Traditional Chinese medicine: A Bayesian network model of public awareness, usage determinants, and perception of scientific support in Austria

IntroductionDespite the paucity of evidence verifying its efficacy and safety, traditional Chinese medicine (TCM) is expanding in popularity and political support. Decisions to include TCM diagnoses in the International Classification of Diseases 11th Revision (ICD-11) by the World Health Organization (WHO) and campaigns to integrate TCM into national healthcare systems have occurred whilst the public perception and usage of TCM, especially in Europe, remains undetermined. Accordingly, this study investigates the popularity, usage patterns, perception of scientific support for TCM, and its relationship to homeopathy. MethodsA cross-sectional survey was performed in Austria and data from 1382 participants were analysed. A Bayesian network model retrieved partial correlations indicating distinct associations between sociodemographic determinants, complementary and alternative medicine (CAM) usage patterns, readiness to vaccinate, and TCM related variables. ResultsTCM was broadly known by the Austrian population (89.9% of women, 90.6% of men), with 58.9% of women and 39.5% of men using TCM between 2016 and 2019. 66.4% of women and 49.7% of men agreed with TCM being supported by science. We found a strong positive relationship between the perceived scientific support for TCM and trust in TCM-certified medical doctors. Moreover, perceived scientific support for TCM was negatively correlated with the proclivity to get vaccinated. Additionally, our Bayesian network model yielded distinct associations between TCM-, homeopathy-, and vaccination-related variables. ConclusionTCM is widely known within the Austrian general population and actively used by a substantial proportion. However, a crucial disparity exists between the commonly held public perception that TCM is scientific and findings from evidence-based studies. As public opinion towards TCM, and the proclivity to use it, are promoted through institutionalisation and official acknowledgement, it would be critical to sustain and support the distribution of unbiased, science-driven information by governmental institutions and policymakers to encourage informed patient-driven decision-making. Strengths and limitations of this studyO_LIThis is the first study to comprehensively explore the usage patterns and sociodemographic associations of TCM in a European population, not based on data deriving from the seventh round of the European Social Survey. C_LIO_LIWe are the first study on CAM usage patterns to graphically explore and report data using a Bayesian Gaussian copula graphical model--thereby, retrieving distinct partial correlations. C_LIO_LIWe provide an up-to-date summary of TCM, set forth our findings at a geopolitical scale and highlight that the discrepancy between the paucity of evidence underpinning most TCM modalities and the international promotion of TCM is also reflected in the widely-held public perception that TCM is supported by science. C_LIO_LIDue to the retrospective character of our cross-sectional survey, answers are naturally prone to recall and response bias. C_LIO_LIOur sample is skewed towards the young, people with higher levels of education, and shows a relative underrepresentation of males. Therefore, we post-stratified our sample using representative data from Austrias federal statistical office "Statistik Austria" as a robustness check. C_LI