Main Article Content
Abstract
Background and Objectives: Herbal medicine use is growing globally, and pharmacists play a crucial role in ensuring its safe and effective application. This study assessed the knowledge, attitudes, and practices (KAP) of community pharmacists toward herbal medicine in Erbil City, Kurdistan Region, Iraq.
Methods: A descriptive cross-sectional study was conducted among 400 community pharmacists in both public and private pharmacies between December 2024 and February 2025. Data were collected using a validated self-administered questionnaire via Google Forms and hard copies. Statistical analysis was performed using SPSS version 27, with a p-value ≤ 0.05 considered significant.
Results: Most participants were female (69%) with an average age of 28 years; 62.5% worked in private pharmacies. Overall, 41.5% of pharmacists demonstrated fair knowledge, 30.8% poor knowledge, and 27.8% high knowledge of herbal medicine. Gender and income were significantly associated with knowledge levels (p < 0.05). Nearly half of the participants (48.3%) exhibited poor practice toward herbal medicine use, and personal use was significantly associated with better practice (p = 0.016).
Conclusion: Pharmacists in Erbil showed limited knowledge and suboptimal practice concerning herbal medicine, particularly regarding herb–drug interactions. Targeted training programs and stronger regulatory frameworks are essential to enhance pharmacists’ competence and ensure safe patient counseling.
Keywords
Article Details
Copyright (c) 2026 Zina Abdulkhaliq Rasheed, Kameran Hassan Ismail

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
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- Santanello C, Carr A. Pharmacists’ Knowledge, Perceptions, and Practices Regarding Herbal Medicine. Innov Pharm 2019;10:15. https://doi.org/10.24926/iip.v10i3.2059.
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- Le J, Ji H, Zhou X, Wei X, Chen Y, Fu Y, et al. Pharmacology, Toxicology, and Metabolism of Sennoside A, A Medicinal Plant-Derived Natural Compound. Front Pharmacol 2021;12. https://doi.org/10.3389/fphar.2021.714586.
- Chen W, Balan P, Popovich DG. Review of Ginseng Anti-Diabetic Studies. Mol Basel Switz 2019;24:4501. https://doi.org/10.3390/molecules24244501.
- Shao J-W, Jiang J-L, Zou J-J, Yang M-Y, Chen F-M, Zhang Y-J, et al. Therapeutic potential of ginsenosides on diabetes: From hypoglycemic mechanism to clinical trials. J Funct Foods 2020;64:103630. https://doi.org/10.1016/j.jff.2019.103630.
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- Humadi S, Hassan SM, Ahjel SW. The Use and Perception of Herbal Remedies in the Management of Nephrolithiasis Among Diverse Iraqi Patients Residing in Karbala: A Cross-Sectional Survey Conducted in Southern Iraq. Azerbaijan Pharm Pharmacother J 2023;22:135–40. https://doi.org/10.61336/appj/22-2-29.
- Al-Arifi MN. Availability and needs of herbal medicinal information resources at community pharmacy, Riyadh region, Saudi Arabia. Saudi Pharm J 2013;21:351–60. https://doi.org/10.1016/j.jsps.2012.11.004.
- Thin SM, Thet D, Li JY, Nakpun T, Nitadpakorn S, Phanudulkitti C, et al. A systematic review of community pharmacist practices in complementary medicine. Pharm Pract 2022;20:2697. https://doi.org/10.18549/PharmPract.2022.3.2697.
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- Alghamdi KS, Petzold M, Alsugoor MH, Makeen HA, Persson CL, Hussain-Alkhateeb L. Multi-stakeholder perspective on community pharmacy services in Saudi Arabia: A systematic review and meta-analyses for 2010–2020. Explor Res Clin Soc Pharm 2025;18:100608. https://doi.org/10.1016/j.rcsop.2025.100608.
References
Kropi K, Jastone KP, Kharumnuid SA, Kumar Das H, Naga MM. Cross-cultural study on the uses of traditional herbal medicine to treat various women’s health issues in Northeast India. J Ayurveda Integr Med 2024;15:101024. https://doi.org/10.1016/j.jaim.2024.101024.
WHO. Integrating Traditional Medicine in Health Care 2023. https://www.who.int/southeastasia/news/feature-stories/detail/integrating-traditional-medicine(accessed October 18, 2025).
