Construct For Use and Recurring Use of Natural Health Products: Qualitative Insights from Consumers in Malaysia

Construct for use and Recurring use of Natural Health Products: Qualitative Insights from Consumers in Malaysia

Wardah Mustafa Din*¹, Zurina Mahadi¹, Latifah Amin², Ahmad Firdhaus Arham¹, Yusnaini Md Yusoff¹

¹Pusat Pengajian Citra Universiti (School of Liberal Studies), Universiti Kebangsaan Malaysia

²Institut Islam Hadhari (Institute of Islamic Civilization), Universiti Kebangsaan Malaysia

DOI: https://dx.doi.org/10.47772/IJRISS.2025.905000163

Received: 16 April 2025; Accepted: 07 May 2025; Published: 04 June 2025

ABSTRACT

Adoption of Natural Health Products (NHP) in daily health routine among consumers are increasing, especially after the Covid-19 pandemic. The aim of this study is to explore the various reasons behind the use of NHP and understand the construct that motivates consumers to make a recurring purchase of NHPs. To explore this aim, the study employs a qualitative approach of in-depth interviews with 30 participants whom are consumers of at least one (1) natural health product in Malaysia for the past one year. Participants were interviewed using a semi-structured protocol, and data were transcribed and thematically analysed. There are three main purpose of NHP usage among participants, which are to treat illness, to control symptoms or pain related to illness and to prevent illness or promote general health. Motivational constructs for repurchase of NHPs are perceived efficacy to health and well-being, reduction in prescribed medicine dosage and its reasonable price. In summary, there are myriad of reasons underlying the preferences towards the consumption of NHP among Malaysians and the constructs of use are often complex, depending to individual objectives.

Keywords: Natural health products, consumer, qualitative research, factors for use, factors for repurchase.

INTRODUCTION

Importance of natural products in management of health and well-being dated back since ancient times as evidenced by many ancient medical manuscripts across the civilization[1]^,[2]. Ethno-pharmacology and ethno-botanical studies displays exhaustive database of medicinal plants, herbals and other natural products that is being used to cure illness in the early times and acts as evidence to pursue further pharmacology studies [3]^,[4]. Many ethnics are still using the herbs and natural resources until now as ailments and medications in its original formulation[5]^,[6], but most natural health products now, are being commercially manufactured due to many reasons. Among the reasons, accessibility to raw materials[7], convenience of use and development of recent technology in manufacturing and formulation[8].

Valued at close to USD $10 billion, the health supplement product market in Southeast Asia is continuously ascending due to the rise of health conscious consumers[9]. Additionally, according to the National Pharmaceutical Regulatory Agency (NPRA) Annual Report for year 2019, which reports that the highest new product registration is from natural health products mounting to 994 applications from the total of 1324 applications. NHP encompasses both the traditional products and health supplements with 679 and 315 registrations for each product category. These numbers significantly display the vast amount of NHP products that are being marketed to consumers via different platforms, among others includes herbal drinks, supplement capsules and tablets as well as topical herbal formulations.

Studies across countries highlights that consumers use natural health products for myriad of reasons. A qualitative study among consumers in Germany explored that among reasons of herbal use are for treatment of illness for all age groups and to prevent illness and promoting general health were for elderly citizens[10]. Besides that, a study in Jordan highlight the same findings quantitatively whereby majority responded that the use of herbal medicines are for treatment of illness, while other reasons are for maintaining health and prevention of illness[11]. Two other different purpose of use mentioned by consumers from United Arab Emirates (UAE) are for relaxation and increase immunity[12]. In Malaysia, many studies display the high prevalence of herbal products use among patients and consumers[13]^,[14]. Recently, the purpose of use being studies was for the prevention of a specific illness such as Covid-19[15] and to cure and slow the progress of cancer[16]. A survey on complementary and alternative medicine (CAM) use among elderly in Malaysia shows that the main purpose of use is to maintain overall health and well-being[17].

Currently in Malaysia, NHP’s are regulated under NPRA, and official guidelines are available for producers and manufacturers. In the aspect of consumers, consumers can check the registration of NHPs in the Quest3+ website, and make a report for products which give adverse effects via the NPRA portal. These initiatives are pivotal to safe guard consumers and guide consumers to make informed choices, as many consumers have perceptions that any natural products are safe[18]. NHPs contain pharmacologically active molecules that might give therapeutic effects and might also potentially be able to cause adverse effects to human health due to toxic phytochemical content[19], herb-drug interaction[20] and synergistic effects of herbs and medicine[21].

