Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products
Abstract
1. Introduction
2. Methods
2.1. Study Design
2.2. Participant Characteristics
2.3. Surveys
2.4. Data Analysis
3. Results
3.1. General Results
3.2. Perceptions of Herbal Supplements/Natural Products
3.3. Interactions with Patients about Herbal Supplements/Natural Products
3.4. Education on Herbal Supplements/Natural Products
3.5. Knowledge about Herbal Supplements/Natural Products
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
- Pharmacist Survey Questions
- Demographics
- 1.
- Please indicate your age.
- a.
- 21–30/31–40/41–50/51–60/>60
- 2.
- Please indicate your gender.
- a.
- Male/Female/Other
- 3.
- My primary practice setting is best described as:
- a.
- Chain pharmacy
- b.
- Independent pharmacy
- c.
- Hospital pharmacy
- d.
- Academic/educational setting
- e.
- Other (Text box)
- 4.
- Please indicate the approximate number of years you have been practicing as a licensed pharmacist (Text box)
- 5.
- Please indicate the state in which you practice:
- a.
- PA/Other (Text box)
- 6.
- My primary practice setting is in:
- a.
- Rural area/Suburban area/Urban area
- 7.
- I have personally used herbal supplements and/or natural products.
- a.
- Yes (Text box for which ones)/No
- 8.
- I have personally utilized mind and body practices.
- a.
- Yes (Text box for which ones)/No
- 9.
- What percentage of your patients do you think use some form of herbal supplements or natural products?
- a.
- 0%/1–20%/21–40%/41–60%/61–80%/81–100%
- 10.
- What percentage of your patients that use herbal supplements and natural products discuss them with you?
- a.
- 0%/1–20%/21–40%/41–60%/61–80%/81–100%
- 11.
- When you know a patient uses herbal supplements or natural products, you document their use in the patient’s profile:
- a.
- Never/1–20%/21–40%/41–60%/61–80%/81–100%
- 12.
- Patients have asked me about all the following herbal supplements and natural products:If ‘Yes’ is selected, participants are then prompted about how often (Daily; weekly; monthly; or yearly)
- a.
- Echinacea/Turmeric/Elderberry/Ginger/Garlic/Fenugreek/Saw palmetto/Flax seed/flax oil/Aloe vera/Wheat grass/barley grass/Valerian/Milk thistle/Ginkgo/Ginseng/Beet root/Ashwagandha/Apple cider vinegar/CBD/Vitamin D/Zinc/Omega 3/Mushrooms
- b.
- Other (Text box for what else is asked about)
- 13.
- During my years of practice as a pharmacist, I have noticed:
- a.
- More patients seem to be utilizing herbal supplements and natural products.
- b.
- Less of my patients seem to be utilizing herbal supplements and natural products.
- c.
- No change in the number of patients that have been using herbal supplements and natural products.
- Attitudes Towards Herbal Supplements and Natural Products
- 14.
- As a pharmacist, it is important to be knowledgeable about herbal supplements and natural products.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 15.
- I am confident in my ability to counsel patients on herb–drug interactions.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 16.
- I am confident in my ability to counsel patients on herbal side effects.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 17.
- I need to gain additional knowledge to properly counsel patients on herbal supplements and natural products.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 18.
- I am confident in my ability to recommend or discourage use of herbal supplements and natural products based on patient specific factors.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 19.
- I discuss drug–herb interactions and side effects when a person:
- a.
- Buys an herbal supplement or natural product
- b.
- Inquiries about an herbal supplement or natural product
- c.
- Never
- 20.
- In general, I consider the use of vitamins and minerals safe.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 21.
- In general, I consider the use of herbal supplements and natural products safe.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 22.
- I believe there is a benefit for utilizing herbal supplements and natural products to prevent disease.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 23.
- I believe there is a benefit in using herbal supplements and natural products to treat symptoms of some diseases.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 24.
- I believe there is a benefit in using herbal supplements and natural products to cure disease.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 25.
- I believe it is important to consult a health care provider (MD, PharmD, etc.) before utilizing herbal supplements or natural products.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- Education
- 26.
- Training in herbal supplements and natural products was:
- a.
- a required component of my schooling
- b.
- an elective component of my schooling
- c.
- Not included in my schooling
- 27.
- Herbal supplement and natural product training was covered in my pharmacy residency.
- a.
- Yes/No/Did not complete a pharmacy residency
- 28.
- Have you completed any herbal supplement or natural product continuing education credits?
- a.
- Yes/No
- 29.
- I would like to learn more about herbal supplements and natural products.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- Resources
- 30.
- Evidence-based resources regarding herbal supplements and natural products are readily available to me at work.
- a.
- Yes/No/Unknown
- 31.
