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Journal of Applied Pharmaceutical Science Vol. 7 (12), pp. 144-150, December, 2017
Available online at http://www.japsonline.com
DOI: 10.7324/JAPS.2017.71220
ISSN 2231-3354
Exploring the use of and perceptions about honey as complementary
and alternative medicine among the general public in the state of
Selangor, Malaysia
Mohd Shahezwan Abd Wahab1, Noordin Othman2*, Noor Hazwani Izzati Othman1, Amirah Adhwani Jamari1,
Aida Azlina Ali3
1Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, 42300 Puncak Alam, Malaysia.
2Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, PO Box 344, Al-Madinah Al-Munawwarah, Saudi Arabia.
3Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Selangor, 42300 Puncak Alam, Malaysia.
ARTICLE INFO
ABSTRACT
Article history:
Received on: 13/07/2017
Accepted on: 15/10/2017
Available online: 30/12/2017
Objective: Honey has been used as a biologically-based complementary and alternative medicine (CAM) since
ancient times. The present study aimed to explore the use of and the perceptions about honey as a CAM among
the general public in Selangor.
Method: A cross-sectional study using a self-completed questionnaire was employed. Participants were
recruited using convenience sampling method from three towns in the state of Selangor.
Results: 56 % (168/300) of respondents used honey as CAM. Most users used honey as a dietary supplement
for well-being (71.4 %, 120/168), or to treat coughs (57.1%, 96/168), and sore throats (53 %, 89/168). A small
percentage of users (13.1 %, 22/168) used honey to treat asthma. The respondents generally showed favourable
perceptions about honey as CAM as more than 60 % of them rated strongly agree and agree for each of the
perception item in the survey. The users obtained their supply of honey from supermarkets (42.3%, 71/168),
grocery stores (32.7 %, 55/168), and friends/family (31%, 52/168). In addition, most users sought information
about honey from friends/family (63.1 %, 106/168), the Internet (60.7 %, 102/168) and advertisements (39.3 %,
66/168).
Conclusion: The respondents generally had favourable perceptions about honey as CAM. Future work should
aim to produce more scientific evidences of the benefits and safety of honey. The use of honey supplies from
unreliable sources as CAM and unreliable sources of information as well as potential self-medication with
honey for serious diseases should raise concerns.
Key words:
Complementary and
alternative medicine; honey;
Malaysia; perceptions,
survey.
INTRODUCTION
The use of the complementary and alternative medicine
(CAM) is common among the general public (Ventola, 2010).
The two main CAM categories are the biologically-based
therapies (e.g., herbs, vitamins, and minerals) and the mind-body
* Corresponding Author
Noordin Othman, Department of Clinical and Hospital Pharmacy,
College of Pharmacy, Taibah University, PO Box 344, Al-Madinah Al-
Munawwarah, 30001 Saudi Arabia. Tel.: +966559234544;
Fax: +96648461172. E-mail: noordin_uia @ yahoo.com
practices (e.g., massage, acupuncture, and meditation). Among the
CAM modalities, the biologically-based therapies have been
reported as the most commonly used in many previous studies (Siti
et al., 2009; Clarke et al., 2015; Barnes et al., 2007). In a
nationwide survey in Malaysia, 69.4 % (4821/6947) of the
respondents had used CAM at least once in their lifetime and 55.6
% (3863/6947) of them had used CAM within the previous 12
months of the survey (Siti et al., 2009). In the survey, the use of
the biologically-based therapies were found to be the most
common with 88.9 % and 87.3 % of the surveyed CAM users had
used the modalities to overcome their health problems and
maintain their health, respectively (Siti et al., 2009).
Wahab et al. / Journal of Applied Pharmaceutical Science 7 (12); 2017: 144-150 145
Honey has been used as a biologically-based CAM since
ancient times (Eteraf-Oskouei and Najafi, 2013). In Malaysia,
people have often used honey in combination with other herbs to
treat diseases or to maintain their health (Siti et al., 2009). The use
of honey as CAM has also been reported in many other countries
such as Argentina (Kujawska et al., 2012), India (Savithramma et
al., 2007), Korea (Lee et al., 2004) and the United States of
America (U.S.A.) (Burge and Albright, 2002). In a survey carried
out in Romania, 20.5 % (45/220) respondents stated that they
would consume honey as medicine.
