Abstract
Background
The global use of Complementary and Alternative Medicine (CAM) is steadily rising. Patients diagnosed with prostate cancer often turn to CAM to manage or improve their condition. As CAM becomes increasingly common in cancer care, understanding patients’ views on formalising it within the healthcare system has grown more important. This study, therefore, aimed to explore the perspectives on the formalisation of CAM among current users diagnosed with prostate cancer at the Korle-Bu Teaching Hospital.
Methods
The study employed an exploratory descriptive qualitative design. The design and reporting conformed to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to ensure clarity and methodological rigour. Sixteen men with prostate cancer receiving treatment at the Korle-Bu Teaching Hospital were purposively selected to take part in the study. A semi-structured interview guide was specifically developed and used to gather data from the participants. The entire interview was audio-recorded, transcribed verbatim, and analysed through thematic content analysis, coding, and categorisation.
Results
The study found that participants view the legalisation and regulation of CAM treatments, the incorporation of herbal remedies into conventional treatments, the extension of the National Health Insurance Scheme to include CAM therapies, and the approval of herbal medicines by the Food and Drugs Authority (FDA) and medical practitioners as positive factors that influence the formalization and use of CAM among men with prostate cancer.
Conclusion
To promote safe and integrated care, Ghanaian health authorities should prioritise the formal regulation and potential insurance coverage of CAM therapies, as these measures are critical in supporting the views of men with prostate cancer regarding CAM formalisation.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12906-026-05273-x.
Keywords: Complementary and alternative medicine, Current users, Prostate cancer, Herbal medicine, Perspectives, Formalisation.
Background
Complementary and Alternative Medicine (CAM) has been defined to encompass various health practices outside of conventional treatments, such as herbal therapies, homoeopathy, and chiropractic care [1]. Over the past few decades, CAM has gained substantial global popularity, driven largely by media and internet marketing [2–4]. As a result, CAM has been formally integrated into patient care settings in various countries outside Ghana [5–7].
The use of CAM is becoming increasingly popular among patients with cancers, particularly those with prostate cancer, across the globe [8]. Studies have indicated that the global average of patients with cancer using CAM is 51% [9, 10]. It is estimated that around one in four men diagnosed with prostate cancer worldwide use at least one form of CAM [11, 12].
In developed countries, the popularity of therapies such as homoeopathy, acupuncture, and chiropractic care has increased considerably [11], with the World Health Organisation (WHO) estimating that 25% − 50% of the population uses CAM [13]. In developing countries, including Ghana, nearly 80% of the population relies on CAM practices like herbal medicine, prayer, and divination for primary healthcare [14–16].
Patients with cancers use CAM for diverse reasons [17]. Studies have shown that patients diagnosed with prostate cancer use CAM to manage cancer-related symptoms and side effects of conventional cancer treatments, boost their immune system, improve quality of life, and feel recovered and well-managed [16, 18, 19]. Besides, beliefs about CAM’s effectiveness, safety, affordability, and accessibility also influence its utilisation among patients with cancer [20]. A systematic review of published articles on CAM use revealed that individuals with cancer frequently turn to CAM to enhance well-being, minimise chemotherapy side effects, alleviate anxiety, boost self-esteem, and improve overall quality of life [21]. These findings align with several studies that identify improving health, fostering hope, boosting the immune system, and managing the ill effects of cancer and its treatments as key motivations for CAM use [22, 23].
Notably, patients with cancer engage with CAM in diverse ways. For instance, Berretta and colleagues reported that some physicians discuss and recommend CAM interventions to their patients before use [24]. However, Källman and associates found that certain hospital attendees began using CAM therapies, such as herbal medicines, after their cancer diagnosis without consulting their doctors [25]. Several studies have also noted that familiarity with preparation and administration techniques motivates the use of CAM [26] and reported that methods such as heating or boiling are commonly employed [27, 28]. Additionally, a study by Tembane and Andel et al. highlighted that patients in African countries, including Ghana and Gabon, utilise various plant species in multiple recipes and formulations for rectal insertions [29, 30].
