Homeopathy (2015) 104, 176e181

Ó 2015 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.homp.2015.05.001, available online at http://www.sciencedirect.com

ORIGINAL PAPER

The homeopathic choice for children: a

qualitative research on the decision
making process of the families
Elio Rossi1,*, Marco Picchi1, Mariella Di Stefano1, Anna Maria Marongiu2 and Patrizia Scarsini2
1
Homeopathic Clinic, Local Health Unit n. 2, Tuscan Regional Homeopathic Reference Centre, Italy
2
U.O. Psychology, Local Health Unit n. 2, Italy

Aim: To explore the experiences of parents who chose homeopathic treatment for their
children, with particular regard to the decision-making process within the family and the
availability of conventional and homeopathic healthcare services.
Methods: Semi-structured interview with parents immediately after or before the
homeopathic visit at the Homeopathic Clinic of Campo di Marte Hospital of Lucca (Italy)
from1st March, 2012 to 18 July 2012. Answers were analyzed by frequency of response
and grouped into main areas: 1. Choice of homeopathy. 2. Intra-family dynamics. 3.
Behaviour in emergency situations. 4. The relationship with the homeopathic doctor.
5. The role of friends and acquaintances. 6. The ‘cut off’ of use of homeopathy.
Results: Parents who choose homeopathic treatments for their children are strongly
influenced by context. The choice of homeopathy is usually made by mothers and is
rarely hindered by fathers, grandparents or friends, whose approval is important and en-
courages parents to use homeopathy for their children, both for prevention and treat-
ment. Easy access to the homeopathic doctor was frequently requested, especially for
acute situations.
Conclusion: This research confirms the importance of context in decision making pro-
cesses. Other characteristics of families which use homeopathy, such as level of education,
personal coping strategies and family context should be investigated. Homeopathy
(2015) 104, 176e181.

Keywords: Patient choice; Children; Homeopathy; Decision making process;

Conflicts between parents

Introduction Agency (ARS) in Tuscany Region2 in 2009 reported that

According to the last survey on health conducted by the
Italian National Institute of Statistics (ISTAT) in 2005, in
Italy 9.6% of children aged <14 years use CM (Comple-
mentary Medicines), of which 7.9% use homeopathy.1
Many of the parents of children and teenagers who receive
CM use CM for themselves (31% both, 64.4% one, usually
the mother). A survey performed by the Health Regional
*Correspondence: Elio Rossi, Ambulatorio di omeopatia,
Padiglione B, Ospedale Provinciale Campo di Marte, 55100
Lucca, Italy.
E-mail: omeopatia@usl2.toscana.it
Received 10 February 2014; revised 5 May 2015; accepted 5 May
2015
25.2% of pediatric patients under the age of 14 used CM.
The most common was homeopathy used by 23.4%
(acupuncture 0.5%; herbal medicine 1.3%).
Our research suggests that people who choose homeop-
athy have a relatively high level of education, prefer to
participate in the management of their own health and
have a lot of information at their disposal, both on conven-
tional and unconventional medicine.3 These parents
perceive consultation with a homeopath as being more
appropriate than consultation with a conventional physi-
cian.4
However, with the exception of these data, very little in-
formation is available about the reasons that motivate fam-
ilies to choose homeopathic therapy, and about the social
and family context that can promote or hinder their choice,

