Complementary and alternative medicine (CAM) refers to a group of systems, practices, and products that are not typically considered part of conventional medical methods (Babar, Syed, Naing and Hamzah, 2012; Pham, Yoo, Tran and Ta, 2013; Samara, Barabra, Quzaih and Zyoud, 2019). CAM encompasses treatments that are either complementary to or substitutes for conventional drug therapies (Jafari, Zanganeh, Kazemi, Lael-Monfared and Tehrani, 2021). Literally, the term “alternative” refers to practices that replace conventional medical treatments, while “complementary” refers to those that are used alongside conventional treatments (Samara et al., 2019). The National Center for CAM classifies CAM therapies into categories such as “alternative medicine systems, mind-body interventions, biologically based therapies, body-based and manipulative methods, and energy therapies” (Singh and Kamath, 2021). In some cultures, certain CAM methods, including prayer and Quran recitation, which fall outside these categories, are widely popular among the general population (Dehghan, Ghanbari, Heidari, Mangalian and Zakeri, 2021; Samara et al., 2019). The classification of prayer and Quran recitation as CAM aligns with World Health Organization (WHO) benchmarks that encompass traditional therapeutic practices. The WHO Traditional Medicine Strategy underscores the cultural and historical significance of such modalities and emphasizes the integration of Traditional and Complementary Medicine (TCM) into national health systems. This strategy aims to provide a framework for the safe and effective delivery of TCM across diverse health contexts (Permatasari, Hasina and Pratama, 2020; Zeid, Andersen and Kristiansen, 2019).

According to the WHO, 75% of the global population still relies on traditional medical systems (Singh and Kamath, 2021). The prevalence of CAM usage ranges from 9.8% to 76% (Ashraf et al., 2019), and its popularity continues to grow (Singh and Kamath, 2021; Steel et al., 2018). This increasing interest in CAM is attributed to its perceived effectiveness, safety, cost-effectiveness, and alignment with personal, religious, and spiritual beliefs (Ashraf et al., 2019; Iktidar et al., 2022). CAM is often self-administered or initiated under the supervision of a specialist (Steel et al., 2018).

Studies on CAM have identified several factors driving its use, including the rising cost of modern medical care, dissatisfaction with conventional treatments, a desire for greater personal involvement in health management, holistic health beliefs, and improved access to CAM services (El-Olemy, Radwan, Shihab and Dawood, 2014). The primary users of CAM include patients with conditions such as asthma, arthritis, psoriasis, cancer, chronic liver disease, irritable bowel syndrome, and gastroesophageal reflux (Yurtseven et al., 2015; Zeidabadi, Abbas, Mangolian Shahrbabaki and Dehghan, 2022). Commonly used CAM methods worldwide include herbal medicine, spiritual healing/prayer, massage therapy, acupuncture, hypnosis, meditation, vitamins, and homeopathy (Ashraf et al., 2019).

In Iran, CAM is widely used, with approximately 95% of cancer patients and 31% of dermatology patients relying on it (Jafari et al., 2021). During the stressful COVID-19 pandemic, herbal and complementary medicine used to prevent and treat illness, as well as to strengthening the immune system against the virus (Nguyen, De Tran, Pham, Dao and Dewey, 2021). In support of this finding, numerous studies have shown that CAM can be effective in reducing symptoms, treatment and prevention COVID-19 infection (Kretchy et al., 2021; Nilashi, Samad, Yusuf and Akbari, 2020; Wu, Dong, Chi, Yu and Wang, 2021). However, evidence for the effectiveness of most CAM interventions still needs evaluation (Jeon et al., 2022).

COVID-19, known as acute respiratory syndrome, is a viral disease characterized by symptoms such as fever, fatigue, muscle pain, diarrhea, and, in severe cases, lung damage (Bulatova et al., 2022). Social distancing remains the primary method for preventing COVID-19 infection (Badakhsh et al., 2021), while treatment for infected individuals includes rest and adequate fluid intake (Dehghan et al., 2021). Despite the success of vaccines and drug therapies in combating COVID-19, interest in CAM remains high, and a wide range of CAM methods have been proposed and investigated as preventive and therapeutic measures against the virus (Bulatova et al., 2022). Given the increasing prevalence of COVID-19, burnout among healthcare workers, and the lack of definitive treatments, drugs, equipment, and manpower particularly in less developed countries CAM approaches with minimal side effects may serve as preventive measures, especially for mild cases, which constitute the majority of patients (Badakhsh et al., 2021).

