the five NCAAM modalities. There were discrepancies between the NCCAM modalities and the factor loadings. For alternative medical systems, folk medicine and naturopathy did not load correctly. Prayer and meditation did not load correctly on mind-body interventions. Neither chiropractic nor massage loaded properly on manipulative and body-based methods. In order to obtain proper factor loadings, we determined there should be eight separate CAM modalities: (1) acupuncture, (2) alternative medical system, (3) mind-body interventions, (4) biologically based treatments, (5) chiropractic, (6) massage, (7) energy therapies, and (8) prayer. These findings suggest that although intellectually these types of CAM may group together, when statistically tested, they do not. These findings conclude that it is imperative to look at CAM modalities in a new way, taking advantage of differences in ways in which people use them.