Knowledge, Attitude and Practice of Herbal Medicine among women with a view to prepare an information booklet in Hail Region, Saudi Arabia
Dr. V. Indra1, Reem Auwad Al-Shammari2, Amgaad Ayed Alharbi2, Sheham2, Nouf Alenzi3
1Principal Investigator Cum Assistant Professor, University of Hail, Kingdom of Saudi Arabia
2Co-Investigator Cum Clinical Instructor, University of Hail, Kingdom of Saudi Arabia
3Co-Investigator Cum Lecturer, University of Hail, Kingdom of Saudi Arabia
*Corresponding Author E-mail: indra.selvam1@gmail.com
ABSTRACT:
Herbal medicine is commonly used in Saudi Arabia among women compared to conventional drugs. Herbal medicine is used as the primary source of healthcare for approximately 75-80% of the world population and its use is particularly widespread in the developing countries, where it is considered more culturally acceptable, less dangerous and a more natural form of medicine that is compatible with the human body. This study was designed to evaluate the KAP level of herbal medicine usage among women in Hail, Saudi Arabia. A self-administered questionnaire was used to capture the data from 132 participants based on convenience sampling method. The data from each of the questionnaire were coded and entered into SPSS software which was used for data analysis. After the study, information booklet was prepared and distributed to the participants to improve their knowledge on usage of common herbal medicine which influences the correct usage of herbal medicine in day-to-day life.
KEY WORDS: Herbal medicine usage, information booklet, healthcare.
INTRODUCTION:
Herbal medicines are commonly used in Saudi Arabia among women alongside conventional drug therapy. However, special attention must be paid when using such medicines and supplements with other drugs. Herbal medicine is used as the primary source of healthcare for approximately 75-80% of the world population and its use is particularly widespread in the developing countries, where it is considered more culturally acceptable, less dangerous and a more natural form of medicine that is compatible with the human body.
Herbal medicine is defined as “herbal preparations produced by subjecting herbal materials to extraction, fractionation, purification concentration, or other physical or biological processes.
They may be produced for immediate consumption or as the basis for herbal products. Herbal medicine may contain excipients or inert ingredients, in addition to the active ingredients they are generally produced in larger quantities for the purpose of retail sales” [1]. However, there is no specific definition or classification for herbal medicines. This is not surprising given their diversity as herbal medicines are chemically rich preparations of, essentially, any plant material. Complementary medicine’ can be utilized to identify a range of pharmaceutical-type preparations, inclusive HMs, homoeopathic remedies, essential oils and dietary supplements [2]. This statement was corroborated by Samojlik et al. [3], who additionally found that HMs are used in the modern day for health maintenance, the treatment or prevention of minor ailments and some chronic diseases among women, and they are often taken in addition to conventional medicine in the more serious and/or chronic conditions. However, complementary medicine, including herbal remedies among women, is certainly not a modern day phenomenon and has historically been used in the pharmacological treatment of disease [4], when it may have more commonly been known as traditional folk healing.
Much of the women in developing countries still relies on traditional medicine practitioners and their collection of medicinal plants to meet all manner of healthcare needs. In developed countries modern medicine may exist alongside more traditional practices, with HM maintaining its popularity for historical and cultural reasons among women. Interestingly, the last few years have seen a substantial increase in the use of HMs in the developed world. In this regard, Cavaliere et al. [5] found that, in the USA alone, 4.8 billion dollars was spent on various HMs and dietary supplements by women. However, in the USA most herbal medicine are marketed as dietary supplements and are thus not regulated in the same way as drugs since supplements do not require pre-approval on the basis of, for example, efficacy. The out of pocket expenditure associated with the use of herbal medicines was estimated to amount to £31 million in the United Kingdom [6] and £1 billion in Germany [7] among women.
Another important issue arises when the terminology, regulatory status and categorization of herbal medicine is considered. More specifically, in the USA herbs can be defined as drugs, foods or dietary supplements. The Dietary Supplement Health and Education Act of 1994 (DSHEA) defined a dietary supplement as a substance intended to supplement the diet that is not represented by a conventional food group. Herbs and other botanicals and their extracts or concentrates were specifically mentioned as being dietary supplements.
Samojlik et al. [3] found that, in almost all European Union (EU) member states, HMs are considered medicinal medicine and include plants, parts of plants and plant preparations. In the majority of cases the HMs are presented with therapeutic or medical claims. Furthermore, in some cases, the same herb may be simultaneously available as a drug, herbal product and food supplement, making the regulation of herbal medicine somewhat complex. Potentially hazardous plants are controlled and are designated as prescription only medicines (POMs) and others are subject to dose and route of administration restrictions; however, the duration of treatment with these herbs is not controlled. Other herbs can be obtained only from a pharmacy under the supervision of a pharmacist [8].