The 2003 survey has identified the medical benefit of
honey as an important motivation factor for the Romanian people
to use honey (Arvanitoyannis and Krystallis, 2006). In a more
recent Romanian survey carried out in 2012, 98 % (1421/1449) of
respondents reported that they had consumed honey and 88 %
(1275/1449) of all respondents agreed that honey would be good
for health (Pocol and Bolboacă, 2013). In another survey in Saudi
Arabia, 87.3 % (289/331) of respondents claimed that they had
used honey because of its medicinal properties (Ismaiel et al.,
2014). Honey mostly consists of fructose and glucose.
However, it also contains a wide range of substances such as
phytochemicals, flavonoids, enzymes, vitamins, minerals and other
compounds (Ajibola, 2015). The constituents of honey work
synergistically to produce its medicinal effects (Eteraf-Oskouei
and Najafi, 2013; Ajibola, 2015). Over the past decades, numerous
laboratory and clinical studies have shown the efficacy of honey
especially in terms of its antibacterial properties, and in wound
management (Eteraf-Oskouei and Najafi, 2013; Ajibola, 2015). In
addition, the benefits of using honey in treating ophthalmic and
dental diseases, and common ailments such as coughs, have also
been reported (Salehi et al., 2014; Atwa et al., 2014; Paul et al.,
2007). Moreover, animal model studies have suggested that honey
may be beneficial in the treatment of metabolic, cardiovascular,
and neoplastic diseases (Eteraf-Oskouei and Najafi, 2013; Hussein
et al., 2012; Bardy et al., 2008; Abdulrhman et al., 2013). The
usefulness of honey and its well-documented antioxidant and anti-
inflammatory properties make it attractive and viable to be
developed as a treatment modality for various diseases, and for the
maintenance of health (Ajibola, 2015; Bhatti et al., 2016).
Although there are many studies which are in favor of the
usefulness of honey in the treatment of various diseases,
information about its use and perceptions of the general public
about honey as CAM is still lacking. Previous studies which
sought public opinions about honey were mainly market surveys
or consumer behavior studies that focused on honey as food. This
present study aimed to explore the use of honey and the
perceptions of the public in the state of Selangor, Malaysia about
honey as CAM.
The findings from this study may be used to assist the
healthcare professionals in gaining a better understanding of the
use of honey as CAM and may draw the attention of researchers
for further investigations to produce more scientific evidences of
the benefits and safety of honey.
Methods This study was a cross-sectional survey which explored
the use of and the perceptions of the public about honey as CAM.
A questionnaire was developed based on relevant literature with
some modifications (Pocol and Bolboacă, 2013; Wahab et al.,
2014; Mitha et al., 2013; Hassali et al., 2012a). The questionnaire
was constructed in the English language, translated into Malay and
then back-translated into English to ensure its accuracy and
validity. The final questionnaire contained survey items in both
languages. To assess face and content validity, the questionnaire
was reviewed by professors in pharmacy and researchers whose
studies were related to honey. The questionnaire was then piloted
among 50 adults who were sampled using convenience sampling
technique to assess its readability, clarity and comprehensibility.
However, results from the pilot survey were not included in the
final data analysis. In the main study, honey would be considered
as CAM if it was used to treat diseases, or to promote health
and/or general well-being in the past three months. The
questionnaire consisted of two sections: (1) respondents’
demographic details and their patterns of honey use; and (2)
perceptions about honey as CAM. In the second section of the
questionnaire, respondents were asked to indicate their agreement
using a 5-point Likert type scale ranging from 1=strongly disagree
to 5=strongly agree. The study received ethical approval from the
ethical committee of the Faculty of Pharmacy of Universiti
Teknologi MARA (UiTM).
