Abstract
<title>Abstract</title> <p>Background The internet and social media have become increasingly important sources of online health information and play a growing role in individuals health-related decisions. This may also influence the use of and attitudes towards complementary and alternative medicine (CAM). Most existing studies do not distinguish between complementary medicine and alternative medicine, although both differ considerably in their application and conceptual meaning. This study, however, explicitly differentiates between the two forms of CAM while estimating the effect of online information-seeking behaviour. Methods Data from the International Social Survey Programme 2021 “Health and Health Care II” (ISSP 2021) is employed. Internet use, internet access, and digital health literacy serve as the main explanatory variables CAM use. Attitudes toward CAM are also examined, as well as their differences in relation to usage. Additionally, the influence of the quality of the healthcare system is examined using two macro-level variables (out-of-pocket health expenditures and the health access and quality index) and one micro-level variable (individual satisfaction with the healthcare system). Multilevel logistic regression models are applied. Results Access to the internet and frequency of internet use show significant positive effects on CAM use in general. However, regarding alternative medicine, internet usage shows significant negative effects. Digital health literacy demonstrates mixed results for CAM use overall, while high digital health literacy appears to have positive effects on alternative medicine use. Females tend to use CAM more frequently, but not alternative medicine specifically. Education shows a significant negative association with CAM use and alternative medicine use, whereas poverty tends to have an overall positive influence. Satisfaction with the healthcare system shows a negative association with all forms of CAM use. The results also indicate that out-of-pocket expenditures and the objective quality of the healthcare system have positive effects on CAM use and alternative medicine use. While some determinants overlap in their effects, important differences remain between attitudes and actual usage behavior. Conclusion The findings suggest that internet-related factors generally have positive effects on CAM use. However, these effects are not consistent when distinguishing between complementary and alternative medicine. This strengthens the assumption that future studies should pay greater attention to the conceptual distinction between complementary and alternative medicine.</p>