Perception and Use of Herbal Medicine in General Practice Patients: A Cross-Sectional Study in Saudi Arabia

Background: In Saudi Arabia, herbal medicine is an essential component of traditional health practices, reflecting a deep cultural appreciation for natural remedies. Despite widespread use, comprehensive data on perceptions and utilization among general practice patients are scarce. This study aims to elucidate the patterns of herbal medicine use, associated beliefs, and communication with healthcare professionals in this context. Methods: A cross-sectional survey was conducted using an online questionnaire distributed through social media and professional networks, targeting adult residents of Saudi Arabia. The survey encompassed questions on demographic characteristics, use of herbal medicine, reasons for use, sources of herbal products, perceptions of efficacy and safety, and discussions with healthcare professionals about herbal medicine usage. Results: The survey was completed by 1,184 participants, with 736 (62%) reporting the use of herbal medicines in the past 12 months. Among these users, the age group 30-39 was most represented (328/1,184, 27.8%), while participants over 60 were the least (66/1,184, 5.6%). Herbal medicines were primarily used for general wellness (332/736, 45%) and treatment of specific ailments (221/736, 30%). The majority obtained their herbal medicines from pharmacies (427/736, 58%), and 294 (40% of users) used them as alternatives to prescribed medications. Only 259 (35% of herbal medicine users) had discussed their usage with healthcare professionals. Most users believed in the safety (515/736, 70%) and effectiveness (478/736, 65%) of herbal remedies, with a significant portion (626/736, 85%) advocating for more scientific research. Conclusion: This study reveals a significant engagement with and positive perception of herbal medicine among general practice patients in Saudi Arabia, alongside a notable gap in communication between patients and healthcare providers. The findings highlight the need for integrating discussions on herbal medicine into patient care, encouraging evidence-based, safe use through better-informed healthcare practices.


Introduction
Herbal medicine, a cornerstone of traditional and folk healing practices worldwide, has grown in popularity as individuals increasingly seek natural and holistic approaches to healthcare [1].In Saudi Arabia, the use of herbal medicine is deeply rooted in cultural traditions and is often considered complementary or alternative to conventional medical treatments [2].Despite its widespread acceptance and utilization among the general population, the integration of herbal medicine within the formal healthcare system remains a complex and often controversial issue, driven by concerns about efficacy, safety, and regulatory oversight [3].
The global market for herbal remedies continues to expand, reflecting a growing consumer interest in natural health products [4].This trend underscores the importance of understanding how the general public perceives and uses herbal medicines, especially in regions with rich ethnobotanical traditions like Saudi Arabia [5].However, there remains a significant gap in the literature regarding the contemporary use of herbal medicines in the Middle East, particularly from the perspective of general practice patients who might be navigating both conventional and traditional health paradigms.
Previous studies have highlighted several factors influencing the use of herbal medicines, including cultural beliefs, dissatisfaction with conventional healthcare, the perceived safety and naturalness of herbal products, and recommendations from family and social networks [6,7].Yet, data are scarce on the specific The online survey platform was selected for its robust data privacy measures, ease of use, and capability to handle large volumes of respondents simultaneously.To mitigate the risk of multiple entries by the same participant, IP (internet protocol) address checks and digital cookies were employed.The survey was made available in both Arabic and English to maximize accessibility and participation.

Statistical analysis
Data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26, Armonk, USA).Descriptive statistics were generated for demographic variables and responses related to the use and perception of herbal medicine.Continuous variables were summarized using means and standard deviations, whereas categorical variables were reported as frequencies and percentages.

Ethics consideration
The study protocol was reviewed and approved by the Institutional Review Board of the leading academic institution overseeing the research.Participation was voluntary, with all respondents informed about the study's aims, their rights as participants, and the confidentiality of their responses before participation.Consent was implied upon the completion and submission of the online questionnaire.

Use of herbal medicine
Of the respondents, 752 (63.5%) reported using herbal medicines in the past 12 months.The frequency of use was reported as rarely (less than once a month) by 312 respondents (41.5% of users), occasionally (1-3 times a month) by 284 respondents (37.8% of users), and frequently (once a week or more) by 156 respondents (20.7% of users).The purposes for using herbal medicines were reported as follows: general wellness/prevention (422 respondents, 56.1% of users), to treat a specific illness or condition (519 respondents, 69.0% of users), on the advice of a healthcare professional (158 respondents, 21.0% of users), as a substitute for prescription medication (185 respondents, 24.6% of users), and other reasons (68 respondents, 9.0% of users, with the most common specified reason being "traditional family use").Herbal medicines were obtained primarily through purchase from a pharmacy (412 respondents, 54.8% of users), online purchases (234 respondents, 31.1% of users), gifted by friends/family (156 respondents, 20.7% of users), homegrown (89 respondents, 11.8% of users), and other sources (61 respondents, 8.1%) (Table 2).