The respondents of the survey were members of the
general public selected from three towns in Selangor, a west coast
state of Peninsular Malaysia. The three selected towns, namely,
Shah Alam, Puncak Alam, and Sabak Bernam, were chosen due to
logistic reasons. In the present study, 100 respondents were
recruited from each town using non-proportional quota sampling
method. In each town, one main business area was identified and
two researchers approached potential respondents to be recruited
as participants in the study. Selection of the respondents was
performed in a non-probability manner. Each individual who
agreed to participate in the survey was assured of confidentiality
and anonymity. The survey was self-completed by the
respondents. The completion of the questionnaire indicated
consent for their participation in the study. All data were analyzed
using SPSS statistical software (version 23). For the purpose of
analysis, the Likert-type scale responses of “strongly agree and
agree” and “strongly disagree and disagree” were grouped
together. Data analysis utilized the chi-squared or Fisher’s exact
tests for categorical variables and the independent t-test for
continuous variables. A P value of < 0.05 would be considered
significant.
RESULTS
Table 1 shows the demographic characteristics of the
respondents. Out of 300 respondents who completed the
questionnaires, 56 % (168/300) indicated that they had used honey
as CAM in the past three months.
146
Wahab et al. / Journal of Applied Pharmaceutical Science 7 (12); 2017: 144-150
There was no significant difference in the use of honey as
CAM among respondents from the three towns. Approximately 60
% (105/168) of the users were female. Most users (57.1 %,
96/168) were 30 years and younger. The majority of the
respondents were Malays (78.3 %, 235/300). Compared to the
non-users of honey, the users were significantly more likely to
comprise of respondents who identified themselves as Malays
(users: 85.7 % [144/168] vs. non-users: 68.9 % [91/132]; P< 0.01).
In addition, the users of honey were significantly more likely to
earn more than RM 2000 monthly compared to the non-users
(users: 51.2 % [86/168] vs. 32.6 % [43/132]; P< 0.01). Table 2
shows the patterns of use of honey among the users. The most
common type of honey used was Tualang (45.8 %, 77/168). The
majority of respondents used honey as a dietary supplement for
well-being (71.4 %, 120/168). Many users claimed that they used
honey to treat common ailments such as coughs (57.1 %, 96/168),
and sore throats (53%, 89/168). A small percentage of users (13.1
%, 22/168) used honey to treat asthma. The users obtained their
honey supplies from the supermarkets (42.3 %, 71/168), grocery
stores (32.7 %, 55/168), and from friends/family (31%, 52/168). In
addition, most users (79.2%, 133/168) were willing to spend about
RM 20 and higher for honey. Users sought information about
honey from friends/family (63.1 %, 106/168), the Internet (60.7%,
102/168), advertisements (39.3 %, 66/168) and the newspaper
(37.5 %, 63/168). In general, the respondents showed favourable
perceptions about honey as CAM as more than 60 % of them rated
strongly agree and agree for each of the survey statement (Table
3). The majority of both the honey users and non-users strongly
agreed and agreed that there was a sufficient evidence supports the
benefits of honey as a complementary medicine (users: 66.1 %
[111/168] vs. 68.2 % [90/132]; P = 0.85) and that the use of honey
as food supplement for general health should be promoted (users:
86.9 % [146/168] vs. 80.3 % [106/132]; P = 0.21). We found no
significant difference in the perceptions of the users and non-users
for the two survey statement.
Table 2: Pattern of honey use by usersa (n = 168).
Pattern of honey use
n (%)
Type of honey usedb
Tualang
Acacia
Kelulut
Nenas
Manuka
Gelam
Others
Unsure of the type
77 (45.8)
20 (11.9)
15 (8.9)
11 (6.5)
7 (4.2)
6 (3.6)
23 (13.7)
64 (38.1)
Used honey as dietary supplement for general well-being
120 (71.4)
Used honey for treatment of diseasesb
Coughs
Sore throat
Wound
Asthma
Animal stings
Skin diseases
Stomach ache
Ulcers
Others
96 (57.1)
89 (53)
28 (16.7)
22 (13.1)
21 (12.5)
21 (12.5)
9 (5.4)
6 (3.6)
25 (14.9)
Frequency of using honey
Very frequent
Frequently
Sometimes
Occasionally
Rarely
19 (11.3)
33 (19.6)
65 (38.7)
18 (10.7)
33 (19.6)
Table 1: Characteristics of study respondents.
