Manuscript Title: Regulatory and Implications of Complementary and Alternative Medicine (CAM) Use for Infection Prevention: Insights From the Gulf Cooperation Council (GCC) Countries

Purpose: The growing use of complementary and alternative medicine (CAM) for infection prevention across Gulf Cooperation Council (GCC) countries raises important concerns regarding patient safety and the lack of evidence-based regulation. This study aimed to assess the prevalence of CAM use, identify associated demographic factors, and explore public perceptions to support healthcare policy development. Patients and Methods: A cross-sectional online survey was conducted over a three-month period among GCC residents aged 18 years and older. A self-administered questionnaire was distributed via social media platforms (eg Facebook, WhatsApp, and Twitter) using a convenience sampling approach, supplemented by snowballing. Although the calculated target sample size was 385, a total of 340 participants completed the survey. The questionnaire included items related to demographics, CAM practices, knowledge, and beliefs. Data were analyzed using IBM SPSS Statistics version 26, and chi-square tests were used to explore associations between CAM use frequency and participant characteristics. Results: Herbal products (62%) and spiritual healing (14%) emerged as the most commonly used CAM practices, with ginger, Curcuma longa, and garlic being the most frequently used herbs. More frequent CAM use was significantly associated with education level (χ²(3) = 19.01, p <0.001, Cramér’s V = 0.160), country of residence (χ²(5) = 35.28, p <0.001, Cramér’s V = 0.217), and prior infection experience (χ²(2) = 35.14, p <0.001, Cramér’s V = 0.217). Higher usage was reported among Saudis, individuals with higher education, and those previously ill. No significant associations were found with age, health status, or fear of infection. Although 85% of users reported no side effects, reliance on informal sources and limited provider consultation raised safety concerns. Conclusion: Widespread CAM use highlights the urgent need for regulatory oversight, provider education, and culturally sensitive public health strategies to ensure safe integration into infection prevention efforts.