Cooperman et al. [9] have previously concluded that the safety, quality, and efficacy of HMs and herbal dietary supplements (HDS) (i.e., herbal medicines with added vitamins or minerals) are a result of their active ingredients, but these medicine can contain other active ingredients that have unexpected consequences among women. Furthermore, Bozin et al. [10] found that the chemical composition of medicinal herbs, and the derived HMs and HDS, count on several biological factors (e.g., the part of the plant used, the stage of growth at the point of harvest and the growth conditions) among women. Accordingly, Samojlik et al. [3] proposed that all herbal medicine must be described as complex pharmaceutical products. Moreover, Williamson et al. [11] showed that, worldwide, around 80% of HM consumers rely on the advice of friends regarding the use of such remedies and only 25% consulted their physician prior to the administration of HMs to their children and women.
In Saudi Arabia the registration of medicinal medicine with the Ministry of Health is obligatory, as is the registration of medicine that makes medicinal claims or contains active ingredients that may exhibit medicinal effects, such as herbal preparations, health and food supplements, medicated cosmetics, antiseptics, and medical devices [12]. The use of herbal remedies is very common in Saudi Arabia is no exception to it. Anecdotally, it is thought that herbal medicine is popular as a result of a widespread belief that the preparations are natural and therefore safe [13]. Traditional medicine in Saudi Arabia is based on herbal remedies and spiritual healing and is widely used across the country, both as a commodity and as part of homemade remedies among women.
In 1940 the use of allopathic medicine in large Saudi Arabian cities began. Since then, health authorities have invested heavily in developing sophisticated hospitals. Based on the Legal Status of Traditional and Complementary/Alternative Medicine worldwide review [14], women of Saudi Arabia today enjoys excellent health facilities. Although there was some governmental resistance to the use of complementary/alternative medicine (CAM) up until the 1990s, the demand for access to traditional healthcare allowed for some professionals who had trained abroad to begin practice in Saudi Arabia. The most commonly requested therapies are acupuncture, homeopathy and nutritional products. In fact, in Saudi Arabia herbal remedy is freely available to all residents through herbal remedy shops or from retail outlets [15]. The only outlet that is under the ministry of health (MOH) control is pharmacies. Though substantial proportions of herbal medicines are registered with the MOH, a large number of unregistered herbal medicine care also dispensed from a wide range of outlets, other than pharmacies.
Assessed therapeutic usage and herbal remedies among women in Taif city [16]. This study revealed that a reasonable proportion of the respondents used herbs to treat women. Over half of that responded (58.0%) had used herbs for treatment in the four months prior to completing the questionnaire and 70.3% had used herbs for treatment at some point in the past. In another study done by Jazieh et al.[15], which was conducted in the oncology department at King Abdulaziz Medical City for women, Riyadh, it was found that 90.5% (n=453) of adult women used some form of CAM as part of their cancer treatment.
This study also found that 386 patients (85.2%) used dietary supplements, including: Zamzam water (59.8%), honey (54.3%), black seed (35.1%) and water over which the Quran had been recited (29.8%), as well as other remedies. Only 18% of the respondents discussed CAM use with their physician prior to use, compared to 68% who discussed it with religious clergy leaders (Sheikhs). Another notable practice in Saudi Arabia among women is the increased prevalence of self-medication, along with a concomitant use of herbal and conventional medicines [17]. This is an area of great concern due to its potential for drug–herb interactions [18].
PROBLEM JUSTIFICATION:
Despite the fact that, several studies were done to measure public interest toward the use of herbal medicine among women [19][20], awareness of herbal remedies, the safety of herbal dietary supplements, their attitude towards combining herbals and drugs have not been adequately addressed. To our knowledge nobody investigated the knowledge, attitude and practice of Herbal Medicine among women in Hail region, Saudi Arabia, therefore, the present study attempts to investigate women’s knowledge with regards to the herbal medicine, the attitudes towards the usage of herbal medicine, and the motivation for the use of herbal medicines.
OBJECTIVE:
1. To assess the level of Knowledge of using herbal medicine among women
2. To assess the level of Attitude of using herbal medicine usage among women
3. To assess the level of Practice of herbal medicine usage among women
4. To correlate the level of knowledge with attitude and practice of using herbal medicine among women
5. To associate the level of KAP of herbal medicine usage with selected demographic variables
POPULATION, SAMPLE, AND SETTING:
This is an exploratory approach so the sampling is non-probability, non-randomized convenience sampling. Women in the age group of 20-70 of Hail region were conducted for study. Technique is convenience sampling. Women available at the time of data collection ( N = 132 )were involved in the study.
