Numerous definitions of complementary therapies exist. Nursing and other health professions frequently call the area complementary therapies, whereas NCCAM refers to them as complementary medicine. The broad
scope of these remedies and the many health professionals and therapists who are involved in delivering them create challenges for finding a definition that captures the breadth of this field.

As defined by the NCCAM, “Complementary and alternative medicine is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” (NCCAM, 2012, p. 1). In this context, conventional refers to Western biomedicine. The NCCAM definition acknowledges that other systems of health care exist and are used. According to the World Health Organization, 80% of health care in developing countries is comprised of indigenous traditional health practices rather than Western biomedicine (World Health Organization, 2012).

The lack of precision in the meaning of complementary therapies poses challenges when comparing findings across surveys that have been conducted on use of complementary procedures. Some surveys have included a large number of practices, whereas others have been limited in scope. For example, in the NCCAM/National Center for Health Statistics Survey (NCCAM, 2008a), adding prayer for health reasons to the analyses increased the percentage of use of complementary therapies from 36% to 62%.

The field of complementary therapies is constantly changing as new remedies are identified—a number of which are from other systems of care or used in a variety of native cultures. NCCAM now classifies these multiple therapies and systems of care into three categories, although acknowledging the existence of many other practices and systems of care. One large category of therapies that is used in nursing is not included as a specific group in the recent NCCAM classification: energy therapies. The NCCAM categories and examples of the types of therapies in each classification plus other major categories are shown in Exhibit 1.1. Some of these procedures have been widely used and researched, whereas others are relatively unknown in the United States. A number of the therapies noted in Exhibit 1.1 have been a part of nursing for many years.

Other methods for classifying complementary therapies are provider-based and nonprovider-based administration. Remedies that are provider based require a professional/therapist to administer them, whereas therapies that are nonprovider based do not require the presence of a professional. For example, a therapist is required for acupuncture but one is not required for acupressure. Herbal preparations and food supplements—the most used groups of complementary therapies—are self-administered. For many procedures, once the technique has been taught, a therapist is not needed. Meditation is an example of this type of self-administered therapy. Nonprovider therapies are usually much less costly than the provider-administered therapies.

Globally, as people migrate for economic reasons, wars, drought, or political factors, health professionals are becoming increasingly aware
of culture-specific health practices used in other countries. These remedies may be ones carried out by shamans, healers, family members, or the patient. Knowledge about common practices in various ethnic groups assists nurses in providing culturally sensitive care to promote health. A danger health professionals face is assuming that all people from a
culture, a country, or an area of the world engage in the same health practices. For example, assuming that all Native Americans use sage as part of their healing services is erroneous. Health practices vary across the many Native American tribes/nations found in the Americas. Likewise, health practices differ among those from the huge African continent. Thus, individual assessments are needed to determine the healing practices a given person might be using, and acceptable therapies that might be employed.

Interest in, and use of, complementary/alternative therapies has increased exponentially in recent years. Many individuals often used these therapies (e.g., prayer, meditation, herbal preparations); however, they were not called complementary therapy. Surveys have addressed use within English-speaking and largely Caucasian groups (Barnes, Powell-Griner, McFann, & Nahin, 2004; Sharafi, 2011; Su & Li, 2011). Recently, surveys have explored complementary therapy use within minority groups in the United States: African Americans (Barner, Bohman, Brown, & Richards, 2010); Hispanic adolescents (Feldman, Wiemann, Sever, & Hergenroeder, 2008); Whites, Mexican Americans, and Chinese Americans (Chao & Wade, 2008); and Asian Americans (Mirsa, Balagopal, Klatt, & Geraghty, 2010).

Interest in the use of complementary therapies is a phenomenon found not only in the United States but in many other countries as well. Research on the use of these therapies has been conducted in various countries, including Saudi Arabia (Al-Faris et al., 2008), Germany (Ernst, 2008), Japan (Hori, Mihaylov, Vasconcelos, & McCoubrie, 2008), Scotland (Thomson, Jones, Evans, & Leslie, 2012), and Turkey (Erci, 2007). The number of people using complementary therapies varied in these survey reports, but percentage of use was near 50% in all of the countries reporting.

Numerous studies have explored the use of complementary therapies in specific health conditions, including obesity (Bertisch, Wee, & McCarthy, 2008), asthma (Fattah & Hamdy, 2011), cancer (Wyatt, Silorskii, Wills, & Su, 2010), stroke (Shah, Englehardt, & Ovbiagele, 2009), and arthritis (Hoerster, Butler, Mayer, Finlayson, & Gallo, 2011). The Cochrane Database of Systematic Reviews contains reviews of the efficacy of numerous complementary therapies in the treatment of specific conditions (Cochrane Database of Systematic Reviews, 2012). In addition to the use of complementary therapies for health conditions, complementary therapies are often used to promote a healthy lifestyle. An example would be the use of Tai Chi to promote flexibility and prevent falls in older adults.

Some researchers have attempted to identify characteristics of users of complementary therapies. Nguyen and colleagues (2011) found that more women than men use these therapies. They also noted that a higher
percentage of individuals using complementary therapies have academic degrees as compared with a nonuser group. These findings were further validated in the national survey conducted by the NCCAM and the National Center for Health Statistics (NCCAM, 2008a). Struthers and Nichols (2004) reviewed studies on the use of complementary therapies in racial and ethnic minority populations. They found that the use of complementary therapies was not greater in minority groups. However, it is not known how many therapies not listed on surveys were used by immigrants or those in minority groups.