The results of this study show that health food store personnel were unaware of the reporting system for ADRs. They also perceived and identified ADRs differently than does the medical community. When the ADR resulted in consumer dissatisfaction, however, the product was returned to the manufacturer, including a report of some type. Table summarizes participants' demographic characteristics.
Demographics of health food store personnel interviewed (n=12)
Generally, health food store personnel did not know that suspected herbal-related ADRs could be reported to Health Canada, whom to contact to report ADRs or which types of reactions should be reported.
- Q: Are you familiar with the reporting system in Canada for side effects?
- A: No. [interviewer explains] I didn't know about it at all. (#10)
Most participants described examples of “side effects” (a lay term for ADRs as defined by Health Canada) associated with NHPs that were reported by consumers. Store personnel considered predictable untoward responses, such as a niacin flush, or diarrhea from a “detoxification” product, as examples of possible ADRs about which they might inform consumers prior to purchase of the product. They reported that these “true” ADRs were rare. More common was a situation they described as NHPs that “did not agree” with or “did not suit” specific customers. This situation might manifest as an upset stomach or “uneasy feeling” after taking the product. Although these effects would be classified as ADRs by Health Canada, health food store personnel did not consider them cause for concern about the product per se. Rather, such incidents were conceptualized as a need to help the consumer find a better product “fit”:
I think I would take it back from them thinking that maybe it really didn't suit them and then I will ask them why, what happened to you? Why don't you feel that it suited you, or maybe I will tell them “why not try another one to see if it suits you.” In that way, I could guide them. (#8)
Health food store personnel described more serious symptoms, such as rashes, as the result of individual allergies, which they did not classify as ADRs. Often, store personnel would attribute “side effects” to inappropriate product use by consumers rather than ADRs (allergies, and effects associated with inappropriate use, are considered ADRs by Health Canada). Health food store personnel therefore perceived and identified ADRs differently than the medical community. Participants stated that they commonly referred customers to their healthcare providers, or the product manufacturer, for more information if they suspected that a customer had a reaction.
Oh, I take it very seriously. I want to make sure that … if it was really serious I would say “go and see your doctor,” and if it was a side effect and I don't really know why [it happened] I would give them the phone number and the website to contact the company so that they can directly call them and double-check with them because they have to know that as well, and if they don't feel comfortable, I will call them myself with them there. (#10)
This example relates to another key theme that emerged from the data: the strong drive of health food store personnel to provide good customer service. Store personnel described the importance of developing and maintaining relationships with their customers, and this extended to provision of advice and information about NHPs. Health food store staff appear to encourage consumers to see them as a source of information about NHPs to help maintain customer loyalty.
You know, at the store level we have to be prudent to gain enough information about the dangers and risks of products to be able to guide the consumer, and they are, after all, looking at us for advice. (#2)
[Customers] want technical information, and they are looking to us as if we're naturopaths in a health food store, not sales associates in a health food store. (#12)
Another perceived component of providing good customer service was swift response to product dissatisfaction (possibly resulting from ADRs) by accepting returns. The return procedure included collection of customer contact information, subsequently submitted to the manufacturer in conjunction with the reason for the return in order to recoup retailer losses on the product. Health food store personnel had difficulty conceptualizing ADRs, and thus also had difficulty describing how they might respond if one occurred. They talked about how they would return products to the manufacturer and refund the cost if the customer were dissatisfied with the product for any reason:
Even if it is not a bad reaction … you believe them and you refund it regardless, but just by their answers. You have to trust them; whether you believe it or not you have to return the product if they have a reaction, and then we just take their information and we contact the company and sometimes the company calls them back. [It happens about] once a week. (#9)
Thus, participants essentially reported ADRs to product manufacturers as a consequence of processing product returns. They described their continuing relationships with the manufacturers, in particular with staff answering questions about their products and the department that handles returns.
I know this company, because … we buy many of their products. … They give us very good information. Especially if they have enough time with you, they don't hurry you and they explain things and they also tell you things. You know, we are not doctors – they just advise [us], so they are very good. (#8)
Participants described how the return policy was used as a mechanism to generate customer loyalty and satisfaction by reducing the customer's perceived risk. The return policy was also used to evaluate a product's quality to help decide whether the store should continue to sell it.
We have a very good return policy, and we actually encourage people to give us the feedback: if they're not satisfied, we want to hear about it, because we might not carry the line in the future if there are problems with it. It helps us, and it helps us not to lose the customer as well, where some people, if they bought something [and] they have no recourse to get any money back or refund, they might just stop shopping at this location, or other locations, for that matter. Whereas if they come back here, well, we could encourage them to exchange the product or try something else that may be more to their liking, and that way we could have a satisfied customer that continues to come back. (#4)
The costs of the returned product can be recouped by the store that accepts the return from the customer only if the product is returned to the manufacturer with customer contact information and a reason for the return:
We write up a credit request from the company and we fax the company the credit request. We phone them and we email them and we put the paperwork together, and leave the product to be picked up by the company at some point. It is just pretty much a form that asks for return address, name, phone number, that sort of thing. (#11)
Health food store personnel considered manufacturers responsible for providing good-quality products.
Sometimes batch numbers are also messed up. We have had [product] recalls before. I would go with the company first. For sure, it would be the company's responsibility. (#6)