How social media incidental news exposure influences identification with traditional Chinese medicine

Chong-Ya Liu; Shuo Liu

doi:10.2224/sbp.16522

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Published: Sep 2, 2026

DOI: https://doi.org/10.2224/sbp.16522

Issue: Vol. 54 No. 9 (2026)

Keywords:

cultural identification, traditional Chinese medicine, incidental news exposure, sense of belonging, emotional susceptibility

How social media incidental news exposure influences identification with traditional Chinese medicine

Chong-Ya Liu

School of Foreign Languages, Nanyang Institute of Technology

Shuo Liu

Fanli Business School, Nanyang Institute of Technology

Cite this article: Liu, C.-Y., & Liu, S. (2026). How social media incidental news exposure influences identification with traditional Chinese medicine. Social Behavior and Personality: An international journal, 54(9), e16522.

Abstract

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Identification with traditional Chinese medicine culture among international audiences has received limited research attention, particularly regarding how social media incidental news exposure relates to this outcome. Thus, we examined the link between incidental news exposure and international identification with traditional Chinese medicine culture, and investigated whether sense of belonging and emotional susceptibility mediated this relationship. We analyzed survey data from 665 participants from six countries and used path analysis with bootstrapped resampling to test our hypotheses. Results revealed that incidental news exposure was positively related to identification with traditional Chinese medicine culture, and both sense of belonging and emotional susceptibility played mediating roles. These findings clarify the relationship between incidental news exposure and cultural identification, and highlight the psychological processes involved in international communication of traditional Chinese medicine.

Article Highlights

Incidental exposure to traditional Chinese medicine content on social media was positively related to international audiences’ identification with traditional Chinese medicine.

Sense of belonging and emotional susceptibility each independently mediated the link between incidental exposure and identification with traditional Chinese medicine.

Social media platforms should leverage incidental exposure to strengthen cross-cultural dissemination of traditional Chinese medicine while reducing fragmented or biased understanding.

Traditional Chinese medicine (TCM) is an important symbol of Chinese culture and plays a unique role in global health governance and cultural exchange. The World Health Organization (2019) reported that 170 Member States have documented the use of traditional and complementary medicine, highlighting its international presence. However, TCM still faces multiple challenges in achieving international recognition, including cultural misunderstanding, concerns regarding its scientific validity and credibility, and language barriers (Hoenders et al., 2024; Liu et al., 2025).

In recent years, social media has enabled communication of TCM culture, creating new opportunities and challenges. Its random push mechanism allows audiences to stumble upon TCM news without actively searching, which is associated with subtle shifts in perceptions and attitudes (Knudsen, 2023; Oeldorf-Hirsch, 2018). Such incidental news exposure occurs when algorithms or user sharing deliver news and content to users who are not seeking it (Campbell & Hawkins, 2025; Geise & Maubach, 2024). This makes it easier for incidental-exposure users to be attracted by superficial content, such as short videos, pictures, or headlines, and for them to perform shallow cognitive processing of information, even if they lack the motivation to actively acquire such information (Schäfer, 2023). This pattern may be associated with subtle shifts in users’ perceptions of TCM. Repeated low-effort exposure can increase familiarity, emotional accessibility, and positive appraisal of the subject (Palumbo et al., 2021; Schäfer, 2023).

To date, research has examined influences on TCM cultural identity, including demographics, media exposure, and sociocultural contexts (Rybicka et al., 2023). Media exposure is an important pathway via both traditional media and new media. Traditional media emphasize scientific authority to facilitate recognition of TCM (Raquepo et al., 2023), whereas new media rely on fragmented, user-generated, and emotional narratives that may facilitate participation and belonging. However, research has primarily focused on active news consumption and its effects on perceptions and attitudes (Raquepo et al., 2023), and the emerging phenomenon of social media and incidental news contact remains underexplored. Although some scholars have begun linking fragmented emotional content to cultural communication (Schäfer, 2023), the mediating roles of sense of belonging and emotional responses in the relationship between media exposure and cultural identification remain underexplored. To address these gaps, this study examined the association between social media incidental news exposure and international audiences’ identification with TCM culture by integrating self-determination and emotion-rendering perspectives, and assessing the mediating roles of sense of belonging and emotional susceptibility. Our aim was to explore the psychological pathways through which everyday algorithmic encounters may relate to international audiences’ identification with TCM.

