Objectives
The objectives of this study are: 1) to assess the attitudes and practices of Alberta pharmacists regarding NHPs offered for sale in community pharmacies and 2) explore Alberta pharmacists' views of the evidentiary basis for clinical and related uses of NHPs, the indications for which NHPs are used and the regulatory process for approval and licensing of NHPs.

Methods
Using Qualtrics, a web-based data collection and analysis software, and a study instrument made up of fifteen (15) open-ended, closed and rating scale questions, we surveyed the attitudes and practices of 403 community pharmacists in Alberta regarding NHPs offered for sale in community pharmacies.

Results
Majority of pharmacists surveyed (86%) recommend NHPs to clients sometimes to very often. Vitamin D, calcium, multivitamins, prenatal vitamins, probiotics and fish oil and omega-3 fatty acids were the most frequently recommended NHPs. Most common indications for which NHPs are recommended include bone and musculoskeletal disorders, maintenance of general health, gastrointestinal disorders and pregnancy. Review articles published in the Pharmacist's Letter and Canadian Pharmacists Journal were the primary basis for recommending NHPs. Majority of pharmacists surveyed recommend the use of NHPs concurrently with conventional drugs while a significant proportion recommend alternative use. Pharmacists in the study overwhelmingly provide counselling on NHPs to clients based on information obtained mainly from the Natural Medicines Comprehensive Database.

Conclusion
The study findings indicate a high prevalence of pharmacy care relating to NHPs among study participants. Although pharmacists' practices around NHPs are consistent with the existing licensing framework, we found some involvement in problematic practices that necessitate further research and potential policy scrutiny. The study also uncovered patterns of recommendations, including sources relied on in recommending NHPs and in providing counselling to patients, that raise concerns about the quality and credibility of NHP-related care provided to pharmacy patrons.