Perception of Honorific Titles Among Chiropractors in Malaysia: A Qualitative Study

Abstract

Objective

The purpose of this study was to explore the perceptions of chiropractors in Malaysia regarding the use of honorific titles and how these perceptions influence their professional identity and patient interactions.

Methods

This descriptive qualitative study used semistructured interviews with 9 chiropractors registered with the Association of Chiropractic Malaysia. Participants were selected based on their active practice in Malaysia, with exclusion criteria including prior participation in similar studies and potential conflicts of interest. Thematic analysis was performed to identify key patterns and themes from the interview data.

Results

Participants viewed honorific titles as essential to their professional identity, with many expressing concerns that the prohibition of the title “Doctor” undermines their credibility. Confusion among the public regarding the qualifications of chiropractors was a recurrent theme. Participants highlighted the need for clearer guidelines and public education to address these misconceptions. Although some supported the Traditional and Complementary Medicine Act 2016, others believed that it hindered professional recognition.

Conclusion

The findings suggest a need for regulatory reforms and public education campaigns to enhance the professional identity of chiropractors in Malaysia. Further research should explore the impact of honorific titles on patient outcomes and examine regional variations in perceptions within the chiropractic community.

Introduction

Honorific titles, such as “Doctor” and “Professor,” are integral to professional settings, signifying respect, authority, and recognition of expertise. These titles have a long history of conveying social standing and professional achievement. The use of honorific titles dates back centuries, with the title “Doctor” originating from the Latin word doctus, meaning “to teach” or “learned.”¹ Initially, this title was reserved for scholars and academics who had achieved the highest level of education and were granted the right to teach. Over time, the title “Doctor” became associated with medical practitioners, and in many countries, it is now synonymous with health care professionals who hold medical degrees.²

However, the application of such titles in fields like chiropractic is complex due to the varying levels of education for chiropractors in different countries. In some countries, chiropractors hold a bachelor’s degree, whereas in others, they may have a master’s degree or a professional degree such as Doctor of Chiropractic (DC). This variation can lead to confusion among the public and other health care professionals regarding the qualifications and expertise of chiropractors. International work shows that the honorific title “Dr” can shape patients’ perceptions of practitioner expertise and even their willingness to pay for complementary medicine services.³ This distinction creates challenges in terms of professional identity and patient interactions. In Malaysia, the regulation of titles used by Traditional and Complementary Medicine (T&CM) practitioners is governed by the T&CM Act 2016 (Act 775), which adds further complexity to the situation by restricting the use of certain titles among T&CM practitioners, including chiropractors.^4,5 The specific prohibition on the title and prefix was formally gazetted on April 14, 2022, bringing the restriction into force.⁵

The T&CM Act 2016 aims to regulate and standardize the practice of T&CM in Malaysia, ensuring that practitioners adhere to specific guidelines and do not mislead the public regarding their qualifications. However, the prohibition on the use of titles such as “Doctor” has raised concerns among chiropractors who believe that this restriction may undermine their professional standing and create confusion among patients. The chiropractic profession, although relatively new in Malaysia, is growing, and chiropractors are increasingly concerned about how they are perceived by the public and other health care professionals. The restriction on the use of the title “Doctor” may contribute to misconceptions about the scope of chiropractic practice and the qualifications of chiropractors.^5,6

A study of perceptions has the potential to influence how the chiropractic profession is perceived both by the public and within the broader health care community in Malaysia. Exploration of chiropractors’ perspectives on the use of honorific titles can offer valuable insights into the ways in which professional identity and patient interactions are shaped by regulatory frameworks. Ultimately, this study may inform future policy decisions and contribute to the ongoing development and recognition of chiropractic as a vital health care profession in Malaysia.