Demographic characteristics
Usersa (n = 168)
Non-usersb (n = 132)
P value
Total
(n = 300)
Number (percentage)
Township
Shah Alam
Puncak Alam
Sabak Bernam
57 (33.9)
55 (32.7)
56 (33.3)
43 (32.6)
45 (34.1)
44 (33.3)
0.08c
100 (33.3)
100 (33.3)
100 (33.3)
Gender
Male
Female
63 (37.5)
105 (62.5)
57 (43.2)
75 (56.8)
0.32c
120 (40)
180 (60)
Age
Mean (SD)
30.98 (9.15)
30.37 (10.9)
0.60d
30.7 (9.97)
Age group
30 and below
31 and above
96 (57.1)
72 (42.9)
80 (60.6)
52 (39.4)
0.55c
176 (58.7)
124 (41.3)
Race
Malay
Non-Malay
144 (85.7)
24 (14.3)
91 (68.9)
41 (31.1)
<0.001c
235 (78.3)
65 (21.7)
Education level
University level
Lower than university level
126 (75)
42 (25)
96 (72.7)
36 (27.3)
0.66c
222 (74)
78 (26)
Monthly incomee
RM 2000 and lower
More than RM 2000
82 (48.8)
86 (51.2)
89 (67.4)
43 (32.6)
0.001c
171 (57)
129 (43)
aReported to use honey to treat diseases, or to promote health and/or general well-being in the past three months.
bNever use honey to treat diseases, or to promote health and/or general well-being in the past three months.
cChi-squared used.
dIndependent t-test used.
eRM 1 is approximately USD 0.25.
Wahab et al. / Journal of Applied Pharmaceutical Science 7 (12); 2017: 144-150 147
Source of obtainment of honeyb
Supermarkets
Grocery stores
Friends and/or family
Health / organic stores
Pharmacies
Traditional medicine outlets
Night markets
Beekeepers
Online
Other sources
71 (42.3)
55 (32.7)
52 (31)
35 (20.8)
34 (20.2)
26 (15.5)
21 (12.5)
20 (11.9)
12 (7.1)
18 (10.7)
Spending on honeyc
<RM 20
RM 20 – RM 40
RM 41 – RM 60
>RM 60
35 (20.8)
52 (30.9)
51 (30.4)
30 (17.9)
Source of information about honeyb
Friends and/or family
Internet
Advertisements
Newspapers
Mass media (e.g. radio, television, etc.)
Books
Scientific articles
Health professionals
Others
106 (63.1)
102 (60.7)
66 (39.3)
63 (37.5)
60 (35.7)
50 (29.8)
33 (19.6)
29 (17.3)
12 (7.1)
aSurveyed among honey users only.
bRespondents can provide more than one response and therefore responses
do not add up to 100 %.
cRM 1 is approximately USD 0.25.