This study aims to explore in-depth each construct pertaining the purpose of use and recurring use of NHP among Malaysian consumers. In-depth understanding about the constructs provides deeper phenomena, context and experience of a consumer in using NHP and hence deliver important new insights which complements quantitative data available. Significance of the findings provide guidance to policymakers in both regulation of natural health products and upstream supply and demand chain of herbals in Malaysia.

METHODOLOGY

Data collection

To explore the purpose underlying usage of natural health products (NHP) and the constructs of preferred choice and recurring use among Malaysians, a qualitative approach of in-depth interviews were applied for data collection. Qualitative data is suitable to explore and understand complex phenomena and study in-depth dynamics of the research subject matter[22]. Participants were recruited using a purposeful sampling strategy that focuses on the need to obtain ‘information rich cases’, in other words, respondents who are willing to talk freely and openly about the specific subject of interest. Criteria of respondents includes: i) consumers, which at least use one NHP in the past 5 years, ii) Malaysian citizen, iii) adult (18 years old and above) and iv) able to converse in Bahasa Malaysia. Total participants for the interview is 30 adults (n=30). Consents were recorded in a written document from each respondent and also verbally sought again before each interview. All interviews are being conducted face to face within the states of Peninsular Malaysia.

A semi-structured protocol was administered in all of the interviews with three (3) main questions while allowing the researchers to probe additional questions in response to the answers provided by the participants if needed. Video and audio recording of each interview was done and transcribed verbatim afterwards. Interview were conducted in Bahasa Malaysia which is the formal language for Malaysia. Transcripts were translated for report and publication purposes.

Data analysis

Data obtained from in-depth interviews are recorded and transcribed. The verbatim transcripts are thematically analysed using Atlas.Ti software, Version 22. Thematic analysis involves methodically reading through the verbatim transcripts and segmenting and coding the text into categories that highlights what the group discussed[23]. Statements in the verbatim transcript are tagged in the software to appropriate identified themes. The themes are then assessed, compared and interpreted and any similarities and differences will be noted. This process is done continuously via workshops with all researchers until a consensus is achieved. To secure the trustworthiness of the analysis, the transcripts in Bahasa Malaysia were returned to the participants to check on the interpretation whether or not they fit their actual meanings, definitions or perceptions[22]. This is important step to reduce bias from researchers. Data saturation is achieved after no new emerging themes are being discussed by the participants.

FINDINGS

In this section, brief details of all of the participants are being reported, followed by main themes pertaining the purpose of use and constructs for recurring use. Brief descriptive analysis is being done for the sake of tabulating the mentioning of a particular theme, and guiding the elaboration of results. Quotations of the interviews were carefully selected to be representative for the themes and are meticulously translated by researchers to English from Bahasa Melayu. For each quote, the code of participants is mentioned, and names remain anonymous.

Participants

Demographic profiles of the in-depth interview participants (n=30) are described in Table 1. Participants are all consumers of at least one NHP and voluntarily participated in the study. Among the participants, 60% were women. Participants were categorized into youth (18-35 years old), adults (35-60 years old) and senior citizens (above 60 years old). Percentage of youths and adults are balanced, which is 36.7% of youth participants and 40.0% of adult participants. Married participants are dominant (63.3%) compared to unmarried participants (30.0%). Among the profiles that were captured in the study is either participants consuming a single product or using multiple products (more than one product) simultaneously. More participants use more than one product simultaneously (56.7%).

Table 1. Demographic profiling of participants

Purpose of use

In the study, three different purposes of use were revealed, namely to treat illness, to control symptoms or pain related to the illness and to prevent illness or promote general health. Participants that use NHP to treat illness, mostly are for treatment of mild illnesses such as gastric, skin inflammation, sinusitis, and period pain. Whereas participants that use NHP to control symptoms or control pain related to the illness, are patients of high blood pressure, diabetes, chronic sinusitis, asthma, and acute knee pain. Promoting general health and using NHP as a supplement for the main reasons of increasing energy, increasing immune system, improving blood circulation and reducing stress.