thus expanding or reducing the area of use of homeopathy
for the families.
During our 16 years of homeopathic practice in a public
clinic, parents have often told us about their difficulties in
using homeopathic remedies. The reasons range from con-
flict with grandparents (who frequently take care of grand-
children full time and are often not sufficiently informed
about CM) to the problem of getting in touch with the ho-
meopathic doctor during an emergency or acute situations.
As a consequence, parents have to manage the therapies
alone and decide whether to use homeopathic or allopathic
drugs, for example when the fever persists or a sore throat
is too severe.
In the present work we investigated the most frequent
problems of the families who choose the homeopathic
approach for their children.
Aim
To explore the experiences of parents who chose homeo-
pathic treatment for their children, with particular regard to
the decision-making process within the family and the
availability of conventional and homeopathic healthcare
services.
Methods
Semi-structured interviews, about half an hour long,
were conducted, with 20 open questions administered by
a psychologist immediately after or before the homeopath-
ic consultation; the parents of the children were asked to
participate in a research concerning their opinions and ex-
periences as CM users. Answers were recorded on audio
tape and transcribed to an MS Word file. Field notes
were taken on block notes, and each note was marked
with the number of the case. The questions concerned de-
mographic data, parents’ decision to choose homeopathy,
relatives and friends’ reaction to the choice, children’s pa-
thologies, satisfaction with the results, ease of access to
the homeopathic doctor, behaviour in case of serious dis-
eases. Starting from the twenty answers provided for
each question, we identified some main themes allowing
us to study the most common experiences, cases, situa-
tions or opinions [Figure 1].
Sample
The sample was parents of 20 pediatric patients treated
with homeopathy for at least six months at the Homeopath-
ic Clinic of ‘Campo di Marte’ Hospital (Lucca, Tuscany)
from 1st March to 18th July 2012. The sample was selected
so as to cover a wide range of ages and diseases (Table 1).
The inclusion criteria were: families of patients aged
<14years, followed at the hospital for at least six months.
The children sampled were 9 females (mean age: 9 years)
and 11 males (mean age: 8 years).
Family decision making and homeopathy
E Rossi et al
177
Data analysis
The data analysis was conducted by a psychologist with
specific training in both qualitative and quantitative data
analysis. Qualitative analysis aimed to understand the rea-
sons that led parents to choose homeopathy for their chil-
dren and the most appropriate context for the
homeopathic approach to diseases. As in the case of
acupuncture,5 we hypothesized a ‘path model’ in which
parents, like anyone involved in decision-making strategies
for other people, make choices not only according to the
outcomes but also to the changes that take place in a partic-
ular context. We collected responses concerning the history
of the family and its internal dynamics, including grandpar-
ents’ influence. We continued with the responses related to
the relationship with the homeopathic doctor in connection
to the use of homeopathy, and considered the importance of
the broader context of friends and acquaintances.
The interviewees’ records were analyzed in their mani-
fest as well as latent content, taking into account the
most commonly used words (‘grandparents’, ‘health’, ‘pre-
vention’, ‘friends’, ‘illness’, ‘mother’s willingness’, ‘doc-
tors’.....), trying not to lose the non-verbal expressions of
uncertainty, doubt, and desire of the parents. We were inter-
ested in exploring how people behaved in their social real-
ity and the interviewer (a psychologist) did not interfere
with any expressions of feeling or opinion. We had also
provided for the interpretation of any outlying cases, but
