Dynamics of Decision-Making in Medical Pluralism: A Systematic Review of Conceptual Models

Plurality of treatment choice is often observed, as in many instances people choose to use both conventional and complementary and alternative medicine (CAM). The existing models of healthcare utilization or healthcare behavior do not specifically address this medical pluralism. Hence, to understand an individual's pluralistic choice of treatment, major studies describing this have been systematically reviewed in this study in order to extract the principal factors driving such choice. Also, applicability of current healthcare models is qualitatively analyzed in order to identify whether they properly explain the factors driving such pluralistic choices.

A systemic literature review was performed of 20 studies including 6 National Surveys. The major variables included were prevalence of integrative medicine in the last 12 months, nature of pluralism, major factors driving plurality of choice and the underlying model describing such choices.

Mean usage of plurality was 44.48% (95% CI, 44.12-44.84%). The major drivers of plurality were enabling (access) and cognitive factors, followed by post-decision dissonance, philosophical congruence and social factors. The studies followed several established conceptual models with almost equal distribution. These major factors and the underlying treatment models were significantly dependent upon each other (Fisher's exact test; P = .025), but the cognitive and personality factors were found to be significantly exclusive (t = 2.39; P = .017).

Medical pluralism incorporates a multitude of decision factors, which are separately related to different healthcare-decision models. Among them, personality trait was observed to be an important but neglected component of existing models. From the existing studies, no single pluralism-driven integral model could be established, satisfying all the important conditions of pluralistic choice.