International Journal of Clinical Pharmacy

, Volume 34, Issue 4, pp 529–537 | Cite as

Community pharmacists’ attitudes relating to patients’ use of health products in Japan

  • Yasuko Asahina
  • Satoko Hori
  • Yasufumi SawadaEmail author
Research Article


Background There is little information about Japanese pharmacists’ perceived facilitators and barriers to communication with patients about orally taken health products, including herbs and dietary supplements. Objective To explore Japanese pharmacists’ attitudes relating to patients’ use of health products. Method Qualitative study involving focus group interviews with pharmacists was conducted. Data were analyzed using the constant comparative method. Setting Focus group interviews with community pharmacists were conducted in Japan. Main outcome measure Pharmacists’ views and experiences about patients’ health product use and their perceived facilitators and barriers to communication. Results Sixteen pharmacists participated and were asked to describe their views and experiences about patients’ health product use. Some were uncomfortable inquiring about 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. Other pharmacists had similar views or experiences, but those who were proactive in communicating with patients were motivated by certain predisposing factors, such as their professional responsibility for ensuring patients’ health and safety. Conclusion This study showed that differences in opinion about their roles might create differences in pharmacists’ attitudes toward patients’ health product use. This highlights the importance of reconsidering pharmacists’ roles in community settings. Further studies and debate are needed in order to clarify the pharmacists’ roles and to ensure the design of educational objectives that would enable pharmacists to support their patients in using health products and prescription drugs safely.


Alternative medicines Complementary medicines Focus group interview Herbs and dietary supplements Japan Pharmacist Qualitative study 



The authors would like to thank the pharmacists who contributed to this study and Fuki Kurimoto for her help as a note taker.


This study was funded by a Grant-in-Aid for Fellows of the Japan Society for the Promotion of Science (21-8567).

Conflicts of interest

None declared.


