RETRACTED: Factors affecting the demand for medicinal plants: Implications for rural development in Rasht, Iran

RETRACTED: Factors affecting the demand for medicinal plants: Implications for rural development in Rasht, Iran

Land Use Policy 68 (2017) 316–325 Contents lists available at ScienceDirect Land Use Policy journal homepage: www.elsevier.com/locate/landusepol Fa...

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Land Use Policy 68 (2017) 316–325

Contents lists available at ScienceDirect

Land Use Policy journal homepage: www.elsevier.com/locate/landusepol

Factors affecting the demand for medicinal plants: Implications for rural development in Rasht, Iran ⁎

MARK



Seyyed Ali Noorhosseinia, , Esmaeil Fallahib, Christos A. Damalasc, , Mohammad Sadegh Allahyarid a

Young Researchers and Elite Club, Rasht Branch, Islamic Azad University, Rasht, Iran Department of Agricultural Economics, Shiraz University, Shiraz, Iran c Department of Agricultural Development, Democritus University of Thrace, Orestiada, Greece d Department of Agricultural Management, Rasht Branch, Islamic Azad University, Rasht, Iran b

A R T I C L E I N F O

A B S T R A C T

Keywords: Consumer attitudes MDPs Acceptance Promoters Deterrents

Medicinal plants (MDPs) play a critical role in the healthcare provision of much of the world’s population, with undoubtedly increasing demand both in the number of species and in the volume of plant material being traded, but what drives demand for MDPs is not well understood. This study was conducted to evaluate factors affecting the demand for MDPs in the area of Rasht in northern Iran. A questionnaire was used as the primary means of data collection from consumers who were familiar with MDPs. The mean scores of identified favouring and disfavouring factors along with the bootstrapping confidence interval and Shannon’s entropy were used for ranking consumers’ attitudes. The main promoters of the demand were: the low complication by the consumption of MDPs, the consumers’ recommendation to others about the use of MDPs, and the lower prices of MDPs than common chemical medicines. Exploratory factor analysis revealed that the main promoters could be grouped into three factors related to i) health benefits and availability of MDPs, ii) effectiveness and suitability of MDPs, and iii) price and tradition. On the other hand, the lack of insurance coverage of MDPs consumers, the lack of proper processing and packaging of MDPs, and the lack of adequate information about MDPs use by the authorities were the most important inhibiting factors of consumers’ demand for MDPs. Factor analysis revealed that the main deterrents could be grouped into four factors related to i) limited support of MDPs, ii) poor access to processed MDPs, iii) lack of alternatives and spatial limitations, and iv) uncertainty and lack of confidence. The data provide a useful snapshot of the factors affecting the demand for MDPs in Rasht of northern Iran. The information sheds some light on what drives the acceptance of MDPs by the consumers and provides interesting policy insights into the development of production concerning the sector of MDPs in northern Iran. Methodologically, the study could constitute a base for the formation of a theory for the demand of MDPs in future research.

1. Introduction Medicinal plants (MDPs) are globally valuable sources of herbal products and of the most important sources of human food and medicines (Chen et al., 2016). They are an integral component of an alternative health care system in many societies, particularly in the developing countries (Hamilton, 2004). Over the past few years, the MDPs have regained a wide recognition due to an increasing faith in herbal medicine derived from its fewer side-effects compared to conventional medicine in addition to the necessity of meeting the requirements of medicine for an increasing human population (Dubey et al., 2004; Kala et al., 2006; Noorhosseini et al., 2011; Sen et al., 2011). Up to 80% of



the people in developing countries are totally dependent on herbal drugs for their primary healthcare and over 25% of the prescribed medicines in developed countries are derived from wild plant species (Dubey et al., 2004; Hamilton, 2004; Jasemi et al., 2016). Thus, demand of MDPs in different countries is increasing day by day. This seems to be due to the proved effectiveness of many of these materials in the scientific community. Therefore, there is a global trend of increasing acceptance for many popular and effective species in Europe, North America, and Asia, growing between 8 and 15% per year (Grünwald and Büttel, 1996). Iran has a great history in the use of herbal plants for medicinal purposes (Sharafzadeh and Alizadeh, 2012). The flora of Iran contains

Corresponding authors. E-mail addresses: [email protected] (S.A. Noorhosseini), [email protected], [email protected] (C.A. Damalas).

http://dx.doi.org/10.1016/j.landusepol.2017.07.058 Received 4 May 2017; Received in revised form 3 July 2017; Accepted 29 July 2017 0264-8377/ © 2017 Elsevier Ltd. All rights reserved.

