An epistemic network analysis of patient decision-making regarding choice of therapy

S. Zörgő*, G. J.Y. Peters, K. Csajbók-Veres, A. Geröly, A. Jeney, A. R. Ruis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Patient decision-making concerning therapy choice has been thoroughly investigated in the Push/Pull framework: factors pushing the patient away from biomedicine and those pulling them towards Complementary and Alternative Medicine (CAM). Others have examined lay etiology as a potential factor in CAM use. We conducted semi-structured interviews with patients employing only biomedicine and those using CAM. The coded and segmented data was quantified and modelled using epistemic network analysis (ENA) to explore what effects push/pull factors and etiology had on the decision-making processes.There was a marked difference between our two subsamples concerning push factors: although both groups exhibited similar scaled relative code frequencies, the CAM network models were more interconnected, indicating that CAM users expressed dissatisfaction with a wider array of phenomena. Among pull factors, a preference for natural therapies accounted for differences between groups but did not retain a strong connection to rejecting conventional treatments. Etiology, particularly adherence to vitalism, was also a critical factor in both choice of therapy and rejection of biomedical treatments. Push factors had a crucial influence on decision-making, not as individual entities, but as a constellation of experienced phenomena. Belief in vitalism affects the patient’s explanatory model of illness, changing the interpretation of other etiological factors and illness itself. Scrutinizing individual push/pull factors or etiology does not explain therapeutic choices; it is from their interplay that decisions arise. Our unified, qualitative-andquantitative methodological approach offers novel insight into decision-making by displaying connections among codes within patient narratives.

Original languageEnglish
Pages (from-to)3105-3132
Number of pages28
JournalQuality and Quantity
Issue number4
Publication statusPublished - Aug 2023


  • Complementary and alternative medicine
  • Decision-making
  • Epistemic Network Analysis
  • Lay etiology
  • Push and pull factors
  • Qualitative


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