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 |
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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 |