Public awareness and the use of CAM are complex phenomena that have grown significantly over the past decade. One reason for this dramatic increase is the widespread exposure to information through the internet and mass media. Commercial advertisements, official press, medical journals, and books have promoted the use of complementary medicine, particularly among younger generations who show a keen interest in CAM (El-Olemy et al., 2014). Various studies have reported positive attitudes toward CAM among medical students (Ameade, Amalba, Helegbe and Mohammed, 2016; Rotter, Jerzynski, Hinse, Binting and Brinkhaus, 2021). Similarly, studies on Iranian medical and pharmacy students have found that they possess sufficient knowledge of and exhibit positive attitudes toward CAM (Parvinroo, Daeihamed, Rafiei and Tajik, 2021; Sadeghi, Rabiepoor, Forough, Jabbari and Shahabi, 2016). As part of the younger generation in every society, medical students may play a significant role in promoting the use of CAM. However, access to vast amounts of information from diverse sources, coupled with the lack of formal education about CAM, may lead to its incorrect use among students (El-Olemy et al., 2014; Iktidar et al., 2022). Therefore, it is crucial to investigate the attitudes and usage of CAM among both medical and non-medical students.

This study can help identify educational gaps among medical and non-medical students and improve educational programs. By examining students’ attitudes toward CAM, there may be a need for further education on scientific evidence or the development of educational programs that provide accurate, evidence-based information about CAM. This can reduce misuse and increase awareness. A better understanding of attitudes and the use of CAM can lead to the effective integration of these practices into modern medicine, benefiting both patients and healthcare systems. Medical students represent future healthcare providers whose CAM attitudes may influence clinical practice; non-medical students reflect public perspectives that shape demand. This comparison highlights gaps in CAM education and public health outreach.

Additionally, this study can contribute to the development of ethnopharmacology, offering a deeper understanding of the interaction between culture, traditional medicine, and modern medicine. However, only a limited number of studies dealt with the attitudes of non-medical students towards CAM. Besides, no studies compared the attitudes of medical and non-medical students towards CAM and their use of CAM. Within this context, this study aims to compare the opinions, attitudes and use of CAM between the medical and non-medical students.

The present study was conducted to investigate and compare the attitudes and the use of CAM in medical and non-medical students.

The results showed that medical students had higher attitude scores and a more positive view of CAM compared to non-medical students. Similarly, Ashraf et al. found that pharmacy students held more positive beliefs and attitudes toward complementary medicine than non-pharmacy students (Ashraf et al., 2019). Additionally, Akan et al. in Turkey reported that medical students exhibited positive attitudes toward the use of CAM (Akan et al., 2012). Al Mansour et al. in Saudi Arabia also documented a positive attitude toward CAM among medical students (Al Mansour et al., 2015).

Contrary to our finding, Iktidar et al. reported that non-medical students had a more favorable attitude towards complementary medicine than medical students (Iktidar et al., 2022). Similarly, Alshahrani’s study in Saudi Arabia found no significant differences in attitudes toward CAM between medical and non-medical students (Alshahrani, 2024). Medical students may have more favorable attitudes and greater knowledge of CAM due to their educational exposure. Ashraf et al.'s study showed that, despite the lack of formal education on CAM and limited knowledge, pharmacy students demonstrated better practical knowledge of herbal medicine compared to non-pharmacy students (Ashraf et al., 2019). This may be attributed to their greater educational exposure. Furthermore, some studies have indicated that students believe CAM should be made more scientific. Numerous reports in the literature suggest that medical students support the inclusion of CAM in their curricula to guide and improve its practice in professional healthcare delivery (Hussain et al., 2012; James, Bah and Kondorvoh, 2016). Although there is a need to revise academic curricula for medical students to incorporate CAM education, it is equally important to inform and educate non-medical students. Improving their attitudes and knowledge about CAM can ensure its correct and effective use.

We found a significant difference between medical and non-medical students in terms of the general use of CAM and nutritional supplements. Consistent with our findings, Liu et al. reported that medical students had a more positive attitude and a higher rate of using nutritional supplements compared to non-medical students (Liu et al., 2018). However, no other studies on this issue have been identified, highlighting the need for further research to confirm our findings. Given the influence of Iranian culture, which is often conveyed through social and entertainment media, students may have a greater familiarity with practices such as yoga, which originates from India, a neighboring country. This underscores the importance of cultural context in shaping knowledge and attitudes toward CAM.

In our study, 72.8% of medical students and 61.0% of non-medical students reported using at least one method of CAM, including medicinal plants, nutritional supplements, and prayer. Similarly, Alshahrani’s study in Saudi Arabia found that herbal medicine was the most commonly used CAM method among medical students (21%), while spiritual healing/Quran recitation was the most prevalent among non-medical students (19%) (Alshahrani, 2024). Ashraf et al. identified medicinal herbs, massage, spiritual healing, yoga, and homeopathy as the most common CAM methods among pharmacy and non-pharmacy students (Ashraf et al., 2019). Additionally, Iktidar et al. reported that homeopathy was the most widely known CAM method among medical students (44.6%), while herbal medicine was the most popular among non-medical students (45.7%) (Iktidar et al., 2022). Other studies have also highlighted medicinal plants and food supplements as the most frequently used CAM methods among medical students and healthcare personnel (Ameade et al., 2016; Bulatova et al., 2022; Samara et al., 2019). However, the preferred CAM methods vary across countries. For example, magnetic therapy and spiritual healing are the most well-known CAM methods in Saudi Arabia, medicinal plants are the most popular in Turkey (Bishop, Yardley and Lewith, 2006) and herbal medicines were more popular in Kuwait (Ilori, Akintayo, Adewale and Oyetola, 2021). These differences can be attributed to variations in cultural and belief systems (Iktidar et al., 2022; Yurtseven et al., 2015).