The study was conducted at community centers of Hail, Kingdom of Saudi Arabia after acquiring prior permission from the concern authority.
PROTECTION OF HUMAN SUBJECTS:
This study proposal was submitted to the Institutional Ethical Committee and clearance was received. Participation will be strictly voluntary with implied consent assumed with return of the completed questionnaires. No names will be used for data collection. There are no risks identified for being included in this study.
RESEARCH DESIGN:
An exploratory descriptive research design was used. The researchers evaluated the knowledge, attitude and practice of Herbal Medicine among women in Hail region, Saudi Arabia.
TOOLS OF DATA COLLECTION:
The researchers constructed a self-administered questionnaire after reviewing the related literature and with experts opinion. Validity and Reliability of the tool was established . It was divided in 2 parts.
First part:
Included assessment of personal data.
Second part:
1. To assess knowledge structured interview questionnaire will be used-(10)
2. To assess Attitude equal statement of positive and negative(10) in 4 point likert Scale will be utilized
3. To assess Practice- statement’s will be made for scoring (10)
Scoring system:
1. The knowledge will be scored based on the no of correct responses
2. The Attitude and Practice will be rated using a Linkert scale with 0 being low and 4 being high.
VALIDITY AND RELIABILITY:
These tools were reviewed by jury of 7 expertise’s in the field of women’s health to test its contents and face validity. Prior to data collection, Pilot study was conducted for (10) women. It was conducted to evaluate the efficiency and content validity of the tool, to find the possible obstacles and problems that might be faced during data collection. Women included in the pilot study were excluded from the sample, to avoid contamination of research sample. A data collection for this study was carried out in the period from the beginning of the second semester in the academic year 2016/2017. The researchers first explained the aim of the study to the participants and reassured that information collected would be treated confidential and that would be used only for the purpose of the research.
PROCEDURE:
Two steps were involved in the development of this study:
Step 1-Approval of Human Research Review and Ethical Committee
Step 2-Implementation of the study in community and maternity hospital
RESULTS:
The analysis of the data is organized and presented under the following sections.
Section I: Analysis of sample characteristics regarding demographic variables
Section II: Assessment of level of knowledge of using herbal medicine among women
ection III: Assessment of level of attitude of using herbal medicine among women
ection IV: Assessment of level of practice of using herbal medicine among women
Section V: Correlate the level of knowledge with attitude and practice
Section VI: Associate the Knowledge level of herbal medicine usage with selected demographic variables
Major findings of the study:
· The majority participants belonged to the age group of 20-30
· 18.18% and 10.6% under age group of 31-40 and 41-50 respectively
· 3.78% and 1.51% under age group of 51-60 and 61-70
· 50.76% of women belonged to college level
· 4.55% belonged to post graduation level
· 88.5% of women of age group 20-30 use herbal medicine
· 11.49% of women of age group don’t use herbal medicine during 20-30s
· Information about herbal medicine in age group 20-30 is recommended by family members, 3% by friends and 2% by media
Section I: Analysis of sample characteristics regarding demographic variables:
Table 1 Demographic variables – Frequency distribution
Demographic variables |
Frequency (N) |
Percentage (%) |
Age |
|
|
20-30 |
87 |
65.91 |
31-40 |
24 |
18.18 |
41-50 |
14 |
10.6 |
51-60 |
5 |
3.78 |
61-70 |
2 |
1.51 |
Education |
|
|
nil |
19 |
14.39 |
high school |
40 |
30.3 |
college level |
67 |
50.76 |
post graduation |
6 |
4.55 |
Table 2 Age Vs Herbal Medicine usage – Frequency distribution
Age |
Yes (N) |
% out of total samples |
No (N) |
% out of total samples |
20-30 |
77 |
88.5 |
10 |
11.49 |
31-40 |
22 |
91.67 |
2 |
8.33 |
41-50 |
13 |
92.85 |
1 |
7.14 |
51-60 |
5 |
100 |
0 |
0 |
61-70 |
2 |
100 |
0 |
0 |
Table 3 Age Vs Herbal Medicine information – Frequency distribution
