FACULTY OF PHARMACY Research Proposal A SURVEY ON KNOWLEDGE, ATTITUDE AND PRACTICE AMONG PHARMACISTS TOWARDS NUTRITIONAL SUPPLEMNTS IN COMMUNITY PHARMACIES IN SELANGOR. Part A Name : Tina Belle Matrix Number : 1608-7490 Course Code : PHAR 3914 Program : Bachelor of Pharmacy : Dr. Nur Akmar Binti Taha Part B Name of main supervisor MONTH AND YEAR OF RESEARCH PROPOSAL SUBMISSION Introduction Complementary and alternative medicines (CAM) are a group of various medical and health care products not usually included in conventional medicines and the most common subset of it are nutritional supplements.(Mehralian, Yousefi, Hashemian, & Maleksabet, 2014) Majority of people have consumed at least some form of nutritional supplements at some point in their lives. According to U.S Food & Drug Administration (FDA), nutritional supplements can be defined as nutritional ingredients that include vitamins, minerals, amino acids and herbs or botanicals, as well as other substances that may be used to supplement the diet. (FDA, 2017) A community pharmacy is where most people purchase their nutritional supplements. With long opening hours, no advisory appointment, no receptionists and no direct charges, community pharmacies are more accessible than any other setting. This gives pharmacists in the community access to a variety of people in good and poor health as well as to people who may not have contact with other health professionals. (CE, JS, & RE, 2011) The role of the today’s pharmacists is expanding to include pharmaceutical care concepts: from drug compounding and dispensing to providing drug information and patient care, making the pharmacist into one of the most available and trusted healthcare providers rather than a shopkeeper in a commercial enterprise. (Rathinavelu, 2016) In Malaysia and Singapore, the growing trend in the consumption of vitamins and dietary supplements among consumers today is something that pharmacies in the community should certainly pay close attention to. The region's high demand for and acceptance of vitamins and dietary supplements is due to the increase in health awareness, together with higher levels of education and awareness through social media and government efforts (Radzi,2017) However, the professional role of the community pharmacist has been trained to be mainly involved in the preparation and distribution of prescriptions. As a result, the training of pharmacists is targeted more on pharmacology, pharmaceuticals and pharmaceutical chemistry and pharmacists are often perceived as ‘drug experts’ rather than experts on health supplements.(Health, n.d.) In a research done in Japan on community pharmacists' attitudes relating to patients' use of health products, some of the pharmacists were uncomfortable inquiring and being asked about patients' health product use, due to lack of scientific evidence for their efficacy and safety, lack of knowledge to advise patients properly, and fear that they could not answer patients' questions. (Asahina Y, 2012) The educational strategies of the rational model target individuals and groups and aim to promote positive choices and prevent negative choices in health behaviour. This is done by presenting information that is relatively unbiased. The knowledge, attitude and practice (KAP) model reveal misconceptions or misunderstandings that may hinder our activities and potential barriers to behavioral change.(Mehralian et al., 2014) So, the three fields of knowledge, attitudes and practice (KAP) can therefore be measured by research. Using the KAP study, the pharmacists knowledge, attitude and practice regarding nutritional supplements can be assesed. Literature Review Author Study Design/ Setting / Country/ Outcome Scales Conclusion Duration of Study (t) (Mehralian, Cross-sectional To assess Men participants Yousefi, Tehran, Iran the knowledge, are more likely Hashemian, & (n= 500) and measure the knowledgeable professional than women attitude participants about and practice dietary of pharmacists supplements. about Attitude and dietary practice supplements. influenced by KAP some other Maleksabet, 2014) underlying factors like age, experience, education and ownership situation. (Harris, Kingston, To determine General attitudes Rodriguez, & pharmacy faculty towards CAM are members’ and positive among Choudary, 2006) Cross-sectional Minnesota, USA students’ attitudes pharmacy faculty and perceptions members and regard- students, and most ing the use of believe that CAM complementary should be taught and alternative in the pharmacy medicine (CAM). curriculum. (Hirschkorn, Meta-analysis Identify the role There is strong Griener, Cali, & Toronto,Canada of the pharmacist support for the Boon, 2009) (n= 259 articles) in relation to sale of NHPs / DS natural health in pharmacies and products (NHP) a role in NHP / and dietary DS counseling for supplements (DS) pharmacists is emphasized. However, a reoccuring problem is that pharmacists are poorly equipped to advise patients on these products on their shelves and this raises concerns on their ethics Problem Statement In many developed countries, the popularity and use of nutritional supplements has increased and its also gaining popularity in developing countries.(Mehralian et al., 2014) Many people have more health awareness and expect their community pharmacists to be equipped with answers to their queries. Pharmacists play an important role in this because they potentially can have a great impact to public health as being in the most accessible setting. However, a survey of pharmaceutical customers in Australia found that the majority were never advised on diet and exercise, only about a third expected general health information and less than a quarter- earned diet advice. (CE et al., 2011) Another study done in Texas, USA show that pharmacists who encountered patients did not respond to CAM inquiries comfortably but thought they needed adequate knowledge of CAM. But in pharmacies that stored herbal or homeopathic products were more likely to promote the use of CAM by when medically appropriate. (Shah S et al., 2005) According to an article in Nutraingriedients, around 80% of Malaysian pharmacists often teach themselves about the benefits of CAM and nutritional supplements and believe that their profession should play a greater role for their clients in nutritional supplements and other complementary medicines. Customers also expect more information about their supplements from pharmacists compared to 5 years ago. (Scattergood, 2016) Since there is an increasing trend in nutritional supplement consumption, it is vital to asses the knowledge, attitude and practice of community pharmacists towards nutritional supplements. Significance/ Rational of study The findings of the study will provide a better view of the relationship between knowledge, attitude and practice towards nutritional supplements among community pharmacies in Selangor. The study can evaluate these pharmacists especially in a community setting. There are only a few studies that have been conducted among pharmacies in Malaysia Hence, this study would be able to identify the factor affecting the roles of pharmacists in nutritional supplements in community pharmacy. Research Hypothesis The roles of pharmacist in nutritional supplements will be affected by the level of knowledge, attitude and practice. Objectives Main Objective To assess knowledge, attitude and practice among pharmacists towards nutritional supplements in community pharmacies in Selangor. Specific Objectives a) To measure the knowledge, attitude and practice of community pharmacists towards nutritional supplements b) To determine the association between knowledge level and practice on nutritional supplements, attitude and practice on nutritional supplements respectively. c) To assess the association between demographic data (age, gender, years of practice, education level-degree/masters) towards knowledge, attitude and practice of nutritional supplements, respectively. Theoretical Framework The theoretical framework refers to the theory which a researcher chooses to guide them in their research. A theoretical framework is the use of a theory designed to explain an event. (Imenda, 2014). Hence, this will project the related problem and explain the reason for creating the study. This research is designed to assess the level of knowledge, attitude and practice on nutritional supplements. Independent variables Gender Age Years of practice Graduate qualifications Dependant variables Dependant variables Dependant variables Knowledge on nutritional supplements Attitude on nutritional supplements Practice on nutritional supplements From the figure above, the objective of this research is to study the relationship of demographic data (age, gender and educational level) of the respondents towards the knowledge and attitude of community pharmacists on nutritional supplements in Selangor. This survey also determines the relationship between knowledge and attitude, attitude and practice respectively on nutritional supplements.