Social Media Incidental News Exposure and International Identification With Traditional Chinese Medicine Culture

Incidental news exposure refers to a passive method of information acquisition whereby individuals are exposed to news content by chance, without actively searching for it. This kind of exposure usually occurs when users browse other content on social media and it is driven by mechanisms such as platform recommendations and diffusion of social relationships, presenting a fragmented and embedded information form (Ardèvol-Abreu et al., 2019; Schäfer, 2023). Identification with TCM culture, on the other hand, refers to the psychological state of value identification, emotional belonging, and self-positioning formed by international audiences in the process of contacting and understanding Chinese medicine culture. Specifically, value identification refers to the extent to which individuals agree with or accept TCM-related beliefs and values; emotional belonging refers to a sense of emotional connection or affinity with TCM culture; and self-positioning refers to how individuals perceive their own relationship to TCM (e.g., whether they see it as relevant to themselves). The concept of TCM culture identification can be traced back to the theory of ethnic identity, which emphasizes an individual’s emotional connection, value identity, and behavioral tendencies toward a specific culture (Roberts et al., 1999). When browsing unrelated content such as entertainment and social posts, users may be exposed to news items about TCM culture through information flow recommendation and social diffusion mechanisms, a process that may be accompanied by deepened understanding of and enhanced emotional connection with TCM culture (Oeldorf-Hirsch, 2018).

First, incidental news exposure on social media has been found to be associated with international users’ accidental exposure to TCM culture, and such exposure may be associated with stronger cultural identification tendencies. The information that international users are inadvertently exposed to while using social media may be subliminally associated with their cognitive changes (Radwan, 2022; Schäfer, 2023). Multiple incidental exposures to TCM culture content may be associated with initial cognitive familiarity, even when international users do not actively search for such content. Cognitive consistency theory suggests that individuals tend to accept information that is consistent with established frames, with this tendency being associated with cognitive reinforcement (Morvan & O’Connor, 2017). This gradual integration of cognitive experience may be subtly associated with users’ attitude toward TCM culture, contributing to an increased sense of identity.

Second, the content push of social media episodic news contact is characterized by randomness and fragmentation, a feature that may inadvertently stimulate international users’ interest in TCM culture and motivation to explore (Campbell & Hawkins, 2025; Virós-Martín et al., 2024). When users become interested in a topic, they may engage in deeper information processing through the central route to seek a more comprehensive perception (Marquart & Naderer, 2016). Although episodic news encounters on social media provide information about TCM culture in a predominantly fragmented form, they can fill knowledge gaps (Jensen, 2013). This exploration process may be associated with enhanced acceptance and identification with TCM culture, potentially contributing to the formation of a sense of identification among international viewers. On this basis, we proposed the following hypothesis:

Hypothesis 1: Social media incidental news exposure will be positively related to international audiences’ identification with traditional Chinese medicine culture.

The Mediating Role of Sense of Belonging

According to self-determination theory, sense of belonging, competence, and autonomy constitute the three basic psychological needs of human beings (Deci & Ryan, 2000). Sense of belonging is the basic motivation for individuals to aspire to establish an emotional connection with other people or groups in social interactions (Baumeister & Leary, 1995; Ryan & Deci, 2000). In a globalized media environment, sense of belonging not only originates from real communities, but may also be stimulated and reinforced during media interactions and cultural encounters (Akter et al., 2024).

First, social media incidental news exposure is associated with an increased sense of belonging among international users (Schäfer, 2023). According to self-determination theory, a sense of belonging emphasizes an individual’s emotional experience of feeling accepted, understood, and cared for in social interactions (Deci & Ryan, 2000). Users who are repeatedly exposed to TCM-culture-related content during chance encounters may show a pattern consistent with the mere exposure effect (Palumbo et al., 2021; Schäfer, 2023; Zhang et al., 2024), which reflects the idea that a strengthened sense of belonging tends to be accompanied by heightened emotional susceptibility to culturally relevant information (Mahar et al., 2013).

Second, international users’ sense of belonging may be positively related to their level of identification with TCM culture. According to social identity theory, an increased sense of belonging is often associated with a greater tendency for individuals to identify with the values, traditions, and symbolism of a culture they engage with or are exposed to (Tajfel et al., 2001). Content such as healing stories and demonstrations of traditional rituals presented on social media are associated with increased emotional resonance and acceptance of the culture by the audience (Ward & Kennedy, 1999). Such interactive behaviors may be associated with the enhancement of individual TCM cultural identity, and with its wider dissemination of TCM culture and increased level of international identity. On this basis, we proposed the following hypotheses:

Hypothesis 2: Sense of belonging will mediate the association between social media incidental news exposure and international audiences’ identification with Chinese medicine culture.