no such intervention was necessary.
Informed consent and ethicalapproval
All patients were asked to sign a privacy disclaimer and
an informed consent form for the use of their data and their
answers for future research. There are no rules or laws in
Italy that recommend to obtain ethical approval when no
drugs are administered. However, authorization was asked
to the person responsible for the clinical structure in which
the Homeopathic Clinic is located.
Results
The use of open questions allows researchers to collect
information that could otherwise be lost when using closed
questions. However, the information collected was hetero-
geneous and difficult to analyze and synthesize. In order to
facilitate the interpretation of the results, we grouped par-
ents’ answers into five main components (each composed
of three or more items). We added a sixth, general compo-
nent, which helped synthesize the relationship between the
environmental context in which parents choose to comply
to the homeopathic approach and the various situations in
which the homeopathic remedies are used.
Components
1 Choice of homeopathy “My children have never taken
antibiotics!” (SB.’s mother)
Item 1: “Who are your family members?”
Homeopathy
 Family decision making and homeopathy
E Rossi et al
178
Figure 1 Flow chart of decision-making strategies used by parents for the homeopathic treatments for their children.
Item 2: “How long have you known and have you been
using homeopathy?”
Item 3: “Can you describe the reasons that made you
use homeopathic treatments?”
Item 4: “Who uses homeopathic remedies in your fam-
ily?”
Item 9: “What kind of problems related to your chil-
dren’s health do you most frequently face?”
Families are mainly composed of parents with two chil-
dren. Only one family has three or more children. Half of
the parents know and have been using homeopathy for
more than 15 years.
Homeopathy
The main reason for using homeopathy is for prevention,
e.g. to prevent colds in winter, also for allergies. Homeop-
athy is often used by the whole family. The most frequently
mentioned problems were colds, cough, sore throat,
catarrhal otitis, asthma, anxiety-linked disorders, celiac
disease, conjunctivitis (Table 1).
2 Intra-family dynamics “The mother proposed and the
father agreed” (AT’s parents)
Item 5: “Did you find any resistance in your family to
your choice of homeopathic medicine?”
Item 6: “If any, how did you solve these disagree-
ments?”
 Family decision making and homeopathy
E Rossi et al
179
Table 1 Most frequently faced diseases in the sample did not oppose such treatment administered for their grand-
Item 9 e What kind of problems related to your children’s health do
children. Grandparents often agreed and actively collabo-
you most frequently face? rated in treating children with homeopathic remedies;
they were rarely skeptical, and in any case did not influence
Asthma 3 the parents’ decisions. “The children are mine, and if the
Allergy 3
Sore throat 5 grandparents want to see their grandchildren, they must
Headache 1 follow my instructions” was the answer of a mother during
Colds 12 an interview.
Upper respiratory tract 2
Lower respiratory tract 2 3 Behaviour in emergency situations “In the end and by
Intestinal diseases 1
Anxiety 1 necessity we use traditional drugs” (GR.’s parents)
Sleeping disorders 1 Item 10: “Have you ever experienced emergency situ-
Conjunctivitis 1 ations for your children’s health, which caused con-
Flu syndrome 3
Ear infection 2 flicts in the choice of homeopathic versus allopathic
Prevention respiratory recurrent diseases 12 treatment? How was the emergency situation solved?”
Item 11: “What would you need in order to be able to
make a more serene decision?”
Item 7: “Which parent proposed homeopathy to treat Item 15: “Have you ever faced any emergency situa-
the children?” tions in which the medical personnel did not respect
Item 8: “As a parental couple have you ever disagreed your choice to use homeopathic treatments?”
