Pharmacists' knowledge, attitudes, self-efficacy and counseling on herbs and dietary supplements

The primary research goal was to determine the extent to which pharmacists' traits (i.e., knowledge, attitudes, self-efficacy concerning HDS counseling) contribute and/or mediate the performance of HDS-related patient counseling. To support this primary goal, the secondary goal was to develop measures of pharmacists' knowledge, attitudes, self-efficacy concerning HDS counseling, and performance of HDS counseling.;There were four general phases for the completion of this research: instrument development, pilot testing and revision of measures, large-scale validation of measures, and testing hypothesized relationships between pharmacists' traits and their performance of HDS counseling (i.e., using path analysis). Properties of the measures were examined using approaches based on classical test theory and nonparametric item response theory-based Kernel regression.;Each measure was generated based on existing measures, literature and input from experts. Upon refinement of the measures based on the pilot study (n=25), a large-scale validation study was performed using 13 knowledge items, 10 general counseling items, 7 HDS-related counseling items, 5 self-efficacy items and 4 attitude items (i.e., open-mindedness). The validation study (n=179) resulted in the acceptable evidence of reliability (alpha values ≥ 0.7 for all measures, except the knowledge measure [alpha = 0.41]) and evidence of unidimentionality for each measure supported its construct validity. Path analysis demonstrated that knowledge and attitudes towards HDS directly and indirectly affected pharmacists' performance of HDS counseling, mediated by self-efficacy of HDS counseling. Knowledge, attitude, and self-efficacy (standardized beta coefficient = 0.20, 0.23, 0.59, respectively) accounted for 42% of variance of HDS counseling although pharmacists' knowledge levels on HDS were uncorrelated with their attitudes towards HDS.;Self-efficacy, i.e., confidence, in counseling on HDS is the main factor to explain whether counseling is performed by a pharmacists, while attitude and knowledge were weak predictors of counseling on HDS. This suggests that in order to change pharmacists' behavior such as counseling, the focus should be on confidence in addition to knowledge and attitude. Further research is needed to valid the knowledge measure, link counseling to patient outcomes, and examine generalizability in different groups of pharmacists and pharmacists in different countries.