Understanding pharmacists' engagement with selected forms of complementary and alternative medicine: A cross-sectional survey of health and dietary supplements

• We explored pharmacists’ knowledge, attitude and practice toward CAM. • We found moderate CAM knowledge with gaps in herbs like silymarin and ginkgo biloba . • Pharmacists generally value CAM but still question its scientific support. • Many pharmacists advise on CAM, yet few refer patients to CAM specialists. • Pharmacists’ CAM knowledge varies with practice location, ethnicity and experience. The rising use of complementary and alternative medicine (CAM), particularly health and dietary supplements, alongside conventional therapies highlights the need for pharmacists to be knowledgeable and confident in guiding patients. In pharmacy practice, these product-based forms of CAM are the most commonly encountered. This study aimed to assess pharmacists’ knowledge, attitude and practice (KAP) towards CAM (operationally define in this study as health and dietary supplements), examine interrelationships among these domains and explore the influence of demographic factors. A cross-sectional survey was conducted between April and May 2025 among pharmacists in hospitals, health clinics and community pharmacies across Malaysia. Using convenience sampling, 150 responses were collected, with 141 valid responses analysed. A validated self-administered questionnaire (I-CVI: 0.83–1.00; S-CVI/Ave: 0.98–1.00) assessed KAP through 25 items. Descriptive statistics, Pearson correlation and Chi-square/Fisher’s exact tests were used for data analysis. Pharmacists demonstrated moderate knowledge (mean=6.26 ± 2.49), mixed attitude (mean=27.13 ± 3.37) and mixed practice (mean=12.44 ± 2.71) regarding health and dietary supplements as forms of CAM. Over half (50.3%) reported frequent use of these products and most provided counselling on interactions (67.4%) and adverse effects (53.9%). However, 57.4% never referred patients to CAM specialists, suggesting limited integration into broader healthcare networks. Despite mixed views, overwhelming support was reported for integrating CAM-related education into pharmacy curricula (97.2%) and the national healthcare system (84.3%). Significant positive correlations were found between knowledge and practice (r=0.480, p<0.001), attitude and practice (r=0.295, p<0.001), and knowledge and attitude (r=0.204, p=0.015), indicating that improvements in one area may positively influence others. Work setting, ethnicity, years of working experience and practice location significantly influenced knowledge scores. Pharmacists’ engagement with CAM, primarily health and dietary supplements, was characterised by variable knowledge, attitude and practice. While openness was evident, gaps remain in delivering consistent, evidence-based guidance to patients. Structured education, standardised guidelines, equitable resource access and stronger regulatory support are needed. Targeted training and policy reform are vital to integrate pharmacists into collaborative, patient-centred care models while acknowledging the defined scope of CAM addressed in this study.