Knowledge, attitudes, and practice of traditional Chinese medicine among the Malaysian urban population: a cross-sectional study informing China-Malaysia health cooperation strategies

Traditional Chinese medicine (TCM) plays a significant role in Malaysia’s pluralistic healthcare system and acts as an important carrier of China-Malaysia health communication. However, systematic evidence on TCM knowledge, attitudes and practice (KAP) among the general urban population in Malaysia is still lacking, restricting evidence-based bilateral health collaboration. This cross-sectional study investigated TCM-related KAP among the Malaysian urban population, as well as their expectations for local TCM development and suggestions regarding China-Malaysia TCM exchanges and cooperation. Findings are expected to generate population-based evidence and support the design of targeted China-Malaysia cooperation strategies for TCM development, popularization and regulatory coordination. A cross-sectional study was conducted through face-to-face questionnaire surveys among Malaysian urban population from multiple states between June 3 and 29, 2025. A total of 316 questionnaires were distributed, and 300 valid responses were collected, yielding a valid response rate of 94.9%. Guided by the KAP model, the questionnaire assessed TCM knowledge, attitudes, practice, as well as expectations and suggestions for China-Malaysia TCM cooperation. Chi-square tests and text analysis were used to examine categorical variable distributions and to identify key themes and sentiment patterns in open-ended responses. While 60.0% held positive attitudes toward TCM, 34.4% reported limited familiarity with TCM. Although 69.0% had used TCM, only 2.3% did so frequently; nevertheless, 70.7% would recommend it to others. Major usage barriers included limited awareness (38.7%) and unclear efficacy (30.3%). Support was high for scientific validation (66.3%) and medical insurance inclusion (55.7%). Public priorities for improvement included enhancing public awareness (56.0%), promoting Halal certification (46.0%), herbal quality control (39.3%), and government policy support (35.3%). Key priorities for China-Malaysia cooperation included medical skills exchange (53.0%), scientific research (48.3%), and talent training (46.3%). Satisfaction differences indicated that TCM knowledge level directly influences efficacy evaluation, and positive attitudes and higher usage rates are closely correlated with favourable assessments of TCM therapeutic outcomes ( p < 0.01). Ethnic differences revealed that Chinese respondents demonstrated significantly higher TCM knowledge and positive attitudes than other ethnic groups ( p < 0.01). Text analysis revealed a predominantly positive orientation (83.3%), with enhancing public awareness identified as the most urgent need (90.8%). The Malaysian urban population generally maintains positive attitudes towards TCM. but limited awareness, cultural adaptability barriers, and insufficient policy support hinder its further development. On the basis of scientific verification, efforts should be made to strengthen public education, standardize Halal certification and improve quality supervision systems. Through institutionalized China-Malaysia cooperation in TCM, technical communication, joint scientific research and personnel training can be promoted to realize the localized, standardized and sustainable development of TCM in Malaysia, supporting the formulation of bilateral health cooperation strategies.