complementary and alternative medicine ( cam ) is widely used both as a supplement to conventional or mainstream health care and as part of traditional health care systems and practices . the definition of cam is so diverse that it is difficult to formulate a universally accepted list of therapies and practices that fall under its ambit . the national centre for complementary and alternative medicine ( nccam ) in the usa defined cam as a group of diverse medical and health care systems , practices , and products that are not presently considered to be part of conventional medicine . australian data , published in 2007 , reported that 69% of the population had used one or more forms of cam in the previous 12 months . however , the use of cam varied with age , sex , and a range of other factors . those with chronic health issues , cancer , and/or chronic pain in particular , were found to have made greater use of cam . exact estimates of expenditure on cam have been difficult to determine though there is little doubt that it is enormous . in 2002 , it was estimated that the amount spent on cam in the usa was us $ 2.7 billion , us$ 2.4 billion in canada , and us$ 2.3 billion in the united kingdom . what is thought of as conventional health care varies from country to country across geographical boundaries and cultures and changes with time , an indication that the boundary between cam and conventional medicine is blurred and constantly shifting . baer believes this blurring and blending has given rise to the integrative medical movement whose aim is to use the best of both cam and conventional care . in saudi arabia , tibbu nabawi or prophetic medicine is broadly accepted and practiced by most physicians and the public . this is evidenced by the study of national center for cam in saudi arabia 2010 and al - faris et al . , who recorded that more than 70% of the public in the riyadh region had used practices related to prophetic medicine in their lifetime . the attitude of health care providers toward the use of complementary therapies , and their exposure to education on cam , requires careful consideration in contemporary health care . many factors influence the use of cam : dissatisfaction with conventional care , a desire for greater personal involvement in the maintenance of health , holistic health beliefs , lack of access to adequate health care services , and ready availability of cam services . in one study , it was found that more patients were expressing their desire for cam services . it is hardly surprising therefore that several national and international studies that surveyed physicians practices and beliefs on cam noted a considerable variation in responses regarding the practice of , referrals for , and safety and efficacy of specific types of cam . in line with this trend , the present study was carried out to assess the level of knowledge of cam and measure attitudes of health professionals in the riyadh region , saudi arabia , toward cam . the present study was a cross - sectional descriptive survey carried out in the riyadh region , including riyadh city and surrounding governorates , saudi arabia , from january 2010 to march 2010 . health professionals working in all hospitals in the specified region formed the target of the study . according to the saudi demographic census of 1429h ( 2008 ) , the riyadh region has 42 hospitals and 363 primary health care centers with 4924 physicians , 440 pharmacists , 5391 allied health personnel , and 1168 technicians . of the health professionals , 380 were randomly selected using a multistage random sample technique . the plan was to include physicians ( 50% ) , allied health personnel and pharmacists ( 20% for each ) , and technicians ( 10% ) in the sample . 15 hospitals were chosen randomly : 5 from governmental hospitals related to ministry of health ( moh ) , 5 from governmental hospitals not related to moh , and 5 from nongovernmental hospitals . in total , the number of hospitals included in the study was 19 . from these selected hospitals , a systematic random sample was drawn to obtain a sample of physicians , pharmacists , allied health personnel , and technicians . data were collected by means of self - administered questionnaires which requested socio - demographic data , knowledge about cam and its sources , and attitudes toward cam especially for its integration into the health care services and medical school curricula . of special emphasis could be the most common cam practices in saudi arabia such as the prophetic medical practices and the patient - physician relationship with regard to cam . twenty data collectors were trained and skilled to deal with participants and expected obstacles in data collection . proper consent , voluntary participation , confidentiality , and the right to withdraw were all ensured . the study was approved by the ethical committee of the national center of complementary and alternative medicine ( nccam ) in riyadh . after revising the answered questionnaires , those with incomplete or with faulty data were excluded from the study ( 51 ) . the remaining questionnaires ( 306 ) were coded and the data entered