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more than 8000 species, of which 1100 are used in traditional Iranian medicine (Padasht, 2006; Omidbaigi, 2011; Mashayekhan et al., 2016). About 4000 t of medicinal herbs are harvested every year and almost 40 million ha of Iran’s land is considered suitable for growing medicinal herbs. In addition, about 500,000 ha of rangelands and forests are earmarked for the cultivation of herbal plants, according to the sixth national development plan of Iran (Iran Daily, 2015). World trade volume of MDPs is more than 43 billion dollars and has been predicted to reach to 5 trillion dollars in 2050 (Mashayekhan et al., 2016). According to ethnobotanical studies, there are about 1000 plant species in Guilan Province, half of which can be used as medicinal herbs (Akbarzadeh et al., 2010; Iravani et al., 2013). It is therefore imperative to recognize the economic importance of MDPs and help raise awareness of these plants as an important natural resource. In general, demand for herbal medicines is increasing in developing countries, whereas there are signs that many consumers in developed countries are also turning to herbal medicines. Based on previous research, studies on MDPs demand concerning the attitude of consumers will be important (Iravani et al., 2013; Dehghanpur and Dehghanizadeh, 2014; Javanbakht and Esmaili, 2014). The demand potential of the MDPs trade had been largely unknown in the past in Iran and most likely in other developing countries and consequently poorly developed. The consumers of indigenous MDPs come from a wide range of social strata, with major differences in buying power and belief systems. However, the market only supplies a uniform range of raw or semi-processed products, with practically no choice as to the quality of the products, processing, and packaging. Thus, there are large opportunities to supply different types of medicinal products to suit the demands of a diverse consumer group. A great deal of interest in MDPs for their potential to yield useful drugs has been developed in recent years worldwide. The increasing popularity of herbal medicinal products in developed countries has given new dimension to the demand of MDPs in the international market (Samsam Shariat and Moattar, 1990). The sheer magnitude of the people using plants for health care and the huge number of plant species used in these practices hinder the assessment of demand and supply of MDPs in the country. Also, the demand for MDPs reflects distinct cultural preferences and the relative opacity of the MDPs trade at the level of gatherers, traders, and the industry makes the assessment even more difficult. The lack of any mechanism for the maintenance and strengthening of information pertaining to supply, demand, and consumption of botanicals at the national and state level adds to the difficulty in making the demand and supply estimation for the country (Yesilada, 2005). In Iran, healthcare authorities have tried to integrate traditional medicine into the main healthcare system of the country and nowadays there are trained doctors and physicians who get specialized in traditional medicine and rely mainly on processed herbal products in their prescriptions (WHO, 2001). Most of the herbal products targeted and used in this sector are under strict regulatory and safety control. There is also another aspect of herbal medicine market in Iran that includes traditional herbal shops or Attaris. Rural development in Iran was mainly designed for transforming the social lives of the villagers, including actions and initiatives taken to improve the standard of living in the countryside and remote villages (Azkia and Hooglund, 2011). Towards that direction, agricultural activities would play a key role and economic activities would relate to the primary sector, production of foodstuffs, and raw materials. However, in practice, relevant transformations that could facilitate the above targets were not materialized. The rural development plans were designed and implemented in a top-down, centralized model and, consequently, the rural people did not have a real standing in such plans. In addition, plans were not problem-oriented and were rather extrinsic in nature, somehow embarking on distribution of resources. The unfairness of this distribution intensified social inequalities. Despite this fact, local populations in rural areas can bring about endogenous initiatives for development.

The MDPs sector and its development are identified as one of the neglected areas in the strategies for rural development of Iran. Iran established its national policy on traditional medicine and regulation of herbal medicines in 1996, developing the main framework of laws and regulations (WHO, 2005). No national program currently exists. A national office for traditional medicine and regulation of herbal medicines was established within the Ministry of Health in 1981 as a part of the Department of Pharmaceutical Affairs and then an expert committee was established in 1995. Also, a national research institute on herbal medicines was founded in 1999. Most available herbal products are considered as dietary supplements and thus are not required to meet the standards for normal drugs. Due to the significance of MDPs for the country, the Iranian Academy of Medical Sciences has taken steps to promote traditional and herbal medicines and to integrate Iranian traditional medicine into the scientific conventional medical system (Bodeker et al., 2005). However, little has been done at the farmers’ level, except from some micro-projects that focused on participatory approaches. Generally speaking, there are rather inappropriate conditions for the development of Iranian rural communities due to a lack of a coherent strategy for sustainable rural development, unavailability of appropriate infrastructures in rural areas, lack of coordinated programs in rural development, weak management of governmental structures, and lack of diversification in non-agricultural activities (Namdar and Sadighi, 2013). Lately, the Ministry of Agriculture has been drawing special attention towards the expansion of MDPs cultivation and a high professional committee observes and monitors all activities in this regard. Reorganizing the production, distribution, markets, and exports are among the main aims of the rural development in Iran. The objective of this study, in view of the growing interest in herbal products, was to assess the determinants of MDPs demand in Rasht of northern Iran, so that resource management strategies and policy interventions could be suitably modified in view of potential changes in the demand pattern. The information is expected to shed some light on what drives the acceptance of MDPs by the consumers and provide interesting policy insights into the development of MDPs production in northern Iran. 2. Methodology 2.1. Study location and selection of sample The study was conducted in Rasht city of northern Iran. A distinct aspect of the herbal medicine market in Iran is the traditional herbal shops named Attaris. Most of the herbal products in this market sector are raw or partially processed herbal material. Consumers in this group mainly get prescription from herbal shop vendors or traditional healers. The present study considered this part of MDPs users. Accordingly, the statistical society was all consumers of MDPs in Rasht who approach these traditional herbal shops (Attaris) and the sample consisted of 100 people who bought or used MDPs and were generally familiar with the consumption of MDPs. It should be noted that the number of the units in this study may be small for a big city like Rasht and it may not reliably reflect the entire population. This is a serious limitation of the study concerning statistical inference, but given that improved understanding of the determinants of MDPs demand was considered more important than quantifying magnitudes and generalizing the results over the entire population, the sample was considered sufficient to map out different patterns of MDPs demand observed in the dataset. Participants were selected through a purposive sampling method. Purposive sampling is a non-probability sampling technique in which the researcher relies on his (her) own judgment when choosing members of the population to participate in the study (Baxter and Babbie, 2003). The primary consideration in purposive sampling is the judgment of the researcher as to who can provide the best information to achieve the objectives of the study with significant saving in time and money (Black, 2011). Purposive sampling can be very useful for 317