In addition, although not using honey as CAM for the
past 3 months of the survey, the majority of the non-users (65.2 %,
86/132) rated strongly agree and agree that they would rather use
honey to treat common ailments such as coughs and sore throats
than using modern medicines. The honey users were significantly
more likely to strongly agree and agree with the other 6
survey statements compared to the non-users. It was also observed
that a significantly higher proportion of male respondents
strongly agreed that there was sufficient evidence that supports
the use of honey as CAM compared to the female respondents
(male: 75 % [90/120] vs. female: 61.7 % [111/180]; P = 0.04). The
female respondents however were significantly more likely to
strongly agree and agree that honey can stimulate body natural
therapeutic power compared to their male counterpart (male: 55.8
% [67/120] vs. female: 64.4 % [116/180]; P< 0.01). In regards to
age, although the younger respondent group (30 years and below)
were significantly more likely to strongly agree and agree that
there is a need to disseminate information about honey to the
public (younger: 84.7 % [149/176] vs. older: 74.2 % [92/124]; P<
0.01), significantly higher proportions of respondents from the
older group (31 years and above) strongly agree and agree that
honey can stimulate body natural power (younger: 56.8 %,
[100/176] vs. older: 66.9 % [83/124]; P = 0.04), and that honey is
easy to be used (younger: 78.4 % [138/176] vs. older: 82.3 %
[102/124]; P = 0.01). Compared to their younger counterpart the
respondents in the older group were also significantly more likely
to strongly agree and agree that they would rather use honey as
CAM to treat common ailments than using modern medicines
(younger: 63.1 % [111/176] vs. older: 73.4 % [91/124]; P = 0.03).
Overall, the Malay respondents appeared to be more favorable
towards honey as CAM compared to the non-Malays. Significantly
higher proportion of the Malay respondents rated strongly agree
and agree to 7 out of 9 survey statements. Our findings also
showed that those who had university education were more likely
to strongly agree and agree that they would not mind to spend
money on honey as CAM (university level: 64 % [142/222] vs.
lower than university level: 57.7 % [45/78]; P< 0.01). Although
we found that those who earn more than RM 2000 and above
monthly were more likely to use honey as CAM in the past 3
months of the survey compared those who earn less than RM 2000
a month, the higher earner group showed no significant difference
in their perceptions about honey as CAM when compared to those
in the lower earner group.
Table 3: Perceptions of respondents towards honey as CAM.
Statement
Frequency (%) of responses
P value
Strongly
Agree and
Agree
Neutral
Disagree
and
Strongly
Disagree
Users /
Non-
users
Gender
Age
Ethnicity
Education
level
Income
Sufficient evidence supports the benefits of honey
as a complementary medicine
201 (67)
88 (29.3)
11 (3.7)
0.85
0.04
0.01
0.02
0.11
0.24
The use of honey as food supplement for general
health should be promoted
252 (84)
39 (13)
9 (3)
0.21
0.95
0.42
0.07
0.92
0.10
More information should be provided to the public
regarding the health benefits of honey
241 (80.3)
54 (18)
5 (1.7)
<0.01*
0.13*
<0.01*
<0.01*
0.11*
0.14*
I believe that honey can stimulate body natural
therapeutic power
183 (61)
76 (25.3)
41 (13.7)
<0.01
<0.01
0.04
0.02
0.76
0.62
I would rather use honey to treat common
ailments such as coughs and sore throats than
using modern medicines
202 (67.3)
78 (26)
20 (6.7)
0.18
0.64
0.03
0.26
0.73
0.90
I would recommend honey to others as an
alternative to modern medicine in treating
common ailments
211 (70.3)
69 (23)
20 (6.7)
<0.01
0.33
0.61
0.01
0.11
0.91
I would not mind spending money on honey as a
complementary or alternative medicine
187 (62.3)
85 (28.3)
28 (9.3)
<0.01
0.73
0.09
<0.01
<0.01
0.47
Honey is easy to be used as a complementary or
alternative medicine
240 (80)
53 (17.7)
7 (2.3)
<0.01*
0.44*
0.01*
<0.01
0.16
0.81
Honey has no side effects
217 (72.3)
69 (23)
14 (4.7)
0.02
0.36
0.78
<0.01
0.07
0.53
*P value by Fisher’s exact test
148
Wahab et al. / Journal of Applied Pharmaceutical Science 7 (12); 2017: 144-150
DISCUSSION
The current study presented the use of and the
perceptions about honey as CAM among the general public in
Selangor. The findings indicated that more than half of the
respondents used honey in the past three months as CAM. The use
of honey as dietary supplement for general well-being was noted
in more than 70 % of the users. The Malays were noted be
significantly more likely to use honey as CAM in the past three
months of the survey. The Malay respondents were also observed
to be more favourable towards honey as CAM as significantly
more Malay respondents strongly agreed and agreed with 7 out of
9 survey statements. The use of honey in the Malay traditional
medicine is undeniably common and has been applied in this
medical system for centuries. Moreover, honey is regarded as
nutritious and healthy in Islam, which is the main religion for the
Malays in Malaysia (Eteraf-Oskouei and Najafi, 2013). Therefore,
the high usage of honey as CAM among the Malay respondents in
the current study may have been influenced by their local culture
and religion.
