Consultation behavior regarding herbal medicine use among adults in Palestine: a cross- sectional study

Technical Summary: Consultation Behavior Regarding Herbal Medicine Use Among Adults in Palestine

Problem Statement
Herbal medicine is deeply embedded in the cultural and historical traditions of Palestine, serving as a primary healthcare resource for a substantial portion of the population. Despite its widespread use, significant concerns persist regarding the safety, efficacy, and integration of these remedies into conventional medical practice. A critical gap exists in patient-provider communication; individuals frequently utilize herbal remedies without disclosing this usage to healthcare professionals. This lack of disclosure increases the risk of herb–drug interactions, adverse effects, and inappropriate self-medication. While previous studies in Palestine have documented the prevalence and ethnopharmacological aspects of medicinal plants, there is limited understanding of the specific determinants of consultation behavior—specifically, why patients choose to consult (or not consult) healthcare professionals before using herbal medicines.

Methodology
This study employed a cross-sectional, web-based survey design conducted in November 2025. The target population consisted of adults aged 18–64 years residing in the West Bank, Palestine.

• Sampling: A convenience sampling method was used via online platforms, resulting in a final sample of 403 participants.
• Instrument: Data were collected using a 24-item, self-administered, closed-ended questionnaire. The instrument, translated into Arabic, assessed knowledge, attitudes, and practices (KAP) regarding herbal medicine, as well as communication patterns with healthcare providers.
• Validation: The questionnaire was piloted with 20 participants and validated by three experts in pharmacy and clinical research. It demonstrated good internal consistency (Cronbach's α reported as XX in the text, though the specific value was redacted in the source).
• Analysis: Statistical analysis was performed using IBM SPSS Statistics version 21. Descriptive statistics summarized the data. Associations were tested using Chi-square tests, and binary logistic regression was utilized to identify independent predictors of consultation behavior. Variables were recoded to ensure statistical power (e.g., age groups, Likert scales).

Key Results
The study revealed a high prevalence of herbal medicine use and significant gaps in clinical communication:

• Prevalence: 96.5% of participants reported using herbal medicine, primarily for digestive (58.6%) and respiratory (52.6%) conditions.
• Communication Gaps: 43.2% of participants never consulted a healthcare professional (physician or pharmacist) before using herbal remedies. Furthermore, 65.3% had never discussed herbal medicine use with a physician. Conversely, 37.0% of participants reported that healthcare providers never asked them about their herbal use.
• Perceptions and Beliefs: A majority (64.5%) believed herbal medicines have fewer adverse effects than conventional medications. Additionally, 56.8% believed herbs act faster than conventional drugs.
• Sources and Drivers: The primary drivers for use were perceived safety (54.8%) and accessibility (49.9%). The most common sources were herbalists (Attar) (66.3%) and family/friends (46.4%).
• Predictors of Consultation:
  • Beliefs: Believing that herbal medicines have fewer adverse effects was a significant independent predictor of not consulting a professional (OR = 1.604, p = 0.001).
  • Provider Perception: Perceiving healthcare professionals as knowledgeable was associated with consultation behavior (OR = 0.61, p = 0.027).
  • Demographics: Age was significantly associated with trust in social media and beliefs regarding adverse effects, but age and gender were not significant predictors in the final regression model for consultation behavior.

Key Contributions

• Quantification of the Communication Gap: The study provides empirical data quantifying the disconnect between herbal medicine users and healthcare providers in the West Bank, highlighting that the majority of users do not disclose their herbal intake to clinicians.
• Identification of Behavioral Determinants: It identifies specific cognitive factors—namely the belief in the superior safety of herbs and the perception of provider knowledge—as key drivers influencing whether a patient seeks professional advice.
• Source Mapping: The research delineates the primary channels through which Palestinians access herbal medicine, emphasizing the reliance on traditional herbalists and informal social networks over clinical advice.

Significance and Claims
The paper claims that herbal medicine use is ubiquitous among Palestinian adults, occurring alongside dangerously low rates of clinical communication. The authors argue that this disconnect poses significant clinical risks, particularly unmonitored herb–drug interactions.

The study asserts that improving health literacy, enhancing patient–provider communication, and strengthening regulatory oversight are essential to promote safe herbal medicine use. Specifically, the authors recommend:

1. Public Health Campaigns: To correct misconceptions regarding the inherent safety of herbal remedies.
2. Clinical Integration: Healthcare providers should proactively screen for herbal use during routine consultations, and hospitals should embed standardized herbal documentation into admission protocols.
3. Regulatory Action: The Palestinian Ministry of Health should enforce stricter oversight of herbal shops through mandatory licensing and quality control.

The authors conclude that while the study offers critical insights, it is limited by potential recall and social desirability biases inherent in self-reported data, as well as a sample demographic skewed toward young, female students with medical backgrounds, which may limit the generalizability of the findings to the broader Palestinian public.