Abstract
Objectives
To ascertain the recommendations, training and education of health food store employees and determine how they communicate the costs, benefits and risks associated with natural health products for the HIV/AIDS community.
Methods
Four male research assistants, posing as asymptomatic HIV-positive individuals, inquired of employees of all retail health food stores in a major Canadian city as to what is recommended for their condition. The research assistants asked about product costs, side effects, potential drug interactions and efficacy. They also inquired as to employee education related to Complementary and Alternative Medicine (CAM) and noted whether employees asked about which conventional medications they were taking and whether they recommended that the subjects seek physician or CAM provider advice.
Results
A total of 32 stores were included. Eight store employees (25%) offered no advice; eight (25%) inquired whether the subjects were currently taking medications; six (19%) suggested visiting a physician; and eight (25%) suggested visiting a CAM provider. A total of 36 different products (mean 2.3 per employee) were recommended with considerable variability in product evidence and cost. The education of the employees varied from postgraduate education (n=3), to undergraduate degree (n=3), college level (n=5) in CAM, or no formal education in CAM (n=21).
Conclusion
There was considerable heterogeneity in advice on natural food products provided by employees of natural food stores and, in general, these individuals had limited formal training in CAM. The products they recommended had limited evidence supporting their efficacy and in some instances were potentially harmful and had considerable costs. The findings of this study support the need to further examine how best to regulate this growing component of the health care system.
Résumé
Objectifs
Établir avec précision la formation et l’instruction des employés de magasins d’aliments naturels et les recommandations qu’ils dispensent et déterminer comment ils communiquent aux personnes vivant avec le VIH/sida les coûts, les avantages et les risques associés aux produits naturels.
Méthode
Quatre adjoints à la recherche, se prétendant séropositifs pour le VIH, mais asymptomatiques, ont demandé aux employés de tous les magasins de détail d’aliments naturels d’une grande ville canadienne ce qu’ils recommanderaient vu leur état de santé. Les adjoints se sont informés des coûts des produits, de leurs effets secondaires, de leur efficacité et des interactions médicamenteuses éventuelles. Ils ont aussi interrogé les employés sur leur formation en médecines parallèles et noté si ceux-si leur demandaient quels médicaments conventionnels ils prenaient, et s’ils leur conseillaient d’obtenir l’avis d’un médecin ou d’un praticien en médecines parallèles.
Résultats
L’enquête a porté sur 32 magasins. Huit employés (25 %) n’ont donné aucun conseil; huit autres (25 %) ont demandé aux sujets s’ils prenaient actuellement des médicaments; six (19 %) leur ont suggéré de consulter un médecin; et huit (25 %) leur ont suggéré de consulter un praticien en médecines parallèles. On a recommandé en tout 36 produits différents (2,3 par employé en moyenne), avec des écarts considérables dans la justification et le coût de ces produits. Le niveau d’instruction des employés variait; certains avaient un diplôme universitaire supérieur (n=3), de premier cycle (n=3) ou de niveau collégial (n=5) en médecines parallèles; d’autres n’avaient pas fait d’études en médecines parallèles (n=21).
Conclusion
Les conseils des employés de magasins d’aliments naturels présentaient des écarts considérables, et dans l’ensemble, ces personnes avaient peu étudié les médecines parallèles. L’efficacité des produits recommandés n’était pas éprouvée, et certains produits étaient potentiellement nocifs et très chers. Les résultats de l’étude confirment le besoin de pousser la recherche sur les meilleurs moyens de réglementer ce volet en pleine expansion du système de soins de santé.
Footnotes
Acknowledgements: The authors thank Dr. Joel Ray for detailed review and revision of the final manuscript, and Mr. Taras Hollyer for assistance in questionnaire development.
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