Although most indications for honey use by the users in
the present study involved common ailments, 13.1 % (22/168) of
them used honey to treat asthma. The use of honey as CAM for
asthma is in fact not uncommon (Savithramma et al., 2007;
Alshagga et al., 2011; Orhan et al., 2003). In a cross-sectional
survey carried out among adult asthmatic patients in a Malaysian
general hospital, 61.1 % (58/95) of the patients used CAM and
honey was identified as one of the most common type of CAM
used (Alshagga et al., 2011). Studies using honey to treat asthma
have also been published (Rhman, 2007; Kamaruzaman et al.,
2014). Despite yielding promising findings, these studies were
confined to research on small animal and non-randomized human
studies. Randomized clinical trials to verify the efficacy and safety
of honey in asthma are still lacking. Hence, the fact that a small
percentage of the respondents in the current study used honey as
CAM to treat asthma has raised a cause for concern. Although
honey use may be argued to be relatively safe, such practice may
delay appropriate treatment and may put patients at risk of disease
exacerbations. Therefore, the use of honey in treating asthma
especially as an alternative medicine should not be recommended
(Eteraf-Oskouei and Najafi, 2013).
In the present study, 57.1 % (96/168) and 53 % (89/168)
of the honey users used the substance to treat coughs and sore
throat, respectively. The potential usefulness of honey on its own
or in combination with other ingredients for treating coughs (Paul
et al., 2007; Raeessi et al., 2013; Cohen et al., 2012; Sulaiman et
al., 2011) and sore throats (Sulaiman et al., 2011) has been
reported in previous studies. Honey is in fact recommended in
treatment guidelines to treat coughs (Morice et al., 2006; Fashner
et al., 2012). Nonetheless, evidence of the effectiveness of the
local honeys (e.g., Tualang, Kelulut, and Nenas) in treating
coughs, sore throats and other common ailments are still limited.
This paucity warrants further studies. In the present study, the
majority of the honey users and non-users strongly agreed and
agreed that there was sufficient evidence for the benefits of honey.
Despite such belief, it should be noted that the majority of honey
users utilized the Internet and advertisements as their sources of
information about honey. As a matter of fact, the use of the
Internet to seek information about CAM is common among the
public (Hyodo et al., 2005; Diaz et al., 2002). Nevertheless, such
information obtained from the Internet would not necessarily be
reliable and valid, and it could be misleading (Hyodo et al., 2005).
Furthermore, a previous study by Hassali et al. (2012b) found that
many advertisements for CAM did not comply with the Medicine
Advertisements Board (MAB) guidelines and the Malaysian Code
of Advertising Practice. Therefore, patients planning to use or
already using honey as CAM should be recommended to talk to
their healthcare providers so that they can be informed about both
the benefits and limitations of using honey in treating diseases.
The non-users of honey in the present study appeared to
be skeptical towards honey in several instances. For examples, the
non-users were noted to be less likely to strongly agree and agree
that honey as CAM would be free from side effects, and that it
could stimulate the body's natural therapeutic power. In addition,
the non-users were also less likely to strongly agree and agree that
they are willing recommend honey as CAM to others and to pay
for honey as CAM. These skeptical attitudes and the unwillingness
to pay for honey as CAM could be the reasons why honey was not
a choice of treatment modality among the non-users. Interestingly,
although not using honey as CAM in the past 3 months of the
survey, the non-users also showed interest in using honey to treat
common ailments than using the modern medicines.