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its simplest form, for a dataset with a sample size of N, it takes B ‘bootstrap’ samples of size N with replacement from the original dataset and computes the estimator for each of these B bootstrap samples. The B bootstrap estimates are a sample of size B from which we can make inferences about the estimator. To run the bootstrap we took 1000 random samples (resample) from the original sample and a 95% percentile confidence interval was used. Furthermore, we used the Monte Carlo exact test to calculate the exact significance of the Mann-Whitney and Kruskal-Wallis tests. The exact Monte Carlo methods provide a powerful means of obtaining accurate results when the dataset is small, tables are sparse or unbalanced, the data are not normally distributed, or the data fail to meet any of the underlying assumptions necessary for reliable results using the standard asymptotic method (Mehta and Patel, 2011). In using the Monte Carlo exact test by SPSS, we set the confidence interval at 95% and the number of samples at 10,000. Exploratory factor analysis was employed to delineate the underlying dimensions of respondents towards MDPs demand both in terms of favouring and disfavouring factors. This method was used because an a priori hypothesis about the factors or patterns of the measured variables affecting MDPs demand did not exist. Factor analysis is designed for interval data, although it can also be used for ordinal data (e.g. scores assigned to Likert scales) like in this study (Kim and Mueller, 1978; Manly, 2005; Field, 2009). The factor analysis used principal component analysis (PCA) with factor extraction and Varimax rotation. The four commonly used decision rules were applied to identify the factors: (1) minimum eigenvalue of one; (2) minimum factor loading of 0.4 for each indicator item; (3) simplicity of factor structure; and (4) omission of single item factors. Bartlett’s test and Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy showed that the research variables were suitable for factor analysis in both parts (KMO = 0.716, Bartlett’s test = 191.732, P < 0.01 for the favouring factors and KMO = 0.730, Bartlett’s test = 402.135, P < 0.01 for the disfavouring factors). Also, to choose the best items for analysis, an antiimage matrix was considered and there were no scores lower than 0.50. The analysis was conducted using SPSS16 statistical software.

situations where the researcher needs to reach a targeted sample quickly and where sampling for proportionality is not the primary concern (Daniel, 2011). Furthermore, purposive sampling is helpful for pilot studies and for hypothesis generation. The downside of a nonprobability sampling method is that an unknown proportion of the entire population is not sampled. This entails that the sample may or may not represent the entire population accurately. Therefore, the results cannot be used in generalizations pertaining to the entire population. Initially, a list of the herbal shops (Attaris) in Rasht was obtained and then four famous Attaris were purposively selected as the survey places of this study. Potential participants in this project were approached independently, considering their availability and their willingness to participate in the study. The survey was conducted in the winter of 2014. 2.2. Data collection: process and instruments A questionnaire that was designed by the authors was used as the primary means of data collection from the sample. The questionnaire contained three different parts. The first part included nine items about what favours the consumption of MDPs measured on a five-point Likert type scale (from 1 = strongly disagree to 5 = strongly agree), the second part included 13 close-ended items about what hinders the consumption of MDPs measured on a five-point Likert type scale (from 1 = strongly disagree to 5 = strongly agree), and the third part included questions about the socio-demographic characteristics of respondents, such as gender, age, marital status, family size, education, place of living, main profession, activity in the cultivation of MDPs, and area under cultivation. The questionnaire was designed based on literature review (Iravani et al., 2013; Mashayekhan et al., 2016) and authors’ experience, and was pre-tested in a pilot survey with 10 other respondents. The aim of the pilot survey was to ensure that the questions included were clear and that the respondents could answer easily. During the pilot survey, it was observed that a few questions were not clearly understood by the respondents. Hence, some questions were dropped and a number of additional questions were included. The draft schedule was then modified and improved based on the feedback received from the pilot survey. The reliability of the questionnaire was estimated using the Cronbach’s alpha. The values ranged between 0.70 and 0.82. Data were collected through face-to-face interviews with each one of the respondents. To avoid any potential bias, it was made clear to the respondents that the study was for academic research and an oral consent was obtained. The interviews were conducted in a friendly way and there was good cooperation without any refusals. For this purpose, two trained interviewers who were familiar with conducting surveys were recruited. Each interview lasted approximately 20 min. The study did not require approval by an ethics committee or a recognized institutional review board because it was a simple observational evaluation exclusively for academic research purposes with full anonymity of participants.

