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Table 2 General Characteristics of Eligible Studies

From: Barriers, knowledge, and training related to pharmacists’ counselling on dietary and herbal supplements: a systematic review of qualitative studies

Title

Author and Year Published

Country/Countries of Participants

Term(s) Used to Describe Dietary and Herbal Supplements (DHS)

1. Regulatory Status of the DHSs Included in the Study

2. If Applicable, How are the DHSs Included in the Study Regulated?

Types of DHS Included in Study

Methodologies Used

Theoretical Underpinning

Types of Pharmacists Included in Study

Number of Participants

Outcomes of Study

Themes Discussed

Community pharmacists’ professional practices for complementary medicines: a qualitative study in New Zealand

Barnes and Butler. 2020 [30]

New Zealand

Complementary Medicines (CMs)

1. Yes, but limited

2. Medicines Act regulations, Dietary Supplement Regulations, proposed Therapeutic Products Act (which will replace the current Medicines Act in New Zealand)

Herbals, homoeopathics, vitamins, minerals, traditional medicine, and “natural” or plant-based products

Semi-structured interviews

Not reported

Community

27 participants:  all pharmacists

Pharmacists’ views on CMs in New Zealand, motivations and justifications for selling CMs, and professional and ethical issues CMs raise

1. Description of CMs

2. Pharmacists’ personal perspectives

3. Motivations for stocking and selling CMs

4. Community pharmacists’ advisory role for CMs

5. Knowledge, training and information sources on CMs

6. Professional and ethical issues

7. Role of pharmacy organizations

Integrating traditional Chinese medicines into professional community pharmacy practice in China-Key stakeholder perspectives

Yao et al. 2020 [31]

China

Traditional Chinese Medicine (TCM) and Herbal Medicines (HM)

1. Yes, but limited

2. Not reported

Not reported

Semi-structured interviews

Grounded Theory

Community and clinical

14 participants: 7 pharmacists, 1 regulatory authority representative, 2 pharmacy school representatives, 1 professional organization representative, 2 chain pharmacy representatives and 1 key opinion leader

Perceptions of key stakeholders about the enablers and challenges to pharmacists’ adopting a role in patient care associated with the concurrent use of HMs

1. Purposes of HMs use by the public

2. Perception about integrative medicine

3. Perception about the safety of HMs

4. Perception about pharmacists’ role in HMs

5. Major barriers hindering pharmacists taking up a more professional role related to HMs

6. Actions needed to support pharmacists taking up a more professional role related to HMs

Advancing the pharmacist’s role in promoting the appropriate and safe use of dietary supplements

Harnett et al. 2019 [32]

United States

Dietary Supplements (DS) and Natural Products (NP)

1. Yes

2. Regulated by the FDA and FTC

Herbal products, nutritional and vitamin and mineral supplements, homoeopathic preparations

Semi-structured interviews

Grounded Theory

Practicing pharmacists in various settings (including retail and health systems) and pharmacist officers/leaders in various professional and regulatory organizations

22 participants: 12 pharmacists and 10 key stakeholders

Key stakeholder and pharmacist perceptions about the actions needed to enable pharmacists to fulfill a professional role related to DS use

1. Education and training

2. Strategies for ensuring high standards related to regulation of DS safety and quality assurance

3. Workplace resources

4. DS research

Barriers to pharmacists adopting professional responsibilities that support the appropriate and safe use of dietary supplements in the United States: Perspectives of key stakeholders

Ung et al. 2019 [33]

United States

Dietary supplements (DS)

1. Yes, but limited

2. FDA

Vitamins, minerals, herbals, nutritional supplements including probiotics and fish oils

Semi-structured key informant telephone interviews

Grounded theory

Community

22 participants: 12 pharmacists and 10 stakeholders

Pharmacists’ and key stakeholders’ perceptions and opinions about accepting roles that ensure the appropriate and safe use of DS

1. Awareness of DS use and knowledge of potential benefits and harms 2. Perceived responsibility of pharmacists in caring for patients regarding DS use 3. Incorporation of DS use into pharmacists’ current practice 4. Participants’ responses to proposed responsibilities related to DS