on the therapy to be used in case of illness of your chil-
dren?” 50% of our sample reported that their children had not
Item 16: “What are the attitudes of the families of experienced any serious acute conditions; other children
origin towards the parents’ choice of treating children had used allopathic treatment because of the severity of
with homeopathy?” the disease. Others, who had received adequate support
Item 17: “How did you manage grandparents’ re- from the homeopathic physician, continued to use homeop-
quests to change therapy for your children?” athy. The majority of parents reported sufficient knowledge
to face non-serious diseases; 30% said that a more support
Couples usually agreed to use homeopathy for their chil- from the homeopathic doctor (along with more help from
dren (sometimes only two fathers did not agree the pharmacists and therapeutic indications on the labelling
completely), but the mothers were usually unwavering; of homeopathic medicines) could support them in acute
the mothers were also those who proposed homeopathic conditions. All parents who had used allopathic drugs
remedies. In almost half of the cases there was no disagree- said they had done so because of the severity of the disease.
ment on the use of homeopathy even for acute diseases. In
case of high fever, fathers chose to integrate the homeo- 4 Relationship with the homeopathic doctor “I thought it
pathic therapy with traditional drugs (generally paraceta- was useful and pleasant to find homeopathy in the public
mol and sometimes antibiotics). In 30% of the sample, health service” (SG.’smother)
both parents preferred allopathic treatment for chronic dis- Item 12: “In relation to health problems of your family
eases. The difficulty was sometimes admitted, but mothers and in particular of your children, what do you think
prevailed over fathers on the choice of continuing the ho- about your relationship with your homeopathic doc-
meopathic remedy: “Fever is our body’s natural response tor?”
to fight an external pathogenic agent”. Item 13: “Have you ever experienced any difficulties
Homeopathy occasionally seems to be an ideological in accessing or communicating with your homeopath-
choice, and in these cases mostly due to the mother’s ic doctor?”
opinion. When homeopathy was ineffective, fathers were Item 14: “How did you solve difficulties that may have
more willing than their wives to turn to allopathic medi- arisen in the consultation of the homeopathic doc-
cine. There were mothers who said: ‘...I dragged him to tor?”
this choice ..’ ‘..allopathic medicines should be used Many parents were satisfied with their homeopathic doc-
only as a last resort.’. In some cases the homeopathic tor, but they say that the waiting list was too long and that
choice appears to be more radical, more ideological, and access to the public service was difficult (60%). The gen-
the attitude of greater intransigence during the homeopath- eral comment was that: “.if there were more homeopathic
ic treatment generally depends on the mother. In acute dis- doctors in the public health system, there would be more
ease that continue after homeopathic treatment without people interested in.”. The homeopathic doctor should
resolution the husband generally would generally prefer al- be more widely represented in the Public Health System
lopathic treatment, while the mother would continue with in order to attract an increasing number of people. More
homeopathy: “I’m the one who is generally pushing to- homeopathic doctors within the Healthcare System “would
wards these types of therapies; (.) the allopathic medi- increase the possibility of use by households, especially
cines are the last to be taken and by necessity”. those in need”. Families rarely change their GP, but try to
35% of the sample reported that grandparents were not solve the difficulties by turning to private consultation or
adequately informed on complementary medicine, but using their own homeopathic knowledge. Parents