Information herbal medicine |
||||
Age |
Family (N) |
Friends (N) |
Media (N) |
Health professional (N) |
20-30 |
82 (94.25) |
3 (3.44) |
2 (2.29) |
0 |
31-40 |
22 (91.66) |
2 (8.33) |
0 |
0 |
41-50 |
13 (92.85) |
1 (7.14) |
0 |
0 |
51-60 |
5 (100) |
0 |
0 |
0 |
61-70 |
2 (100) |
0 |
0 |
0 |
Table 4 Common Herbal Medicine Usage Response Evaluation
Herbal Medicine |
% |
Right answer |
Wrong answer |
No answer |
FENUGREEK |
Common use |
67.61 |
11.74 |
20.45 |
|
Part used |
65.34 |
17.21 |
18.32 |
Method of preparation |
62.18 |
18.89 |
20.34 |
|
Observed side effects |
61.29 |
19.67 |
19.38 |
|
COSTUS |
Common use |
24.24 |
13.44 |
62.31 |
|
Part used |
21.39 |
18.75 |
60.78 |
Method of preparation |
25.89 |
12.32 |
63.89 |
|
Observed side effects |
24.24 |
13.44 |
62.31
|
|
MOLMOL |
Common use |
62.5 |
18.56 |
18.94 |
|
Part used |
63.72 |
20.34 |
16.9 |
Method of preparation |
60.85 |
22.45 |
18.93 |
|
Observed side effects |
61.38 |
20.34 |
18.49 |
|
FOENICULUMVULGARE |
Common use |
50 |
40.01 |
10.45 |
|
Part used |
49.75 |
41.56 |
9.59 |
Method of preparation |
48.89 |
40.89 |
10.54 |
|
Observed side effects |
49.28 |
41.45 |
10.29 |
|
NIGELLA SATIVA |
Common use |
54.92 |
23.53 |
22.92 |
|
Part used |
55.23 |
23.19 |
21.94 |
Method of preparation |
54.18 |
22.63 |
22.84 |
|
Observed side effects |
53.89 |
23.09 |
23.21 |
Table 4 depicts the common use, parts used, method of preparation and observed side effects for each herbal medicine. 5 herbal medicinal plants namely fenugreek, costos, molmol, foeniculum vulgare and nigella sativa were considered for this study.
Section II: Assessment of level of knowledge of using herbal medicine among women
Table 5 Assessment of level of knowledge of Herbal Medicine Usage
Questionnaire |
Mean |
SD |
I am aware that there is harm in trying herbal products. |
4.4 |
0.942 |
I am aware that some herbal products may have side effects. |
3.56 |
0.832 |
I am aware that some herbal products may interact with other medications. |
2.69 |
0.428 |
I know that some herbal products can be dangerous especially if taken in high doses. |
2.13 |
0.278 |
I know that when using herbal products, you need to be concerned about overdosing or taking too much. |
4.88 |
0.979 |
I know that it is better to consult a healthcare provider before taking herbal products. |
4 |
0.892 |
I know that I should inform my physician of any herbal product that I am taking. |
2.75 |
0.488 |
As far as I know, the government regulates herbal remedies to make sure that they are safe. |
4.25 |
0.91 |
I understand what is meant by “NO APPROVED THERAPEUTIC CLAIM” on the labels of herbal products. |
5.5 |
1.937 |
Assessment of knowledge level on herbal medicine usage is shown in table 5. Majority (Mean = 4.88) agreed on side effects of overdose of herbal medicine usage and (Mean = 4.4) half the sample size were aware that government recommends herbal remedies as safest medicine. Agree and strongly agree were combined together to form agree, disagree and strongly disagree into disagree.
Section III: Assessment of level of attitude of using herbal medicine among women
Table 6 Assessment of level of attitude of Herbal Medicine Usage
Questionnaire |
Mean |
SD |
Generally speaking, herbal medicines are good for people’s health and well-being |
3.21 |
0.784 |
Herbal products tend to be less expensive than conventional medications |
3.38 |
0.803 |
Herbal medicines are safer than conventional medicine |
10.15 |
5.038 |
Herbal medicines are more effective than conventional medicine |
9.42 |
4.729 |
It is not dangerous to take herbal medicine with other prescription drugs |
12 |
6.971 |
Herbal products are only appropriate for treating minor conditions such as a cold or stomachache |
7.76 |
3.478 |
Herbal products should not be used to treat serious health conditions such as heart diseases and cancer |
3.38 |
0.803 |
There is a lot of misinformation about herbal products circulating |
3.06 |
0.573 |
Health claims on the labels of many herbal products are exaggerated or unproven |
2.93 |
0.524 |
Assessment of attitude level on herbal medicine usage is shown in table 6. Majority (Mean = 10.15) agreed on positive attitude as herbal medicine is safe compared to conventional medicine. Only few women (Mean = 3.06) were aware on negative attitude regarding information of herbal medicine usage.