2.3.1. Shannon’s entropy The concept of Shannon’s entropy, defined as a measure of uncertainty of a random variable, has a dominant role in information theory. This concept is used to determine the weight of an attribute based on the differences among attributes without any additional or subjective information. We used the formulas below to obtain the degree of importance of alternatives in the following steps (SoleimaniDamaneh and Zarepisheh, 2009; Ghorbani et al., 2012; Allahyari et al., 2016; Noorhosseini et al., 2017): - Conversion of decision matrix to the without-scale matrix:

x ij

Rij =

m



x ij2

(1)

i=1

2.3. Statistical analysis

Pij = Descriptive statistics, i.e., frequencies, percentages, means, and standard deviations were calculated for each variable. Also, the Shannon's entropy method was used for ranking attitudes as explicitly described below. In addition, Mann-Whitney and Kruskal-Wallis tests were used for refinery analysis of the data. Because the sample came from a population with an unknown distribution, the bootstrap method was used for supporting data analysis. The bootstrap method is based on resampling of the original random sample drawn from a population with an unknown distribution (Kisielinska, 2013). Bootstrapping seeks to uncover more information about the properties of estimators for ‘unknown’ populations and ill-behaved parameters (Bayazidi et al., 2012). Bootstrapping provides a standard error and a confidence interval for the mean for which parametric estimates are unavailable. At

Rij m



Rij

(2)

i=1

In the above formulas: m = number of existing options and x = mean - Calculation of the amount of indices entropy: m

E = −K ∑ [Pi × ln Pi]

(3)

i=1

In the above formula: K =

1 ln(m)

- Calculation of the amount of uncertainty or deviation degree: 318

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3. Results and discussion

Table 1 Personal characteristics of consumers of MDPs. Characteristic Gender Female Male Age (years) Less than 25 From 25 to 35 From 36 to 45 More than 45 Education Illiterate Primary and junior high school High school/diploma College education Marital Status Single Married Family size (person) Less than 3 From 3 to 6 More than 6 Place of living City Village Main job Employee Farmer Self-employed Housewife Activity in cultivation of MDPs No Yes Area under cultivation (ha) Lack of culture Less than 1 ha Between 1 and 3 ha

Percentage

SD

Mean





6.874

33.60









1.277

3.19

















3.1. Personal characteristics of consumers of MDPs Most respondents (59%) were male with an average age for the studied sample 33.6 years (Table 1). Three out of four respondents (75%) had a college education and the rest had completed high school, indicating a sample of well-educated participants. The majority of the respondents was married (71%) and was living in an urban area (94%). The average family size was about 3 people. Most respondents were employees (71%) without farms, whereas few were farmers (2%). Despite this fact, some respondents (17%) had some experience of MDPs production (Table 1).

41 59 12 50 35 3 0 1 24 75

3.2. Consumers’ attitudes favouring MDPs consumption

29 71

The bootstrap confidence interval of the mean scores along with Shannon’s entropy revealed that the most important factors favouring the demand for MDPs were the low complication by the consumption of MDPs, the consumers’ recommendation to others about the use of MDPs, and the lower prices of MDPs than common chemical medicines (Table 2). Single people showed higher satisfaction (P < 0.05) than married ones concerning the effectiveness of MDPs in preventing diseases and also they had higher perceptions (P < 0.01) of low complication by the consumption of MDPs (Table 3). Also, well-educated people showed higher satisfaction by the effectiveness of MDPs (P < 0.05) than non-educated ones. Because of the small size of the sample, the results of resampling with the Monte Carlo exact test were also considered for each variable and the same results of significant level were obtained. Factor analysis showed that 61.86% of the total variation in respondents’ favouring attitudes towards MDPs was determined by three factors named: i) health benefits and availability, ii) effectiveness and suitability, and iii) price and tradition (Table 4). In this table, each variable was usually loaded on only one factor, but it is possible that some variables were loaded on two or more factors or even they may appear as dipoles. The variables were positioned in factors as follows. The first factor explained 27.95% of the total variation in respondents’ favouring attitudes towards MDPs demand. Four variables, i.e., easy availability of MDPs, low complication by the consumption of MDPs, consumers’ recommendation to others, and curing diseases through the consumption of MDPs were loaded on this factor, which was named health benefits and availability. The second factor explained 18.28% of the total variation in respondents’ favouring attitudes towards MDPs and was named effectiveness and suitability. It contained variables involved in information sharing, suitability of herbal medicines to the health system, and satisfaction by the use of MDPs. The third factor, named price and tradition, explained 15.63% of the total variation. It contained the variables lower prices of MDPs than chemical medicines

63 35 2 94 6 71 2 15 12 83 17 83 12 5

SD: standard deviation.

dj = 1 − Ej

(4)

- Calculation of the index weight:

Wi =

di n



dj

(5)

i=1

The above weight is a parameter that can describe how much important the attitude is. The smaller the value of the entropy, the larger the entropy-based weight, then the more information the specific attitude provides and the more important this attitude becomes in the decision-making process. Table 2 Consumers’ attitudes favouring MDPs demand. Favouring item

Low complication by the consumption of MDPs. Consumers’ recommendation to others about the use of MDPs. Lower prices of MDPs than common chemical medicines. Curing diseases through the consumption of MDPs. Information share about the use of MDPs. Satisfaction with the effectiveness of MDPs. Use of traditional medicine with consumption of MDPs. Easy availability of MDPs for everyone. Suitability of herbal medicines to the health system.

Ej

dj

0.534 0.568 0.577 0.572 0.546 0.522 0.505 0.500 0.478

0.466 0.432 0.423 0.428 0.454 0.478 0.495 0.500 0.522

Scale: from 1 = strongly disagree to 5 = strongly agree. a CI: 95% confidence interval.