Informing the homeopathic practice for Turkish pharmacists: reviewing the example of Portuguese community pharmacies

Cavaco et al. 2017 [34]

Turkey

Homeopathy

1. Yes

2. Turkish Pharmacy Law and Turkish Traditional and Complementary Medicine Act

Homeopathic remedies

Semi- structured interviews and an initial documentary analysis

Not reported

Community

6 participants:  all pharmacists

Portuguese pharmacists’ attitudes (knowledge, feelings, and behaviour) towards pharmacy-based homeopathy

1. General homeopathic practice

2. Emerging feelings

3.Healthcare market opportunity

4.Homeopathic education

5. Regulatory framework

6. Patients’ support

Development of a strategic model for integrating complementary medicines into professional pharmacy practice

Ung et al. 2017 [35]

Australia

Traditional Medicine (TM) and Complementary Medicine (CM)

1. Yes, but limited

2. Therapeutic Goods Administration (TGA)

Herbal medicine, dietary supplement, health supplement, vitamins, minerals, and natural products

Focus group interviews (FGIs)

Not reported

Community

11 participants: all pharmacists

Pharmacists’ perspective on how barriers to the integration of TM/CM products into pharmacy practice could be resolved.

1.Dilemmas that pharmacists had to face during their day-to-day practice

Four major next steps:

1. Education and training2. Build CM evidence base3. CM information resources4.Workplace support for best CM practice

Key stakeholder perspectives on the barriers and solutions to pharmacy practice towards complementary medicines: an Australian experience

Ung et al. 2017 [36]

Australia

Traditional Medicine (TM) and Complementary Medicine (CM)

1. Yes

2. Therapeutic Goods Administration (TGA)

Dietary supplements, herbal medicines, health supplements, vitamins, minerals and natural products, traditional medicine

Semi-structured interviews

Not reported

Community

11 participants: 2 pharmacists, 1 pharmacy owner, and 8 key stakeholders

Pharmacists and key stakeholder leaders’ perceptions and opinions regarding the barriers that hinder pharmacists from providing care related to the use of CMs and solutions that would support pharmacists’ in extending their role in this area.

9 barriers hindering pharmacists’ duty of care regarding CMs:

1. Insufficient knowledge about CMs

2. Pharmacists’ attitude towards CMs

3. Lack of research skills

4. Lack of evidence for efficacy and safety of CM

5. Lack of access to trustworthy information and support

6. Lack of time

7. Consumers’ attitudes

8. Lack of a defined role for pharmacists

9. Poor inter-professional communication with doctors

7 solutions to support pharmacists’ extended role in CMs:

1. The integration of CMs into pharmacists’ undergraduate and professional education development

2. A clear definition of the pharmacists’ role in CMs

3. Pharmacies employing a naturopath

4. The establishment of reliable, easily accessed information

5. Promoting quality CMs research

6. Collaboration among health care professionals

7. The provision of consumer education

Assessing the Awareness and Knowledge on the Use of Probiotics by Healthcare Professionals in Nigeria

Amarauche 2016 [37]

Nigeria

Probiotics

1. Yes

2. National Agency for Food and Drug Administration and Control (NAFDAC).

Not reported

Semi-structured questionnaires

Not reported

Community

221 participants: physicians, pharmacists, dentists, and nurses *Did not specify how many of each.

The knowledge and awareness of healthcare professionals in Nigeria on probiotics

Not reported

Perceptions of traditional, complementary and alternative medicine among conventional healthcare practitioners in Accra, Ghana: Implications for integrative healthcare

Kretchy et al. 2016 [38]

Ghana

Traditional complementary and alternative medicine (TM-CAM) products

1. Yes, but limited

2. Traditional and Alternate Medicines Directorate (TAMD)

Not reported

Semi-structured interviews

Not reported

Hospital

23 participants: 5 physicians, 8 pharmacists, 5 nurses and 5 dieticians

Perceptions of conventional healthcare

professionals on integrative medicine

1. Knowledge gap

2. The paradox of TM/CAM

3. Experience of use and prescription

4. Guided integration

Pharmacists’ knowledge and attitudes about natural health products: a mixed-methods study