The implementation of measures such as regularisation or legalisation of CAM, along with plans to guide visits to herbal centres, can motivate individuals to use CAM products [31]. In a study, Mutola and colleagues indicated that certifying and scientifically evaluating traditional medicines promotes the regulation and integration of CAM into mainstream healthcare, and cancer patients’ willingness to use such treatments [32]. Similarly, a study indicated that training herbalists and regulating the use of CAM promote the safety and patronage of herbal medicines [33]. Also, in a study to determine the factors influencing people’s intention to use CAM, Kretchy and colleagues found that implementing appropriate public health policies, such as counselling and evidence-based complementary treatments, is essential for integrating herbal medicine practitioners into the main healthcare system and guiding individuals in seeking herbal medicine treatments [34]. Likewise, Drozdoff and Armson, along with their respective colleagues, others pointed out in their studies that introducing CAM counselling sessions and a guideline questionnaire in routine cancer care within biomedical healthcare systems increased individuals’ willingness to use CAM [35, 36]. In addition, Asare and colleagues found in their study that extending the health insurance policy to cover CAM therapies increased the utilisation of such treatments [37].
Moreover, the use of CAM is influenced by both personal and social factors [38]. Mothibe and associates affirmed in their study that people in Africa use CAM because they believe traditional medicines have been used long before the arrival of biomedical treatments and continue to be used today [31]. In Ghana, many patients diagnosed with prostate cancer use CAM due to challenges associated with conventional treatment, the desire for improved well-being, perceived immune support, accessibility, and affordability [15].
In healthcare, understanding how individuals perceive and engage with various aspects of their treatment is crucial [39]. Patients with cancer hold specific opinions and perspectives regarding the use and formalisation of CAM [40], which significantly influence their uptake and continued reliance on CAM therapies. However, in Ghana, research exploring patients’ perspectives on CAM formalisation remains limited. Existing studies focus primarily on CAM prevalence and reasons for use, highlighting a major gap in understanding the perspectives of local patients. Exploring these perspectives is essential, as insights into patients’ motivations and opinions can inform policy development, healthcare integration, and regulatory practices. Therefore, this study aims to explore the perspectives on the formalisation of CAM among current users diagnosed with prostate cancer at the Korle-Bu Teaching Hospital in Ghana.
Methods
Study design and setting
A qualitative exploratory descriptive design was employed. This design was chosen for the study because it offers a comprehensive understanding of the phenomenon by examining the views on the formalisation of CAM among current users diagnosed with prostate cancer. The study was designed and reported in accordance with the COREQ checklist [41] to ensure methodological rigour and transparency. The study was conducted in the Korle-Bu Teaching Hospital in Ghana. The study was conducted at the Medical Outpatient of the Cancer Unit of the teaching hospital located in the Greater Accra Region of Ghana.
Sampling technique and sample size
The target population was limited to men diagnosed with prostate cancer and attending the Korle-Bu Teaching Hospital for treatment. A purposive sampling technique was used in selecting participants for the study. The study included sixteen (16) men diagnosed with prostate cancer, as data saturation was reached after interviewing the sixteenth participant.
Inclusion and exclusion criteria
The inclusion criteria for the study comprised men aged thirty years and older who were diagnosed with prostate cancer, who were using CAM, and were receiving conventional treatment at the Oncology Medical Outpatient of the Korle-Bu Teaching Hospital. Whereas the exclusion criteria included men with prostate cancer who were weak and had limited availability.
Data collection tool and procedure
A semi-structured interview guide was specifically developed for this study to collect data from participants, and it has been provided as Supplementary File 1 (English version). The interview guide was developed in line with the research objective and was divided into two sections: A and B. Section A included the participants’ socio-demographic information, while Section B contained the main open-ended research questions. A pre-test of the interview guide was conducted with two men who met the inclusion criteria to evaluate its validity, and the result guided the researchers in adjusting the interview guide. Consent was obtained from the Korle-Bu Teaching Hospital as well as the men who agreed to partake in the study. Face-to-face interviews were conducted in English at a location, date, and time convenient for both the participants and the researchers. Each interview lasted between 20 and 30 min. The researcher kept the field records. The researchers employed thematic content analysis to analyse the data as the data were being gathered.