Homeopathy
 Family decision making and homeopathy
E Rossi et al
180
especially appreciate that homeopathic doctors prescribe
allopathic drugs only when absolutely necessary.
5 The role of friends and acquaintances in the choice of
homeopathy “What will they use?!” (AP.’s grandpar-
ents)
Item 18: “Have you observed any disposition towards
homeopathic treatments among your friends and ac-
quaintances?”
Item 19: “What do you think could be key methods to
support the choice of homeopathy?”
Item 20: “Which homeopathic treatment would you
suggest to a friend, and for what kind of illness?”
Family friends of our sample generally believe that the
choice of non-conventional treatment is growing steadily.
However, some of them expressed criticism or skepticism
over homeopathic medicine; others thought that only a
limited number of people would turn to homeopathy to
treat their children.
The best key methods to support the choice of homeop-
athy in their view was: passing information by word of
mouth among friends, increasing the number of homeo-
pathic doctors in the public health service, more informa-
tion from the media and the web or from pharmacists
(50% in total).
Indeed, some families find it “useful to consult
internet blogs to get information and to share opinions,
the informal network of friends can also be useful to sup-
port the dissemination and use of homeopathic medi-
cine”. Parents in our sample would suggest to their
friends to use homeopathic treatments mainly for preven-
tion, and for allergy, asthma, anxiety, gastrointestinal
diseases and dermatitis.
6 ‘Cut off’ in the use of homeopathy (An hypothesis of
decision making strategy toward the use of CM based
on environmental conditions)
In our sample data we observed that when parents’
friends and grandparents are in favour of homeopathy,
they generally use it for their children to prevent diseases
rather than just to cure. In acute conditions, parents decide
to use allopathic drugs if “they find it difficult to contact the
homeopathic doctor” (57%), and they always (100%) say
that: “an easier access to the homeopathic doctor would
make it easier to choose”.
Discussion
Our sample was very limited, yet the parents we inter-
viewed often answered in a similar way. We observed
that homeopathic remedies are used for a wide range of dis-
eases, but mainly for those of the upper respiratory tract.
The decision to use homeopathy is made mostly by the
mothers but with the fathers’ agreement, and homeopathy
is often used by other relatives as well. Homeopathy often
seems to be a cultural choice, in agreement with Kemper
et al. (2008) “.largely because they found these health
care alternatives to be more congruent with their own
values”.6
Homeopathy
Prevention is the main objective and is connected with
the first child’s birth. Some parents previously used home-
opathy for their health care. One of the most common
causes in our homeopathic clinical practice7 is of a family
with a little child in his/her first year of nursery who imme-
diately starts to suffer from upper respiratory tract diseases
(coryza, pharingo-tonsillitis, otitis, etc.), and to take antibi-
otics, corticosteroids, etc. Once recovered, the child returns
to the nursery/school and, after a short time has the same
problems (fever, respiratory symptoms). The pediatrician
prescribes the same treatment, and so on, week after
week. The request for homeopathic treatment often starts
from this (negative) experience.
Analyzing intrafamily dynamics we observe that grand-
parents rarely agree with the parents’ homeopathic choice,
as they are accustomed to allopathic drugs, but their
opinion is rarely explicitly expressed. It seems they do
not dare to oppose the parents’ ideas and the consequent
decisions. If any conflict appears within the family, this
can take place in acute conditions that are experienced
only by a small number of families. In such cases, they
are willing to use allopathic medicine, and their choice
does not depend on the physician, but on the possible
severity of the disease.
The parents’ choice to use homeopathic remedies when
there are no severe diseases seems to be different from that
described by Rise and Seinsbekk4 “None of the parents
used solely homeopathic treatment, and they emphasized
that they still would see a physician and use conventional
medical treatment when necessary”. In this article parents
seem to choose the therapeutic approach for their children
case by case. However, better access to the homeopathic
doctor would probably make it possible to use complemen-
tary medicine even in presence of more severe diseases.
Very often homeopathic doctors are not accessible to the
patient; it is quite difficult to phone them or to have a
home visit when needed; they are not available at week-
ends, and non-homeopathic acute medical service is pro-
vided.
This problem calls into question the relationship with the
homeopathic doctor: parents said that the choice of a spe-
cific homeopathic doctor depends on his/her accessibility
(even by phone) and flexibility (he sometimes has to
consider allopathic remedies as well). This is in agreement
with Kliems and Witt8 “Patients identified the availability
of time, both in itself and as a prerequisite for other physi-
cian characteristics, as the single most important factor”.
Owing to the long waiting lists in public homeopathic
clinics, people sometimes prefer to book the visit in
advance, so as to be able to see the doctor at regular inter-
vals.
Taking into account all the answers we received, there
seem to be some ‘cut off’ points to make parents’ ‘homeo-
pathic choice’ suitable for several contexts or situations.
Firstly, many of the parents decided to use it for their chil-
dren when they already used it for themselves or it is partic-
ularly congruent with their own beliefs. When
grandparents and friends appreciated (or used) the homeo-
pathic approach, parents expanded its use to preventive