Kheir et al. 2014 [39]

Qatar

Natural health products (NHP) & Complementary and alternative medicine (CAM)

1. Yes, but limited

2. Not reported

Herbal products (Echinacea, Saw palmetto, St John’s wort, Valerian, Cranberry Extract, Black cohosh, Ginseng, Ginger, Ginkgo biloba, Garlic), Vitamin supplements, Traditional Chinese medicine, Homeopathic products

Mixed methods: Questionnaire and focus-group (FG) discussions

Not reported

Community and hospital

110 participants: 110 pharmacists (92 pharmacists from quantitative component and 18 from qualitative component)

Attitude and knowledge of pharmacists in Qatar towards natural health

products

1. NHP Knowledge

2. Perception of CAM

3. Reference Sources

4. Challenges and Barriers

5. NHP Regulations

Community pharmacists’ attitudes relating to patients’ use of health products in Japan

Asahina et al. 2012 [40]

Japan

Health products

1. Not reported

2. N/A

Not reported

Focus group interviews (FGIs)

Not reported

Community

16 participants: pharmacists

Japanese pharmacists’ attitudes relating to patients’ use of health products

1. Pharmacists’ ideas on health products

2. Perceived barriers to communication with patients about health products

3. Perceived facilitators to communication with patients about health products

4. Need for support in information provision and monitoring of patients

Understanding pharmacists’ experiences with advice-giving in the community pharmacy setting: a focus group study

Simmons-Yon et al. 2012 [41]

United States

Complementary and Alternative Medicines (CAM)

1. No

2. N/A

Not reported

Focus group interviews (FGIs)

Not reported

Community

31 participants: 10 community pharmacists and 21 advanced doctor of pharmacy students

The experiences of community pharmacists providing advice about symptoms and CAM

1. Pharmacists as advisors

2. Pharmacists as medical liaisons 3. CAM-related advice

4. Educational needs

Assessment of herbal weight loss supplement counseling provided to patients by pharmacists and nonpharmacists in community settings

Jordan et al. 2011 [42]

United States

Herbal dietary supplements

1. Not reported

2.N/A

Apple Cider Vinegar Diet, Chitosan, CitraMax, CLA (conjugated linoleic acid), CLA Extreme,CLA-1300, Ephedra, Ezee Slimming Patch, Fücothin, Green tea/green tea extract (various brands), Less Stress Weight Control, Hoodia (various brands),Hydroxycut; Hydroxycut Hardcore, Mega-T Green Tea, Metabolife, Metabolift, Optim-3 CLAS Supreme,Sea Thin, Slender Formula,SlenderWeigh, Slim 7, Thermonex, Thermo Slim Tea, Trim Spa, Ultimate Fat Metabolizer, Ultra Plan Metabolic Supreme Herbal

Interviews

Not reported

Community

52 participants: 27 pharmacists and 25 nonpharmacists (cashiers, sales clerks, pharmacy technicians)

The amount of appropriate counselling provided to patients by nonpharmacists and pharmacists in retail settings regarding herbal dietary supplements for weight loss

1. Herbal supplements and lactation/pregnancy

2. Supplement-drug interactions 3. Effects of herbal dietary supplements for weight loss

4. Safety of herbal dietary supplements for weight loss

5. Recommended herbal product

6. Potential adverse effects of herbal supplements for weight loss

7. Potential allergens in herbal supplements for weight loss

Reporting natural health product related adverse drug reactions: is it the pharmacist’s responsibility?

Walji et al. 2011 [43]

Canada

Natural health products (NHPs)

1. Yes

2. Canadian regulations state requirements for the manufacture, packaging, labelling, storage, importation, distribution, and sale of NHPs.

