Community Pharmacists’ Knowledge, Attitude, and Professional Practice Behaviors Towards Dietary Supplements: Results from Multi-Center Survey in Ethiopia

Figures & data

Figure 1 Sampling procedures and the number of individuals selected from each city.

Abbreviation: DRO, drug retail outlets.

Table 1 Demographic Characteristics of the Study Respondents (N = 600)

Characteristics	Frequency	Proportion
Gender
Male	360	60
Female	240	40
Age
Under 25	104	17.3
25–35	318	53.0
36–45	147	24.5
>45	31	5.2
Education level
Pharmacy technician	56	9.3
Diploma pharmacy	164	27.3
B. Pharm	359	59.8
MSc	21	3.5
Experience in community pharmacy
<5	247	41.2
5–10	203	33.8
10–20	140	23.3
>20	10	1.7
Position in pharmacy
Employee	464	77.3
Owner	136	22.7

Abbreviations: B. Pharm, Bachelor of Pharmacy degree; MSc, Master of Science degree.

Table 2 Distribution of the Level of Knowledge, Attitude and Practices Towards Dietary Supplements Across Demographic Characteristics (N = 600)

Characteristics	Level of Knowledge		P-Value	Level of Attitude		P-Value	Level of Practice		P-Value
	Good, n (%)	Poor, n (%)		Positive, n (%)	Negative, n (%)		Good, n (%)	Poor, n (%)
Gender
Male	244 (40.7)	116 (19.3)	0.48	204 (34.0)	156 (26.0)	0.07	162 (27.0)	198 (33.0)	0.02*
Female	156 (26)	84 (14)		118 (19.7)	122 (20.3)		85 (14.2)	155 (25.8)
Age
Under 25	48 (8.0)	56 (9.3)	<0.001^*	47 (7.8)	57 (9.7)	0.08	36 (6.0)	68 (11.3)	0.09
25–35	223 (37.2)	95 (15.8)		167 (27.8)	151 (25.2)		137 (22.8)	181 (30.2)
36–45	101 (16.8)	46 (7.7)		88 (14.7)	59 (9.8)		56 (9.3)	91 (15.2)
>45	28 (4.7)	3 (0.5)		20 (3.3)	11 (1.8)		18 (3.0)	13 (2.2)
Education level
Pharmacy technician	22 (3.7)	34 (5.7)	<0.001^*	19 (3.2)	37 (6.2)	0.009^*	17 (2.8)	36 (6.5)	0.003^*
Diploma pharmacy	97 (16.2)	67 (11.2)		86 (14.3)	78 (13.0)		58 (9.7)	106 (17.7)
B. Pharm	264 (44.0)	95 (15.8)		207 (34.5)	152 (25.3)		157 (26.2)	202 (33.7)
MSc	17 (2.8)	4 (0.7)		10 (1.7)	11 (1.8)		15 (2.5)	6 (1.0)
Experience in community pharmacy
<5	136 (22.7)	111 (18.5)	<0.001^*	121 (20.2)	126 (21.0)	0.201	79 (13.2)	168 (28.0)	<0.001^*
5–10	140 (23.3)	63 (10.5)		117 (19.5)	86 (14.3)		85 (14.2)	118 (19.7)
10–20	114 (19.0)	26 (4.3)		77 (12.8)	63 (10.5)		77 (12.8)	63 (10.5)
>20	10 (1.7)	0 (0.0)		7 (1.2)	3 (0.5)		6 (1.0)	4 (0.7)
Position in pharmacy
Employee	294 (49.0)	170 (28.3)	0.002^*	234 (39.0)	230 (38.3)	0.003^*	162 (27.0)	302 (50.3)	<0.001^*
Owner	106 (17.7)	30 (5.0)		88 (14.3)	48 (8.0)		85 (14.2)	51 (8.5)

Notes:

* Statistically significant, P-values were calculated using the χ² test.

Abbreviations: B. Pharm, Bachelor of Pharmacy degree; MSc, Master of Science degree.