319

Wj

0.111 0.103 0.101 0.102 0.108 0.114 0.118 0.119 0.125

Mean

3.73 3.72 3.67 3.56 3.51 3.49 3.43 3.31 3.20

Bootstrap CIa Lower

Upper

3.54 3.54 3.52 3.41 3.33 3.30 3.25 3.12 3.01

3.91 3.88 3.84 3.72 3.68 3.68 3.61 3.49 3.41

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Table 3 Comparison of independent variables in terms of factors favouring MDPs demand (Mann-Whitney and Kruskal-Wallis tests). Favouring item

Mann-Whitney test Cultivation

Living place M-Ca

Z ns

Z

1.13 1.33ns 0.09ns 0.43ns 1.19ns 1.65ns 0.16ns 0.80ns 0.28ns

Favouring item

Kruskal-Wallis test

0.64 1.43ns 0.15ns 0.03ns 0.50ns 0.29ns 0.96ns 1.13ns 0.52ns

Main job Z Use of traditional medicine with consumption of MDPs. Lower prices of MDPs than common chemical medicines. Curing diseases through the consumption of MDPs. Consumer’s recommendation to others about the use of MDPs. Easy availability of MDPs for everyone. Satisfaction with the effectiveness of MDPs. Low complication by the consumption of MDPs. Information share about the use of MDPs. Suitability of herbal medicines to the health system.

1.80 1.61ns 3.25ns 3.68ns 2.07ns 3.44ns 3.60ns 1.65ns 1.31ns

0.55–0.57 0.17–0.19 0.91–0.92 0.99–1.00 0.62–0.64 0.79–0.81 0.37–0.40 0.26–0.28 0.64–0.66

Education M-C

ns

M-C ns

0.25–0.27 0.17–0.19 0.92–0.93 0.67–0.70 0.23–0.25 0.08–0.10 0.88–0.90 0.40–0.42 0.19–0.21

Use of traditional medicine with consumption of MDPs. Lower prices of MDPs than common chemical medicines. Curing diseases through the consumption of MDPs. Consumer’s recommendation to others about the use of MDPs. Easy availability of MDPs for everyone. Satisfaction with the effectiveness of MDPs. Low complication by the consumption of MDPs. Information share about the use of MDPs. Suitability of herbal medicines to the health system.

Marriage

a

Z

0.62–0.66 0.64–0.66 0.36–0.39 0.29–0.32 0.57–0.60 0.32–0.35 0.29–0.32 0.66–0.68 0.74–0.76

0.47 0.80ns 1.27ns 0.62ns 2.24ns 7.40* 0.59ns 3.10ns 1.69ns

M-C ns

1.44 0.60ns 0.11ns 0.41ns 0.95ns 1.99* 2.49** 0.08ns 0.47ns

0.14–0.16 0.55–0.57 0.90–0.92 0.67–0.70 0.34–0.36 0.40–0.50 0.00–0.01 0.94–0.96 0.63–0.66

Family size M-C

ns

Z

Gender

0.94–0.95 0.64–0.66 0.52–0.55 0.13–0.15 0.38–0.41 0.01–0.15 0.67–0.69 0.19–0.21 0.48–0.51

Z 1.34 2.87ns 0.41ns 0.39ns 0.38ns 1.35ns 0.64ns 0.01ns 1.34ns

M-C ns

0.96 1.42ns 1.39ns 0.63ns 0.48ns 0.03ns 0.50ns 0.16ns 0.99ns

0.33–0.36 0.15–0.17 0.16–0.18 0.52–0.55 0.62–0.64 0.97–0.98 0.61–0.64 0.87–0.89 0.31–0.34

Age M-C

ns

Z

0.50–0.53 0.23–0.26 0.82–0.84 0.78–0.81 0.18–0.20 0.50–0.53 0.72–0.74 0.97–0.98 0.52–0.54

Z

M-C ns

2.72 2.75ns 4.21ns 3.41ns 4.50ns 1.61ns 1.73ns 0.99ns 4.33ns

0.43–0.46 0.44–0.46 0.23–0.26 0.32–0.36 0.20–0.22 0.66–0.68 0.63–0.65 0.81–0.83 0.22–0.25

ns: non-significant. ** Significant at P < 0.01. * Significant at P < 0.05. a Monte Carlo exact test (95% confidence interval lower bound-upper bound).

(Table 6). To ensure the exact significance of the applied tests, the Monte Carlo resampling method was considered and confirmed the initial asymptotic values. In addition, an exploratory factor analysis was conducted for disfavouring items, too. The results revealed that 62.93% of the total variation in respondents’ perceptions of disfavouring items of MDPs was determined by four factors, i.e., limited support of MDPs, poor access to processed MDPs, lack of alternatives and spatial limitations, as well as uncertainty and lack of confidence to some people and places that sell MDPs (Table 7). The variables were positioned in factors as follows. The first factor explained 17.77% of the total variation in respondents’ perceptions of MDPs demand. Variables like the lack of insurance coverage, the lack of MDPs physician specialists, the lack of

and relationship with traditional medicine with consumption of MDPs.