In the present study, honey users in general held the
belief that honey would have no side effects, probably due to the
fact that honey is a natural product, and therefore is presumed safe.
Nevertheless, although relatively harmless, the adverse effects
from the consumption of honey have been reported (Paul et al.,
2007; Özhan et al., 2004; Yocum and Khan, 1994). In a previous
study in the U.S.A., the use of honey to suppress coughs produced
a combination of mild reactions that included hyperactivity,
nervousness, and insomnia (Paul et al., 2007). Other adverse
effects relating to honey that have been reported include
bradycardia and hypotension due to honey poisoning (Özhan et al.,
2004; Jauhari et al., 2009), and allergy reactions (Yocum and
Khan, 1994).
The present survey also showed that the majority of users
obtained their honey supplies from the supermarkets and grocery
stores. Previous studies on international market al.so indicated
similar findings (Ványi et al., 2011; Batt and Liu, 2012). However,
whether the honey obtained from the supermarkets and grocery
stores would have similar quality and therapeutic effects to those
reported in previous laboratory and clinical studies has remained
questionable. The limitations of using table honeys obtained from
the supermarket for treating wounds compared to the use of
medical-grade honeys (MGH) have been reported in a British
study (Cooper and Jenkins, 2009). The study found that honey
obtained from the supermarkets in Britain showed low
antibacterial activities compared to those of the MGH. Moreover,
Wahab et al. / Journal of Applied Pharmaceutical Science 7 (12); 2017: 144-150 149
honey obtained from the supermarkets contained a wide range of
potentially pathogenic microorganisms (Cooper and Jenkins,
2009), including Clostridium botulinum (Küplülü et al., 2006).
Furthermore, the rise of counterfeit and adulterated honey that has
become commonplace in the market in the recent years should
provide a cause for concern (Yeow et al., 2013). Counterfeit and
adulterated honey may not have the health benefits of pure honey
and can be harmful.
Honey as a CAM has both strengths and limitations. Due
to the local traditional medical systems that often incorporate
honey as a treatment modality, the use of honey as CAM can be
widespread. Healthcare providers especially doctors and
pharmacists should therefore remain vigilant of the CAM
modalities used by their patients (Miller et al., 2000). Moreover,
they should be proactive in inquiring their patients about the use of
CAM in an open and non-judgmental manner (Wahab et al.,
2016). There should be a concern if patients rely solely on honey
for treatment and avoid medical attention especially for treatment
of serious diseases. In addition, members of the public who intend
to use honey to treat diseases or maintain their health should be
made aware of both its strengths and limitations. The present study
has several limitations. In this study the respondents were recruited
using convenience sampling method. Potentially those who agreed
to participate in the study were generally interested in honey, even
if they were not using it, thereby predisposing the results of this
study to sampling bias. Because only three towns were selected,
and that the selection of participants was made using convenience
sampling method, the respondents were not representative of the
local population; thus, the generalizability of the results of this
study would be limited even at the regional level.
CONCLUSION
The majority of the respondents showed favourable
perceptions about honey as CAM, and had either used the
substance to treat diseases, or to promote health and general well-
being. However, three issues have raised some concerns: the use of
table honeys from unreliable sources and of questionable quality
as CAM; the use of unreliable sources of information for honey
use; and, the potential self-medication using honey for treating
serious diseases. Future work should not only aim to produce more
scientific evidences of the benefits and safety of honey, but also to
enhance consumers’ understanding about both the strengths and
limitations of honey as CAM to prevent misconceptions.
ACKNOWLEDGEMENT
Financial support and sponsorship: This work was supported in
part by the Universiti Teknologi MARA under the Lestari grant,
600-IRMI/DANA 5/3/LESTARI (0006/2016).
Conflict of Interests: There are no conflicts of interest.
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How to cite this article:
Wahab MSA, Othman N, Othman NHI, Jamari AA, Ali AA.
Exploring the use of and perceptions about honey as
complementary and alternative medicine among the general public
in the state of Selangor, Malaysia. J App Pharm Sci, 2017; 7 (12):
144-150.