Hypothesis 2a: Social media incidental news exposure will be positively associated with sense of belonging among international audiences.

Hypothesis 2b: Sense of belonging will be positively associated with international audiences’ identification with traditional Chinese medicine culture.

The Mediating Role of Emotional Susceptibility

Emotional susceptibility refers to individuals’ sensitivity to external emotional stimuli, and the tendency to react strongly to external emotional information (Larsen, 2000). According to affective framing theory, the framing of emotionally charged messages in the media is often associated with enhanced emotional responses from the audience and changes in their perception, memory, and evaluation of the content (Nabi, 2003). Social media pushes emotional content related to TCM culture through algorithms, providing international users with opportunities for accidental exposure to emotional triggers in a cross-cultural context. This unconscious exposure mechanism may be associated with increased emotional susceptibility, enhanced emotional resonance, and rising acceptance of and identification with TCM culture among international audiences.

First, social media incidental news exposure has been found to be associated with effectively enhancing international users’ emotional susceptibility (Campbell & Hawkins, 2025). In the context of incidental news exposure, the social media platform pushes TCM cultural content with emotional color, including vivid narratives and visual effects. During this process, the enhancement of emotional susceptibility may stem from the superimposed effect of multiple exposures and emotional arousal, causing heightened psychological sensitivity and empathic tendencies toward the emotionalized cultural content (Brader, 2020). This latent cumulative association is seen as a key mechanism linked with increased emotional susceptibility (Gil de Zúñiga et al., 2017).

Second, we anticipated that increased emotional susceptibility would be positively associated with increased cultural identification with TCM among international users. Attitude change theory suggests that strong emotional responses are often accompanied by changes in cognitive processing styles and are associated with acceptance of and identification with a particular culture (Marquart & Naderer, 2016). This emotional response is associated with greater attention to TCM-related news that aligns with users’ emotions and with adjustments to their cognitive frames following repeated exposure to emotional information (Entman, 1993). In cross-cultural communication contexts, emotional susceptibility may play a bridging role between international users’ understanding and acceptance of TCM culture. Therefore, this study proposed the following hypotheses:

Hypothesis 3: Emotional susceptibility will mediate the association between international audiences’ social media incidental news exposure and identification with Chinese medicine culture.

Hypothesis 3a: Social media incidental news exposure will be positively associated with emotional susceptibility among international audiences.

Hypothesis 3b: Emotional susceptibility will be positively associated with international audiences’ identification with Chinese medicine culture.

Method

Participants and Procedure

We constructed a two-axis country selection framework to improve representativeness and cross-cultural comparability. The first axis captured new media penetration using country digital profiles (Kemp, 2024), while the second axis captured the institutional environment for TCM-related practices using the World Health Organization Global Report on Traditional and Complementary Medicine (World Health Organization, 2019), which provides harmonized cross-country policy indicators that support consistent international comparison. Using stratified maximum difference sampling based on the composite gradient of new media penetration × degree of institutionalization, we selected six countries: Singapore, Australia, the United States, Canada, Pakistan, and Nigeria. Singapore and Australia have high levels of new media penetration and institutionalization. The United States and Canada have similarly higher new media penetration but a lower degree of institutionalization than Singapore and Australia. Pakistan and Nigeria both have low new media penetration, yet they differ in whether traditional and complementary medicine is formally recognized in national policy. Indicators, sources, and institutionalization codes are provided in Table A1 in the Appendix. See Figure A1 in the Appendix for a visualization of the relationship between social media penetration and TCM institutionalization across the six countries.

Questionnaire development was conducted over an 8-day period in August 2024. The Institutional Review Board of Nanyang Institute of Technology (NIT-IRB-2024-011) reviewed and approved the study. Following ethical approval, data collection via Credamo began on November 20, 2024, and continued for approximately 1 month. We required respondents meet the following criteria before entering the questionnaire: (a) aged 18 years or over; (b) holding recent, continuous residence in their reported country (verified by IP/region checks); (c) having used at least one mainstream social media platform in the past month; and (d) providing electronic informed consent. The questionnaire was presented in plain English with a minimum self-rated reading proficiency threshold. We used Credamo’s quality control checks, such as behavioral monitoring, device and geographic check, VPN screening, and attention testing, to eliminate invalid samples. Of 700 responses we received, 665 were retained (valid response rate = 94.88%) from six countries. The country distribution was approximately balanced. The final model estimated P = 50 free parameters (Amos output), yielding an N:P ratio of 665:50 (~13:1), which met the common recommendations for structural equation modeling with this level of complexity. Therefore, the sample was adequate for the primary path and mediation analyses.