3.3. Consumers’ attitudes disfavouring MDPs consumption The bootstrap confidence interval of the mean scores along with Shannon’s entropy revealed that the most important factors disfavouring the demand for MDPs were the lack of insurance coverage of MDPs consumers, the lack of proper processing and packaging to encourage consumption MDPs, and the lack of adequate information about MDPs use by the authorities (Table 5). There was a significant difference (P < 0.05) between single and married respondents in terms of lack of prescription of MDPs and herbal medicines by doctors and geographic locations as a limiting factor in the use of MDPs Table 4 Factor analysis for favouring items of MDPs demands. Favouring item

Factor loads Health benefits and availability

Easy availability of MDPs for everyone. Low complication by the consumption of MDPs Consumers’ recommendation to others about the use of MDPs. Curing diseases through the consumption of MDPs.

Effectiveness and suitability

0.750 0.730 0.709 0.693

Information share about the use of MDPs. Suitability of herbal medicines to the health system. Satisfaction with the effectiveness of MDPs.

0.738 0.732 0.575

Lower prices of MDPs than common chemical medicines. Relationship between use of traditional medicine with consumption of MDPs. Variance% Cumulative% Eigenvalues

Price and tradition

0.865 0.507 27.95 27.95 2.516

320

18.28 46.24 1.645

15.63 61.86 1.406

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Table 5 Consumers’ attitudes disfavouring MDPs demand. Disfavouring item

Ej

Lack of insurance coverage of MDPs consumers. Lack of proper processing and packaging of MDPs. Lack of adequate information about MDPs use by the authorities. Lack of determination on the use of MDPs by the supplier. Lack of prescription of herbal medicines by doctors. Lack of specialist physicians in the field of MDPs. Lack of confidence to some people and places that sell MDPs. Lack of adequate substitutes MDPs in front of the other methods of treatment. Geographic locations as a limiting factor in the use of MDPs. Uncertainty of the healing properties of MDPs. Lack of vogue or customary usage of MDPs. Lack of easy access to processed MDPs. The difficulty of keeping MDPs.

dj

0.543 0.575 0.524 0.523 0.481 0.511 0.495 0.520 0.478 0.485 0.486 0.462 0.469

Wj

0.457 0.425 0.476 0.477 0.519 0.489 0.505 0.480 0.522 0.515 0.514 0.538 0.531

Mean

0.071 0.066 0.074 0.074 0.081 0.076 0.078 0.075 0.081 0.080 0.080 0.084 0.082

3.97 3.89 3.82 3.72 3.72 3.66 3.52 3.48 3.47 3.44 3.40 3.23 2.96

Bootstrap CIa Lower

Upper

3.80 3.74 3.64 3.51 3.54 3.47 3.33 3.31 3.29 3.25 3.22 3.01 2.78

4.15 4.05 4.00 3.92 3.90 3.84 3.71 3.64 3.68 3.62 3.59 3.43 3.13

Scale: from 1 = strongly disagree to 5 = strongly agree. a CI: 95% confidence interval.

formed a factor named poor access to processed MDPs, which explained 17.57% of the variance. Lack of alternatives and spatial limitations as well as uncertainty and lack of confidence to some people and places that sell MDPs were the two remained factors, which explained 27.58% of disfavouring items of MDPs demands. The first one included the

adequate information about MDPs use by the authorities, and the lack of proper processing and packaging of MDPs were loaded on this factor, which was named limited support of MDPs. Lack of easy access, difficulty of keeping, lack of instructions on the use of MDPs by the supplier, and lack of vogue or customary usage of MDPs were the variables which

Table 6 Comparison of independent variables in terms of factors disfavouring MDPs demand (Mann-Whitney and Kruskal-Wallis tests). Disfavouring item

Mann-Whitney test Cultivation Z

M-C ns

a

0.21–0.23 0.38–0.40 0.07–0.08 0.82–0.83 0.30–0.32 0.40–0.42 0.32–0.34 0.71–0.73 0.59–0.61 0.31–0.33 0.77–0.79 0.72–0.73 0.09–0.10

Difficulty of keeping MDPs. Uncertainty about the healing properties of MDPs. Lack of confidence to some people and places that sell MDPs. Lack of adequate substitutes MDPs in front of other methods of treatment. Lack of prescription of MDPs and herbal medicines by doctors. Lack of determination on the use of MDPs by the supplier. Lack of easy access to processed MDPs for use. Lack of vogue or customary usage of MDPs. Lack of adequate information about MDPs use by the authorities. Lack of insurance coverage for MDPs consumers. Lack of specialist physicians in the field of MDPs. Lack of proper processing and packaging to encourage consumption MDPs. Geographic locations as a limiting factor in the use of MDPs.

1.20 0.80ns 1.80ns 0.20ns 1.00ns 0.80ns 1.00ns 0.30ns 0.50ns 1.00ns 0.20ns 0.30ns 1.60ns

Disfavoring item

Kruskal-Wallis test Main job Z

Difficulty of keeping MDPs Uncertainty about the healing properties of MDPs Lack of confidence to some people and places that sell MDPs Lack of adequate substitutes MDPs in front of other methods of treatment Lack of prescription of MDPs and herbal medicines by doctors Lack of determination on the use of MDPs by the supplier. Lack of easy access to processed MDPs for use Lack of vogue or customary usage of MDPs. Lack of adequate information about MDPs use by the authorities Lack of insurance coverage for MDPs consumers Lack of specialist physicians in the field of MDPs Lack of proper processing and packaging to encourage consumption MDPs Geographic locations as a limiting factor in the use of MDPs