In the present study, the internet and social networks were the primary sources of information about CAM for both medical and non-medical students. Similarly, Yurtseven et al. found that the internet (52.2%) and television (27.2%) were the main sources of CAM information (Yurtseven et al., 2015). Iktidar et al. reported that medical and non-medical students in Bangladesh relied on friends, personal experience, and newspapers as their primary sources of CAM information (Iktidar et al., 2022). Ashraf et al. identified family, friends, and mass media as the most common sources of CAM information among pharmacy and non-pharmacy students (Ashraf et al., 2019). Given the widespread accessibility of the internet and the vast amount of content available online (Jafari et al., 2021), it is reasonable to expect the internet to be a primary source of information. However, we found a significant difference between medical and non-medical students in terms of utilizing healthcare professionals as a source of information. To date, no other studies have identified healthcare professionals as a significant source of CAM information.

Regarding the reasons for using CAM, there was a significant difference between medical and non-medical students in terms of using medicinal plants. Ilori et al. found that the majority of participants in Nigeria used CAM to mitigate the adverse psychological effects of COVID-19 (Ilori et al., 2021). Kichen et al. reported that nursing students used prayer, meditation, and traditional medicine to manage stress caused by their work and study environments (Kinchen and Loerzel, 2019). EL-Olemy et al. found that spiritual healing and Quran recitation were commonly used by Egyptian non-medical students and their families for direct healing purposes (El-Olemy et al., 2014). Since the reasons for using CAM vary across cultures, it is essential to pay closer attention to the attitudes of individuals in different communities to ensure the correct and effective use of CAM.

There was no significant difference between medical and non-medical students in terms of consulting a physician before using CAM methods. Tozun et al.'s study on Turkish healthcare personnel and medical students found that consultation was one of the three main sources of information about CAM methods (Tozun, Bag, Pektas, Soyacikgoz and Tekindal, 2022). In contrast, Liu et al. reported that the majority of medical and non-medical students used supplements without consulting a physician (Kinchen and Loerzel, 2019). However, the number of studies investigating CAM use among non-medical students remains limited, underscoring the need for further research to validate our findings. Additionally, given the importance of consulting a physician before using CAM methods, it is crucial to educate CAM users about potential side effects through social media and other accessible platforms (Zakeri, Bagheripour, Iriti and Dehghan, 2021; Zakeri, Mohammadi, Bazmandegan and Zakeri, 2020).

This study has several limitations. Conducted in a single country, its findings may lack generalizability to university students in other cultural contexts. As data were collected online, participation bias may have favored students with greater pre-existing interest in CAM, potentially inflating positive attitudes. Future studies should employ stratified random sampling across universities to enhance representativeness. Methodologically, Questionnaire 1 utilized a 7-point Likert scale (0–6) with “0”(never/rarely) capturing absolute non-use. However, the absence of a midpoint risks oversimplifying frequency gradations. Similarly, the 6-point agreement scale may have amplified extreme responses by excluding a neutral option, potentially overestimating CAM-related attitudes. Future surveys should implement balanced scales (e.g., 5- or 7-point) to capture nuanced perspectives, and compare forced-choice versus neutral-inclusive designs. Furthermore, this study did not assess CAM knowledge a critical limitation when interpreting attitudes. Future research should evaluate knowledge levels to determine whether favorable views reflect evidence-based understanding or cultural familiarity. Convenience sampling restricts generalizability beyond digitally engaged populations, while self-reported data may introduce social desirability bias. Finally, the temporal context of the COVID-19 pandemic may have increased CAM usage; thus, further studies are needed to confirm these findings.

The results of the present study indicate favorable attitudes toward CAM and a high level of CAM use among both medical and non-medical students¶. Therefore, identifying the different educational needs of these two groups and developing appropriate educational programs tailored to these needs could improve students’ knowledge of CAM, particularly among non-medical students. Additionally, training on CAM should emphasize the conscious and safer use of available complementary medicine methods. National guidelines must be advocated to standardize CAM education, and policymakers should ensure alignment with broader healthcare policies. Collaborative efforts among medical institutions, CAM practitioners, and regulatory bodies are imperative to harmonize educational content with clinical practice. Furthermore, programs to familiarize stakeholders with region-specific CAM practices must be prioritized, alongside addressing transnational challenges such as the proliferation of misinformation regarding CAM use. Attention must be directed toward challenges in CAM curriculum development and budgeting, the necessity of CAM instruction by trained faculty, and cultural-regulatory heterogeneity, particularly in regions where CAM is deeply culturally entrenched. Longitudinal studies to assess the impact of CAM education on clinical practice and to investigate cultural and social determinants of attitudes toward CAM are essential in future research.