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Indian Journal of Nutrition

Research Article


Knowledge Attitude and Practices about Nutritional Supplements of the Students of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia

Chandika RM1*, Uthakalla VK2, Hussein EA3, Abdullah SM4 and Afifi SF5

1Assistant Professor, Bio Statistics, Department of Clinical Nutrition, Applied Medical Sciences College, Jazan University, Jazan, Saudi Arabia

2Professor, Department of Community Medicine, Alluri Sita Ramaraju Academy of Medical Sciences, Eluru, Andhra Pradesh,India

3Professor, Department of Clinical Nutrition, Applied Medical Sciences College, Jazan University, Jazan, Saudi Arabia

4Associate Professor of Haematology and Blood Transfusion, Medical Laboratory Department, Faculty of Applied MedicalSciences, Jazan University, Jazan, Saudi Arabia

5Professor & Head of the Department, Clinical Nutrition Department, Applied Medical Sciences College, Jazan University,Jazan, Saudi Arabia


Corresponding author: Rama Mohan Chandika, Assistant Professor, Bio Statistics, Department of Clinical Nutrition,Applied Medical Sciences College, Jazan University, Jazan, Saudi Arabia, E-mail: ramamohan.chandika@gmail.com


Citation: Chandika RM, Uthakalla VK, Hussein EA, Abdullah SM, Afifi SF. Knowledge Attitude and Practices about Nutritional Supplements of the 02 Students of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia. Indian J Nutri. 2017;4(2): 157.


Copyright © 2017 Chandika RM, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Indian Journal of Nutrition | ISSN: 2395-2326 | Volume: 4, Issue: 2


Submission: 07/03/2017; Accepted: 29/03/2017; Published: 10/04/2017


Abstract


Background: Nutritional Supplements (NS) include vitamins, minerals, herbs, meal supplements, sports nutrition products, natural food supplements and other related products used to boost the nutritional content of the diet.

Objectives: The objective of the study was 1) To determine the usage of nutritional supplements in Applied Medical Science College students. 2) To find their Knowledge, Attitude and Practices regarding nutritional supplements. 3) To find the association between knowledge, attitude and practices with sociodemographic variables.

Materials and methods: We conducted a descriptive cross-sectional questionnaire-based study in 2016 at College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia. Convenient sampling was used. The data was taken through questionnaires and analyzed by using the SPSS 21.0 version.

Results: Majority 59 (52.21%) respondents were graded as good knowledge level of nutritional supplement. The majority of the respondents using nutritional supplements 63 (55.75%) and the most used type of nutrition supplement are vitamins 42 (66.67%). The majority of nutrition supplement users felt better 59 (93.65%) and majority consuming the supplements with doctor advice/prescription. The knowledge of nutritional supplements was attained by majority of doctors/pharmacists 79 (69.91%). Most of the students were non-smokers 109 (96.46%) and do regular exercise 111 (98.23%). The correlation between Knowledge, Attitude and Practice (KAP) of nutritional supplements with gender and marital status were statistically significant.

Conclusion: The usage of nutrition supplements in students is high. Hence, the knowledge, especially regarding the role of nutritional supplements in health and diseases must be highlighted in the medical science curriculum with the objective of producing well-informed professionals who can, later on, have a positive impact on the health of society.


Keywords:

Nutritional supplements; BMI; Likert scale; Frequency


Introduction


Nutritional Supplements (NS) include vitamins, minerals,herbs, meal supplements, sports nutrition products, natural food supplements and other related products used to boost the nutritionalcontent of the diet [1]. US Food and Drug Administration define NS as ‘a dietary supplement or product intended for ingestion that contains a “dietary ingredient” intended to add further nutritional value to (Supplement) the diet. NS are defined as concentrated sources of nutrients or other substances with a nutritional or physiological effect that supplements the normal diet [2]. Currently, dietary supplements are used in both developing and developed countries. The nutrition and supplements market size was of US $96 billion in 2012 and was expected to raise approximately US $104 billion globally [3].


Given the fact, lifestyle is being more and more identified as important for healthy life; emphasis on proper nutrition is enormously increasing [4]. Nutrition transition has been linkedup with growing prevalence rates of non-communicable diseases which are increasingly becoming major mortality causes. Nutrition knowledge plays an important role in raising public awareness and ultimately the health of the society [5]. Inappropriate use or contamination may cause potential health problems [6-9]. Multiple research group believe that supplementing the diet of well-nourished adults has no clear benefit and might even be harmful and should not be used for prevention of chronic diseases [10-12].