The chiropractic profession, established in 1895 by Daniel David Palmer in the United States, has evolved substantially over the past century.^7,8 Chiropractic is a health care discipline that focuses on diagnosing, treating, and preventing neuromusculoskeletal disorders, particularly those related to the spine. Chiropractors use noninvasive methods such as spinal manipulation, soft tissue therapy, and exercise prescription to manage conditions like back pain, neck pain, and headaches.⁹ Over the years, chiropractic has become a recognized and regulated profession in many countries.¹⁰

In Malaysia, chiropractic is classified as a recognized practice area under the T&CM Act 2016.¹¹ This Act regulates T&CM practices in Malaysia, ensuring that practitioners meet specific standards and adhere to guidelines set by the Ministry of Health. The inclusion of chiropractic under this Act has been a significant milestone for the profession in Malaysia, providing official recognition and a framework for practice.¹¹ However, the Act also restricts chiropractors from using the honorific title “Doctor.” This rule is intended to protect the public because many Malaysians have limited awareness of chiropractic. A recent survey found that 46.2% of respondents were unsure whether they could differentiate a chiropractic doctor from a medical doctor, and only 37.4% believed they could do so.¹² Although well-intentioned, the prohibition has nevertheless created challenges for chiropractors practicing in Malaysia.

The title “Doctor” has traditionally been associated with holders of doctoral degrees or with medical practitioners. In many jurisdictions, chiropractors are permitted to use the prefix “Dr” because their education culminates in a first professional doctorate, such as DC; this is common in the United States and Canada, where the public generally recognizes chiropractors as health care professionals with expertise in musculoskeletal care.¹³ By contrast, most accredited chiropractic programs outside the United States, Canada, and South Korea award a bachelor’s or master’s degree. In Malaysia, the public use of “Dr” is regulated independently of academic credentials. The T&CM Act 2016 prohibits all registered T&CM practitioners, including chiropractors, from using the prefix, even when they hold a professional doctorate.

In the United States, the title “Doctor of Chiropractic” is widely recognized, and chiropractors are considered health care providers with the right to use the title “Doctor.” This title reflects their extensive education and training, which includes both academic and clinical components similar to other health care professions.^14,15 In Canada, chiropractors also use the title “Doctor of Chiropractic” under similar recognition.¹⁶

In the United Kingdom, the General Chiropractic Council (GCC) allows chiropractors to use the honorific title “Doctor” or “Dr.” However, it must be made clear that this title refers to a “Doctor of Chiropractic” and not a medical doctor. Chiropractors must ensure that any public-facing content, such as advertisements, websites, or social media, clearly states that they are chiropractors and not medical practitioners. Failure to do so can lead to allegations of misconduct under GCC regulations.^17,18

Similarly, in Australia, the Chiropractic Board of Australia permits the use of the title “Doctor” for chiropractors, provided that it is accompanied by an appropriate descriptor, such as “Doctor of Chiropractic,” to avoid any potential confusion with medical doctors. This is intended to ensure transparency and clarity in public communications and advertisements, as regulated by the Chiropractic Board of Australia and other relevant authorities.^19,20

These guidelines are designed to maintain professional standards and protect the public from any potential misunderstanding regarding the qualifications and expertise of chiropractors.

The history of honorific titles, particularly “Doctor,” illustrates their evolving significance in different contexts. The title “Doctor” was first bestowed in the Middle Ages as an honorific for scholars who had attained the highest levels of education and were granted the right to teach. By the 15th century, the title had become closely associated with the medical profession, though it was also used by those holding doctoral degrees in other fields.¹ In the 18th and 19th centuries, the title “Doctor” became widely recognized as a mark of professional achievement in medicine, leading to its prevalent association with medical practitioners.²

However, the situation is different in Malaysia, where the T&CM Act 2016 prohibits T&CM practitioners, including chiropractors, from using the title “Doctor.” The rationale behind this prohibition is to prevent confusion among the public and ensure that individuals do not misrepresent their qualifications. Although this is a valid concern, it has created a dilemma for chiropractors, who believe that the restriction on using the title “Doctor” may diminish their professional standing and credibility.⁶ The prohibition of the title may also lead to confusion among patients, who may not fully understand the qualifications and scope of practice of chiropractors.