Section IV: Assessment of level of practice of using herbal medicine among women
Table 7 Assessment of level of practice of Herbal Medicine Usage
Questionnaire |
Mean |
SD |
I personally used herbal products as medicine |
1.91 |
0.203 |
I have given any herbal product to my child/children |
2.81 |
0.493 |
I have recommended the use of herbal medicine to anyone |
2.69 |
0.474 |
I believed that the herbal medicines are effective |
2.53 |
0.458 |
I observed any types of side effect after I used the herbal medicines |
13.2 |
6.892 |
I preferred herbal medicines than conventional Western medicine |
6 |
2.047 |
I discussed my herbal medicines to my doctor |
10.15 |
5.038 |
I wish to know more about these herbal products |
1.76 |
0.178 |
I personally used herbal products as medicine |
1.91 |
0.203 |
Assessment of practice level on herbal medicine usage is shown in table 7. Majority (Mean = 10.15) agreed on good practice of discussing herbal medicine usage with doctors. Only few women (Mean = 1.76) were aware on good practice to know more information about herbal medicine. Only few women (Mean = 1.91) were aware on good practice of using herbal products as medicine.
Section V: Correlate the level of knowledge with attitude and practice:
Table 8 Correlation of knowledge with attitude
Level of Attitude |
|||
Knowledge Level |
Positive |
Negative |
Total |
N (%) |
N (%) |
N (%) |
|
Strongly agree |
3 (75.0) |
1 (25.0) |
4 (100.0) |
Agree |
58 (86.56) |
9 (13.43) |
67(100.0) |
Disagree |
32 (86.48) |
5 (13.51) |
37(100.0) |
Strongly disagree |
16 (66.67) |
8 (3.33) |
24(100.0) |
Total |
109 (82.57) |
23(17.42) |
132 (100.0) |
Level of knowledge of herbal medicine usage was correlated with attitude of usage. Those with good knowledge were more positive.
Table 9 Correlation of knowledge with practice
Level of Practice |
|||
Knowledge Level |
Good practice |
Nil practice |
Total |
N (%) |
N (%) |
N (%) |
|
Strongly agree |
72 (97.29) |
2 (2.7) |
74(100.0) |
Agree |
40 (93.3) |
3 (6.97) |
43(100.0) |
Disagree |
2(20) |
8(80) |
10(100.0) |
Strongly disagree |
2 (40) |
3 (60) |
5(100.0) |
Total |
116(87.87) |
16(12.12) |
132 (100.0) |
Level of knowledge of herbal medicine usage was correlated with practice. Those with good knowledge on herbal medicine involved good practice of herbal medicine.
Table 10 Correlation of attitude with practice
|
Level of practice |
||
Attitude Level |
Good practice |
Nil practice |
Total |
N (%) |
N (%) |
N (%) |
|
Positive |
104(92.04) |
9(7.96) |
113(100.0) |
Negative |
8(42.10) |
11(57.89) |
19(100.0) |
Total |
112(84.84) |
20(15.15) |
132 (100.0) |
Level of attitude of herbal medicine usage was correlated with practice of usage. Those with positive attitude level depicted good practice.
Section VI: Associate the Knowledge level of herbal medicine usage with selected demographic variables
Table 11 Association of knowledge level about herbal medicine usage with selected demographic variables
Demographic variables |
Chi 2 |
df |
P=value |
Age |
0.470 |
2 |
0.8955 |
Occupation |
2.032 |
2 |
0.6588 |
Educational status |
1.938 |
2 |
0.3821 |
Source of information |
2.121 |
1 |
2.1242 |
Table 11 discloses the association of knowledge of herbal medicine usage among women with selected demographic variables like age, occupation, educational status and sources of information. The association is statistically tested by chi-square. It indicated that chi square value computed between the knowledge scores and age of participants (c2 = 0.470), occupation of participants (c2 = 2.032), educational status of participants (c2 = 1.938) and sources of information (c2 = 2.121) was found statistically no significant at 0.05 level of significance.
CONCLUSION:
This study aims to evaluate the knowledge, attitude and practice of herbal medicine among women in Hail, Saudi Arabia. An exploratory descriptive design was utilized in this study. Correct information of using common herbal medicine was given to the respondents in the form of booklet by which they will be benefited. After the study, information booklet was distributed to the participants to improve their knowledge on usage of common herbal medicine which influences the correct usage of herbal medicine in day-to-day life.
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Received on 14.05.2017 Modified on 22.06.2017
Accepted on 20.07.2017 © A&V Publications all right reserved
Int. J. Adv. Nur. Management. 2017; 5(4): 299-304.
DOI: 10.5958/2454-2652.2017.00064.6