into the spss statistical package , version 16 . data were presented and statistically analyzed using the mean and standard deviation for quantitative data and frequencies for qualitative data . the chi - square test was used to test the association of different variables with socio - demographic data of participants . the evaluation of the degree of agreement of health professionals to some aspects of cam was done by the likert scale . a mean score of 11.74 represented strongly disagree , 1.752.49 meant disagree ; 2.493.24 meant agree , and a mean score of 3.254 represented strongly agree . the mean age of the participants was 36.739.91 years with 56.2% of them were males , 43.5% saudi and 90.5% working in the riyadh city . of the participants , physicians represented 47.1% , pharmacists and allied health personnel represented about 21% for each while technicians represented 10.7% , with a mean of 11.578.82 years of experience [ table 1 ] . socio - demographic data of the studied population of the participants , 88.9% reported they had some knowledge about cam compared with 11.1% who had never heard about cam . a total of 94.74% of those with a doctorate degree and 92.53% of those with a bachelor 's degree had significantly higher knowledge than those with a diploma , masters , and a fellowship with a statistically significant difference ( p = 0.004 ) . , newspapers , and the radio represented 60.1% of the sources of knowledge on cam followed by family members , relatives , and friends ( 29.08% ) and then health educational organizations ( 14.71% ) . other not so common sources ( 8.17% ) included the internet and books [ table 2 ] . participants with a doctorate degree had educational organizations as the source of their knowledge , which was significantly higher than participants with other degrees ( p = 0.008 ) . however , the pharmacist group had the highest score with knowledge derived from health educational organizations . next were physicians , then allied health personnel , and finally technicians with a statistically significant difference ( p = 0.036 ; table 3 ) . socio - demographic data and knowledge related to cam sources of knowledge about cam and socio - demographic data the most important and commonly used cam practices in the kingdom from participants perspective were related to prophetic medicine , including prayer , honey and bee products , medical herbs , hijama , nutrition and nutritional supplements , cauterization , and camel milk and urine ( 90.5% , 85% , 76.9% , 70.6% , 61.4% , 55.9% , and 52.5% , respectively ) in addition to medical massage ( 61.8% ) and acupuncture ( 55% ; figure 1 ) . of the physicians participating in the study , 115 ( 80% ) there was a need for more research , more information , and internet sites for cam . these practices have to be integrated into the health care services , and medical school curricula . also , special centers should be set up to provide cam [ figure 2 ] . most important used cam practices in saudi arabia likert score (  sd ) of requirements related to cam after its recent establishment in saudi arabia , nccam made its priority to undertake a situation analysis of the position of cam in the kingdom , particularly with regard to current attitudes and the knowledge of health professionals . since it was obvious that patients were reluctant to disclose their use of cam , it was incumbent on health professionals to be proactive by initiating talking on cam . the definition of cam was discussed with all participants of this study to avoid confusion and misconceptions . with the use of probability sampling and a response rate of 80.53% , the results gave a fairly representative view of knowledge and attitudes of health professionals in the riyadh region , to the subject . results of the present study showed that technicians were less knowledgeable ( 78.13% ) than physicians ( 87.50% ) , pharmacists ( 90.48% ) , and allied health personnel ( 95.45% ) . previous studies in industrialized countries and developing ones showed that health care givers had relatively poor knowledge of herbal medicine and supplementary foods and their possible interactions and toxic effects . pharmacists seemed to be more knowledgeable than physicians , nurses , and technicians . in a study in the united arab emirates carried out by hassan et al . in 2000 , it was found that in spite of physicians lack of knowledge about different types of cam , they did not consider it quackery . in the present study , those with a doctorate and a bachelor 's degree were the most knowledgeable . this partly reflects the increased interest in cam in the new generation and the better qualified health professionals . it also partly reflects the revision of some curricula to include cam , as has been the case in the college of pharmacy . of the health professionals in the present study , a total of 8.2% of the participants had acquired their knowledge from the internet or books or training courses and lectures . this was unexpected since many licensed electronic databases ( e.g. , natural medicine comprehensive database , http://www.naturaldatabase.com/ ) have been available for several years . therefore , there should be educational campaigns with lectures , seminars , and other activities to demonstrate and explain the tools associated with these databases . however , wahner - roedler found positive relations between the use of computer technology and the internet as a source of knowledge and self - training in addition to its use as a communication tool with peers and colleagues . most published studies indicate that physicians agree on the need for the dissemination of more information about cam , and 6281% of them expressed the need for education and training on its practices . health professionals in the present study stated that prophetic medicine including prayer , honey and bee products , medical herbs , hijama , food supplements , and cauterization , as well as acupuncture and massage therapy were the most important of the cam practices used in the region . western researches have intimated that acupuncture was the most accepted cam practice for physicians ( 43% ) followed by chiropractic ( 40% ) and massage therapy ( 21% ) . of the physicians participating in the present study , 115 ( 80% ) these results are in agreement with some european studies , and with a study by hassan et al . who found that most physicians in the united arab emirates talked about cam with their patients . those working in hospitals as well as old health professionals were less tolerant and more opposed to cam practices . this aversion may be due to the lack of evidence on cam and the nature of its practices . gianelli found that 42% of general practitioners in italy did not give advice to their patients to use cam . however , other studies have indicated the acceptance of cam by general practitioners and specialists . studies done in germany and russia stated that physicians used cam together with conventional medicine . while wahner - roedler recorded that physicians in usa had got good results with cam and 44% of these physicians referred patients to cam practitioners . in the uk and netherlands , pharmacists felt that they needed continuous training on the use of herbs and their interaction with drugs . the limitations of the present study are that since it represented the riyadh region only , the results can not be generalized to cover all regions in saudi arabia . at the same time , the absence of similar local knowledge and studies on attitudes toward cam makes it difficult to guarantee the credibility of results . the study sampling did not take into account the different specialties of the physicians and allied health personnel . the role played by health educational organizations , textbooks , internet , and training courses as the sources of knowledge about cam is insignificant . the attitude toward cam is generally positive but there is a need for more evidence - based knowledge , research , and internet sites for cam . the integration of cam practices into health care services and curricula of medical schools is essential . the initiation of the talking about evidence - based cam practices with patients should be encouraged and improved .
background : complementary and alternative medicine ( cam ) is a popular treatment option for many populations . 
 the present work is aimed at studying the knowledge and attitude of health professionals in the riyadh region , saudi arabia , toward cam.material and methods : in this cross - sectional survey , a multistage random sample was taken from health professionals working in hospitals in riyadh city and surrounding governorates . 
 data were collected through a self - administered questionnaire , from 306 health professionals working in 19 hospitals , on socio - demographic data , knowledge about cam and their sources , and attitudes toward cam practices.results:of the participants , 88.9% had some knowledge about cam . 
 respondents with a doctorate degree ( 94.74% ) and 92.53% of those with a bachelor 's degree had significantly higher knowledge of cam than subjects with a diploma , a fellowship , or a master 's degree ( 68.75% , 76.67% , and 85.41% , respectively , p = 0.004 ) . 
 mass media represented 60.1% of sources of the knowledge of cam followed by family , relatives , and friends ( 29.08% ) and health educational organizations ( 14.71% ) . 
 participants estimated that prophetic medicine including prayer , honey and bee products , medical herbs , hijama , nutrition and nutritional supplements , cauterization , and camel milk and urine were the most commonly used cam practices ( 90.5% , 85% , 76.9% , 70.6% , 61.4% , 55.9% , and 52.5% , respectively ) in addition to medical massage ( 61.8% ) and acupuncture ( 55% ) . 
 one hundred and fifteen ( 80% ) physicians were ready to talk with their patients on cam.conclusion:the willingness to improve knowledge and create a positive attitude in health professionals toward cam has increased . 
 religious practices , especially those related to prophetic medicine , are more common in the region . 
 health educational organizations have to play a greater role by being the source of evidence - based knowledge of cam . 
 talking on cam with patients should be improved by rooting them on evidence - based practices .