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

Background: 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. Research design and methods: 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. Results: 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). Conclusions: 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?.