Exploring beliefs about dietary supplement use: focus group discussions with Dutch adults

Exploring the Dietary Supplement Use During COVID-19: Insights from Community Pharmacists, Pharmacy Staff, Academics, and Industry Experts

Introduction: The increased use of dietary supplements is a consequence of the coronavirus disease 2019 (COVID-19) pandemic. Although their efficacy has not been consistently proven, they have been perceived as a preventive tool against COVID-19. Less strict regulations and debates on their definitions in a regulatory framework raise concerns about safety issues. Apart from dietary supplement use, information demand has increased, and pharmacists have played a key role as accessible health professionals. This study aimed to reveal the opinions of community pharmacists, pharmacy staff, sector representatives, and academicians regarding the sale and use of dietary supplements during the COVID-19 pandemic. Methods: A qualitative study approach was followed, using grounded theory. Data were collected between September 2021 and July 2022, analyzed using MAXQDA 2020 software, and reported according to the Consolidated Criteria for Reporting Qualitative Research. Results: After refining the open codes, two themes emerged: dietary supplements and the effects of the pandemic. It was found that increased dietary supplement use was rooted in COVID-19 fear, promotional activities, and social media influence. The interaction between consumers and the dietary supplement industry is bidirectional. Conclusions: Pharmacies, as access points for these products, played a crucial role in struggling with the effects of the pandemic. Although dietary supplements are considered safe, their potential for adverse reactions poses a public health risk. Flexible regulations, unregulated alternative advertising channels, and a lack of awareness of the safety of these products pose a challenge to public health. In this regard, all stakeholders should work to minimize the risks from undergraduate education to professional life.

Donor knowledge and perceptions regarding donation-induced iron depletion and iron supplementation as a blood service policy

BACKGROUND AND OBJECTIVES

Regular whole blood donations are associated with an increased risk of iron deficiency. Iron supplementation is an effective strategy to prevent donation-induced iron deficiency. However, research on donor perceptions towards such a policy is limited. Therefore, we aim to evaluate donors' knowledge on donation-induced iron depletion and their perceptions regarding iron supplementation as a blood service policy.

MATERIALS AND METHODS

Three thousand Dutch whole blood donors were invited to complete a survey assessing their knowledge of donation-induced iron depletion and attitudes and perceptions towards iron supplementation as a policy. Linear regression modelling was used to evaluate associations between explanatory variables and perceptions.

RESULTS

In total, 1093 (77.1%) donors were included in the analysis. Donors had poor knowledge of current iron management policies, but a better understanding of iron metabolism and supplementation. Iron supplementation as a policy was perceived mainly positive by donors, and the majority were willing to use iron supplements if provided. Iron supplementation was not perceived as invasive or negatively affecting donors' motivation to continue donating. Additional iron monitoring, information and donor physician involvement were regarded as important conditions for implementation. Male sex, trust in the blood service, prior experience with iron supplements and openness towards dietary supplements were strongly positively associated with willingness to use iron supplementation.

CONCLUSION

Donors' knowledge regarding donation-induced iron depletion is limited, but not associated with their perceptions regarding iron supplementation. Donors do not consider iron supplementation as invasive, deterring or demotivating, and a majority are willing to take supplements if offered.

Iron supplementation: A qualitative study on the perception of blood donors, blood collection staff and donor physicians

BACKGROUND AND OBJECTIVES

Iron supplementation is an effective strategy to mitigate donation-induced iron deficiency in blood donors. However, evidence on the perception of individuals involved in blood donation on iron supplementation as a blood service policy is lacking. This study aimed to evaluate the knowledge and perception of whole blood donors (donors), blood collection staff (collection staff) and donor physicians (physicians) regarding donation-induced iron loss and iron supplementation.

MATERIALS AND METHODS

Online focus group discussions had four to six participants and followed a structured questioning approach. All participants had to be fluent in Dutch to participate, and donors had donated at least five times. Sixteen donors, eight collection staff members and four physicians participated in this study. Recordings were transcribed, coded and analysed using a grounded theory approach.

RESULTS

Awareness of donation-induced iron loss was limited in donors. Donors and physicians were predominantly positive towards iron supplementation; the primary motivator for donors was to prevent deferral and reduce iron-deficiency-related symptoms. Improving donor health was the main argument for physicians to advocate iron supplementation. Staff had a critical view on iron supplementation as a policy, as they perceived it as unethical and possibly ineffective. A knowledge gap might underlie their concerns.

CONCLUSION

Most individuals involved in blood donation are positive towards iron supplementation as a blood service policy. If implemented, guidance and monitoring is desired and adequate education of all stakeholders is required.