Table 3 Descriptive Analysis of Knowledge, Attitude, and Practice Questionnaire

Questions	Yes, n (%)	No, n (%)
Knowledge items
Generally, I have sufficient information toward dietary supplement	359 (59.8)	241(40.2)
I have sufficient information about the efficiency and effectiveness of a dietary supplement	388 (64.7)	212 (35.3)
I have sufficient information about the adverse effects of a dietary supplement	289 (48.2)	311(51.8)
I have sufficient information about the dosage and administration of the dietary supplement	380 (63.3)	220 (36.7)
I have sufficient information about indications of some dietary supplement in specific groups such as pregnancy, breastfeeding, pediatric and geriatric	376 (62.7)	224 (37.3)
I have sufficient information about drug-supplement interactions	331 (55.2)	269 (44.8)
I have sufficient information about contraindication of dietary supplement and in special groups of chronic patients for example with hypertension, diabetes mellitus, cardiovascular diseases, cancer, kidney disease or others	294 (49.0)	306 (51.0)
Attitude items
Dietary supplements have a positive impact on public health	377 (62.8)	223 (37.2)
Therapeutic efficacy of dietary supplement may be considerable	372 (62.0)	228 (38.0)
Pharmacists should be knowledgeable about supplements and consulting in this field is part of pharmacist’s duties	371 (61.8)	229 (38.2)
The supplement should dispense according to the nutritionist or physician’s prescription	273 (45.5)	327 (54.5)
The supplement should be sold in pharmacies under pharmacist’s supervision	307 (51.2)	293 (48.8)
Supplements considered as an important source of profit for pharmacies	136 (22.7)	464 (77.3)
Price is an important factor for recommending supplements to customers	219 (36.5)	381 (63.5)
Customers usually are influenced by Pharmacist’s comments about supplements	311 (51.8)	289 (48.2)
Practice items
I always allow enough time for advising customers on supplements	267 (44.5)	333 (55.5)
I have studied some scientific references regarding supplements	215 (35.8)	385 (64.2)
I could refer to valid Web Pages and scientific references relevant to dietary supplement in case of need	236 (39.3)	364 (60.7)
I always recommend supplements to consumers with confidence about their effectiveness	301 (50.2)	299 (49.8)
I always inform consumers about the possible adverse effects of dietary supplements	238 (39.7)	362 (60.3)
I always advise consumers about the dosage and administration of supplements	289 (48.2)	311 (51.8)
I always ask consumer’s medical history when I recommend these products	242 (40.3)	358 (59.7)
I always check a whether particular supplement taken by consumer interact with his/her prescription medicines	182 (30.3)	418 (69.7)
I always inform consumers about drug-supplement interactions	213 (35.5)	387 (64.5)
I have self-confidence for recommending a supplement	297 (49.5)	303 (50.5)

Table 4 Mean Scores of Knowledge, Attitude, and Practice

Description	Knowledge Score (Mean ± SD)	P-Value	Attitude Score (Mean ± SD)	P-Value	Practice Score (Mean ± SD)	P-Value
Gender^Table Footnoteb
Male	4.00 (2.37)	0.182	4.05 (2.81)	0.179	4.31 (3.29)	0.105
Female	4.07 (2.66)		3.77 (2.82)		3.87 (3.39)
Age^a
Under 25	2.82 (2.33)	<0.001	2.99 (3.06)	0.003	3.10 (3.34)	0.002
25–35	4.29 (2.43)		3.97 (2.75)		4.25 (3.30)
36–45	4.08 (2.54)		4.40 (2.72)		4.34 (3.28)
>45	5.23 (1.96)		4.65 (2.32)		5.35 (3.21)
Education level^a
Pharmacy technician	2.66 (2.57)	<0.001	2.57 (2.90)	0.003	2.91 (3.43)	<0.001
Diploma pharmacy	3.51 (2.59)		3.85 (2.87)		3.65 (3.33)
Degree (B. Pharm)	4.42 (2.29)		4.21 (2.67)		4.42 (3.19)
Postgraduate (MSc)	5.19 (2.73)		3.62 (3.60)		6.29 (3.96)
Experience in community pharmacy^a
<5	3.39 (2.55)	<0.001	3.34 (2.85)	<0.001	3.35 (3.10)	<0.001
5–10	3.90 (2.28)		4.41 (2.69)		4.21 (3.18)
10–20	5.19 (2.26)		4.18 (2.75)		5.22 (3.54)
>20	6.20 (1.03)		5.90 (2.68)		6.50 (3.66)
Position in pharmacy^b
Employee	3.83 (2.52)	<0.001	3.66 (2.76)	<0.001	3.76 (3.18)	<0.001
Owner	4.72 (2.27)		4.88 (2.81)		5.40 (3.53)

Notes:

a Kruskal-Wallis Test (p < 0.05)

b Mann-Whitney Test (p < 0.05). P-value in bold indicating statistical significance.

Abbreviations: B. Pharm, Bachelor of Pharmacy; MSc, Master of Science degree, SD, standard deviation.

Table 5 Correlation Between Knowledge, Attitude, and Practice Scores

Variable	Correlation Coefficient	P-Value^*
Knowledge-Attitude	0.471	<0.001
Knowledge-Practice	0.546	<0.001
Attitude-Practice	0.741	<0.001

Note:

* Correlation significant at 0.01 levels (2-tailed).

World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. Geneva; 2003. Contract No.: 797. ISBN: 924120916X.

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