1.21 0.02ns 2.22ns 0.20ns 3.15ns 3.18ns 6.15ns 4.24ns 0.18ns 1.70ns 4.39ns 2.71ns 1.52ns

Marriage

Z

Z

M-C ns

0.90 0.20ns 0.00ns 0.69 ns 0.00ns 1.20ns 1.20ns 0.60ns 1.00ns 0.50ns 0.50ns 0.00ns 0.00ns

0.41–0.43 0.85–0.86 0.97–0.98 0.50–0.52 0.99–1.0 0.21–0.23 0.19–0.20 0.56–0.58 0.28–0.30 0.62–0.64 0.96–0.97 0.960.97 0.93–0.94

Education M-C

ns

Living place

a

0.75–0.77 0.99–0.10 0.55–0.57 0.97–0.98 0.37–0.39 0.37–0.39 0.09–0.10 0.02–0.02 0.97–0.98 0.64–0.66 0.22–0.23 0.43–0.45 0.68–0.70

ns: non-significant. * Significant at P < 0.05. ** significant at P < 0.01. a Monte Carlo exact test (95% confidence interval lower bound-upper bound).

321

Z

M-C ns

0.84 2.75ns 1.37ns 0.57ns 3.05ns 3.16ns 0.79ns 3.66ns 2.94ns 1.67ns 0.65ns 2.53ns 2.96ns

0.75–0.77 0.25–0.27 0.52–0.53 0.86–0.87 0.22–0.23 0.19–0.21 0.80–0.82 0.13–0.14 0.24–0.25 0.55–0.57 0.75–0.76 0.40–0.42 0.21–0.23

Gender M-C

ns

0.80 1.60ns 0.40ns 0.80ns 2.21* 0.80ns 0.70ns 0.50ns 0.90ns 0.50ns 1.80ns 0.40ns 2.00*

0.43–0.45 0.09–0.10 0.69–0.70 0.38–0.40 0.02–0.03 0.41–0.43 0.43–0.45 0.53–0.55 0.33–0.35 0.62–0.64 0.06–0.07 0.70–0.72 0.03–0.04

Z 1.20 1.80ns 0.10ns 0.40ns 0.60ns 0.10ns 1.20ns 0.20ns 0.15ns 0.30ns 0.90ns 1.10ns 0.80ns

Family size

Age

Z

Z

M-C ns

0.99 0.06ns 0.02ns 1.31ns 0.52ns 0.73ns 1.45ns 2.08ns 0.99ns 1.47ns 0.93ns 0.41ns 3.54ns

0.60–0.62 0.95–0.96 0.99–1.00 0.52–0.54 0.77–0.79 0.69–0.71 0.53–0.55 0.38–0.40 0.66–0.68 0.47–0.49 0.14–0.15 0.79–0.80 0.16–0.17

M-C ns

0.18–0.20 0.07–0.08 0.85–0.86 0.63–0.65 0.51–0.53 0.91–0.92 0.22–0.23 0.79–0.80 0.88–0.89 0.74–0.75 0.35–0.37 0.24–0.26 0.40–0.42

M-C ns

4.81 7.15ns 3.97ns 1.63ns 5.98ns 6.04ns 2.65ns 4.21ns 3.23ns 0.03ns 2.37ns 4.22ns 6.11ns

0.18–0.20 0.06–0.07 0.25–0.27 0.66–0.68 0.10–0.12 0.10–0.12 0.45–0.47 0.24–0.26 0.36–0.38 1.00–1.00 0.50–0.52 0.24–0.26 0.09–0.10

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Table 7 Factor analysis for disfavoring items of MDPs demands. Disfavoring item

Factor loads Limited support of MDPs

Lack of insurance coverage of MDPs consumers. Lack of specialist physicians in the field of MDPs. Lack of adequate information about MDPs use by the authorities. Lack of proper processing and packaging of MDPs.

Poor access to processed MDPs

Lack of alternatives and spatial limitations

0.827 0.768 0.609 0.599

Lack of easy access to processed MDPs. The difficulty of keeping MDPs. Lack of determination on the use of MDPs by the supplier. Lack of vogue or customary usage of MDPs.

0.855 0.710 0.584 0.532

Lack of adequate substitutes MDPs in front of the other methods of treatment. Lack of prescription of herbal medicines by doctors. Geographic locations as a limiting factor in the use of MDPs.

0.746 0.729 0.564

Uncertainty of the healing properties of MDPs. Lack of confidence to some people and places that sell MDPs. Variance% Cumulative% Eigenvalues

