Urban Malaysians’ knowledge and use of traditional Chinese medicine surveyed

Traditional Chinese medicine enjoys broad goodwill among Malaysians living in cities, but a new study suggests that goodwill has not translated into deep familiarity or regular use. A cross-sectional survey of 300 urban residents across multiple Malaysian states, published in BMC Complementary Medicine and Therapies, found that while six in ten respondents held positive attitudes toward traditional Chinese medicine, or TCM, more than a third admitted they knew very little about it. The research, led by Yibin Zhou and Wenju Zhang of Henan University of Chinese Medicine together with colleagues in China and Malaysia, offers one of the most detailed population-based snapshots to date of how TCM is understood, trusted and used in a multicultural Southeast Asian nation where pluralistic healthcare is the norm rather than the exception.

The study was conducted between June 3 and 29, 2025, using face-to-face questionnaire surveys. Of 316 questionnaires distributed, 300 valid responses were returned, a valid response rate of 94.9 percent. The survey instrument was built around the knowledge, attitudes and practice framework, a well-established model in health services research that treats knowledge, attitudes and behavior as distinct but linked dimensions of health decision-making. Respondents answered structured questions about their familiarity with TCM, their emotional and evaluative attitudes toward it, their actual usage patterns, and their expectations for the future development of TCM in Malaysia. They also answered open-ended questions about China-Malaysia cooperation in traditional medicine, which the researchers then subjected to text analysis to identify dominant themes and sentiment.

The headline numbers reveal a striking gap between affection and engagement. Although 69.0 percent of respondents had used TCM at some point, only 2.3 percent reported using it frequently. Yet 70.7 percent said they would recommend TCM to others, and 60.0 percent expressed generally positive attitudes toward it. In other words, Malaysians in urban areas are broadly sympathetic to TCM and willing to endorse it, but most engage with it occasionally rather than as a sustained part of their healthcare. The most commonly cited barriers were limited awareness, reported by 38.7 percent of respondents, and uncertainty about efficacy, reported by 30.3 percent. These findings suggest that the problem is not resistance but unfamiliarity: potential users simply do not know enough about what TCM offers or what evidence supports it.

Statistical analysis sharpened this picture. Chi-square tests showed that TCM knowledge level directly influenced how respondents evaluated its efficacy, and that positive attitudes and higher usage rates were closely correlated with favorable assessments of therapeutic outcomes, with p values below 0.01. This is more than a statistical curiosity; it implies a feedback loop in which knowledge builds confidence, confidence encourages use, and positive experience reinforces favorable attitudes. Conversely, people with little knowledge are less likely to try TCM and less likely to judge it effective if they do. The authors argue that public education is therefore not merely an accessory to TCM development in Malaysia but its central precondition.

Ethnicity emerged as a powerful differentiator. Chinese respondents demonstrated significantly higher TCM knowledge and more positive attitudes than members of other ethnic groups, again with p values below 0.01. This is unsurprising in historical terms, since TCM traveled to Malaysia with Chinese diaspora communities and has long been embedded in Chinese-Malaysian cultural life. But the finding carries policy weight in a multiethnic society where healthcare traditions, including Malay and Indian systems of traditional medicine, coexist under the country’s traditional and complementary medicine framework, governed by the Traditional and Complementary Medicine Act 2016, known as Act 775. If TCM is to serve the whole population rather than a single community, the data suggest, outreach must cross ethnic and cultural lines.

Cultural adaptation was a recurring theme in respondents’ expectations. Nearly half, 46.0 percent, prioritized Halal certification of TCM products, a critical consideration in a country where Islam is the federal religion and where Muslim consumers must verify that herbal preparations, and sometimes animal-derived ingredients, meet religious requirements. Herbal quality control was a priority for 39.3 percent, and government policy support for 35.3 percent. By far the most frequently cited improvement priority was enhancing public awareness, named by 56.0 percent of respondents. Text analysis of the open-ended responses reinforced this: sentiment was predominantly positive, at 83.3 percent, and enhancing public awareness emerged as the single most urgent need, flagged by 90.8 percent of coded responses.