Use of homeopathic medicine for children related to
family and enviromental condiƟons
Emergency
situaƟons
treatment
Treatment
and
prevenƟon
Only
treatment
Agreement between Favorable aƫtude of Wide availability oŌhe
mother and father grandparents and friends homeopathic doctor
Figure 2 Use of homepathic medicine for children related to fam-
ily and environmental conditions.
purposes. This seems to be similar to what happens with
acupuncture.5 Friends and acquaintances are important to
arouse interest in homeopathy or to support the choice of
homeopathic treatment, and many parents in our sample
recommended it to their friends because of its effectiveness
to cure the diseases they had to face. “Family, friends and
health care professionals played a role in these processes,
providing support, advice, and increasing people’s general
familiarity with acupuncture”.5
Another ‘cut off’ point seems to be linked to the avail-
ability of the homeopathic doctor: parents said that when
they are able to reach the specialist easily, they could
manage acute conditions consistently with their homeo-
pathic choice. We have summarized these concepts in
Figure 2.
Finally, the choice of homeopathy seems to be the result
of interaction among personal beliefs, environmental rein-
forcements and clinical effectiveness, which require a
continuous participatory process of the patients (or of
young patients’ parents). Parents wish to be active in the
healing process (as shown by the great attention to the issue
of prevention), but they are also extremely sensitive when
the context is not favourable to their choice: homeopathic
doctors are not considered as ‘health suppliers’, but as
“wellness resources”.
Conclusions
Parents who choose homeopathic treatment for their
children are strongly influenced by the context. The choice
is usually made by mothers and is rarely hindered by fa-
thers, grandparents or friends, whose approval is consid-
Family decision making and homeopathy
E Rossi et al
181
ered to be very important and encourages parents to use
homeopathy for their children, both for prevention and
treatment.
In severe diseases, easy access to the homeopathic doc-
tor might, in some cases, allow parents to continue to use
homeopathic remedies. In our sample, parents seem to
desire personal management of their own and their chil-
dren’s health, and to avoid a passive attitude towards the
healthcare system. In the future it would be interesting to
study other characteristics of people who use homeopathy,
e.g. level of education, inclusion/exclusion from the social
context, personal coping-strategies, with particular atten-
tion to internal/external collocation of both locus of con-
trol, and decision-making strategies.
Conflict of interest
No conflict of interest. All the costs for this study were
supported by the Public Healthcare System of the Tuscany
Region.
Acknowledgments
We thank Laura Cignoni for the English translation.
References
1 Istat. Le medicine non convenzionali in Italia (Non conventional
medicine in Italy), Year of 2005, http://www.istat.it/salastampa/
comunicati/non_calendario/20070821_00/testointegrale.pdf; 2007
(accessed in August 2014).
2 Da Fre M, Voller F. Regional survey on complementary medicine,
bio-natural and wellness practices (2010). Unit of Epidemiology,
Regional Health Agency of Tuscany. Collana dei Documenti ARS
56, http://www.ars.toscana.it/files/pubblicazioni/Volumi/2011/56_
medicine_complementari.pdf; 2011 (accessed in September 2014).
3 Du Y, Knopf H. Paediatric homoeopathy in Germany: results of the
German Health Interview and Examination Survey for Children
and Adolescents (KiGGS). Pharmacoepidemiol Drug Saf 2009
May; 18(5): 370e379 http://dx.doi.org/10.1002/pds.1720.
4 Rise MB, Steinsbekk A. How do parents of child patients compare
consultations with homeopaths and physicians? A qualitative study.
Patient Educ Couns 2009 Jan; 74(1): 91e96 http:
//dx.doi.org/10.1016/j.pec.2008.07.039.
5 Bishop FL, Lewith GT. Patients’ preconceptions of acupuncture: a
qualitative study exploring the decisions patients make when seeking
acupuncture. BMC Complementary Altern Med: 102. Available at:
http://www.biomedcentral.com/1472-6882/13/102, 2013;13 (Ac-
cessed in June 2014).
6 Kemper KJ, Vohra S, Walls R. The use of complementary and alter-
native medicine in pediatrics. Pediatrics 2008; 122: 1374.
7 Rossi E, Bartoli P, Panozzo M, Bianchi A, Da Fre M. Outcome of ho-
meopathic treatment in paediatric patients: an observational study
from 1998 to 2008. EUJIM 2010; 2: 115e122.
8 Kliems H, Witt CM. The good doctor: a qualitative study of German
homeopathic physicians. J Altern Complement Med 2011; 17(3):
265e270.7 http://dx.doi.org/10.1089/acm.2010.0158. Epub 2011
Mar.
Homeopathy