Dubale S, Usure RE, Mekasha YT, Hasen G, Hafiz F, Kebebe D, et al. Traditional herbal medicine legislative and regulatory framework: a cross-sectional quantitative study and archival review perspectives. Front Pharmacol 2025;16:1475297. https://doi.org/10.3389/fphar.2025.1475297.
Wang H, Chen Y, Wang L, Liu Q, Yang S, Wang C. Advancing herbal medicine: enhancing product quality and safety through robust quality control practices. Front Pharmacol 2023;14. https://doi.org/10.3389/fphar.2023.1265178.
Hijazi MA, Shatila H, El-Lakany A, Aboul Ela M, Kharroubi S, Alameddine M, et al. Beliefs, practices and knowledge of community pharmacists regarding complementary and alternative medicine: national cross-sectional study in Lebanon. BMJ Open 2019;9:e025074. https://doi.org/10.1136/bmjopen-2018-025074.
Santanello C, Carr A. Pharmacists’ Knowledge, Perceptions, and Practices Regarding Herbal Medicine. Innov Pharm 2019;10:15. https://doi.org/10.24926/iip.v10i3.2059.
Khoshnoud MJ, Hajian A, Asemani O. Drug counseling for herbal medicines: patients’ perspectives on the professional performance of pharmacists in urban pharmacies. BMC Complement Med Ther 2025;25:335. https://doi.org/10.1186/s12906-025-05079-3.
Omer BA, Hamad SW, Salih SS, Sahid SM, Anwar TK, Bradosty SW, et al. Natural Therapies Utilization in Erbil Kurdistan Region, Iraq. Euphrates J Agric Sci 2025;17:1182–95.
Dehghan F, Dabaghzadeh F. Practice of community pharmacysts regarding dietary supplements in osteoarthritis management: a mystery shopper study in Iran. J Pharm Health Care Sci 2025;11:86. https://doi.org/10.1186/s40780-025-00492-9.
Ezrari S, Ben Khadda Z, Boutagayout A, Rehali M, Jaadan H, El Housni Z, et al. Health risks and toxicity mechanisms of medicinal and aromatic plants (MAPs): A comprehensive review of adverse effects on organ systems, genotoxicity and reproductive toxicity. Fitoterapia 2025;184:106630. https://doi.org/10.1016/j.fitote.2025.106630.
Brunelli L, Arnoldo L, Mazzilis G, d’Angelo M, Colautti L, Cojutti PG, et al. The knowledge and attitudes of pharmacists related to the use of dietary supplements: An observational study in northeastern Italy. Prev Med Rep 2022;30:101986. https://doi.org/10.1016/j.pmedr.2022.101986.
Alkharfy KM. Community pharmacists’ knowledge, attitudes and practices towards herbal remedies in Riyadh, Saudi Arabia. East Mediterr Health J 2010;16:988–93. https://doi.org/10.26719/2010.16.9.988.
Shraim NY, Shawahna R, Sorady MA, Aiesh BM, Alashqar GSh, Jitan RI, et al. Community pharmacists’ knowledge, practices and beliefs about complementary and alternative medicine in Palestine: a cross-sectional study. BMC Complement Altern Med 2017;17:429. https://doi.org/10.1186/s12906-017-1940-8.
Humadi S, Hassan SM, Ahjel SW. Herbal Medicine Between Current Practice and Knowledge Needs: A National Cross-Sectional Survey in Iraq. Iraqi J Pharm Sci 2024;33:208–18. https://doi.org/10.31351/vol33iss4pp208-218.
Carr A, Santanello C. Pharmacists’ Knowledge, Perceptions, and Practices Regarding Herbal Medicine. Innov Pharm 2019;10:10.24926/iip.v10i3.2059. https://doi.org/10.24926/iip.v10i3.2059.
Hu X-Y, Logue M, Maund E, Santer M, Willcox ML, Islam S, et al. Pharmacists’ perspectives on recommending herbal medicines for acute infections: a qualitative study. BJGP Open 2024;8:BJGPO.2023.0138. https://doi.org/10.3399/BJGPO.2023.0138.
Kiflu M, Tsega SS, Moges TA, Alem HA, Getachew M. Pharmacy professionals’ understanding, attitude and practice toward pharmaceutical care in Motta town, Northwest Ethiopia: A cross-sectional study. SAGE Open Med 2024;12:20503121241267239. https://doi.org/10.1177/20503121241267239.