Research suggests that the use of honorific titles can significantly influence patient perceptions and trust in health care professionals. A study conducted by Gilbey and Perezgonzalez³ in New Zealand found that patients were more likely to trust and seek care from practitioners who used the title “Doctor.” The study also found that the use of the title “Doctor” was associated with higher perceived competence and professionalism. This finding is particularly relevant to the chiropractic profession, where establishing trust and credibility with patients is essential for effective care.³

In Malaysia, the prohibition of the title “Doctor” for chiropractors may have unintended consequences, potentially undermining the profession’s efforts to gain public trust and recognition. Without the ability to use the title, chiropractors may struggle to differentiate themselves from other T&CM practitioners and convey their expertise to patients. This could lead to a lack of understanding among the public regarding the qualifications and capabilities of chiropractors, ultimately affecting the profession’s growth and development in Malaysia.

To date, no peer-reviewed study has explored chiropractors’ perceptions of honorific titles in Malaysia or elsewhere. In contrast, limited work has examined Malaysian patient perspectives: a cross-sectional survey in Klang Valley reported that only 50.2% of respondents had good awareness of chiropractic and 46.2% were unsure whether they could differentiate a chiropractic doctor from a medical doctor, indicating substantial public confusion.¹² An exploratory clinic-based study identified educational background as the strongest predictor across 10 patient-trust dimensions.²¹ Because the T&CM Act 2016 regulates title usage at the level of practitioner conduct, an initial focus on chiropractors’ own perceptions is warranted. Clarifying practitioners’ views provides foundational evidence for future patient-centered studies and for the development of public-education strategies.

Therefore, the purpose of this study was to assess the perceptions of honorific titles among chiropractors in Malaysia, with particular emphasis on their views regarding the use of the title “Doctor,” the implications of the T&CM Act 2016, and how these factors influence their professional identity and patient interactions.

Methods

Study Design

This study used a descriptive qualitative design, focusing on understanding chiropractors’ perceptions of honorific titles in Malaysia. Semistructured interviews were used to allow for in-depth exploration of participants’ views while maintaining a flexible structure that facilitated further probing into relevant issues.

Ethics Approval and Consent to Participate

The 253rd Joint Committee on Research and Ethics of the IMU University reviewed and approved the current study—project number: BCh I/2022(35).

Setting, Population, and Sampling Frame

This study was conducted across Malaysia and targeted all chiropractors registered with the Association of Chiropractic Malaysia (ACM). No official national census of practicing chiropractors is available; however, annual registers of the Ministry of Health’s T&CM Division listed 97 new registrations in 2021 and 118 in 2023, suggesting a national workforce of approximately 400 chiropractors (no data were published for 2022).^22,23 With 357 members in the 2023 register, the ACM represents about 89% of practicing chiropractors, making it an appropriate sampling frame. On April 8, 2023, the ACM office emailed an invitation, information sheet, and consent form to every registered member. The information sheet outlined the study aims, inclusion criteria, interview procedure, confidentiality safeguards, absence of foreseeable risks, potential benefits, and researcher contact details.

Inclusion and Exclusion Criteria

Inclusion criteria were that participants were registered chiropractors with ACM and were willing to participate in the interview process.

Exclusion criteria were chiropractors who were not in Malaysia, those not proficient in the language used for the interviews, and individuals with potential conflicts of interest, such as involvement in policy making regarding honorific titles. Also excluded were chiropractors who had previously participated in similar studies on honorific titles to avoid bias in the results.

Sample Size and Saturation

In qualitative research, sample size is guided by data saturation, the point at which no new themes or insights emerge. Guest et al²⁴ suggest that saturation is often reached with 12 to 15 interviews, although smaller, relatively homogeneous samples may achieve it sooner. For this study, 10 chiropractors volunteered; 1 was excluded for practicing abroad, leaving 9 participants. This cohort provided variation in sex, years of practice, practice setting, and geographic region. Data saturation was predefined as the point at which no new codes appeared across 2 consecutive interviews. Saturation occurred after interview 8 and was confirmed with a ninth interview, after which recruitment ceased in line with the saturation point, available resources, and the approved project timeline.

