Health & Medical Medications & Drugs

Dietary Supplement Knowledge: RPh vs Health Food Employees

´╗┐Dietary Supplement Knowledge: RPh vs Health Food Employees

Limitations


Important limitations exist in this cross-sectional survey.

Sampling pharmacists in western New York may reflect a sample population largely representative of a single pharmacy school and thus not represent graduates from other institutions. To account for regional bias, samples were included from central New York as well. A majority of schools in the United States incorporate CAM into pharmacy curricula, but without standardization, the course content (e.g., herbal medicine, homeopathy) and emphasis may differ between programs. This study also may not be generalizable to all pharmacy practice settings, as only community pharmacists were included, excluding other types of pharmacists.

Selection of participating pharmacies and health food stores was not subject to a true randomization scheme and was instead based on convenience until meeting a sample quota. This approach weakens results. The protocol prohibited more than one participant per venue, limiting generalization of employee findings to whole sites. However, an assortment of private and chain venues may help to expand generalizability to different community pharmacies and reduce sampling bias.

Another limitation is that the questions were not formally validated. The questions were similar in design and content to those of Chang et al. Pharmacists created and adapted the questions, but the questions were not tested in the health food store employee population.

The "I don't know" response choice may have caused some participants to ignore instincts in guessing either "true" or "false" for fear of choosing an incorrect response. As probability would dictate, participants have a 50% chance of correctly guessing the answer when answering true/false questions, but the average number of correct responses for the health food store employees was below 50%.

The knowledge survey assessed various levels of knowledge about common dietary supplements. Patients seeking dietary supplements may only expect a basic understanding about those products. Only composite knowledge scores were subject to statistical analysis, failing to distinguish between basic and advanced dietary supplements knowledge. In addition, participants were not provided an operationalized definition of CAM when assessing confidence. Participants may have different perceptions about CAM (e.g., herbal medicines vs. acupuncture), influencing their confidence during assessment.

Other limitations relate to the survey setting. Pharmacists and health food store employees were not allowed to use any references while answering questions. This policy ensured that test questions assessed current knowledge and not the individual's ability to retrieve information from informational resources. This may not reflect how the two groups would actually answer the same questions under normal circumstances, but differing resources between venues would introduce unknown bias. Recall of specific trial names also may have biased results.

Participants were surveyed at a location of employment during working hours, which may have caused participants to rush through answering questions to return to employee responsibilities.

The study's high refusal rate may introduce nonresponse bias (71% acceptance). Refusal may have been directly related to a lack of confidence about CAM.



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