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Asking the right question: a comparison of two approaches to gathering data on 'herbals' use in survey based studies.

McLay, James S.; Pallivalappila, Abdul R.; Shetty, Ashalatha; Pande, Binita; Al Hail, Moza; Stewart, Derek


James S. McLay

Abdul R. Pallivalappila

Ashalatha Shetty

Binita Pande

Moza Al Hail

Derek Stewart


Background: Over the last decade academic interest in the prevalence and nature of herbal medicines use by pregnant women has increased significantly. Such data are usually collected by means of an administered questionnaire survey, however a key methodological limitation using this approach is the need to clearly define the scope of ‘herbals’ to be investigated. The majority of published studies in this area neither define ‘herbals’ nor provide a detailed checklist naming specific ‘herbals’ and CAM modalities, which limits inter-study comparison, generalisability and the potential for meta-analyses. The aim of this study was to compare the self-reported use of herbs, herbal medicines and herbal products using two different approaches implemented in succession. Methods: Cross-sectional questionnaire surveys of women attending for their mid-trimester scan or attending the postnatal unit following live birth at the Royal Aberdeen Maternity Hospital, North-East Scotland. The questionnaire utilised two approaches to collect data on ‘herbals’ use, a single closed yes/no answer to the question 'have you used herbs, herbal medicines and herbal products in the last three months'; and a request to tick which of a list of 40 ‘herbals’ they had used in the same time period. Results: A total of 889 responses were obtained of which 4.3% (38) answered ‘yes’ to herbal use via the closed question. However, using the checklist 39% (350) of respondents reported the use of one or more specific ‘herbals’ (p[less than]0.0001). The 312 respondents who reported ‘no’ to ‘herbals’ use via the closed question but 'yes' via the checklist consumed a total of 20 different ‘herbals’ (median 1, interquartile range 1–2, range 1–6). Conclusions: This study demonstrates that the use of a single closed question asking about the use of ‘herbals’, as frequently reported in published studies, may not yield valid data resulting in a gross underestimation of actual use.


MCLAY, J.S., PALLIVALAPPILA, A.R., SHETTY, A., PANDE, B., AL HAIL, M. and STEWART, D. 2016. Asking the right question: a comparison of two approaches to gathering data on 'herbals' use in survey based studies. PLoS ONE [online], 11(2), e0150140. Available from:

Journal Article Type Article
Acceptance Date Feb 9, 2016
Online Publication Date Feb 25, 2016
Publication Date Feb 25, 2016
Deposit Date Apr 19, 2016
Publicly Available Date Apr 19, 2016
Journal PLoS ONE
Print ISSN 1932-6203
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 11
Issue 2
Article Number e0150140
Keywords Herbs; Herbal medicine; Pregnancy; Questionnaires; Health service research; Flowering plants; Oils; Systematic reviews
Public URL