  1. 1.
    Ishihara J, Sobue T, Yamamoto S, Sasaki S, Tsugane S. Demographics, lifestyles, health characteristics, and dietary intake among dietary supplement users in Japan. Int J Epidemiol. 2003;32:546–53.PubMedCrossRefGoogle Scholar
  2. 2.
    Imai T, Nakamura M, Ando F, Shimokata H. Dietary supplement use by community-living population in Japan: data from the National Institute for Longevity Sciences Longitudinal Study of Aging (NILS-LSA). J Epidemiol. 2006;16:249–60.PubMedCrossRefGoogle Scholar
  3. 3.
    Ohama H, Ikeda H, Moriyama H. Health foods and foods with health claims in Japan. Toxicology. 2006;221:95–111.PubMedCrossRefGoogle Scholar
  4. 4.
    Ministry of Health LaW. Food for specified health uses (FOSHU). 2011. Accessed 15 Oct 2011.
  5. 5.
    Ministry of Health LaW. List of approved FOSHU (in Japanese). 2011. Accessed 15 Oct 2011.
  6. 6.
    Ministry of Health LaW. Food with nutrient function claims (FNFC). 2011. Accessed 15 Oct 2011.
  7. 7.
    Daiwa Institute of Research. Regulation and market trends concerning health products, New industry report winter 2010 (in Japanese). 2011. Accessed 15 Oct 2011.
  8. 8.
    Ministry of Health LaW. Annual reports on statistical survey on trends in pharmaceutical production (in Japanese). 2008. Accessed 15 October 2011.
  9. 9.
    Adachi M, Saito H, Kobayashi H, Horie Y, Kato S, Yoshioka M, et al. Hepatic injury in 12 patients taking the herbal weight loss AIDS Chaso or Onshido. Ann Intern Med. 2003;139:488–92.PubMedGoogle Scholar
  10. 10.
    Lai RS, Chiang AA, Wu MT, Wang JS, Lai NS, Lu JY, et al. Outbreak of bronchiolitis obliterans associated with consumption of Sauropus androgynus in Taiwan. Lancet. 1996;348:83–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Stickel F, Baumuller HM, Seitz K, Vasilakis D, Seitz G, Seitz HK, et al. Hepatitis induced by Kava (Piper methysticum rhizoma). J Hepatol. 2003;39:62–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Fugh-Berman A. Herb-drug interactions. Lancet. 2000;355:134–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Bailey DG, Spence JD, Munoz C, Arnold JM. Interaction of citrus juices with felodipine and nifedipine. Lancet. 1991;337:268–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Gordon JB. SSRIs and St. John’s wort: possible toxicity? Am Fam Physician. 1998;57(950):3.Google Scholar
  15. 15.
    Kudo T. Warfarin antagonism of natto and increase in serum vitamin K by intake of natto. Artery. 1990;17:189–201.PubMedGoogle Scholar
  16. 16.
    Canter PH, Ernst E. Herbal supplement use by persons aged over 50 years in Britain: frequently used herbs, concomitant use of herbs, nutritional supplements and prescription drugs, rate of informing doctors and potential for negative interactions. Drugs Aging. 2004;21:597–605.PubMedCrossRefGoogle Scholar
  17. 17.
    Gardiner P, Graham RE, Legedza AT, Eisenberg DM, Phillips RS. Factors associated with dietary supplement use among prescription medication users. Arch Intern Med. 2006;166:1968–74.PubMedCrossRefGoogle Scholar
  18. 18.
    Robinson A, McGrail MR. Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complement Ther Med. 2004;12:90–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Asahina Y, Hori S, Sawada Y. Collecting and sharing information about dietary supplements and functional foods among healthcare professionals using internet-based system (in Japanese with an English summary). Yakugaku Zasshi. 2010;130:131–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Kwan D, Hirschkorn K, Boon H. U.S. and Canadian pharmacists’ attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review. BMC Complement Altern Med. 2006;6:31. doi: 10.1186/472-6882-6-31.PubMedCrossRefGoogle Scholar
  21. 21.
    Asahina Y, Hori S, Ohtani H, Sawada Y. Development and evaluation of an internet-based educational system about herbs and dietary supplements through periodical distribution of information to health professionals (in Japanese with an English summary). Yakugaku Zasshi. 2009;129:773–80.PubMedCrossRefGoogle Scholar
  22. 22.
    Kemper KJ, Amata-Kynvi A, Sanghavi D, Whelan JS, Dvorkin L, Woolf A, et al. Randomized trial of an internet curriculum on herbs and other dietary supplements for health care professionals. Acad Med. 2002;77:882–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Kemper KJ, Gardiner P, Gobble J, Mitra A, Woods C. Randomized controlled trial comparing four strategies for delivering e-curriculum to health care professionals [ISRCTN88148532]. BMC Med Educ. 2006;6:2. doi: 10.1186/472-6920-6-2.PubMedCrossRefGoogle Scholar
  24. 24.
    Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282:867–74.PubMedCrossRefGoogle Scholar
  25. 25.