Data Collection and Ethical Considerations

Ethical approval was granted by the IMU Joint Committee on Research and Ethics. Each participant received an information sheet describing the study purpose, interview procedure, confidentiality safeguards, absence of foreseeable risk, and the right to withdraw at any time without consequence. Written informed consent was obtained before data collection.

Interviews were conducted online using Microsoft Teams (Microsoft Corporation) with end-to-end encryption. One author (K.Y.L.) served as interviewer and followed a semistructured guide for open-ended questions that covered all study objectives while allowing follow-up probes. Sessions lasted an average of 45 minutes. Each interview was recorded with Microsoft Teams, which generated an initial transcript that was reviewed and corrected for accuracy. Transcripts were anonymized and, together with the audio and coding files, stored in a Google Drive workspace (Google LLC) secured with multifactor authentication and accessible only to the research team.

Tools

A self-designed interview guide was used, consisting of open-ended questions that addressed the study’s key objectives. The guide allowed for flexibility in exploring emerging themes during the interviews. See the Supplementary File for questions.

Data Analysis

Thematic analysis was performed to analyze the interview transcripts, following a systematic approach using the 6-phase framework described by Braun and Clarke²⁵ to identify patterns and themes that emerged from the data. For steps, see the Supplementary File. This structured approach to thematic analysis ensured that the findings were grounded in the data, providing a comprehensive understanding of the participants’ perspectives.

Results

Demographic Characteristics

The participants in this study represent a diverse group of chiropractors in Malaysia, encompassing a range of ages, sexes, and educational backgrounds. Nine participants were included in the analysis after excluding 1 participant who, although a member of the ACM, was not in Malaysia. This exclusion was made to ensure the study’s focus on chiropractors within the country.

The participants’ ages ranged from 24 to 33 years, with a mean age of 28 years. The sex distribution was balanced, with 4 participants (44.4%) identifying as female and 5 participants (55.6%) as male. All participants graduated from institutions accredited by the Council on Chiropractic Education Australasia. Of the participants, 8 (88.9%) earned their chiropractic degrees from the IMU University in Malaysia and 1 (11.1%) graduated from the Royal Melbourne Institute of Technology University in Australia. The years of graduation ranged from 2014 to 2023, as illustrated in Figure 1.

Fig 1.

Distribution of participants’ graduation years (n = 9). A box and whisker plot illustrating the spread of years in which participating chiropractors graduated. The box represents the IQR (IQR, 2015-2022); the horizontal line within the box marks the median year (2018). Whiskers indicate the minimum (2014) and maximum (2023) graduation years.

This demographic diversity allowed for a broad range of perspectives on the use and perception of honorific titles within the chiropractic profession in Malaysia. The participants’ varied experiences, both in terms of professional tenure and educational background, contributed to a well-rounded understanding of how these titles are viewed and used in practice.

Thematic Analysis

A visual overview of the interview data is presented in Figure 2, a word cloud highlighting the most frequently mentioned concepts, and Figure 3 displays a thematic map that organizes these concepts into 6 interrelated themes and their subthemes; the themes are described in detail below.

Fig 2.

Word cloud depicting key concepts related to honorific titles among chiropractors in Malaysia. This word cloud visualizes the most frequently mentioned concepts and terms derived from interviews with chiropractors in Malaysia regarding their perceptions of honorific titles. Prominent words such as “Professional,” “Title,” “Health Care,” “Education,” “Standardization,” and “Public” highlight central themes like professional identity, recognition, and challenges in public understanding. The varying sizes of the words reflect their frequency of occurrence, with larger words indicating more frequent mentions. tcm, traditional Chinese medicine.

Fig 3.

Thematic map illustrating relationships between key themes in the study. This thematic map depicts the relationships between the key themes identified in the study of chiropractors’ perceptions of honorific titles in Malaysia. The central theme, “Perception of Honorific Titles,” is linked to the main themes, such as “Honorific Titles as Symbols of Professional Recognition,” “Challenges in Public Perception and Understanding,” and “Impact of Recent Rulings.” Subthemes, including “Public Confusion,” “Professional Identity,” and “Standardization of Titles,’ are also visualized to demonstrate how they interconnect with the broader concepts. The map serves as a visual summary of how these themes and subthemes interact and influence each other in the context of the study. TCM, traditional Chinese medicine.