- What resources do you utilize for information about herbal supplements and natural products (Text box)?
- 32.
- What resources do you recommend to patients for information about herbal supplements and natural products (Text box)?
- 33.
- Is there a specific brand of natural products you tend to recommend to your patients?
- a.
- Yes (Text box for what brand)/No
- 34.
- I know where I can find reliable information about herbal medicines.
- a.
- Strongly disagree/Disagree/Somewhat agree/Strongly agree
- Herbal Quiz
- 35.
- Herbal products are regulated by the FDA under the federal food, drug, and cosmetic act.
- 36.
- Safety and efficacy of herbal products must be proven before they are marketed.
- 37.
- St. John’s wort is commonly used for mild–moderate depression.
- 38.
- Echinacea is a safe treatment for patients with autoimmune disease.
- 39.
- Garlic can increase risk of bleeding.
- 40.
- Ginkgo biloba is commonly used for dementia.
- 41.
- Ginseng is commonly used for the treatment/prevention of the common cold.
- 42.
- Saw palmetto is contraindicated in men with BPH.
- 43.
- Chamomile is safe for diabetic patients.
- 34.
- Ginger is contraindicated in pregnancy.
- Wrap Up
- 45.
- Comment section for feedback (Text box):
Appendix B
- Pharmacy Student Survey Questions
- Demographics
- 1.
- Please indicate your age.
- a.
- Younger than 20/21–25/26–30/31–35/>36
- 2.
- Please indicate your gender.
- a.
- Male/Female/Other
- 3.
- Please indicate your year in school.
- a.
- Professional Year 1 (PY1)/Professional Year 2 (PY2)/Professional Year 3 (PY3)/Professional Year 4 (PY4)
- 4.
- My primary practice setting is best described as:
- a.
- Chain pharmacy
- b.
- Independent pharmacy
- c.
- Hospital pharmacy
- d.
- Long term care pharmacy
- e.
- Research
- f.
- I don’t currently have a pharmacy job
- g.
- Other (Text box)
- 5.
- I have personally used herbal supplements and/or natural products.
- a.
- Yes (Text box for which ones)/No
- 6.
- I have personally utilized mind and body practices.
- a.
- Yes (Text box for which ones)/No
- 7.
- Patients have asked me about all the following herbal supplements and natural products:If ‘Yes’ is selected, participants are then prompted about how often (Daily; weekly; monthly; or yearly)
- a.
- Echinacea/Turmeric/Elderberry/Ginger/Garlic/Fenugreek/Saw palmetto/Flax seed/flax oil/Aloe vera/Wheat grass/barley grass/Valerian/Milk thistle/Ginkgo/Ginseng/Beet root/Ashwagandha/Apple cider vinegar/CBD/Vitamin D/Zinc/Omega 3/Mushrooms
- b.
- Other (Text box for what else is asked about)
- Attitudes Towards Herbal Supplements and Natural Products
- 8.
- In general, I consider the use of vitamins and minerals safe.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 9.
- In general, I consider the use of herbal supplements and natural products safe.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 10.
- I believe there is a benefit for utilizing herbal supplements and natural products to prevent disease.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 11.
- I believe there is a benefit in using herbal supplements and natural products to treat symptoms of some diseases.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 12.
- I believe there is a benefit in using herbal supplements and natural products to cure disease.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- Education
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 13.
- I consider my professors knowledgeable about herbal supplements and natural products.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 14.
- I think it is important to be knowledgeable about herbal supplements and natural products as a future pharmacist.
- a.
- Strongly agree/Agree/Disagree/Strongly disagree
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 15.
- My professors have a generally ___________ feeling towards herbal supplements and natural products.
- a.
- Positive/Negative/Neutral
- b.
- Choose not to answer (Text box: please explain why you chose not to answer)
- 16.
- I would like to learn more about natural product therapies.
- a.
- Yes/No
- 17.
- How would you prefer to learn more about natural products?
- a.
- Required course/Elective course
- Resources
- 18.
- Do you have access to an evidence-based herbal resource through school?
- a.
- Yes/No/Unknown
- 19.
- What resources do you utilize (Text box)?
- Herbal Quiz
- 20.
- Herbal products are regulated by the FDA under the federal food, drug, and cosmetic act.
- 21.
- Safety and efficacy of herbal products must be proven before they are marketed.
- 22.
- St. John’s wort is commonly used for mild–moderate depression.
- 23.
- Echinacea is a safe treatment for patients with autoimmune disease.
- 24.
- Garlic can increase risk of bleeding.
- 25.
- Ginkgo biloba is commonly used for dementia.
- 26.
- Ginseng is commonly used for the treatment/prevention of the common cold.
- 27.
- Saw palmetto is contraindicated in men with BPH.
- 28.
