The study was conducted by researchers at the National Research Center in Complementary and Alternative Medicine at UiT The Arctic University of Norway, together with a colleague from VID Specialized University in Oslo. Between February and August 2024, the team administered an online cross-sectional survey built on an adapted version of the International Complementary and Alternative Medicine Questionnaire, known as the I-CAM-Q, an instrument designed to allow comparisons of complementary medicine use across countries and populations. Participants were 488 first-generation immigrants, meaning people born in Pakistan who migrated to Norway, and 445 second-generation immigrants born in Norway to Pakistani parents, all aged 18 or older. To avoid the skewed samples that plague many online surveys, the researchers used proportional stratified random sampling, drawing participants from the National Register of Citizens so that gender, generation, and age groups were represented in proportion to the underlying population.

The headline numbers are striking. Natural products, which in this context include herbal remedies, spices, oils, and other ingestible preparations rooted in South Asian tradition, were used by 99.3 percent of respondents in the previous year. Religious self-care practices, encompassing prayer and other spiritually grounded health activities, were reported by 75.7 percent. Self-care activities such as yoga and meditation were practiced by 35.1 percent, and 27.8 percent had visited a traditional and complementary medicine provider, whether a herbalist, a practitioner of Unani medicine, or another kind of traditional healer. Taken together, these figures suggest that for this community, complementary medicine is not an occasional experiment or a fringe preference but a continuous, everyday framework of health maintenance.

The intensity of use varied considerably across subgroups, and the patterns are statistically revealing. First-generation women emerged as the heaviest users of all, reporting a median of 16 different traditional and complementary medicine modalities, with an interquartile range of 23, meaning the middle half of these women reported anywhere from a handful to dozens of distinct practices. After adjusting for other variables in logistic regression models, women were significantly more likely than men to engage in self-care practices. Meanwhile, visiting traditional and complementary medicine providers was significantly associated with older age, higher income, and the presence of chronic disease. That last association makes intuitive sense: people living with long-term conditions often seek additional sources of relief when conventional care does not fully resolve their symptoms, and those with more disposable income can afford to pursue options outside the public health system.

One of the most consequential findings concerns geography. Several participants reported visiting traditional and complementary medicine providers abroad, typically during trips to Pakistan or other countries where such practitioners are embedded in the mainstream health landscape. This detail matters for patient safety in ways that a simple prevalence figure cannot capture. Practitioners operating outside Norway are beyond the reach of Norwegian regulation, and the products they dispense may not have been assessed under European standards. When patients later return to Norwegian general practitioners, they may not mention these consultations or the remedies they brought home, creating a hidden layer of pharmacological exposure that clinicians cannot see. The researchers argue that this pattern underscores the need for open, non-judgmental communication about traditional medicine use during clinical encounters.

Why do people turn to these practices? The survey found that traditional and complementary medicine was used mainly for well-being and illness prevention, framing it as part of a proactive, holistic approach to health rather than a desperate fallback. At the same time, 42.7 percent of participants reported using natural products for acute conditions, such as infections, digestive complaints, or minor injuries. This dual role, both preventive and curative, mirrors patterns documented in Pakistan itself, where traditional and complementary medicine is widely used for both health maintenance and illness management, and it confirms that migration does not sever these habits. The researchers interpret the persistence as evidence of a culturally rooted, holistic model of health that continues to make sense to people regardless of which country they live in.

The perceived benefits were overwhelmingly positive, but the survey did not shy away from risks. Although most participants found traditional and complementary medicine helpful, some reported adverse effects, and these were attributed mainly to natural products, with 23.8 percent of users of such products reporting harm. This is a critical nuance. The word natural carries a halo of safety in popular discourse, yet herbal preparations are pharmacologically active substances. They can interact with prescription drugs, vary unpredictably in potency and purity, and in some cases contain contaminants. For a community in which essentially everyone uses natural products, even a modest adverse effect rate translates into a substantial number of people. The authors highlight this as a central argument for integrating questions about traditional medicine into routine healthcare conversations rather than leaving patients to volunteer the information.

The generational comparison embedded in the study design adds another layer of interest. Because the sample deliberately included both migrants and their Norwegian-born children, it offers a window into how health practices transmit, or fade, across generations. The persistence of high overall use suggests that the family remains a powerful conduit for health culture, but the differences between generations in specific modalities hint at selective adaptation. Second-generation immigrants navigate two healthcare worlds simultaneously, and understanding which practices they retain, which they abandon, and which they reinterpret is essential for designing health services that actually meet them where they are. The study’s stratified sampling and statistical adjustments, using Pearson’s chi-square and Fisher’s exact tests for categorical associations alongside non-parametric tests for differences in natural product use and overall use, give these comparisons a methodological solidity that convenience-sample surveys often lack.

Methodologically, the study took care with ethics and privacy. Approval was obtained from the Norwegian Agency for Shared Services in Education and Research, and the Regional Committees for Medical and Health Research Ethics determined that the project did not constitute health research requiring their approval. Participants received information letters in both Norwegian and Urdu and gave explicit informed consent before proceeding. No identifying information such as names, birth dates, or addresses was collected by the researchers, although the survey company linked responses to basic demographic data from the national register to enable the stratified sampling. The work was funded by the National Research Centre for Complementary and Alternative Medicine at UiT, with publication charges covered by the university’s publication fund.

The broader significance of this research extends well beyond the Pakistani-Norwegian community. European health systems are increasingly serving multicultural populations, and studies like this one demonstrate that complementary and traditional medicine is not a marginal phenomenon confined to alternative-lifestyle subcultures. It is a mainstream reality for entire communities, woven into religious practice, family tradition, and everyday self-care. The Norwegian findings argue for a pragmatic response: healthcare providers should routinely and respectfully ask about traditional medicine use, pharmacists should be prepared to advise on interactions involving herbal products, and health services should develop culturally sensitive approaches that acknowledge, rather than dismiss, the healing frameworks patients bring with them. With 99.8 percent of a community engaged in some form of traditional health practice, the choice facing clinicians is not whether these practices exist in their patients’ lives, but whether they will be visible in the medical record.

Subject of Research: Traditional and complementary medicine use among first- and second-generation Pakistani immigrants in Norway

Article Title: Use of traditional and complementary medicines among first- and second-generation Norwegian Pakistanis: a cross-sectional survey

Article References: Use of traditional and complementary medicines among first- and second-generation Norwegian Pakistanis: a cross-sectional survey. (n.d.). https://doi.org/10.1186/s12906-026-05521-0

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05521-0

Keywords: traditional medicine, complementary medicine, Pakistani immigrants, Norway, natural products, herbal medicine, self-care, cross-sectional survey, migrant health, cultural health practices, patient safety, I-CAM-Q