Herbal and homeopathic medicines, vitamins and minerals, probiotics, amino acids and essential fatty acids

Semi- structured interviews

Ethnomethodology

Community

12 participants:  all pharmacists

Pharmacists’ experiences with and responses to receiving or identifying reports of suspected ADRs associated with NHPs from pharmacy customers

1.Responsibility

2. Perception of competency 3. Workplace challenges 4. Pharmacists’ professional role

Over-the-counter advice seeking about complementary and alternative medicines (CAM) in community pharmacies and health shops: an ethnographic study

Cramer et al. 2010 [44]

United Kingdom

Complementary and alternative medicine (CAM)

1. Yes, but limited

2. Not reported

Homoeopathic products, anthroposophical remedies, flower remedies, herbs, food supplements (e.g. spirulina, Aloe vera, probiotics and enzymes) and single vitamins and minerals (e.g. vitamin C and zinc)

Semi-structured interviews and non-participant observation

Ethnography

Community

54 participants: pharmacists, owners/managers and counter assistants (n = 24) and 30 customers

Customer advice seeking about complementary and alternative medicine

1. Help with diagnosis

2. Help finding a general remedy

3. Help with a specific product

4. Free advice 5. Pastoral care

6. Just buying

Responding to patient demand: community pharmacists and herbal and nutritional products for children

Robinson et al. 2010 [45]

England

Herbal and nutritional products (HNPs) and Complementary and alternative medicine (CAM)

1. Not reported

2. N/A

Homeopathic products, herbs, vitamins, minerals, and food supplements

Semi structured interviews and diary recordings (diary sheet), questionnaires

Not reported

Community

22 participants: 5 pharmacists and 17 pharmacy staff

The attitudes and behaviour of pharmacists working in a multi-ethnic community regarding herbal and nutritional products (HNPs) for children

Not reported

An evaluation of pharmacist and health food store retailer’s knowledge regarding potential drug interactions associated with St. John’s wort

Sim et al. 2010 [46]

Canada

Natural health product (NHP)

1. Not reported

2. N/A

St. John’s wort and echinacea

Interview outline (questionnaire) and interview

Not reported

Community

30 participants: 24 pharmacists and 6 NHP retailers

Pharmacists and natural health product retailer’s knowledge on St Johns wort

Not reported

Exploratory study of factors influencing practice of pharmacists in Australia and Thailand with respect to dietary supplements and complementary medicines

Kanjanarach et al. 2006 [47]

Australia and Thailand

Dietary supplements and complementary medicines (DS/CM)

1. Yes - Australia; Minimally regulated -Thailand

2. Not reported

Not reported

Semi-structured interviews

Not reported

Community and hospital

20 participants:  all pharmacists

The opinions and practices of pharmacists in Australia and Thailand in relation to dietary supplements and complementary medicines (DS/CM)

1. How DS/CM have been used

2. Factors influencing customers’ purchasing of DS/CM

3. Efficacy, safety, and necessity of use of DS/CM

4. Attending customers buying or seeking advice 5. Evaluating the necessity and safety of use of DS/CM

6. Providing information about DS/CM

7. Assisting customers in product selection and criteria to select DS/CM products for customers

8. Criteria for selection of DS/CM products to sell in a pharmacy

9. Impact of DS/CM on pharmacy business

An investigation of pharmacists’ and health food store employees’ knowledge about and attitudes toward kava

Webb et al. 2004 [48]

Canada

Herbal medication

1. No (stated that Kava is unregulated)

2. N/A

Kava

Interviews

Not reported

Community

58 participants: 28 pharmacists and 30 health food store employees

The information provided to potential clients by pharmacists and health food retailers regarding the herbal medication kava

Not reported

  1. Abbreviations: complementary and alternative medicine (CAM); complementary medicine (CM); dietary supplements (DS); dietary supplements and complementary medicines (DS/CM); food and drug administration (FDA); focus group (FG); focus group interviews (FGIs); federal trade commission (FTC); herbal medicine (HM); herbal and nutritional products (HNPs); national agency for food and drug administration and control (NAFDAC); natural health products (NHP); natural product (NP); traditional and alternate medicines directorate (TAMD); traditional complementary and alternative medicine (TM-CAM); traditional complementary medicine (TCM); therapeutic goods administration (TGA); traditional medicine (TM)