Theme 1: Perception of Honorific Titles as Symbols of Professional Identity

Summary of Responses

Participants consistently described honorific titles, such as “Doctor,” as symbols that enhance their professional identity. These titles were seen as markers of education and achievement, contributing to a chiropractor’s credibility in the eyes of both colleagues and patients.

Direct Quotes

Participant B: “Honorific titles, like ‘Doctor’ or ‘DC,’ represent a profession, similar to how people are called ‘Mr’ or ‘Ms’ based on their status.” Participant F: “Honorific titles like ‘Doctor’ represent your level of education and profession.”

Analysis

The theme highlights the importance that participants place on honorific titles in affirming their professional status. The connection between titles and perceived expertise suggests that these titles play a significant role in establishing credibility within the health care system. Further exploration could examine how these perceptions influence patient trust and professional interactions.

Theme 2: Confusion and Misuse of Titles Among Health Care Professionals

Summary of Responses

Many participants acknowledged confusion surrounding the use of titles in Malaysia, especially among nonmedical health care professionals. The public often assumes that anyone with the title “Doctor” has a medical background.

Direct Quotes

Participant C: “In Malaysia, if someone has a ‘Doctor’ title, people assume they have a medical background.” Participant G: “I’ve seen misuse of titles among other health care providers, which can confuse the public.”

Analysis

The theme underscores the challenges faced by chiropractors in differentiating themselves from medical doctors. This confusion may lead to misunderstandings in patient-practitioner interactions and affect the professional identity of chiropractors. Addressing these challenges through public education and clearer guidelines could improve clarity and trust.

Theme 3: Impact of Recent Rulings on Professional Titles

Summary of Responses

The ruling that prohibits T&CM practitioners, including chiropractors, from using the title “Doctor” has elicited mixed reactions. Some participants are accepting of the ruling, whereas others believe that it undermines their professional status.

Direct Quotes

Participant H: “I think it’s fair, given that our education is different from that of medical doctors.” Participant F: “I think chiropractors should still be called ‘Doctor’ because of our role in diagnosing and treating conditions.”

Analysis

This theme highlights the tension between maintaining professional identity and adhering to regulatory standards. The varied responses reflect a balance between understanding the rationale behind the ruling and the desire to retain professional recognition. The theme suggests a need for ongoing dialogue and potential revisions to title regulations to address these concerns.

Theme 4: Divergent Opinions on Titles for Chiropractors

Summary of Responses

Participants expressed differing views on the appropriate titles for chiropractors. Some support the continued use of “Doctor” or “Doctor of Chiropractic,” whereas others believe that using “Chiropractor” or “DC” alone is sufficient.

Direct Quotes

Participant G: “I prefer using ‘DC’ or ‘Doctor of Chiropractic’ to make it clear.” Participant E: “I think just using ‘Chiropractor’ is fine.”

Analysis

The divergence in opinions highlights the ongoing debate within the chiropractic profession regarding title usage. The challenge lies in balancing professional recognition with the need to prevent confusion with medical doctors. This theme indicates that further discussion and consensus-building within the profession may be necessary.

Theme 5: Criteria for Awarding the Title “Doctor”

Summary of Responses

Participants generally agreed that the title “Doctor” should be awarded based on specific criteria, such as educational qualifications and clinical experience.

Direct Quotes

Participant J: “The title should depend on clinical experience and exposure.”

Analysis

The emphasis on clear criteria for awarding the title “Doctor” reflects the participants’ desire for transparency and fairness in title usage. Establishing consistent standards across health care professions could help clarify title designations and reduce public confusion.

Theme 6: Public Understanding and Education

Summary of Responses

Participants expressed concern about the public’s lack of understanding regarding health care roles and titles. Educating patients on the significance of titles is seen as essential for improving clarity and trust.

Direct Quotes

Participant I: “The public often fails to differentiate between various health care professionals, leading to confusion.”