The sample comprised more men than women. We measured age in four categories, with almost half of participants being aged 25–39 years. We measured health status from 1 (very healthy) to 4 (unhealthy), with most participants reporting fair health. Level of education was coded from 1 (secondary school or below) to 5 (doctoral degree), with the majority being undergraduates. Occupation was divided into eight categories, including the most commonly chosen category of “other.” Table 1 presents full demographic information.

Table 1. Demographic Characteristics of Participants

Note. Gender was coded as women = 0 and men = 1, with a mean of 0.52 (SD = 0.50); age was coded in four categories with a mean of 2.04 (SD = 0.80); health was coded in four categories with a mean of 2.00 (SD = 0.70); and level of education was coded in five categories with a mean of 2.94 (SD = 0.97).

Measures

The main variables were measured using established scales. We made minor wording adjustments to ensure content validity and contextual fit, while keeping the original meaning. All variables were measured on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

Social Media Incidental News Exposure

We adapted six items from Ardèvol-Abreu et al. (2019) to evaluate users’ incidental exposure to social media content and capture the behavioral characteristics of those exposed to TCM cultural content in noninitiated situations. A sample item is “I come across TCM-related news/content through platform recommendations or notifications rather than active searching.” Cronbach’s alpha was .88, indicating good reliability.

Identification With Chinese Medicine Culture

We adapted the Multigroup Ethnic Identity Measure (Roberts et al., 1999) to evaluate ethnic and cultural identity, tailoring it to fit the TCM context. Although the original scale contains 12 items assessing multigroup ethnic identification, we removed Item 2 because it did not fit TCM as a specific cultural target and might have added construct-irrelevant variance, and retained the remaining 11 items. A sample item is “I am willing to try TCM cultural practices, such as dietary therapy, tuina, or moxibustion.” Cronbach’s alpha was .89, indicating good reliability.

Sense of Belonging

We adapted the Basic Psychological Needs Satisfaction Scale by Ryan and Deci (2000), which comprises 21 items evaluating the three dimensions of competence, autonomy, and relatedness in self-determination theory. Due to the specific content of our study, we focused only on the relatedness dimension, which includes six items. A sample item is “I feel that I can be friends with people who watch news about TCM culture.” Cronbach’s alpha was .87, indicating good reliability.

Emotional Susceptibility

We drew on the Emotional Contagion Scale developed by Doherty (1997), the original version of which comprised 15 items evaluating individuals’ sensitivity to other people’s emotional states and empathy. Due to the study requirements, we adjusted the scale to include six items exploring responsiveness to emotional cues. A sample item is “When I see others smiling, I feel warmth.” Cronbach’s alpha was .89, indicating good reliability.

Data Analysis

First, we analyzed the reliability and validity of the measures using SPSS 27.0 (IBM Corp., Armonk, NY, USA). Second, we conducted a confirmatory factor analysis to assess the measurement model. As the sample included six countries, we examined measurement invariance across countries using multigroup confirmatory factor analysis before testing the structural model. Last, we used Amos 24.0 (IBM Corp., Armonk, NY, USA) to analyze the relationships between observed indicators and underlying constructs, in order to test the research hypotheses.

Results

Common Method Bias Check and Reliability and Validity Testing

We conducted a common method bias test to assess data quality, and the results showed that the first factor explained only 16.31% of the total variance, indicating no significant bias. Furthermore, the Kaiser–Meyer–Olkin test value was .95 and Bartlett’s test was significant (p < .001), confirming the suitability of the data for factor analysis. Convergent validity was supported (see Table 2).

Table 2. Convergent Validity and Composite Reliability of Measures

Note. AVE = average variance extracted; CR = composite reliability.

Descriptive Statistics and Correlation Analysis

Descriptive statistics and correlations are reported in Table 3. There were significant positive relationships among all the examined variables.

Table 3. Descriptive Statistics and Correlations for Study Variables

Note. EXPO = social media incidental news exposure; IDE = international audiences’ identification with traditional Chinese medicine culture; SELF = sense of belonging; ESC = emotional susceptibility.