Perceptions of self-monitoring dietary intake according to a plate-based approach: A qualitative study

Dietary self-monitoring is a behaviour change technique used to help elicit and sustain dietary changes over time. Current dietary self-monitoring tools focus primarily on itemizing foods and counting calories, which can be complex, time-intensive, and dependent on health literacy. Further, there are no dietary self-monitoring tools that conform to the plate-based approach of the 2019 Canada Food Guide (CFG), wherein the recommended proportions of three food groups are visually represented on a plate without specifying daily servings or portion sizes. This paper explored the perceptions of end-users (i.e., general public) and Registered Dietitians of iCANPlateTM-a dietary self-monitoring mobile application resembling the CFG. Qualitative data were collected through virtual focus groups. Focus group questions were based on the Capability, Opportunity, Motivation-Behaviour (COM-B) theoretical framework to explore perceptions of using the CFG and currently available dietary self-monitoring tools. The prototype iCANPlateTM (version 0.1) was presented to gain feedback on perceived barriers and facilitators of its use. Focus group discussions were audio recorded and verbatim transcribed. Trained researchers used thematic analysis to code and analyze the transcripts independently. Seven focus groups were conducted with Registered Dietitians (n = 44) and nine focus groups with members from the general public (n = 52). During the focus groups, participants mainly discussed the capabilities and opportunities required to use the current iteration of iCANPlateTM. Participants liked the simplicity of the application and its capacity to foster self-awareness of dietary behaviours rather than weight control or calorie counting. However, concerns were raised regarding iCANPlateTM's potential to improve adherence to dietary self-monitoring due to specific characteristics (i.e., insufficient classifications, difficulty in conceptualizing proportions, and lack of inclusivity). Overall, participants liked the simplicity of iCANPlateTM and its ability to promote self-awareness of dietary intakes, primarily through visual representation of foods on a plate as opposed to reliance on numerical values or serving sizes, were benefits of using the app. Findings from this study will be used to further develop the app with the goal of increasing adherence to plate-based dietary approaches.

Herbal and Dietary Supplement Use among Adult Patients Undergoing Treatment at a Tertiary Hospital Cancer Center

The use of herbal and dietary supplement in cancer patients has been increasing over the past years, while the risk of its adverse effects and undesirable reactions with conventional treatment has also been accumulating. Limited studies involving perception of herbal and dietary supplements (HDS) by cancer patients have been conducted in our setting. An initial survey was conducted among adult cancer patients undergoing treatment at the Zamboanga City Medical Center (ZCMC) Cancer Institute. HDS users were recruited for focus group discussion (FGD) via purposive sampling. A total of four groups were conducted. Clinical and demographic data were presented through descriptive statistics while data from the FGD were subjected to coding and thematic analysis. Among 22 respondents, more than half (65.4%) of the participants were noted to have used HDS and most (54.5%) were breast cancer patients with stage-II and -III disease. Treatment of cancer, coping with chemotherapy, and relief of symptoms were the major reasons for use. Majority (36.36%) were influenced by the media/internet and most (50%) did not disclose information to their physician. Eight respondents, whose income were below minimum wage, spent more than 25% of their income on HDS, with some having spent more than 50%. This may seriously limit funds and result in failure to adhere to treatment. Among cancer patients in ZCMC, HDS use is widely practiced and half of them do not disclose this information to their physicians. The expenditure on HDS consumes 25 to 50% of the population's meager monthly income. The secrecy surrounding its use and attendant cost may possibly limit adherence and adversely affect outcomes.

Health-, medication- and dietary supplement-related behaviors and beliefs relatively unchanged during the COVID-19 pandemic lockdown

BACKGROUND

The lockdown imposed to counter the coronavirus disease 2019 (COVID-19) pandemic has evoked an unprecedented phenomenon that could affect health behaviors and beliefs.

OBJECTIVE

To examine how medication-, dietary supplement- and health-related behaviors, beliefs and other psychological constructs changed in Polish online health service users during the COVID-19 pandemic lockdown.

METHODS

A one-time online survey accessed through a health service website was completed before and during the pandemic lockdown by separate samples of respondents. The survey examined beliefs about medicines and dietary supplements, consumption of dietary supplements, trust and contact with their advertisements, sources of dietary supplement knowledge as well as perceived health, diet, physical activity and smoking, among other things.

RESULTS

The study included 1560 participants. Most examined outcomes remained unchanged over COVID-19 pandemic lockdown. Beliefs that the dietary supplement quality is well controlled became significantly more pronounced during the lockdown (adjusted ratio of estimates 1.16, 95%CI 1.06-1.27, p = 0.001). Fewer people reported having contact with dietary supplement advertisements (adjusted odds ratio 0.59, 95%CI 0.43-0.83, p = 0.002).

CONCLUSIONS

The results may help understand some health-related issues associated with COVID-19 pandemic lockdown and may be used to shape aspects of health-related policy.

Determinants of Knowledge About Dietary Supplements Among Polish Internet Users: Nationwide Cross-sectional Study

Background

An accurate understanding of dietary supplements (DS) is a prerequisite for informed decisions regarding their intake. However, there is a need for studies on this understanding among the public based on validated research tools.

Objective

This study aims to assess the knowledge about DS among Polish internet users with no medical education and to identify its determinants and design an appropriate predictive model.