Analysis

This theme underscores the importance of public education in addressing misconceptions about health care titles. Increasing awareness and providing clear explanations of health care roles could enhance patient interactions and ensure that titles are used appropriately.

Discussion

The findings of this study highlight several key perceptions among chiropractors in Malaysia regarding the use of honorific titles, particularly “Doctor,” and their implications on professional identity and public perception. This discussion will analyze these findings, compare them with existing literature, and explore their implications for the chiropractic profession in Malaysia.

Chiropractic was formally recognized in Malaysia in 2017, and the local degree program produced its first graduates in 2014.^11,26 The most recent ACM census, conducted in 2025, reports a mean practitioner age of 31 years (range, 22-56 years), confirming that the profession remains predominantly youthful.²⁷ Projecting this figure back to 2023 suggests that our sample’s age profile mirrors the national workforce of the study period rather than reflecting recruitment bias. This demographic reality may shape chiropractors’ perceptions of professional titles, public credibility, and identity formation, and should be borne in mind when interpreting the 6 themes that follow.

The first theme identified in the results, “Perception of Honorific Titles as Symbols of Professional Identity,” underscores the importance that chiropractors in Malaysia place on titles such as “Doctor” in affirming their professional standing. Participants consistently viewed these titles as crucial markers of their educational achievements and expertise. This finding aligns with existing research, which indicates that honorific titles in health care often serve as symbols of authority and credibility.^3,28 The use of “Doctor” by chiropractors, particularly in countries where the title is allowed, has been shown to enhance patient trust and perceived competence.²⁹

Trust is a critical component of the patient-chiropractor relationship, and it plays a significant role in patient outcomes. A study conducted in Malaysia found that trust dimensions such as evaluating problems thoroughly, expressing care, and communicating clearly were highly valued by patients.²¹ The use of honorific titles like “Doctor” can strengthen these trust dimensions, as it reinforces the perception of technical competence and professionalism, which are essential in health care.²¹ However, the restriction on using this title in Malaysia, as imposed by the T&CM Act 2016, poses a significant challenge to the professional identity of chiropractors.^4,5 This regulation may lead to a diminished public perception of chiropractic qualifications and expertise, thereby affecting the profession’s growth in Malaysia.

The second theme, “Confusion and Misuse of Titles Among Health Care Professionals,” further emphasizes the complexity of title usage in Malaysia. Participants expressed concern that the public often assumes anyone with the title “Doctor” has a medical background, leading to potential misunderstandings between chiropractors and their patients. Whether chiropractors should be addressed as doctors hinges on 2 intersecting criteria: possession of a doctoral qualification and statutory permission to practice medicine; in Malaysia, the T&CM Act 2016 explicitly prohibits chiropractors from using the title “Doctor,” aligning public usage of the term with medical practice as defined under the Medical Act 1971. This confusion is not unique to Malaysia; similar issues have been reported in other countries where nonmedical practitioners are allowed to use the title “Doctor” under certain conditions.^14,17,18 Comparable GCC research found that nearly half of respondents believed that chiropractors should not use the title “Doctor,” underscoring persistent international uncertainty about appropriate forms of address.³⁰ This finding suggests a need for clearer public communication regarding the roles and qualifications of various health care professionals, including chiropractors. Public education campaigns, as recommended by participants, could help mitigate these issues and ensure that patients have a better understanding of what to expect from their chiropractic care.³¹

The third theme, “Impact of Recent Rulings on Professional Titles,” highlights the mixed reactions to the T&CM Act 2016’s prohibition of the title “Doctor” among chiropractors, revealing a tension between maintaining professional identity and adhering to regulatory standards. Some participants supported the ruling, recognizing the need to distinguish chiropractic from medical practice, whereas others believed that it undermined their professional status. This divergence mirrors debates in other countries with similar regulations.^15,19 The results suggest that although regulation is necessary to protect public interests, it must also consider the professional needs of chiropractors. Ongoing dialogue between policymakers and the chiropractic community could help strike a balance that maintains public trust while allowing chiropractors to assert their professional identity.

