Understanding the role of scientific evidence in consumer evaluation of natural health products for osteoarthritis an application of the means end chain approach

Abstract

BackgroundOver 30% of individuals use natural health products (NHPs) for osteoarthritis-related pain. The Deficit Model for the Public Understanding of Science suggests that if individuals are given more information (especially about scientific evidence) they will make better health-related decisions. In contrast, the Contextual Model argues that scientific evidence is one of many factors that explain how consumers make health-related decisions. The primary objective was to investigate how the level of scientific evidence supporting the efficacy of NHPs impacts consumer decision-making in the self-selection of NHPs by individuals with osteoarthritis.MethodsThe means-end chain approach to product evaluation was used to compare laddering interviews with two groups of community-dwelling Canadian seniors who had used NHPs to treat their osteoarthritis. Group 1 (n=13) had used only NHPs (glucosamine and/or chondroitin) with “high” scientific evidence of efficacy. Group 2 (n=12) had used NHPs (methylsulfonylmethane (MSM) and/or bromelain) with little or no scientific evidence supporting efficacy. Content analysis and generation of hierarchical value maps facilitated the identification of similarities and differences between the two groups.ResultsThe dominant decision-making chains for participants in the two scientific evidence categories were similar. Scientific evidence was an important decision-making factor but not as important as the advice from health care providers, friends and family. Most participants learned about scientific evidence via indirect sources from health care providers and the media.ConclusionsThe Contextual Model of the public understanding of science helps to explain why our participants believed scientific evidence is not the most important factor in their decision to use NHPs to help manage their osteoarthritis.

Prescribing patterns of glucosamine in an older population: a national cohort study

“…Previous studies of consumer decision-making related to CAM have reported that recommendations of trusted individuals such as health care providers and family and friends appear to play a significant role in non-prescription decision-making [ 24 ]. A recent study examined the extent to which the level of scientific evidence supporting the efficacy of CAM impacts consumer decision-making in the self-selection of these products [ 25 ]. The authors reported that a small number of participants used direct scientific evidence sources in the decision-making process.…”

That's why I take my ONS. Means-end chain as a novel approach to elucidate the personally relevant factors driving ONS consumption in nutritionally frail elderly users

“…Firstly, the abovementioned studies included foods from the category of fast moving consumer goods, whereas in the current study products from the category of foods for special medical purposes were included (FDA, 2013), incorporating a lower freedom of choice. Indeed, in a previous MEC study on medicines, person factors were not directly linked to product attributes either (Tsui, Boon, Boecker, Kachan, & Krahn, 2012). Therefore, it could be that freedom of choice is important for the presence or absence of a direct link between product attributes and person factors.…”

“…Health authorities should not only have an important role in the prescription of ONS, but also -within the limits of what is practically achievable -be involved in a systematic followup of individuals' actual intake, for example via (online) patient diaries (e.g. an application for mobile devices in which ONS users and/or caregivers can register ONS consumption behaviour) in combination with personalized feedback and/or rewards (Burns et al, 2005;Farquhar & Regian, 1994;Schultz, 2006;van der Leeuw & Slootweg, 2013).…”

Adapting regulatory drug‐drug interaction guidance to design clinical pharmacokinetic natural product‐drug interaction studies: A NaPDI Center recommended approach

“…These data indicated that NP use is common in populations treated with drugs with narrow therapeutic indices; in fact, NP‐chemotherapeutic agent interactions have been a longstanding concern 2 . The collective data highlight that NP use is high among individuals with health risks, probably because of beliefs surrounding a benefit of “naturalness” and a desire to avoid toxicity from prescription medications 3,4 …”

“… 2 The collective data highlight that NP use is high among individuals with health risks, probably because of beliefs surrounding a benefit of “naturalness” and a desire to avoid toxicity from prescription medications. 3 , 4 …”