*** p < .001.

Measurement Invariance Across Countries

After establishing the measurement model in the pooled six-country sample, we further conducted a multigroup confirmatory factor analysis to examine measurement invariance across the six countries in terms of the four latent constructs of social media incidental news exposure, sense of belonging, emotional susceptibility, and international identification with TCM. The configural model showed an overall good fit, supporting a comparable factor structure across groups (see Table 4). The metric model also showed an acceptable fit with factor loadings constrained equal across countries. We did not compare latent means across countries, so scalar invariance was not examined. Although the comparative fit index decreased modestly, the root-mean-square error of approximation changed minimally and the standardized root-mean-square residual increased, consistent with commonly used criteria for approximate metric invariance (Chen, 2007; Cheung & Rensvold, 2002). These results supported a consistent factor structure and approximate metric invariance of the four latent constructs across the six countries.

Table 4. Measurement Invariance of the Traditional Chinese Medicine Identification Model Across Six Countries

Note. CFI = comparative fit index; Tucker–Lewis index; RMSEA = root-mean-square error of approximation; CI = confidence interval; LL = lower limit; UL = upper limit; SRMR = standardized root-mean-square residual.

Structural Equation Modeling Analysis

We conducted a structural equation modeling analysis with Amos 24.0 using maximum likelihood estimation. The resulting fit indices are shown in Table 5.

Table 5. Model Fit Indices

Note: CMIN/df = relative chi-square index/degrees of freedom; CFI = comparative fit index; TLI = Tucker–Lewis index; SRMR = standardized root-mean-square residual; RMSEA = root-mean-square error of approximation; CI = confidence interval; LL = lower limit; UL = upper limit.

As shown in Table 6, social media incidental news exposure was significantly and positively associated with international audiences’ identification with TCM culture, sense of belonging, and emotional susceptibility. Thus, Hypotheses 1, 2a, and 3a were supported. Sense of belonging was significantly and positively associated with international audiences’ identification with TCM culture; thus, Hypothesis 2b was supported. Moreover, emotional susceptibility was positively and significantly associated with international audiences’ identification with TCM culture; thus, Hypothesis 3b was supported.

Table 6. Regression Coefficient Test Results for Each Model Path

Note. CR = critical ratio; EXPO = social media incidental news exposure; IDE = international audiences’ identification with traditional Chinese medicine culture; SELF = sense of belonging; ESC = emotional susceptibility.

Mediating Effects Testing

This study tested the mediating role of sense of belonging and emotional susceptibility in the link between social media incidental news exposure and international audiences’ identification with TCM culture using Model 4 of the PROCESS macro 4.0 with 5,000 bootstrapped resamples and 95% confidence intervals (Hayes, 2017). As shown in Table 7, incidental news exposure showed a significant positive association with cultural identity, thus supporting Hypothesis 1. In the mediation model, incidental news exposure was positively associated with sense of belonging and emotional susceptibility, thus supporting Hypotheses 2a and 3a. In turn, both sense of belonging and emotional susceptibility were positively associated with cultural identification, thus supporting Hypotheses 2b and 3b.

Table 7. Path Coefficients in the Mediation Model with Sense of Belonging and Emotional Susceptibility

Note. CI = confidence interval; LL = lower limit; UL = upper limit; EXPO = social media incidental news exposure; SELF = sense of belonging; ESC = emotional susceptibility; IDE = international audiences’ identification with traditional Chinese medicine culture.

Discussion

This study explored the association mechanisms linking social media incidental news exposure, sense of belonging, emotional susceptibility and international audiences’ identification with traditional Chinese medicine culture using structural equation modeling. We found that incidental news exposure was significantly and positively associated with international audiences’ identification with traditional Chinese medicine culture. Sense of belonging and emotional susceptibility functioned as mediating associations in this relationship. This study has validated dual psychological mediation pathways linking incidental news exposure to cultural identity. The findings extend self-determination and emotion-rendering theories to the context of cross-cultural communication by highlighting the relevance of psychological needs and emotional experiences in cultural identity formation.

The results indicated that higher levels of incidental news exposure were significantly and positively associated with stronger international identity when TCM content was embedded in users’ daily exposure. Unlike one-way dissemination, incidental exposure is associated with gradual understanding and attitude shifts through repeated, low-intention engagement. This mode relies on social media interactivity and algorithmic recommendations, with the former associated with visibility via liking, commenting, and sharing, while the latter supports recurrent exposure. Emotional susceptibility often co-occurs with a heightened sense of belonging, which appears to align with higher cultural identification (Mahar et al., 2013). This pattern is consistent with prior evidence indicating that incidental exposure is associated with cognitive and attitudinal change through low-awareness information flow (Gil de Zúñiga et al., 2017). However, previous studies have paid little attention to cultural identity construction, especially in cross-cultural contexts. Our findings in this study suggest that incidental exposure is also relevant in cultural communication.