- Chamomile is safe for diabetic patients.
- 29.
- Ginger is contraindicated in pregnancy.
- Wrap Up
- 30.
- Comment section for feedback (Text box):
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Variable, n (%) | Pharmacists (n = 73) | Pharmacy Students (n = 92) |
---|---|---|
Gender | ||
Male | 23 (32.4) | 18 (19.6) |
Female | 50 (70.4) | 74 (80.4) |
Other | 0 (0.0) | 0 (0.0) |
Primary practice setting * | ||
Hospital | 27 (38.0) | 19 (20.7) |
Chain | 11 (15.5) | 42 (45.7) |
Ambulatory care | 10 (14.1) | - |
Independent | 8 (11.3) | 14 (15.2) |
Academia | 5 (7.0) | - |
Long-term care | 5 (7.0) | 3 (3.3) |
Managed care | 4 (5.6) | - |
Specialty | 3 (4.2) | - |
Government | 1 (1.4) | - |
Other | 5 (7.0) | 9 (9.8) |
Personal use of herbal supplements/natural products | 42 (59.2) | 46 (50.0) |
Personal use of mind/body practices | 44 (62.0) | 40 (43.5) |
Year in school | ||
PY1 | - | 20 (21.7) |
PY2 | - | 19 (20.7) |
PY3 | - | 21 (22.8) |
PY4 | - | 32 (34.8) |
Perception Statements | Pharmacists | Pharmacy Students | ||||||
---|---|---|---|---|---|---|---|---|
n | Median (IQR) * | Strongly Agree/Agree (%) | Strongly Disagree/Disagree (%) | n | Median (IQR) * | Strongly Agree/Agree (%) | Strongly Disagree/Disagree (%) | |
In general, I consider the use of vitamins and minerals safe. | 73 | 3 (3-3) | 90.4 | 9.6 | 92 | 3 (3-3) | 98.9 | 1.1 |
In general, I consider the use of herbal supplements and natural products safe. | 70 | 3 (2-3) | 60.0 | 40.0 | 92 | 3 (3-3) a | 79.3 | 20.7 |
I believe there is a benefit for utilizing herbal supplements and natural products to prevent disease. | 71 | 3 (2-3) ac | 71.8 | 28.2 | 91 | 3 (2-3) a | 73.6 | 26.4 |
I believe there is a benefit in using herbal supplements and natural products to treat symptoms of some diseases. | 72 | 3 (3-3) ac | 80.6 | 19.4 | 90 | 3 (3-3) a | 83.3 | 16.7 |
I believe there is a benefit in using herbal supplements and natural products to cure diseases. | 67 | 2 (1-2) b | 22.4 | 77.6 | 89 | 2 (2-3) a | 48.3 | 51.7 |
As a pharmacist, it is important to be knowledgeable about herbal supplements and natural products. | 73 | 4 (3-4) | 98.6 | 1.4 | - | - | - | - |
I am confident in my ability to counsel patients on herb–drug interactions. | 71 | 3 (2-3) | 54.9 | 45.1 | - | - | - | - |
I am confident in my ability to counsel patients on herbal side effects. | 71 | 2 (2-3) a | 46.5 | 53.5 | - | - | - | - |
I need to gain additional knowledge to properly counsel patients on herbal supplements and natural products. | 72 | 3 (3-4) | 84.7 | 15.3 | - | - | - | - |
I am confident in my ability to recommend or discourage use of herbal supplements and natural products based on patient-specific factors. | 71 | 3 (2-3) | 60.6 | 39.4 | - | - | - | - |
I believe it is important to consult a health care provider (MD, PharmD, etc.) before utilizing herbal supplements or natural products. | 72 | 3 (3-4) | 91.7 | 8.3 | - | - | - | - |
I consider myself knowledgeable about herbal supplements and natural products. | - | - | - | - | 92 | 2 (2-3) a | 28.3 | 71.7 |
I consider my professors knowledgeable about herbal supplements and natural products. | - | - | - | - | 88 | 3 (2.75-3) | 75.0 | 25.0 |
I think it is important to be knowledgeable about herbal supplements and natural products as a future pharmacist. | - | - | - | - | 92 | 4 (3-4) | 96.7 | 3.3 |
