Background
Many Americans consume dietary supplements,
including vitamins, minerals, herbs, and amino acids. Government
regulation of dietary supplements is limited, and patients
typically do not consult with their physicians regarding the use
of supplements.
Methods
We conducted a qualitative study to
describe patients' decisions about the use of dietary
supplements and the communication they have with their
physicians about such use. Four focus groups of customers from 3
local suburban health food stores were interviewed.
Results
The customers in the health food stores we
investigated were motivated to pursue wellness and wanted to
take responsibility for their health. They would welcome a
partnership with their physicians, but generally believed that
physicians are closed-minded and have little knowledge about
dietary supplements. These consumers determined the
effectiveness of dietary supplements through personal study and
subjective experimentation.
Conclusions
The health food store customers in our study
were self-informed consumers who did not consult their
physicians about their use of dietary supplements, because they
did not believe that physicians were knowledgeable about or
interested in supplements. An open-minded patient-centered
approach would help physicians provide better care for patients
who use dietary supplements.
Dietary supplements include vitamins and minerals, herbal
products, tissue extracts, proteins and amino acids, and a
variety of other products. With approximately 50% of the adult
population taking at least one supplement during a given year,
the business of selling them has grown into a
multibillion-dollar industry.[1,2] Government standards for
dietary supplements are very limited, and manufacturers are not
required to demonstrate safety or efficacy.[3] An evidence-based
review of the literature shows that current dietary supplements
vary from safe and effective[4,5] to unsafe or ineffective,[6,7]
and for many products the published data is insufficient to make
any decision about their safety and efficacy.[8]
Physicians and patients should communicate openly about
dietary supplements to obtain a better understanding of their
efficacy and to help in recognizing adverse reactions. Eisenberg
and colleagues[9] have shown that patients do not typically
communicate with physicians about their use of alternative
medicine. In a previous quantitative study,[10] we showed that
customers of health food stores have an above-average education,
identify a personal physician, have medical insurance, often
take pharmaceuticals, and are motivated to be healthy, but they
do not consult with their physicians before using dietary
supplements. In another study, more than 50% of the patients in
a typical family practice used dietary supplements, and they
often did not discuss this with their physicians.[11]
We wanted to understand patients' decision-making processes
and their reluctance to consult with their physicians about
dietary supplements. How do patients choose a product and
determine its efficacy and safety? Why do they choose not to
discuss this choice with their physicians? We chose a
qualitative methodology using focus groups of consumers of
dietary supplements that would allow an in-depth exploration of
these questions.
Methods
We explored the research questions using focus group
qualitative methodology.[12] Three health-food store owners in
suburban Milwaukee recruited customers to participate in the
focus groups. For a 3-week period, the owners asked their
customers if they would be willing to participate in a focus
group sponsored by physicians from the Medical College of
Wisconsin. They were told that the physicians wished to learn
more about dietary supplements and their benefits.
During the focus group interviews, the facilitators presented
open-ended questions and responded to individual comments by
requesting expansion, concurrence, or disagreement from the
other group members and used prompts as needed. The focus group
methodology used is described in the works of Krueger and
Morgan.[12,13]
We read and analyzed the transcripts separately using an
editing analysis style methodology described by Miller and
Crabtree.[14,15] Major categories were identified and data
saturation occurred with the third focus group. In joint
sessions, the investigators arrived at 3 major themes from
analysis of the data.(*)
Results
Of the 33 participants, 23 were women. The ages ranged from
18 to 65 years, and most (23) were in the 30 to 59 years range.
All were white. Twenty-six (79.0%) had some college education.
Seventeen (52.0%) were either college graduates or had a
postgraduate degree. All of the participants took at least 2
dietary supplements. Twenty-four (73.0%) took more than 5
supplements per day, and 12 (36.0%) took more than 10 per day.
Three major themes regarding the use of dietary supplements and
patient-physician interactions emerged from the analysis of the
focus group interviews: wellness, consumer experimentation, and
empowerment (See table on page 2).