    Howard N, Tsourounis C, Kapusnik-Uner J. Dietary supplement survey of pharmacists: personal and professional practices. J Altern Complement Med. 2001;7:667–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Asahina Y, Hori S, Sawada Y. Understanding of definition and safety of oral health products among patients, physicians and pharmacists (In Japanese with an English summary)]. Yakugaku Zasshi. 2010;130:961–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Asahina Y, Hori S, Ohtani H, Sawada Y. Questionnaire survey on clinical performance of pharmacists concerning patients’ use of herbs and dietary supplements (in Japanese with an English summary). Iryou Yakugaku. 2009;35:685–92.CrossRefGoogle Scholar
  28. 28.
    Paluck EC, Green LW, Frankish CJ, Fielding DW, Haverkamp B. Assessment of communication barriers in community pharmacies. Eval Health Prof. 2003;26:380–403.PubMedCrossRefGoogle Scholar
  29. 29.
    Green LW, Kreuter MW. Health promotion planning an educational and environmental approach. 2nd ed. Mountain View: Mayfield Publishing Company; 1991.Google Scholar
  30. 30.
    Vaughn S, Sinagub JM, Schumm JS. Focus group interviews in education and psychology. Thousand Oaks: Sage Publications; 1996.Google Scholar
  31. 31.
    Ohtani H, Matsuda M, Kakehi M, Mori C, Masaoka T, Sawada Y. Development and application of an Internet-based educational system to share pharmaceutical case reports between pharmacists (In Japanese with an English summary)]. Yakugaku Zasshi. 2002;122:185–92.PubMedCrossRefGoogle Scholar
  32. 32.
    Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 4th ed. Thousand Oaks: Sage Publications; 2009.Google Scholar
  33. 33.
    Maykut P, Morehoues R. Beginning qualitative research: a philosophical and practical guide. London: Falmer Press; 1994.Google Scholar
  34. 34.
    Sato I. Method of qualitative data analysis (in Japanese). Tokyo: Shinyo-sha; 2008.Google Scholar
  35. 35.
    Brazier AS, Balneaves LG, Seely D, Stephen JE, Suryaprakash N, Taylor-Brown JW. Integrative practices of Canadian oncology health professionals. Curr Oncol. 2008;15 Suppl 2:s110 es87–91.Google Scholar
  36. 36.
    Hirschkorn KA, Bourgeault IL. Structural constraints and opportunities for CAM use and referral by physicians, nurses, and midwives. Health (London). 2008;12:193–213.CrossRefGoogle Scholar
  37. 37.
    Joos S, Musselmann B, Miksch A, Rosemann T, Szecsenyi J. The role of complementary and alternative medicine (CAM) in Germany - a focus group study of GPs. BMC Health Serv Res. 2008;8:127. doi: 10.1186/472-6963-8-127.PubMedCrossRefGoogle Scholar
  38. 38.
    Maha N, Shaw A. Academic doctors’ views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study. BMC Complement Altern Med. 2007;7:17. doi: 0.1186/472-6882-7-17.PubMedCrossRefGoogle Scholar
  39. 39.
    Roberts CS, Baker F, Hann D, Runfola J, Witt C, McDonald J, et al. Patient-physician communication regarding use of complementary therapies during cancer treatment. J Psychosoc Oncol. 2005;23:35–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Shelley BM, Sussman AL, Williams RL, Segal AR, Crabtree BF. ‘They don’t ask me so I don’t tell them’: patient-clinician communication about traditional, complementary, and alternative medicine. Ann Fam Med. 2009;7:139–47.PubMedCrossRefGoogle Scholar
  41. 41.
    Blendon RJ, DesRoches CM, Benson JM, Brodie M, Altman DE. Americans’ views on the use and regulation of dietary supplements. Arch Intern Med. 2001;161:805–10.PubMedCrossRefGoogle Scholar
  42. 42.
    Vickers KA, Jolly KB, Greenfield SM. Herbal medicine: women’s views, knowledge and interaction with doctors: a qualitative study. BMC Complement Altern Med. 2006;6:40. doi: 10.1186/472-6882-6-40.PubMedCrossRefGoogle Scholar
  43. 43.
    Ministry of Health LaW. Statistical survey on medical doctors, dentists and pharmacists (in Japanese). 2008. Accessed 22 Nov 2011.
  44. 44.
    Semple SJ, Hotham E, Rao D, Martin K, Smith CA, Bloustien GF. Community pharmacists in Australia: barriers to information provision on complementary and alternative medicines. Pharm World Sci. 2006;28:366–73.PubMedCrossRefGoogle Scholar
  45. 45.
    Messerer M, Johansson SE, Wolk A. Sociodemographic and health behaviour factors among dietary supplement and natural remedy users. Eur J Clin Nutr. 2001;55:1104–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Graduate School of Interdisciplinary Information StudiesThe University of TokyoTokyoJapan
  2. 2.Interfaculty Initiative in Information StudiesThe University of TokyoTokyoJapan
  3. 3.Graduate School of Pharmaceutical SciencesThe University of TokyoTokyoJapan

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