We found that 40.0% of breast cancer patients in the North of Thailand reported having demand for MC use. This finding was comparable to actual CAM usage among breast cancer patients reported in Grömitz, Germany (Hammersen et al., 2020), and in New York, USA (Sura et al., 2022). Those countries have a longer history of legalized MC use compared to Thailand. In 2019, the Thai government legalized MC use as an alternative medicine to treat illnesses. Demand for MC use in Thai cancer patients, including breast cancer patients, may have been enhanced by recent attention. After controlling for covariates with backward elimination in the multivariate analysis, four variables were significantly associated with demand for MC use among breast cancer patients in the North of Thailand. Those variables were adequate to excellent health literacy about MC, higher levels of social support, higher monthly household income, and positive attitudes toward MC use.

In our study, we also found that participants that had adequate to excellent levels of health literacy about MC were 4.96 times more likely to report having demand to use MC when compared with those with insufficient and problematic levels of health literacy about MC. This result is similar to that of a previous study in the North of Thailand by Sukrueangkul et al., (2022). Health literacy is a strong factor that has been shown to correlate with demand for MC usage among cancer patients. Another study reported that CAM usage was significantly associated with adequate levels of health literacy among patients with chronic diseases in Japan (Yukawa et al., 2015).

People who reported moderate to high levels of social support were 4.56 times more likely to report demand for MC use when compared with those with low levels of social support. Previous research in Canada by Leos-Toro, Shiplo and Hammond (2018) has also shown that social support to be related to MC use in cancer patients. Another study among breast cancer patients in the northern region of peninsular Malaysia reported that CAM usage was positively correlated with receiving information about cancer and nutritional supplements from sources apart from doctors, including TV and radio (Knight, Hwa, & Hashim, 2015). Thus, a possible explanation of these results is that most of the participants who received social support had received information about MC products from sources that were mostly close friends and family members, television or radio, or social media.

Breast cancer patients with a higher monthly household income were 4.02 times more likely to report demand for MC use when compared with those with lower monthly household income. This result was similar to that of a previous study in Hungary by Sárváry and Sárváry (2019), which reported higher monthly household income was positively correlated with CAM use in breast cancer patients. This finding may be explained by the added costs of MC. In Thailand, the price of MC is quite expensive and is not always covered by welfare health coverage. Thus, when participants have higher monthly household income, they can buy MC for alternative medicine in conjunction with conventional treatment. In some previous studies, such as one in Bandung, Indonesia by Azhar et al., (2016), CAM usage was more common in patients who had lower income, which was more a reflection of seeking alternative treatments in response to conventional treatment being unaffordable. Since Thailand has universal health coverage, this health seeking behavior is less common.

Those participants who reported a fair to good attitude toward MC use were 3.52 times more likely to report demand for MC use when compared to those with poor attitudes toward MC use. This result is similar to that of a previous study in Malaysia by Islahudin et al., (2017), which reported that a positive attitude toward MC was positively correlated with CAM use in cancer patients. As reported in an earlier study in Pennsylvania, USA, by Bauml et al., (2015), attitude toward CAM was the factor that most influenced the decision to use CAM in cancer patients and explained much more variance in CAM use than clinical and demographic variables alone. When participants have a positive attitude towards MC, it reduces fears of the side effects. On the other hand, a lack of knowledge about MC use policy, reduces confidence in the decision to use MC. Similar to a previous study by Sukrueangkul et al., (2022), most patients (53.3%) have positive attitudes toward MC, and demand was intentioned to treat physical and mental symptoms that occur alongside cancer-related symptoms, relieve side effects from treatment, and a desire to live longer and improve their health.

This cross-sectional study found that 40.0% of breast cancer patients in the North of Thailand reported demand to use MC. The factors significantly associated with reported demand to use MC were adequate to excellent health literacy about MC use, moderate to high levels of social support, higher monthly household income, and positive attitudes toward MC use when controlling for effects of other covariates.

In conclusion, this study highlights the factors associated with demand for MC use among breast cancer patients in the of north Thailand. We found substantial demand for MC use among breast cancer patients. Health literacy, social support, monthly household income, and attitudes about MC were significantly associated with demand for MC use. Therefore, improving health literacy, social support, and attitudes about MC, especially among breast cancer patients, could help increase demand for MC as a complementary and alternative medicine to alleviate side effects and enhance cancer treatment.