The findings further suggest that incidental news exposure is associated with an increased sense of belonging, consistent with self-determination theory’s consideration of belonging as a basic psychological need (Deci & Ryan, 2000). That is, sense of belonging was positively associated with identification with TCM culture. When international audiences are inadvertently exposed to TCM content, this noninitiated exposure may reduce preconceived biases and increase emotional resonance. Interactive functions such as liking, sharing, and commenting may further reinforce this process, particularly when cues come from socially close others or familiar cultural networks (Weeks et al., 2023). This study has therefore extended prior work by showing how sense of belonging can serve as a pathway linking incidental exposure to cross-cultural identification.

The findings of this study showed that incidental news exposure was also positively related to increased emotional susceptibility, which was, in turn, related to stronger identification with TCM culture. Emotional resonance is important in incidental encounters and is often associated with the intensity of emotional responses. TCM news usually involves daily-life topics and personal stories, or touching experiences that may trigger emotional resonance in cross-cultural contexts. Such resonance may help audiences perceive the unique value of TCM culture, generate positive emotional evaluations, and support more active sharing and deeper identification. Extending issue-based research, the findings of this study suggest that emotional resonance in incidental news exposure may provide an affective pathway through which cultural identity is strengthened beyond traditional political or social frames.

Practical Implications

This study revealed that social media incidental news exposure was positively associated with international audiences’ identification with Chinese medicine culture. Platforms can optimize recommendation algorithms and use data-driven pushes to embed TCM content into international users’ daily news flows, thus increasing chance encounters. Social activities such as online health consultation and cultural experience videos may also facilitate everyday contact. As sense of belonging played an important mediating role, platforms can strengthen this by enabling TCM-related online communities, regular discussion, and user-generated content. Similarly, to promote emotional susceptibility, communicators could design emotional and storytelling content to enhance resonance and identification.

Limitations and Future Directions

This study has several limitations that should be addressed in future research. First, the questionnaire was self-completed, which may have triggered social expectancy effects and common method bias. Although this study minimized such risks through anonymous completion and question order control, future studies could use behavioral data, tracking surveys, or experimental designs to enhance internal validity. Second, the model did not incorporate other potential mediating and moderating variables. Individuals’ perceptions of cultural distance, platform usage habits, and media literacy levels may also play a role. Third, future studies could introduce heterogeneity and robustness analyses, such as grouping by country, gender, platform type, and frequency of use, and introduce interaction terms with alternative specification regression to identify potential boundary conditions and group differences.

Appendix

Table A1. Country-Level Indicators for Digital Penetration and Traditional Chinese Medicine Institutionalization

Note. ¹Figures are taken from each country’s January 2024 headline indicators reported in the corresponding Digital 2024 country reports by Kemp (2024). ²Data based on Country Summaries and related text sections in World Health Organization (2019). A1 Legislation: Existence of national-level laws or ministerial ordinances covering traditional and complementary medicine (e.g., acupuncture, herbal medicine). A2 Regulatory authority: Existence of a dedicated national or ministerial agency/office responsible for traditional and complementary medicine policy and regulation. A3 Inclusion in public health/insurance: Whether traditional and complementary medicine services are integrated into the public healthcare system or eligible for national insurance reimbursement (partial coverage recorded as 0.5). A4 Licensing and registration: Whether traditional and complementary medicine practitioners are subject to mandatory registration or licensing at national or provincial level. B1 Education system: Existence of nationally accredited university-level education or standardized training frameworks for traditional and complementary medicine. B2 Product regulation: Existence of national systems for registration, labeling, pharmacopoeia entries or equivalent regulatory frameworks for herbal/traditional and complementary medicine products. Scoring: 1 = clearly exists at national level or widely implemented; 0.5 = partially exists (e.g., provincial or pilot coverage only); 0 = no national-level framework. All scores refer to national policies only—local or industry self-regulation is not counted as 1. Institutionalization index (0–10): (A1 + A2 + A3 + A4 + B1 + B2) / 6 × 10, rounded to two decimal places. The institutionalization index is used solely for comparative classification across countries and does not represent the full legal or regulatory breadth of each national system.

Figure A1. Relationship Between Social Media Penetration and Traditional Chinese Medicine Institutionalization Across Countries.

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