The fourth theme, “Divergent Opinions on Titles for Chiropractors,” reflects the varied perspectives within the profession itself. Although some participants favored the continued use of “Doctor of Chiropractic” or “DC,” others believed that simply using “Chiropractor” was sufficient. This debate highlights the broader issue of title standardization within the profession. The findings suggest that achieving consensus on title usage within the chiropractic community could enhance the profession’s cohesiveness and clarify its public image.^11,20 Future discussions within the profession, potentially facilitated by professional associations, could help address these divergent views and establish more uniform practices.

The fifth theme, “Criteria for Awarding the Title ‘Doctor,’” demonstrates the participants’ desire for transparency and fairness in title usage. Participants generally agreed that the title should be awarded based on specific criteria, such as educational qualifications and clinical experience. This perspective is consistent with international practices, where the title “Doctor” is often linked to advanced academic and clinical training.^13,16 Establishing clear, consistent standards for title usage among chiropractors practicing in Malaysia could help reinforce the profession’s credibility and address some of the public confusion noted earlier.

Finally, the sixth theme, “Public Understanding and Education,” emphasizes the need for increased efforts to educate the public about the chiropractic profession and the significance of honorific titles. Participants expressed concern that the public’s lack of understanding regarding health care roles and titles leads to confusion, which can impact patient trust and engagement with chiropractic care. This finding aligns with existing literature, which highlights the importance of public education in addressing misconceptions about health care professions.^3,32 Implementing educational initiatives that clarify the role and qualifications of chiropractors could enhance public perception and support the profession’s development in Malaysia.

Although the regulatory framework examined in this study is specific to Malaysia, similar debates about the professional title “Doctor” have arisen in jurisdictions where chiropractic is still developing or where legislation restricts title use for nonmedical practitioners. Consequently, the themes identified here may offer comparative insights for policymakers and professional associations in countries facing analogous regulatory or public-perception challenges. At the same time, transferability beyond such settings is naturally limited, and any application of the findings must take local legal and cultural conditions into account. In Malaysia itself, trust in chiropractors is multifaceted, shaped by perceptions of technical competence, clear communication, and empathy.²¹ By educating the public and consistently demonstrating their expertise, chiropractors practicing in Malaysia can strengthen these dimensions of trust even while practicing under current title restrictions.

Limitations

This study, although providing valuable insights into the perceptions of honorific titles among chiropractors in Malaysia, is not without its limitations. First, the sample size was relatively small, comprising only 9 participants, which may not fully capture the diversity of opinions within the chiropractic community in Malaysia. Additionally, the study relied on self-reported data, which could be subject to bias, as participants may have provided socially desirable responses or been influenced by their current professional experiences. The virtual nature of the interviews, although necessary due to logistical constraints, may have also limited the depth of interaction and nonverbal communication typically captured in face-to-face interviews.

Another limitation is the focus on chiropractors who are registered with the ACM, which may exclude perspectives from chiropractors who are not affiliated with this organization. This could potentially limit the generalizability of the findings to the broader chiropractic community in Malaysia.

Future Research

Building on the themes identified here, a sequential mixed-methods study that combines a nationwide survey with follow-up interviews could quantify the prevalence of specific attitudes while preserving contextual depth. Future research should also expand the sample to include chiropractors practicing across all regions of Malaysia and conduct longitudinal studies to examine how perceptions of professional titles evolve over time. Comparative work across Southeast Asia and investigations into how titles influence patient trust, satisfaction, and adherence would further inform policy and professional practice.

Beyond immediate empirical work, a policy-oriented research agenda is warranted to evaluate the feasibility of elevating chiropractic education from Malaysian Qualifications Framework Level 6 to Level 8. Such work should include cost-benefit analyses, workforce supply modeling, stakeholder consultations with universities and the T&CM Council, and mapping of clinical placement capacity. Evidence from these studies would indicate whether a doctoral pathway could realistically be adopted in Malaysia and what transitional mechanisms (eg, bridging programs or phased implementation) would be required

Additionally, although 1 survey in Malaysia has assessed general awareness of chiropractic, no study has examined patient perceptions of professional titles. A nationwide mixed-methods project that pairs a patient survey with in-depth interviews could determine whether patients’ views corroborate or diverge from practitioners’ assumptions and assess how title usage influences trust, satisfaction, adherence, and other clinical outcomes. Findings from such patient-centered research would provide essential evidence for policymakers and professional organizations when considering regulations on title usage.

