Establishing a Unified Framework for Natural Health Product Quality: Insights from North American Naturopathic Practitioners

Background: Healthcare professionals have the responsibility to educate their patients on natural health products (NHPs), yet the assessment of NHP quality throughout North America remains relatively subjective and prone to biases. This study aims to qualify multi-ingredient NHPs, based on the subjective and empirical attributes sought by naturopathic doctors (NDs) who regularly prescribe them. Methods: This study was divided into two phases. Phase 1 involved virtual interviews with eight experienced NDs across North America. Phase 2 was an online survey of licensed and practicing NDs based on the key themes extracted from Phase 1. Results: Using an inductive approach to qualitative analysis in Phase 1, four key themes were extracted: sourcing, labelling, monographs, and third-party testing, with each one having several sub-themes. Phase 2 revealed that sourcing was the most important theme, specifically from manufacturing companies that adhere to good manufacturing practices (GMPs), followed by products on which labels provide specific details of the active compounds. Third-party testing ranked third, especially if used to verify that ingredients match the label, and monographs should include referenced evidence on the therapeutic efficacy specific to the recommended dose of the product. Conclusion: NDs believe that the strongest measure of complex NHP quality is the manufacturing company’s ability to adhere to GMPs. Third-party testing could be used to verify standards of quality with product details included in labels and ample referenced evidence in monographs."