Traditional and complementary medicine (TCM) is becoming an increasingly vital element of healthcare systems worldwide, with the World Health Organization acknowledging its potential to enhance health system robustness and promote universal health coverage.^[1] In the Middle East, traditional healing methods stemming from Islamic medicine, herbal therapies, and cultural healing customs have been employed for over a thousand years, significantly influencing healthcare-seeking behaviors among Arab communities.^[2]
In the Kingdom of Saudi Arabia, the healthcare environment is characterized by a notable prevalence of TCM utilization, with approximately 75% of the population engaging in these practices, particularly those suffering from chronic conditions such as diabetes mellitus, cardiovascular diseases, and obesity.^[3],^[4] The nation’s deep-rooted tradition in Islamic medicine is reflected in Quranic scriptures and Prophetic teachings (Tibb al-Nabawi), which document over 100 medicinal plants and therapeutic methods that continue to be used alongside conventional medical treatments.^[5]
As part of the Vision 2030 initiative aimed at transforming healthcare in Saudi Arabia, there is a strong emphasis on preventive medicine and culturally aligned healthcare services. This includes strategically prioritizing the integration of traditional medicine into mainstream healthcare delivery.^[6] The creation of the National Center for Complementary and Alternative Medicine (NCCAM) in 2009 and subsequent regulatory updates in 2019 underscore governmental dedication to incorporating evidence-based traditional practices within formal healthcare frameworks.^[7]
Nevertheless, despite high usage rates and supportive policies, the amalgamation of traditional and complementary medicine with conventional preventive care lacks structure and rigorous evaluation. Existing healthcare models do not provide evidence-based guidelines for safely merging traditional practices with proven preventive measures for chronic disease management. Although various studies indicate potential advantages of specific traditional remedies for preventing diabetes, mitigating cardiovascular risks, and managing obesity, no comprehensive assessments have analyzed integration frameworks or evaluated clinical efficacy, safety profiles, or implementation strategies specifically within Saudi Arabian contexts.
This systematic review aims to fill critical knowledge gaps by investigating both the effectiveness and safety associated with integrating traditional and complementary medicine into conventional preventive healthcare for chronic disease prevention among Saudi populations. Our research focuses on delineating clinical efficacy outcomes; evaluating safety profiles, including adverse events and interactions between herbs and pharmaceuticals; assessing patient satisfaction along with cultural appropriateness; and identifying optimal integration models as well as implementation strategies tailored for Saudi Arabian healthcare settings.

Study Design and Registration
This systematic review was executed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.8 The protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD420251107697.
Search Strategy and Information Sources
We conducted systematic searches of MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases from January 1, 2000, to July 31, 2025. The search strategy combined medical subject headings (MeSH) and free-text terms related to traditional medicine, complementary medicine, Saudi Arabia, preventive healthcare, integration, and chronic disease prevention. Complete search strategies are provided in Supplementary Table 1.
Supplementary Table 1: Complete Search Strategy

Eligibility Criteria
Inclusion criteria: Studies conducted in Saudi Arabian healthcare facilities or involving Saudi Arabian populations, published January 1, 2000, to July 31, 2025, reporting on traditional and complementary medicine integration with preventive healthcare, clinical effectiveness outcomes, safety profiles, patient satisfaction, or implementation strategies. Randomized controlled trials, quasi-experimental studies, cohort studies, cross-sectional studies with intervention evaluation, and implementation studies were eligible. Both English and Arabic language publications were included.
Exclusion criteria: Studies conducted outside Saudi Arabia without cultural relevance, purely qualitative studies without quantitative outcomes, case reports, conference abstracts without full text, veterinary studies, and studies focusing solely on acute treatment rather than preventive care.

Study Selection and Data Extraction
Two reviewers independently screened titles, abstracts, and full texts using standardized forms. Data extraction captured study design, population characteristics, interventions, clinical outcomes (HbA1c, blood pressure, BMI, lipid profiles), safety outcomes, patient satisfaction measures, implementation details, and economic data. Discrepancies were resolved through discussion with a third reviewer.

Quality Assessment
The quality of each study was evaluated utilizing relevant tools contingent on study designs: Cochrane Risk of Bias tool (RoB-2) was applied to RCTs, while ROBINS-I was utilized for non-randomized studies, alongside Mixed Methods Appraisal Tool specifically designed for implementation studies. Two reviewers conducted independent quality assessments, with any disagreements addressed through consultation with a third reviewer.

Certainty Assessment
Evidence certainty was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for each primary outcome. Assessment considered five domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Evidence certainty was rated as high, moderate, low, or very low.

Data Synthesis
We conducted descriptive narrative synthesis with structured tables and figures due to methodological diversity and inconsistent outcome definitions across studies. Meta-analysis was not performed due to heterogeneous populations and intervention types.