Herbal Supplement/Natural Product | Pharmacists (%) | Pharmacy Students (%) | ||||
---|---|---|---|---|---|---|
Daily/Weekly | Monthly/Yearly | Never | Daily/Weekly | Monthly/Yearly | Never | |
Echinacea | 2.8 | 45.1 | 52.1 | 1.1 | 18.5 | 80.4 |
Turmeric | 9.9 | 59.2 | 31.0 | 3.3 | 38.0 | 58.7 |
Elderberry | 11.3 | 42.3 | 46.5 | 5.4 | 41.3 | 53.3 |
Ginger | 2.8 | 46.5 | 50.7 | 6.5 | 47.8 | 45.7 |
Garlic | 2.8 | 52.1 | 45.1 | 6.5 | 37.0 | 56.5 |
Fenugreek | 0.0 | 23.9 | 76.1 | 1.1 | 6.6 | 92.3 |
Saw palmetto | 0.0 | 50.7 | 49.3 | 3.3 | 26.4 | 70.3 |
Flax seed/oil | 2.8 | 40.8 | 56.3 | 1.1 | 25.0 | 73.9 |
Aloe vera | 1.4 | 42.3 | 56.3 | 9.8 | 46.7 | 43.5 |
Wheat/barley grass | 0.0 | 21.1 | 78.9 | 1.1 | 9.8 | 89.1 |
Valerian | 0.0 | 36.6 | 63.4 | 2.2 | 13.0 | 84.8 |
Milk thistle | 0.0 | 43.7 | 56.3 | 2.2 | 20.7 | 77.2 |
Ginkgo | 1.4 | 59.2 | 39.4 | 2.2 | 17.4 | 80.4 |
Ginseng | 1.4 | 52.1 | 46.5 | 2.2 | 18.5 | 79.3 |
Beet root | 0.0 | 19.7 | 80.3 | 1.1 | 7.6 | 91.3 |
Ashwagandha | 7.0 | 25.4 | 67.6 | 3.3 | 14.1 | 82.6 |
Apple cider vinegar | 9.9 | 43.7 | 46.5 | 7.6 | 45.7 | 46.7 |
CBD | 35.2 | 46.5 | 18.3 | 29.7 | 45.1 | 25.3 |
Vitamin D | 50.7 | 36.6 | 12.7 | 58.7 | 19.6 | 21.7 |
Zinc | 32.9 | 51.4 | 15.7 | 47.8 | 22.8 | 29.3 |
Omega-3 | 36.6 | 43.7 | 19.7 | 38.0 | 25.0 | 37.0 |
Mushrooms | 1.4 | 17.1 | 81.4 | 2.2 | 3.3 | 94.6 |
Pharmacists (%) | Pharmacy Students (%) | |||||
---|---|---|---|---|---|---|
True | False | Unsure | True | False | Unsure | |
Herbal products are regulated by the FDA under the federal Food, Drug, and Cosmetic act. | 8.5 | 87.3 * | 4.2 | 5.4 | 90.2 * | 4.4 |
Safety and efficacy of herbal products must be proven before they are marketed. | 5.6 | 91.6 * | 2.8 | 6.5 | 84.8 * | 8.7 |
St. John’s wort is commonly used for mild–moderate depression. | 84.5 * | 8.5 | 7.0 | 66.3 * | 8.7 | 25 |
Echinacea is a safe treatment for patients with autoimmune disease. | 7.0 | 38.0 * | 54.9 | 9.8 | 16.3 * | 73.9 |
Garlic can increase risk of bleeding. | 78.9 * | 2.8 | 18.3 | 65.2 * | 4.4 | 30.4 |
Ginkgo biloba is commonly used for dementia. | 60.6 * | 9.9 | 29.6 | 38.0 * | 5.4 | 56.5 |
Ginseng is commonly used for the treatment/prevention of the common cold. | 33.8 | 22.5 * | 43.7 | 34.8 | 9.8 * | 55.4 |
Saw palmetto is contraindicated in men with BPH. | 25.4 | 47.9 * | 26.8 | 30.4 | 14.1 * | 55.4 |
Chamomile is safe for diabetic patients. | 21.1 * | 4.2 | 74.7 | 21.7 * | 8.7 | 69.6 |
Ginger is contraindicated in pregnancy. | 5.6 | 43.7 * | 50.7 | 12 | 28.3 * | 59.8 |
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Stayduhar, J.M.; Covvey, J.R.; Schreiber, J.B.; Witt-Enderby, P.A. Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products. Pharmacy 2023, 11, 96. https://doi.org/10.3390/pharmacy11030096
Stayduhar JM, Covvey JR, Schreiber JB, Witt-Enderby PA. Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products. Pharmacy. 2023; 11(3):96. https://doi.org/10.3390/pharmacy11030096
Chicago/Turabian StyleStayduhar, Jacey M., Jordan R. Covvey, James B. Schreiber, and Paula A. Witt-Enderby. 2023. "Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products" Pharmacy 11, no. 3: 96. https://doi.org/10.3390/pharmacy11030096
APA StyleStayduhar, J. M., Covvey, J. R., Schreiber, J. B., & Witt-Enderby, P. A. (2023). Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products. Pharmacy, 11(3), 96. https://doi.org/10.3390/pharmacy11030096