Among the three purposes identified in the study, both purposes except preventing illness, were nearly equal in the frequency of mentioning. What significantly was observed was that the mentioning of the purpose differs in regards to participants age, marital status and either using a single product or multiple products. This is clearly tabulated in Table 2 which shows the distribution of purpose of use among participants, stratified to age groups, marital status and single product use.

Table 2. Distribution of purpose of use among participants, according to age, marital status and single use of products.

*The total numbers represent absolute frequency of mentioning a specific purpose with multiple answers being possible.

It is observed in this study that youths are more prone to consume NHP when they are diagnosed with a chronic or acute illness, and are using NHP as a sort of treatment to the illness itself or to control the symptoms or pain related to it. Among the illnesses being mentioned were high-blood pressure, sinusitis and nephrotic syndrome. One of the participants, which uses Nigella sativa sp. oil for treatment of his nephrotic syndrome mentioned that the use of NHP has helped him to treat the illness and reduce the amount of prednisolone prescribed by his doctor from 10 pills per day to eventually only one pill a day (P011).

Another youth participant who has been diagnosed with high blood pressure used NHP to help him manage with the effects of the illness. The participant (P027) used Eurycoma longifolia sp. dried roots which his grandmother bought at a traditional medicine local store. According to his explanation, the remedy was suggested by the store owner, and he drinks the decoction of the herb once daily.

Table 3. Verbatim transcripts of participants

The discussion among adults highlighted a different purpose which is the promotion of general health and well-being. It was mentioned eight times by adults, which is more than the other purposes. Among those mentioned regarding general health is about increasing the immune system and to maintain energy sufficient for everyday routine. A women participant emphasized that she consumes an herbal drink made from several herbal ingredients to give her extra energy for everyday routine, and does not use it for treatment of any specific illness (P003).

One of the senior adult female participants (P029) used more than one NHP to cater different purposes which are to maintain general women’s health, to heal illness and to control the pain related to illness. This gives insights to the study that consumers consume a product for a specific purpose, and therefore will use more than one product if they have more than one purpose. The same participant (P029) used a different NHP to treat her heel spur and another NHP to control her sinusitis.

We also explored whether participants use one single product or multiple products concurrently. The findings show that participants that use NHP for treatment of illness, only use one specific product whereas for participants that consume NHP to maintain general health, they tend to use multiple products. Treatment of illness was mentioned ten times by the participants who used a single product while promoting general health and nine times by the participants who used multiple products. Single use of NHP in treating illness was observed in participants P010 who uses a cream to treat acne and participant P019 who uses herbal products to treat itchy scalp and hair loss.

In a nutshell, there are three different themes of purpose of use which are as demonstrated above in the findings; i.e., for treatment of illness, to control symptoms or pain related to the illness, and to prevent illness or promote general health. Consumers have their own purpose in taking NHPs, according to their condition and needs.

Motivations for Recurring Use

Probing deeper into consumers’ reason for use of NHP, we also explored whether the consumers repurchase and use the NHP repeatedly and their reasons behind it. Interestingly, out of 30 respondents, 14 respondents mentioned repurchasing the NHP more than once and will continue to use the product. The motivating constructs for recurring use are perceived efficacy of the product after experiencing the positive effects, ability to reduce the prescribed medicine dosage for a certain illness, and affordable price.

Participants highlighted that efficacy of NHP is among the motives they repurchase the product. The efficacy however is based on personal experience and is mostly perceived efficacy because the experience is not backed by any clinical data or diagnosed by any clinician. A participant with skin irritation used a cream formulated from Cucurma longa sp. and have been using it for 4 years repeatedly. She mentioned the reason for recurring use is that she experiences positive effects on her skin and will continue to use it due to its effects (P010).

Other reasons for recurring use as mentioned by consumers are the effect of ‘feeling better’ in terms of well-being and maintain energy level. Besides that, she also mentioned that the price is also affordable to repurchase every month. One of the participants (P003) shared that she makes sure that the product will always be available at home, and will stock up every two weeks. The product is an herbal drink which are made from twelve different natural ingredients.

A participant (P004) continued the daily consumption of olive oil (Olea europaea) because it helps to reduce the dosage of her prescribed medicine for Gastroesophageal reflux disease (GERD). According to her, although the olive oil is rather expensive, she is willing to spend for the natural remedy because she could not bear the pain when her stomach aches.