Ethical considerations
The research received approval from the Institutional Review Board (IRB) of the Korle-Bu Teaching Hospital. Consent forms were presented to the men who agreed to participate in the study, and they were asked to sign after meeting the inclusion criteria. To ensure confidentiality and anonymity, coded names and pseudonyms were used in place of the participants’ real names. Privacy was maintained by interviewing the individual participants in the Unit head’s office. Given the study’s setting, the researchers implemented strict measures, including hand washing, wearing of face masks, and avoiding handshakes.
Data analysis
Data analysis was done concurrently with data collection. After each interview session, the recorded data was transcribed word-for-word. The analysis was conducted using thematic content analysis. The researchers reviewed the transcribed interview data, highlighting descriptions relevant to the topic being studied. Key words or phrases were then selected as codes to represent each distinct unit of meaning. The transcribed data, along with the identified words, phrases, ideas, and sentences, were noted. Similar codes were grouped to form subthemes, and these subthemes were then combined into broader themes.
Methodological rigour
Rigour was maintained based on the structure suggested by [42], namely, credibility, dependability, transferability, and confirmability. To achieve credibility in this study, the researchers employed purposive sampling to select the needed participants who were within the inclusive criteria. Dependability was ensured in this study by the full description of the sample, location, methods and analysis. Transferability was realised by the full description of the context of this study. To attain confirmability, the researchers collected detailed opinions of the men diagnosed with prostate cancer regarding CAM formalisation. Data was gathered till saturation was reached, and the data was analysed based on what was exactly offered by the participants.
Results
Data were analysed using thematic content analysis, from which one main theme and four subthemes emerged. The major theme included the perspectives on the formalisation of CAM use among men with prostate cancer, and the four sub-themes comprised legalisation of CAM, regulation of the patronage of CAM, policy on restrictions to CAM centres and perceived best practices for CAM use.
Demographic data of participants
The study included adult male participants aged between 50 and 79 years. They comprised six Akans, four Ga, one Walla, three Ewes, one Wassa and one person who identified as Gyakwasi or Kyereponi. All participants were fluent in English. Thirteen of them were urban dwellers, fifteen were married, and fourteen identified as Christians. Nine of the participants had tertiary education, and the majority of them were retired and unemployed.
Perspectives on the formalisation of CAM among men with prostate cancer
This theme focused on participants’ views regarding the recognition, regulation, and integration of CAM into the healthcare system. Their opinions centred on the belief that CAM could be more beneficial and trustworthy if properly formalised through legislation, regulation, structured policies, and standardised best practices.
Legalisation of CAM treatment
The findings from the study showed that men with prostate cancer believed that the formalisation of CAM must begin with legal recognition. Some of the participants emphasised that herbal and traditional medicine should be regularised to be used for treatment.
“I think that traditional medicine should be regularised; if the government can control and legalise herbal treatments, then that will be fine.” PJ.
“The majority of herbal practitioners we come across on the streets are doing that on their own, and so if the Food and Drugs Board Authority approves such medicinal products, then they will be used.” PN.
Regulation of the patronage of CAM
The outcomes of the study revealed the need for regulations that guide how CAM is used and accessed.
A participant indicated that expert opinions and government interventions were crucial in guiding and directing the use of CAM for treatment.
“As I said, the government should step in and regulate CAM therapies; formalise them, then we know such treatments are safe to be used.” PJ.
Another participant specified that specialisation and improvement in service delivery are essential.
“But what I’m saying is, we should advise herbal practitioners to specialise in one area they are good like what is done in Korle-Bu here and if people will come if they know about it.” PG.
Policies on restrictions to CAM centres
The results of the study revealed that formalisation required clear policies governing how and where CAM services are delivered.
One participant stated that implementing strategies to integrate herbal medicine into mainstream treatment would reduce unnecessary visits to herbal centres and promote proper use of CAM therapies.
“Erm, the fact is, when someone falls sick, people try to find out if they have visited the hospital. So, if CAM is to be used, then there should be a policy implementing it in hospitals.” PL.
