This study is the first to compare the knowledge and attitude between the GP and HCWs regarding herbal use as a protective measure during the COVID-19 pandemic. Most responders were young females in both groups, as noticed in previous studies (Stjernberg et al., 2006; Zhang et al., 2015). The mean age of the respondents was 28+/- 9 years, which is similar to previous studies (Alyami et al., 2020; Stjernberg et al., 2006; Zhang et al., 2015), but this might be explained by the methodology, which was an online questionnaire due to the COVID-19 precautions, and with most of the older adults having limited interest in prolonged online surveys (Smith, 2008). However, older participants might also respond to surveys if an incentive had been given to answer the survey (Saleh and Bista, 2017).
The current study shows that commonly used herbs in Saudi Arabia in both study groups during the pandemic were honey followed by lemon, orange, black seed, and garlic, reasonable findings due to availability, and because cultural practices emphasize that these products can boost immunity. However, a recent study in Saudi Arabia on herbs and natural products used during the pandemic showed garlic first, followed by vitamin C (Alyami et al., 2020). This difference might be because the current study covers a broad choice of herbs and natural products, while the choice was limited in the Alyami et al. study (Alyami et al., 2020).
Remarkably, most of the participants in both groups agreed that herbal use does not protect from the COVID-19 infection but can enhance immunity (Panyod et al., 2020). However, the overall comparison found that the GP had better knowledge than HCWs about herbal medicine regarding their use during the COVID-19 as immune-boosting but not protective agents. In line with this finding, several studies reported that HCWs need further education and training on herbal medicine to improve their knowledge (Hilal and Hilal, 2017; Kemper et al., 2003; Sherif et al., 2019). The explanation of the GP’s good knowledge in the current study could be that the GP continued looking for natural immune-boosting agents to protect themselves against the coronavirus infection during the pandemic, and the influence of cultural beliefs on Islamic and traditional medicine in Saudi Arabia. With regard to HCWs, their scientific thinking and reasoning tendency, lack of interest or trust concerning topics supported by insufficient evidence might explain their poor level of knowledge.
Regarding the association between level of knowledge and age, the current study showed that the older population had a significantly better knowledge, which can be attributed to their life experience.
Worldwide regulations are still not well established or consistent, even though both Western and Eastern countries implemented regulations designated for the use of herbal medicine (Jagadeeswara Reddy et al., 2020). In Saudi Arabia, no well-formulated body of work provides supporting evidence regarding herbal medicine (Kemper et al., 2003). Therefore, the present study found that the main source of information about herbs in both groups was social media, non-evidence-based blogs, and relatives, all leading to incorrect practices. Indeed, there is an urgent need for specific guidelines for Saudi Arabia besides implementing herbal medicine education as part of the modern curriculum.
HCWs do not receive an education or training on complementary and alternative medicine (CAM) or herbs in their undergraduate or postgraduate studies resulting in a lack of knowledge and competency in this type of medicine (Hilal and Hilal, 2017). However, they showed a better general understanding of herbs' effects in terms of beneficial effects and side effects (Asmelashe Gelayee et al., 2017; Sherif et al., 2019). Obviously, research must be conducted on the specific herbs available in Saudi Arabia, as each country has its own kind based on agriculture (Tilburt and Kaptchuk, 2008). HCWs, especially physicians, pharmacists, nurses, and dietitians, who frequently interview patients who take herbs that can potentially lead to cross-reactions with other chemicals and which could be life-threatening, need to have adequate knowledge to conduct proper counseling regarding the use of herbal medicine.