Asking patients the right questions about herbal and dietary supplements: Cross cultural perspectives

Use of dietary supplements (DS) during hospitalization carries risks such as reducing drug treatment efficacy and increasing peri-operative complications due to DS-drug interactions and DS side effects. In this study, we aimed to develop socio-cultural-sensitive patient histories to detect DS use amongst hospitalized patients from different backgrounds.

Prospective cohort study of hospitalized patients from June 2009 through March 2010, using mixed quantitative (questionnaires), and qualitative (semi-structured interviews) research methodology to detect DS use.

Data were provided by 691 of 895 patients (response rate 77.2%). Of these, 359 (51.9%) reported using DS in the previous year. 168 (46.8%) disclosed DS use following a standard question on DS consumption. 191 (53.2%) respondents disclosed DS use only following further questioning utilizing DS-related keywords. Leading questioning techniques that facilitated admitting DS use included: naming common DS (50.6% disclosure rate), and using traditional/herbal medicine (THM) related keywords (41.3% disclosure rate) such as infusions, teas, herbs picked in the garden. A logistic multivariate regression model indicated that disclosure of DS use, by using THM related keywords was associated with non-Jewish religion [EXP(B)=3.57, 95% C.I. 1.70-7.50, p=0.001], dwelling in rural areas (p=0.004), and having a lower degree of education (p=0.01).

Improved history taking regarding DS use in hospitalized patients can be accomplished by using specific keywords that address socio-cultural diversities as in the following question: "Do you use any natural, folk, traditional, grandma remedies, herbs picked in the garden, infusions or herbal teas to improve your health?.