Use of complementary and alternative medicine and its associated factors among people living with chronic diseases in Nepalgunj sub-metropolitan: a mixed methods study

In many parts of the world, people living with long-term illnesses like diabetes, high blood pressure, or joint pain often look beyond the standard medicines prescribed by doctors. They turn to a vast collection of healing practices known as complementary and alternative medicine. These are systems of care, such as herbal remedies, yoga, or traditional healing rituals, that exist outside the mainstream medical framework. While modern medicine focuses on treating specific diseases with pharmaceuticals and surgery, these alternative approaches often emphasize the whole person, using natural substances and lifestyle changes to restore balance. For millions of people, these methods are not a replacement for modern care but a parallel path, used alongside it to manage symptoms or find relief when standard treatments feel insufficient. Understanding why people choose these paths, and how they fit them into their daily lives, is crucial for doctors and health planners who want to ensure patients receive safe, coordinated care.

In the bustling ward of Nepalgunj, a sub-metropolitan city in western Nepal, researchers set out to understand exactly how people with chronic diseases navigate this complex landscape of healing. They conducted a detailed study involving 284 adults who had been living with conditions such as diabetes, hypertension, or musculoskeletal disorders for at least a year. The team did not just ask people to fill out a survey; they also sat down for deep conversations with a smaller group of patients and local health providers to hear the stories behind the numbers. The goal was to map out who was using these alternative treatments, what they were using, and most importantly, whether they were telling their doctors about it.

The findings reveal a community where the line between modern and traditional medicine is frequently crossed. A striking majority of the participants, about 86 percent, reported that they had tried some form of alternative medicine at some point in their lives to manage their chronic conditions. However, the number of people currently using these methods at the time of the study was lower, sitting at roughly 24 percent. This suggests that while many people are curious enough to try these therapies, perhaps during a flare-up of pain or a moment of frustration with side effects, not everyone continues with them as a permanent routine. Among those who were currently using these treatments, the most common choice was Ayurveda, a traditional system of medicine from India that uses herbs, diet, and lifestyle practices. Yoga and various herbal preparations were also popular, with many people mixing these remedies with their prescribed pills.

The study uncovered specific reasons why people in this community leaned toward these alternative options. One of the strongest drivers was the presence of multiple health problems at once. People who were managing two or more chronic conditions were significantly more likely to use alternative medicine than those with just one illness. When a person is juggling several diseases, the number of pills they must take can become overwhelming, and the risk of side effects increases. In these situations, many patients turned to herbal remedies or therapies like yoga, hoping for a gentler approach that could ease their burden without adding more chemical load to their bodies. Another powerful factor was simply proximity. The researchers found that if a patient lived near a place where these services were available, they were far more likely to use them. In Nepalgunj, this often meant accessing services in nearby border towns, where the open border with India makes it easy to cross over and purchase traditional medicines or consult with practitioners.

Social circles played an equally vital role in shaping these health choices. The study showed that most people did not learn about these treatments from doctors or medical journals. Instead, they heard about them from friends, family members, and neighbors. If a neighbor shared a story about how a specific herb helped their blood pressure, that recommendation carried immense weight. This chain of trust meant that health decisions were often made within the community rather than in the clinic. For many, the belief that these natural remedies were safer and free from the harsh side effects of modern drugs was a primary motivator. Some participants expressed a fear that long-term use of pharmaceuticals could damage their liver or kidneys, leading them to seek out what they perceived as a more natural, harmless alternative.

Despite the widespread use of these therapies, a significant gap in communication emerged. The study found that nearly three-quarters of the people using alternative medicine did not tell their doctors about it. When asked why, many said their doctors never asked, or they felt the information was not important enough to share. In some cases, patients feared a negative reaction. The researchers heard stories of doctors who, upon learning about a patient's use of alternative treatments, reacted with anger or strong disapproval, telling them to stop immediately. This fear of judgment, combined with the assumption that the doctor was only interested in the "real" medicine, kept the conversation silent. This silence is dangerous because some herbal remedies can interact with prescription drugs, potentially reducing their effectiveness or causing new health problems.

The researchers concluded that the situation in Nepalgunj is not one of people rejecting modern medicine in favor of tradition, but rather of people weaving both together into a single, pluralistic approach to health. Most patients are using these alternative methods alongside their prescribed treatments, not instead of them. To improve safety and care, the study suggests that doctors need to change how they ask questions. Instead of waiting for patients to volunteer this information or reacting with hostility, health providers should routinely and gently ask about any other treatments patients are using. By creating an environment where patients feel safe to share their full health picture, doctors can help coordinate care that respects the patient's choices while ensuring that all treatments work together safely. The study highlights that while the desire for natural, accessible, and holistic care is strong, bridging the gap between the clinic and the community is essential for the well-being of those living with chronic illness.