TABLE 2: Patterns and purposes of herbal medicine use among respondents
Note: N=752 represents the total number of respondents who reported using herbal medicines in the past 12 months.Percentages for "Frequency of Use" indicate how often respondents use herbal medicines.For "Purposes for Using Herbal Medicines," respondents could select multiple options; therefore, percentages do not sum to 100%."Sources of Herbal Medicines" also allowed multiple responses, reflecting the various ways respondents obtain their herbal medicines.Percentages may not total 100% due to rounding and the possibility of selecting more than one response in certain categories.

Perception and communication
Regarding the safety of herbal medicines, 65.2% of respondents (771 out of 1,183) believed herbal medicines are generally safe to use, 18.4% (218 respondents) did not, and 16.4% (194 respondents) were unsure.Confidence in the effectiveness of herbal medicines was expressed by 58.3% of respondents (690 out of 1,183), while 24.7% (292 respondents) were not confident, and 17.0% (201 respondents) were unsure.

TABLE 3: Respondents' perceptions and interactions regarding herbal medicine
Note: N=1183 represents the total number of survey respondents.For "Perceived Safety of Herbal Medicines," "Confidence in Effectiveness of Herbal Medicines," and "Need for More Research on Herbal Medicines," participants were asked to select one option, hence percentages reflect the proportion of respondents for each choice.In the section on "Discussion with Healthcare Professionals," respondents could only answer yes or no, indicating whether they have ever discussed their use of herbal medicines with a healthcare professional.For those who have had discussions (N=312), the "Receptiveness of Healthcare Professional" reflects their perception of the healthcare professional's attitude towards herbal medicine, where percentages are based on the number of respondents who have discussed herbal medicine with a healthcare professional, not the total survey population.Percentages may not sum to 100% due to rounding.

Discussion
The findings of this cross-sectional study illuminate the significant role that herbal medicine plays in the health-seeking behaviors of general practice patients in Saudi Arabia.Consistent with global trends, our results indicate a high prevalence of herbal medicine use among the study population, underlining its importance as a complementary approach to health and wellness [9].This widespread use underscores healthcare providers' need to engage in open discussions about herbal medicine with their patients, ensuring safe and informed use.
Our study reveals that a substantial portion of participants utilize herbal medicine for general wellness and the prevention of illnesses, reflecting a proactive approach to health maintenance.This finding is in alignment with the growing global emphasis on preventive healthcare and the increasing public interest in natural and holistic remedies [10].The data also suggest that the use of herbal medicine spans a wide range of age groups and is not confined to older populations, which challenges some stereotypes about traditional medicine users and points to a broader cultural acceptance.
Comparatively, the results also highlight a notable reliance on herbal medicines as substitutes for prescription medications among some participants.This trend raises important considerations for healthcare policy and practice, particularly regarding the need for evidence-based guidance on the efficacy and safety of herbal products.It underscores the urgent need for rigorous research to inform both the public and healthcare professionals about the benefits and risks associated with herbal medicine use [11][12][13][14].
Furthermore, the study points to a gap in communication between patients and healthcare providers about the use of herbal medicines.Although a majority of respondents believe in the safety and efficacy of these remedies, fewer have discussed their use with a healthcare professional [11].This lack of dialogue may contribute to potential risks, including adverse interactions between herbal and conventional medications.
Encouraging open conversations about herbal medicine in clinical settings could foster a more integrative approach to healthcare, enhancing patient safety and care quality [15].
This study is subject to several limitations.Firstly, the reliance on self-reported data may introduce response bias, as participants could underreport or overreport their use of herbal medicines due to recall inaccuracies or perceived social desirability.Additionally, the online distribution of the questionnaire, though effective in reaching a broad audience, might have excluded individuals with limited internet access or proficiency, potentially biasing the sample towards a more technologically savvy and possibly younger demographic.Finally, as a cross-sectional study, it captures a snapshot in time and cannot establish causality between the observed patterns of herbal medicine use and specific health outcomes.

Conclusions
In conclusion, this study significantly advances our understanding of the perceptions and use of herbal medicine among general practice patients in Saudi Arabia, revealing a high prevalence of use for various health-related purposes, including general wellness and as an alternative to conventional medicine.The findings underscore the critical need for healthcare providers to initiate more open discussions with patients about the use of herbal medicines to ensure safe and informed healthcare choices.Furthermore, this research highlights the importance of integrating traditional medicine practices and advocating for more rigorous scientific research into the efficacy and safety of herbal medicines.By bridging these gaps, healthcare systems can move towards a more holistic and patient-centered approach to health and wellness, accommodating the diverse healthcare practices and beliefs of the population.

TABLE 1 : Demographic profile of survey participants
Note: N represents the total number of respondents.Percentages may not sum to 100% due to rounding.Age categories are based on respondents' age at the time of survey completion.Education Level categories represent the highest level of education completed by respondents.Employment Status reflects respondents' employment situation at the time of the survey.Region of Residence refers to the main administrative regions of Saudi Arabia where the respondents were living at the time of survey participation.