Methods

The study protocol was prospectively registered with a statistical analysis plan. Polish users of a web-based health service and a social networking service were administered a survey consisting of the recently developed questionnaire on knowledge about DS, the questionnaire on trust in advertising DS, the beliefs about medicines questionnaire, and several other health-related single-item measures and sociodemographic questions. The results were subjected to general linear modeling.

Results

A total of 6273 participants were included. Of the 17 yes or no questions in the questionnaire of knowledge about DS, the mean number of correct responses was 9.0 (95% CI 8.9-9.1). Health service users performed worse than social networking users by 2.3 points (95% CI 2.1-2.5) in an analysis adjusted for potential confounders. Internet users had fewer true beliefs about DS if they presented higher trust in their advertising (adjusted β=−.37; 95% CI −.39 to −.34), used DS (adjusted β=−.14; 95% CI −.17 to −.12), experienced their positive effect (adjusted β=−.16; 95% CI −.18 to −.13), were older or younger than 35 years (adjusted β=−.14; 95% CI −.17 to −.12), expressed interest in the topic of DS (adjusted β=−.10; 95% CI −.13 to −.08), reported getting information about the products from friends (adjusted β=−.13; 95% CI −.15 to −.11), and believed that medicines are harmful (adjusted β=−.12; 95% CI −.15 to −.10). The proposed 5-predictor model could explain 31.2% of the variance in knowledge about DS. The model appeared resistant to overfitting and was able to forecast most of the observed associations.

Conclusions

Polish internet users with no medical education exhibit some false beliefs regarding DS. Trusting the advertising of DS appears to conflict with knowledge about them. There is an urgent need for effective web-based educational campaigns on DS and the promotion of advertising literacy. After the proposed predictive model is externally validated, it may help identify the least informed target audience.

Qualitative exploration of the factors influencing the use of dietary supplements in Iranian women: introduction to areas of focus for developing interventions

BACKGROUND

Literature shows that the consumption of Dietary Supplements (DS) is more common in Iran. This study aimed to explore the experiences of a sample of Iranian women regarding the factors influencing the use of DS.

METHODS

This qualitative content analysis study was conducted in Qods city, Tehran province, Iran from January to March 2020. Forty-two semi-structured in-depth interviews were performed with women. The participants were asked about their experiences about the determinants of the consumption of DS. After the first round of the interviews was done, we performed content analysis of the data and continued up to data saturation.

RESULTS

Two main themes including personal factors (with 5 subthemes including sociodemographic characteristics, perceived benefits of DS, history of illness, physiological conditions, and lifestyle factors) and socio-economic factors (with 3 subthemes including subjective norms, the price of food and commercial considerations of the sectors involved in the production and sale of DS) emerged as the experiences of the participants as to the intake of DS.

CONCLUSIONS

These variables may suggest areas which need to be focused on for performing more effective interventions to affect appropriate consumption of DS in Iran.

Nutraceutical Use among Patients with Chronic Disease Attending Outpatient Clinics in a Tertiary Hospital

Food-drug interphase products, referring to nutraceuticals in this study, are a category of health products containing a combination of food ingredients with active substances for oral consumption. Many of these products are marketed as an alternative to prescription medicine to treat various ailments despite the lack of scientific evidence, influencing patients with chronic diseases to consume nutraceutical products. This study aimed to determine the prevalence and factors associated with knowledge, attitude, and practice of nutraceutical use among patients with chronic disease attending to the outpatient clinic. This is a cross-sectional study involving patients with chronic disease at the outpatient specialist clinic. Samples were recruited from the outpatient clinic using convenience sampling. Data was collected using a self-administered questionnaire, which was self-constructed and validated. We found that the use of nutraceuticals was prevalent among 17.9% of respondents. More than half (60.9%) of the respondents have poor knowledge of nutraceutical and 53.1% of respondents have a positive attitude towards nutraceutical. Gender and morbidities were the factors associated with the practice of nutraceutical usage. Female patients are more likely to have increased use of nutraceutical than male patients and patients with multiple morbidities have higher odds of using nutraceutical than patients with single morbidities. There is a high number of patients who consume nutraceutical products and public knowledge of nutraceutical needs to be improved further. The government should develop appropriate regulation and monitoring of nutraceutical products.

Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review

Herbal weight-loss supplements are sold as self-medication products, and are often used under the misconception that their natural origin guarantees their safety. Food supplements are not required to provide any benefit/risk profile evaluation before marketing; however, possible risks associated with use of herbal extracts in food supplements are becoming more and more documented in the literature. Some herbs are listed as the leading cause of herb-induced liver injury, with a severe or potentially lethal clinical course, and unpredictable herb-drug interactions. Garcinia cambogia (GC) extract and GC-containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we present four cases of acute liver failure in women taking GC extract for weight loss, and a literature review of clinical evidences about hepatic toxicity in patients taking dietary supplements containing GC extract.