A lot of research has been conducted on NS in developed countries and still ongoing. However, there are limited researches conducted on NS in Saudi Arabia. Healthcare practitioners, nurses, pharmacists and health sciences students can widely influence the beliefs and practices regarding health in the general population. They can advice people regarding the usage of nutrition supplements and the effects of those supplements on health [13,14]. Since it is believed that the health behavior of health sciences students will be reflected in their attitude while counseling patients regarding diet and nutrition, it is important to collect their nutrition supplement use data [15,16]. With this background, the study was conducted with the following objectives: 1) To determine the usage of nutritional supplements. 2) To find their Knowledge, Attitude and Practices regarding nutritional supplements. 3) To find the association between knowledge, attitude and practices with socio-demographic variables among the students of Applied Medical Sciences College, Jazan University, Jazan, Saudi Arabia.


Materials and Methods


A descriptive cross-sectional questionnaire-based study was carried out in the Department of Clinical Nutrition, Applied Medical Sciences College, jazan University, Jazan, Saudi Arabia. The students of 6th, 7th level male and female were involved in the study. The total study period of our research was about 10 weeks from October toDecember 2016. Using with an expected frequency of 50% and confidence limits of 10%, the minimum sample size was calculated 92 in 95% confidence level. A total of 145 students pursuing 6th, 7th level undergraduate course in the Department of Clinical Nutrition were requested to fill the questionnaire form after explaining the importance of the study and their contribution to it. Out of 145, only 113 completed questionnaires were received, others did not wish toparticipate in the study or returned incomplete questionnaires.


A structured questionnaire was prepared and distributed using convenient sampling to the target population. The questionnaire consisted of three sections. Section-A: Demographic information this include the respondent’s gender, marital status, height, weight and BMI. Section-B: Items addressing knowledge were answered using a 5-point Likert-type scale ranging from strongly disagree (1) to strongly agree (5). Survey items in this area asked consumers perceptions of the efficacy of nutritional supplements for treatingmedical conditions and/or for promoting health and wellness, as well as their beliefs related to the potential for harmful side effects and interaction potential with other supplements or medications. Respondents were also asked to rate their level of comfort in discussing nutritional supplements use with health care providers and pharmacists. Section-C: Practices and attitude on nutritional supplements. Items were asked in this section were about the lifestyle, frequency of nutritional supplements use, source of information, type of nutrition supplement and reasons for taking the nutritional supplements. The information of the questions for the questionnaire was based on the previous studies [17,18]. After collection of the completed questionnaire, the data was analyzed using SPSS 21.0 version and associations were tested by using the chi-square and Fisher exact tests. Cronbach’s Alpha Index was calculated for finding internal consistency in section-B variables.


Results


A total of 113 students of both sex (74 female and 39 male) in Department of Clinical Nutrition, Applied Medical Sciences College, Jazan University participated in the study. Cronbach’s Alpha Index of interna consistency was 0.7943 for Section-B questions from 1 to 4. Therefore 79.43% of the variance was reliable variance, and only 20.57% of the variance was error variance in the variables. The majority of the respondents were female 74 (65.49%), single 103 (91.15%) and BMI normal 52 (46.02%). All of our study participants have heard about NS they received information either from doctors/pharmacists 79 (69.91%), reading books 16 (14.16%), friends/families 6 (5.31%), television 6 (5.31%), reading articles 4 (3.54%), radio/ journal 1 (0.88%) and newspaper 1 (0.88%) (Table 1). The bulk 76.19% of nutrition supplement users was females. Furthermore, among the NS who are single, 93.65% were the highest users than married individuals. About 49.21% NS users had normal BMI. Among the nutrition supplement users, the most used type of nutrition supplement was vitamins 42 (66.67%) followed by meal supplements 13 (20.63%), protein supplements 4 (6.35%), herbal products 1 (1.59%) and others 3 (4.76%). Other types of supplements used were honey and hormonal supplements (Table 1).


Table 1: Demographic information of the study participants


Overall, respondents agreed that dietary supplements are useful for treating medical conditions and/or promoting health and wellness (Likert Scale mean=4.08). The mean agreement level for consumers that nutritional supplements can interact with other supplements or medications was high (Likert Scale mean=4.25). The lowest level of agreement was related to consumer perception of potentially harmful side effects of nutritional supplements and the level of comfort in discussing nutritional supplements use with doctor/pharmacists (Likert Scale mean=3.78 and Likert Scale mean=4.02 respectively) (Figure 1).


Figure 1: Likert-scale agreement on nutrition supplements.


Majority 59 (52.21%) respondents were grades as good knowledge level on nutrition supplements, and only 54 (47.79%) respondents had a poor knowledge level on nutrition supplements respectively unrelated whether they were users or non-users. Regarding lifestyle practices among study participants, the majority of them were using nutritional supplements 63 (55.75%). Majority of the study participants had a good healthy lifestyle. Most of the students were non-smokers 109 (96.46%). The study participants do exercise at least once a week 39 (34.51%), twice a week 19 (16.81%), three times per week 24 (21.24%) and every day 29 (25.66%) respectively (Table 2).