Recommendations

Based on the findings of this study, several recommendations can be made. First, there is a need for clearer guidelines and public education regarding the use of honorific titles by chiropractors and other health care professionals in Malaysia. The Malaysian Ministry of Health, in collaboration with professional bodies such as the ACM, should develop and implement educational campaigns aimed at informing the public about the qualifications and roles of chiropractors. These campaigns should specifically address any misconceptions that may arise due to the prohibition of the title “Doctor,” ensuring clarity and enhancing public trust in the chiropractic profession.

Second, ongoing dialogue between policymakers and the chiropractic community is essential to ensure that regulations reflect both the public’s need for transparency and the professional identity of chiropractors. Establishing clear criteria for title usage, such as linking the title “Doctor” to specific educational and clinical requirements, could help address the concerns raised by chiropractors while maintaining public trust.

Finally, professional associations should consider promoting standardized titles that effectively communicate the qualifications of chiropractors without causing confusion with medical doctors. This approach, combined with efforts to standardize title usage within the profession, could enhance cohesion and improve the public image of chiropractic in Malaysia.

Further research should investigate how honorific titles influence patient trust, satisfaction, and adherence, and should incorporate patient perspectives to determine whether they corroborate or diverge from practitioners’ assumptions. Comparative work across regions and longitudinal designs will help the chiropractic profession in Malaysia and beyond to develop a cohesive, patient-centered identity.

Conclusion

This study provides new insight into the perceptions of chiropractors practicing in Malaysia regarding honorific titles within the regulatory framework of the T&CM Act 2016. Perceptions of the professional title “Doctor” were not uniform: several participants regarded it as essential for legitimacy and credibility, whereas others believed that it was unnecessary for effective practice. Regulatory restrictions, therefore, affect chiropractors differently and contribute to a complex professional landscape.

Because the T&CM Act 2016 prohibits the use of “Doctor” by chiropractors, tensions arise among statutory compliance, public understanding, and professional identity. Clear guidelines, public education initiatives, and sustained dialogue among regulators, professional bodies, and educators are needed so that chiropractors can maintain an authentic professional identity while meeting legal requirements. Any future regulatory or professional decision must balance practitioner aspirations with patient understanding and safety, which remain paramount.

Funding Sources and Conflicts of Interest

This study was supported by a grant for the period between October 31, 2022, and December 31, 2023, by the IMU University, Malaysia—Research Project No.: BCh I/2022(35). No conflicts of interest were reported for this study.

Contributorship Information

Concept development (provided idea for the research): Y.K.W., K.Y.L.

Design (planned the methods to generate the results): Y.K.W., K.Y.L.

Supervision (oversight, organization and implementation): Y.K.W.

Data collection/processing (experiments, organization, or reporting data): Y.K.W., K.Y.L.

Analysis/interpretation (analysis, evaluation, presentation of results): Y.K.W., K.Y.L.

Literature search (performed the literature search): Y.K.W., K.Y.L.

Writing (responsible for writing a substantive part of the manuscript): Y.K.W.

Critical review (revised manuscript for intellectual content): Y.K.W.

Declaration of Generative AI and AI-Assisted Technologies in the Writing Process

During the preparation of this work the authors used ChatGPT (OpenAI) in order to improve language clarity, grammar, and overall readability. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Practical Applications.

• •Chiropractors in Malaysia view honorific titles such as “Doctor” as important for professional identity and credibility.
• •The current regulatory restriction under the T&CM Act 2016 may contribute to public confusion and diminish the perceived legitimacy of the profession.
• •Clearer guidelines and public education initiatives are needed to enhance understanding of chiropractic qualifications.
• •Engaging policymakers and professional associations in dialogue may help address title-related concerns and support the growth of the profession.

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