Support for scientific scrutiny was also strong. Some 66.3 percent of respondents backed scientific validation of TCM, and 55.7 percent supported its inclusion in medical insurance schemes. These figures point to a public that is not asking for TCM to be exempt from evidence-based scrutiny but rather for it to earn a place within the mainstream health system through demonstrated efficacy, quality assurance and institutional recognition. The authors frame this as a mandate for regulators: on the basis of scientific verification, efforts should strengthen public education, standardize Halal certification and improve quality supervision systems. In Malaysia, where the National Health and Morbidity Survey has tracked traditional and complementary medicine use nationwide, the new study adds a focused, TCM-specific, urban lens that national surveys do not provide.

The survey also probed what Malaysians want from bilateral cooperation with China, the ancestral home of TCM and its largest research and manufacturing base. The top priorities were medical skills exchange, named by 53.0 percent of respondents, scientific research collaboration, named by 48.3 percent, and talent training, named by 46.3 percent. These preferences sketch a practical roadmap. Respondents appear to want Chinese clinical expertise and research capacity brought into Malaysia not as a one-way transfer but through structured exchange, with joint studies validating TCM in the local context and training programs building a Malaysian workforce of qualified practitioners. The study’s authors argue that such institutionalized cooperation could promote the localized, standardized and sustainable development of TCM in Malaysia and support the formulation of bilateral health cooperation strategies.

Methodologically, the study is modest in scale but careful in execution. It was approved by the Institutional Ethics Committee of Management and Science University in Malaysia under reference MSU-RMC-02/FR01/08/L3/013, and all participants provided informed consent consistent with the Declaration of Helsinki. An expert panel reviewed the questionnaire before deployment. The combination of quantitative chi-square testing with qualitative text analysis of open-ended answers allowed the researchers to triangulate: the numbers established what people knew, felt and did, while the text analysis captured how they talked about TCM and what they hoped would change. The predominantly positive sentiment in free-text responses, aligned with the 60.0 percent positive-attitude figure, suggests the quantitative findings were not artifacts of question wording.

What the study cannot do is establish causality or national representativeness. As a cross-sectional survey of 300 urban respondents, it captures a moment in time and a specific population; rural attitudes, longitudinal changes and causal mechanisms remain open questions. The authors acknowledge that systematic evidence on TCM knowledge, attitudes and practice among the general Malaysian urban population had been lacking, which is precisely the gap this study is designed to begin filling. Even with those limits, the consistency of the signals, high goodwill, low knowledge, episodic use, strong demand for validation and certification, gives the findings practical weight.

The broader significance lies in how the study reframes the challenge facing traditional medicine in modernizing health systems. Malaysia is not hostile territory for TCM; it is one of the most receptive environments in the Muslim-majority world, with a long-established Chinese-Malaysian practitioner community and a regulatory framework that formally recognizes traditional and complementary medicine. The bottleneck, the data suggest, is informational and institutional: people do not know enough, products lack trusted certification, efficacy is perceived as unclear, and insurance coverage is absent. Each of these is a solvable problem, and each falls squarely within the domains of public health communication, regulatory science and international research collaboration.

For researchers, the study provides a baseline against which future interventions, whether public awareness campaigns, Halal certification schemes, joint clinical trials or practitioner training programs, can be measured. For policymakers in Kuala Lumpur and Beijing, it converts anecdote about TCM’s popularity into quantified public preferences, complete with ranked priorities for cooperation. And for the urban Malaysians surveyed, it documents a quiet consensus: traditional Chinese medicine is welcome in Malaysia’s healthcare landscape, but only if it arrives with evidence, quality assurance and respect for the country’s cultural and religious standards. Whether the bilateral partnerships imagined in the paper materialize, and whether they close the knowledge gap the study documents, will determine whether that consensus hardens into everyday practice.