DISCUSSION

On the basis of in-depth interviews, our study explored the reasons for consumers using NHP in the general population. Our purposive sampling focused on any consumers currently using NHPs or have once any time before use NHP. In this study, 60% of our participants were female which aligned with findings from other studies which stated that females are more attracted to consuming natural and herbal based products[14], [24], [25].

In this study, three different purposes of use were explored, namely to treat illness, to control symptoms or pain related to the illness and to prevent illness or to promote general health. All reasons are mentioned about the same number of times. Report on the use of medicinal herbs among Surinamese migrants in the Netherlands shows similar findings, with the main purpose of use is for health promotion[26]. This discovery is a bit different from a Focus Group Discussion in Germany whereby, findings demonstrate that the most frequently mentioned purpose is for the treatment of illness in comparison to prevention of illness and promotion of well-being[10].

Participants that use NHP to treat illness, mostly are for treatment of mild to moderate illnesses such as gastric, skin inflammation, sinusitis, and period pain. This is in line with studies that show consumers are most likely to seek natural remedies for mild illness such as headache and colds[27]. Whereas participants that use NHP to control symptoms or control pain related to the illness, are patients of chronic illness such as high blood pressure, diabetes, chronic sinusitis, asthma, and acute knee pain. A study from Mohamad et al. states that women in Malaysia use herbal remedies for chronic illness such as hypertension and diabetes[14].

This study suggested that NHP is mainly used as a supplement to promote general health by increasing energy and immune system, improving blood circulation and reducing stress. The use of NHP for holistic well-being or general health is common especially after the Covid-19 pandemic, whereby consumers perceived to benefit from the natural supplements in some way[15]. Demography wise, what was significantly observed was that the mentioning of the purpose differs in regards to participants age, marital status and either using a single product or multiple products. In a study by Bishop et al. (2010), both demographic and health characteristics contribute independently in the use of complementary and alternative medicine including herbal products[28]. In Ghana, a study highlights that education level and the dosage form of the product influence the choice of using herbal products, but gender, age and occupation does not have a positive relationship[29].

Consumers have personal objectives in seeking NHPs and incorporating it into personal health regimes. According to the Theory of Consumption Values, consumer behaviour of purchase and repurchase of a specific product is influenced by any or all the five different values[30]. From the findings regarding the motivations for recurring use, the reasons are aligned with the consumption value of functional, whereby a consumer make decision based on its function and performance of the product which includes its characteristics of reliability and price. Although for a natural health product, the function and performance experienced by consumers are self-perceived due to minimal clinical evidence data of the product.

Limitation

Even though in-depth interview methodology applied in this study has its strength, we also note the limitations of the study. First of all, like other qualitative analysis, the mentions and themes are not quantifiable. The objective for the qualitative analysis is to provide deep data and insights from the consumers rather than addressing statistically evidenced data. Although a high standard of research protocol was followed to achieve reliability and validity of the data, transcripts and analysis still may be influenced by interpretation of authors and researchers. Furthermore, the data also cannot be generalized to the whole population and could not be easily compared to other locations since the focus of participants are from Peninsular Malaysia only. This also means that the results may not reflect the behaviour of consumers in East Malaysia or other cultural contexts.

CONCLUSION

We conclude that NHPs are being used for different purposes and aims across different gender, age and marital status. There are three main purposes of NHP consumption which are for treatment of illness, controlling symptoms or pain and for prevention of illness and general well-being. There are also three constructs for recurring use i.e., efficacy of the product after experiencing the positive effects, ability to reduce the prescribed medicine dosage for a certain illness, and affordable price. All three constructs are aligned with the functional value in the theory of consumption values. Some consumers are aware of the risks and limitations of NHPs in attaining the objectives of use, but some consumers need to be informed and guided in regards for safe-use of NHPs, especially consumers with chronic illnesses. Therefore, a holistic guideline on safe and quality use of NHPs are pivotal in protecting consumers and patients against risks and adverse effects related to NHPs. Future studies to explore how consumers assess perceived efficacy whether through personal experience, word-of-mouth, or marketing influences would provide further depth in understanding the context of NHP consumption.

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