Another participant stated that implementing policies to fund treatment of prostate cancer treatment would reduce the need for men with prostate cancer to regularly visit herbal centres for treatment.
“Eerr, as I said, the intention will be in relation to money. So, if the government formulates and implements policies to support those with prostate cancer, it will discourage them from seeking treatment at TM centres, anyhow and anywhere.” PF.
Perceived best practices for CAM use
The study’s findings revealed several ideal practices that should accompany CAM formalisation. These practices represent the ideal ways for standardisation, quality, and coordinated use of CAM with biomedical treatment.
To begin with, one of the participants described specific methods they considered ideal for preparing CAM therapies. He emphasised that herbal remedies should be properly processed, typically through cooking, boiling, or soaking, to extract the active healing components.
“You add ‘prekese’ and about four or five kinds of trees and boil them in a pot and drink or take the concoction that is produced.” PN.
Also, another participant described the preferred routes of administration, emphasising that the therapy (CAM) can be taken orally and/or rectally.
“Sometimes, the herbal medicines are in gallons, and you will drink them, and some you will take rectally. I was using mine for an enema.” PI.
Again, one participant suggested that approval from the Food and Drugs Board should precede the use of herbal medicine.
“Eerr, the drugs board should do more research about herbal medicine before such drugs come out for use because I do not expect one medicine to cure more than 6 or 5 illnesses.” PD.
Moreover, a participant emphasised that medical practitioners should be informed about the intention to use CAM therapies.
“But people should not try to use herbal medicine and get addicted. In all situations, you have to find out from your biomedical doctor first before you use it.” PO.
Finally, two of the participants stated that a visit to the hospital is essential and should precede the use of herbal medicine.
“The best practice is to visit a biomedical practitioner or the hospital so that your prostate will be assessed. And understand that while the doctor is treating them, you can take the herbal medicine.” PN.
Discussion
Main findings
The purpose of the study was to investigate the perspectives on the formalisation of CAM among current users diagnosed with prostate cancer. The findings highlighted key participants’ views regarding legal recognition, regulation, policy support, and best practices for CAM use. These findings are discussed in relation to existing literature on CAM formalisation and integration into mainstream healthcare.
The study revealed that legalising CAM treatments would encourage men with prostate cancer to use these therapies under structured and recognised conditions. This aligns with Mothibe and colleagues [31], who reported that enacting the Traditional Health Practitioners Act promotes acceptance of traditional health practitioners. This means that legalisation provides formal recognition, fosters wider acceptance, and validates CAM use for treatment purposes. It enhances the legitimacy of traditional health practices and supports their integration into mainstream healthcare. Despite these promising results, our study had a relatively small sample size (n = 16), which may limit generalizability.
The study also revealed that men with prostate cancer were willing to continue using CAM products if their production and use were regulated through licensing practitioners, certifying products, and encouraging specialisation in healing. These findings are consistent with studies that indicated regulation distinguishes genuine from pseudo-traditional medicines, standardises authentic products, and makes them more comparable to biomedicine [33, 43]. Similarly, Mutola and colleagues emphasised that certification and scientific evaluation of traditional medicines (TMs) are essential for achieving control and integration of TMs into the conventional health system [32]. This implies that men with prostate cancer will be more inclined to use CAM products when there are clear regulations, including licensed practitioners, certified products, and specialised expertise in the field. Therefore, such regulations would enhance trust and foster greater acceptance of CAM therapies.
In the present study, participants disclosed that establishing policies to integrate TMs into conventional treatment and to fund prostate cancer care will support and promote the use of CAM. This finding aligns with several studies highlighting the need for appropriate public health policies, such as counselling and evidence-based complementary treatments, to facilitate the inclusion of herbal medicine practitioners (HMPs) in mainstream healthcare in Ghana [34, 35]. Similarly, Asare et al. and Mantey emphasised in their respective studies that expanding health insurance coverage to include drugs associated with TM care is essential for solidifying integrative care and promoting the use of CAM therapies [37, 44]. The results indicate that such policies will help formalise CAM treatments and provide financial support to individuals who will resort to CAM for a cure. This, in turn, may help promote and sustain the use of CAM therapies among men diagnosed with prostate cancer.