Table 2: Knowledge, attitude and practices among study participants


Nutrition supplements are consumed commonly to maintain good health 34 (53.97%), adequate nutrition 16 (25.40%), physical appearance 8 (12.70%), to lose weight 1 (1.58%) and others 4 (6.35%). Other reasons to take supplements were to gain weight or mothers advice. Most of the nutrition supplement users were consuming the supplements weekly 29 (46.3%), followed by daily 21 (33.33%) and monthly 13 (20.63%). The majority of the nutrition supplement users felt better 59 (93.65%) while 4 (6.35%) did not feel any improvement. 45 (71.43%) of the users consuming the supplements with doctors advice/prescription (Table 3).


Table 3: Attitude and practices among supplement users.


The majority of the users who showed good knowledge about nutrition supplements had good attitude towards it 34 (94.44%) too. On the other hand, users that have poor knowledge about nutritional supplements have a poor attitude towards it 02 (7.41%). There was no statistically significant (P=0.765) relation found between knowledge and attitude (Table 4).


Table 4: Association between knowledge and attitude among NS users.


Respondents with good knowledge and good attitude towards nutritional supplements have a higher percentage of using the nutritional supplements 34 (72.34%) compared to the respondents who have poor knowledge with poor attitude 2 (16.67%). There was a highly significant (P=0.001) association found between knowledge and attitude to practice when compared between nutritional supplement users and non-users (Table 5).


Table 5: Association between knowledge, attitude and practices among NS users.


The majority of participants who have good KAP were female 31 (100%) followed by male 03 (60%), while poor KAP was mostly from male 02 (40%). There was a statistically significant (P=0.015) association found between KAP and gender among nutritional supplement users. The majority of participants who have good KAP were single 30 (100%) followed by married individuals 04 (67.00%), while poor KAP was mostly in married individuals 02 (33.00%). There was statistically significant (P=0.002) association was found between KAP and marital status among nutritional supplement users. The majority of the participants who have good KAP were normal BMI individuals 23 (100%) followed by overweight or obese 11 (85.00%) while poor KAP was mostly in overweight or obese 02 (15.00%). Statistically, there was no significant (P=0.12) association was found between KAP and BMI among nutritional supplement users (Table 6).


Table 6: Association between knowledge, attitude and practices among NS users.


Discussion


Among the current study participants, the majority of the nutritional supplement users were females 76.19% which is similar to the study from Malaysia by ATM Emdadul et al. [17]. In the same way, the result reported as Saudi Arabian women kind ingests NS statistically significantly (P<0.001) higher than male [18,19]. In the present study, women were also compressing greater part of the study population. Women in this study were much higher in number than male colleagues. Therefore there were no similarities between the numbers of study participants in considering Sex, which may have been influenced because of disproportionate distribution of the study participants in considering the sex.


All participants of the current study heard about nutrition supplements, and the majority of the respondents received the information from doctors/pharmacists followed by reading books and friends/families which is similar finding with the study conducted by Ajitha Sharma et al. [20].


In our study majority of the supplement, users were found to havehealthy lifestyle practices like avoiding smoking, maintain normalbody weight and exercised regularly. These findings were similar tothe study by ATM Emdadul et al. [17].


Nutritional supplement users of the present study participants 93.65% believed that chosen type of NS was effective. Multiple studies were also similarly reported that NS consumers have a preconceived impression that these substances are effective in improving health [6,22].


In the present study, NS categorization is taken from the study conducted by ATM Emdadual et al. considered vitamins followed by minerals, herbal products, protein supplements, sports nutrition, meal supplement and others [17]. Multiple studies were considered the categorization of NS as four basic categories: sports foods, dietary supplements, organic acids and herbs/traditional products [23,24]. The differences in categorizing NS may be due to the different nationality and socio-cultural environment. The current study participant’s majority consumed vitamins as nutrition supplements 66.67% which is similar to the study conducted by Aljaloud and Ibrahim [24]. The current findings also can be explained as it has become a popular belief in many countries including Saudi Arabia that the vitamin supplementation maintains health and energy level. Although there are growing evidences that such indiscriminate use of vitamins and micronutrients cause no health benefits over balanced diet, but only increased wastage of money and adverse reactions [25]. Therefore, there is an urgent need to study further reasons for these findings and also with a large sample size and in a heterogeneous population.


Conclusion


The usage of nutrition supplements in students is high. Hence, the knowledge, especially regarding the role of nutritional supplementsin health and diseases must be highlighted in the medical sciencecurriculum with the objective of producing well-informed professionals who can, later on, have a positive impact on the health of society.


Limitations


This is a cross-sectional study with its inherent limitation. Further, the small sample size may not be representing the entire population of Saudi Arabia.


Acknowledgement


Authors are much grateful to those study participants who spare their valuable time, for their input on the current study. We are also thankful to Applied Medical Sciences authority for their kind cooperation.


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