El Hajj MS, Al-Saeed HS, Khaja M. Qatar pharmacists’ understanding, attitudes, practice and perceived barriers related to providing pharmaceutical care. Int J Clin Pharm 2016;38:330–43. https://doi.org/10.1007/s11096-016-0246-0.
Xi X, Huang Y, Lu Q, Ung COL, Hu H. Community pharmacists’ opinions and practice of pharmaceutical care at chain pharmacy and independent pharmacy in China. Int J Clin Pharm 2019;41:478–87. https://doi.org/10.1007/s11096-019-00802-w.
Stoddard GJ, Archer M, Shane-McWhorter L, Bray BE, Redd DF, Proulx J, et al. Ginkgo and Warfarin Interaction in a Large Veterans Administration Population. AMIA Annu Symp Proc AMIA Symp 2015;2015:1174–83.
Le J, Ji H, Zhou X, Wei X, Chen Y, Fu Y, et al. Pharmacology, Toxicology, and Metabolism of Sennoside A, A Medicinal Plant-Derived Natural Compound. Front Pharmacol 2021;12. https://doi.org/10.3389/fphar.2021.714586.
Chen W, Balan P, Popovich DG. Review of Ginseng Anti-Diabetic Studies. Mol Basel Switz 2019;24:4501. https://doi.org/10.3390/molecules24244501.
Shao J-W, Jiang J-L, Zou J-J, Yang M-Y, Chen F-M, Zhang Y-J, et al. Therapeutic potential of ginsenosides on diabetes: From hypoglycemic mechanism to clinical trials. J Funct Foods 2020;64:103630. https://doi.org/10.1016/j.jff.2019.103630.
Alqathama A, Alluhiabi G, Baghdadi H, Aljahani L, Khan O, Jabal S, et al. Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship? BMC Complement Med Ther 2020;20:65. https://doi.org/10.1186/s12906-020-2854-4.
Stayduhar JM, Covvey JR, Schreiber JB, Witt-Enderby PA. Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products. Pharmacy 2023;11:96. https://doi.org/10.3390/pharmacy11030096.
Wada AS, Jatau AI, Bala AA, Haruna A, Isa AM, Safiyya AS, et al. Use of traditional medicines among pharmacists in Nigeria. Complement Ther Clin Pract 2019;35:53–6. https://doi.org/10.1016/j.ctcp.2019.01.014.
Xin RKW, Yee TW, Qin WZ, Kaiyee L, Mohammed AH, Blebil A, et al. Community pharmacists’ knowledge, attitudes, and practices regarding counselling on vitamins and dietary supplements in Malaysia: A study on complementary medicines. Explor Res Clin Soc Pharm 2024;13:100410. https://doi.org/10.1016/j.rcsop.2024.100410.
Welz AN, Emberger-Klein A, Menrad K. Why people use herbal medicine: insights from a focus-group study in Germany. BMC Complement Altern Med 2018;18:92. https://doi.org/10.1186/s12906-018-2160-6.
Humadi S, Hassan SM, Ahjel SW. The Use and Perception of Herbal Remedies in the Management of Nephrolithiasis Among Diverse Iraqi Patients Residing in Karbala: A Cross-Sectional Survey Conducted in Southern Iraq. Azerbaijan Pharm Pharmacother J 2023;22:135–40. https://doi.org/10.61336/appj/22-2-29.
Al-Arifi MN. Availability and needs of herbal medicinal information resources at community pharmacy, Riyadh region, Saudi Arabia. Saudi Pharm J 2013;21:351–60. https://doi.org/10.1016/j.jsps.2012.11.004.
Thin SM, Thet D, Li JY, Nakpun T, Nitadpakorn S, Phanudulkitti C, et al. A systematic review of community pharmacist practices in complementary medicine. Pharm Pract 2022;20:2697. https://doi.org/10.18549/PharmPract.2022.3.2697.
Mohammed SI, Dawood EB, Abaas IS. Perceptions and attitudes of community pharmacists towards patient counseling and continuing pharmacy education programs in Iraq. Iraqi J Pharm Sci 2019;28:30–6. https://doi.org/10.31351/vol28iss2pp30-36.
Alghamdi KS, Petzold M, Alsugoor MH, Makeen HA, Persson CL, Hussain-Alkhateeb L. Multi-stakeholder perspective on community pharmacy services in Saudi Arabia: A systematic review and meta-analyses for 2010–2020. Explor Res Clin Soc Pharm 2025;18:100608. https://doi.org/10.1016/j.rcsop.2025.100608.