In this study, the participants recommended several practices perceived to be best for using CAM therapies, including proper preparation and administration techniques, obtaining FDA approval, and first visiting an orthodox hospital before using CAM. These findings are supported by several studies indicating that CAM users value standardised preparation methods, proper routes of administration, and physician involvement [26–29, 45]. Participants reported using methods such as cooking, boiling, or soaking herbal products, and administering them orally or rectally. These practices reflect a desire for standardised and formalised CAM methods.
Moreover, the men with prostate cancer in the present study emphasised that visits to orthodox hospitals and CAM use should first be communicated to biomedical practitioners. This finding aligns with the outcomes of a study showing that clinician-patient communication enhances safe and effective CAM use [24]. This may suggest that discussion about CAM should be incorporated into clinician-patient communication. This would allow doctors to offer proper guidance on CAM use, maximise its potential benefits, and ultimately enhance the healthcare systems. However, this finding contradicts the results of studies which reported that some of the patients used herbal medicines before visiting health facilities and other clients resorted to CAM after their cancer diagnosis without consulting their physicians [25, 46]. The discrepancy in the outcomes may be due to several factors, such as differences in study settings, the personal characteristics of participants, and variations in the conditions at the various centres where participants received care and treatment. Additionally, the participants in this study suggested that only approved CAM products should be used. This would help assure users of the efficacy and safety of the products being utilised. These findings are similar to those of a study by Kretchy and associates, who reported that participants in their study used herbal medicinal products certified by the Food and Drugs Board Authority in Ghana [34]. These findings indicate that regulatory approval and formalisation of CAM therapies are critical for encouraging their safe and continued use.
Strengths and limitations
The study provided a comprehensive understanding of the views of men diagnosed with prostate cancer on CAM formalisation. However, the small sample size of sixteen participants does not provide a proper representation of all the intentions about CAM use. Additionally, since the study was conducted at a single hospital in Ghana, generalising the findings to other regions may be challenging.
Implication for practice
The study’s findings show that the formalisation of CAM for patients requires stronger legal and regulatory frameworks, including licensing practitioners, certifying products, and enforcing safety standards. Integrating CAM into hospital systems and improving communication between CAM practitioners and biomedical doctors are essential for coordinated and safe patient care. Policies that expand health insurance coverage, support evidence-based CAM interventions, and strengthen FDA oversight will enhance accessibility and trust. Additionally, patient and community education on safe preparation methods, approved products, and proper consultation practices is critical to promoting informed, safe, and responsible CAM use.
Conclusion
The study revealed that men with prostate cancer strongly support the formalisation of CAM, emphasising the need for legalisation, regulation, and policy measures that ensure safe, standardised, and accessible CAM therapies. Also, participants highlighted that certified products, proper preparation methods, and collaboration with biomedical practitioners are crucial for encouraging safe, informed, and sustained use of CAM within the healthcare system.
Supplementary Information
Acknowledgements
The authors would like to show appreciation to the management of the Korle-Bu Teaching Hospital and staffs of the Medical Out-patient Department of the Oncology Unit and all who contributed to this study.
Clinical trial number
Clinical trial number not applicable.
Abbreviations
- CAM
Complementary and alternative medicine
- CM
Complementary medicine
- FDA
Food and Drug Authority
- HM
Herbal medicine
- IRB
Institutional review board
- MoH
Ministry of Health
- WHO
World Health Organisation
Authors’ contributions
Study concept and design: Bonney Osei (BO), Josephine Mpomaa Kyei (JMK) and Luke Laari (LL); acquisition of data: BO; analysis and interpretation of data: BO, JMK and LL; drafting of the manuscript: JMK and LL; critical revision of the manuscript: BO, JMK and LL.
Funding
The authors did not receive any specific financial support or funding for this work.
Data availability
Materials and data will be made available on request.
Declarations
Ethics approval and consent to participate
The Institutional Review Board (IRB) of the Korle-Bu Teaching Hospital was consulted for ethical clearance, and informed consent from participant(s) was obtained. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.
Consent for publication
Publication approval has been granted by the relevant authorities.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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