Uncertainty and lack of confidence

0.839 0.796 17.77 17.77 2.310

17.57 35.34 2.284

14.82 50.16 1.927

12.76 62.93 1.659

and further the results build a basis for customizable marketing communications to enhance profits. Furthermore, the results of the study can be used for the purpose of regional-level forecasting which is important for planning future investments. The low complication by the consumption of MDPs was the most important attitude promoting the demand for MDPs in this study. Fewer side-effects were reported as an important reason for the use of medicinal herbs in Qom city of Iran (Heidarifar et al., 2013). Several people turn to herbal medicine because they regard that botanical remedies are free of undesirable side-effects (Nasri and Shirzad, 2013). In general, herbal medicines are considered safe products and for this reason manufacturers can produce and sell herbs in the market without demonstrating safety and efficacy for their products, as is required for common pharmaceutical drugs (Bent, 2008). However, the perception of fewer side-effects of medicinal herbs than chemical medicines reveals a lack of knowledge about potential complications and side-effects of medicinal herbs. Although herbs are often perceived as ‘natural’ and therefore safe, many side-effects have been reported owing to active ingredients, contaminants, or interactions with drugs (Bent, 2008). Unfortunately, the scientific evidence to establish the safety and efficacy of most herbal products is limited. For the sake of coherence with drug regulations, all medicines should meet equally rigorous safety and efficacy standards for marketing authorization, irrespective of their origin. The usage of spices and herbs is welcome by many consumers, because these products are valued as natural material, rather than fabricated additives. A previous study reported a direct relationship between individuals’ awareness of the therapeutic effects of herbal medicines and their consumption (Javanbakht and Esmaili, 2014). Consumers’ recommendation to others about the use of MDPs was the second most important factor promoting the demand for MDPs. Consumers obtain information about products and services from personal sources (e.g., family, friends, neighbours, other consumers) and also from non-personal sources (e.g., mass media) (Lantos, 2011). Typically, consumers make use of both personal and non-personal sources of information when purchasing products because both sources convey information about search qualities effectively. Information increases consumers’ knowledge about the benefits and potential risks of MDPs consumption and about where to find reliable sources of additional

variables: lack of adequate substitutes MDPs in front of the other methods of treatment, lack of prescription of herbal medicines by doctors, and geographic locations as a limiting factor in the use of MDPs. The second one included the variables: uncertainty of the healing properties of MDPs and lack of confidence to some people and places that sell MDPs.

4. Discussion MDPs could play an important role in domestic economy of Iran, apart from the oil exports, in addition to other non-oil exports. One of the mechanisms for promoting the production of such plants is the development of their processing (Iravani et al., 2013). This study contributes useful data on the demand for MDPs through quantitative methods. Exploring respondents’ attitudes that affect the demand for MDPs, the study achieves in identifying favouring and disfavouring factors affecting the consumption of MDPs in the area of Rasht in northern Iran. In this context, the most important promoting factors of MDPs demand in the study area were: the low complication by the consumption of MDPs, the consumers’ recommendation to others about the use of MDPs, and the lower prices of MDPs than common chemical medicines. By contrast, the lack of insurance coverage of MDPs consumers, the lack of proper processing and packaging of MDPs, and the lack of adequate information about MDPs use by the authorities were the most important inhibiting factors of consumers’ demand for MDPs. Research regarding attitudes towards consumption of MDPs is limited in the literature or does not exist. Therefore, in an international level the results of the study can be a useful gauge for future comparisons in the area of Rasht or other areas with similar consumers’ profile. Methodologically, the study could constitute a base for the formation of a theory for the demand of MDPs in future research. In a national level, the information provides useful policy insights into the development of MDPs production in northern Iran and sheds some light on what drives acceptance of MDPs from the consumers’ point of view. In a regional level, understanding what drives acceptance of MDPs offers important information that can point out appropriate methods for product development and demand creation activities. To this end, the results of the study revealed market segments that can be identified and targeted 322

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(Sajedipoor and Mashayekhi, 2015). It is of major importance, therefore, to furnish the public with adequate information to facilitate better understanding of the risks associated with the use of MDPs and to ensure that all herbal medicines are safe and of suitable quality (Ekor, 2014). Reliable sources of information are necessary for the pharmacist to satisfy the increasing demand on complementary and alternative medicine (Ostermann et al., 2011). Furthermore, the common misconception that the natural products are not toxic and devoid of adverse effects often leads to improper use and unrestrained intake and this may result in severe poisoning and acute health problems (Ekor, 2014). This misconception is widespread in most developing countries and exists in some highly developed countries, where people often resort to ‘natural’ products without awareness or information of the associated risks, particularly in the event of excessive or chronic use. An additional major challenge in many countries is the fact that regulatory information on herbal medicines is often not shared between regulatory authorities and safety monitoring centers (WHO, 2004a). The type of information needed when promoting proper use of MDPs may vary from country to country, depending on cultural and traditional influences, health system structure, and the development of all additional aspects of proper use (WHO, 2004b). Many Iranian policy makers often declare the agricultural sector as the pivot of national independency and development (Hayati and Karbalaee, 2013). Since the 1970’s the rural development as a concept has been highly associated with the promotion of standards of living and as a precondition for reducing rural poverty. However, in the past, rural development had been adversely affected by top-down approaches to development and has become ‘supply-driven’ in many countries. On the contrary, recent developments in decentralization in Iran advocate a ‘demand-driven’ strategy which has the merit of considering the specific demands and potential of each locality. From this point of view, the present study provides strong evidence for developing such a ‘demand-driven’ strategy concerning MDPs. Therefore, the local government institutions and the local community organizations could establish a collaborative partnership for developing a local ‘vision’ and strategy by allocating resources, implementing and evaluating development activities that would better cater the local needs. In this sense, they would ‘jointly’ become the driving force towards rural development, developing a ‘sense of shared ownership’ and becoming ‘managers’ of their development initiatives. Also, micro-projects with the support of Ministry of Agriculture targeting MDPs development could be promoted in rural areas as a kind of this collaborative partnership. The present study provides a practical example of economic potential and research on MDPs, which may help policy planners at national and international levels in linking livelihood and socioeconomic development with natural resource conservation. Local livelihood systems that are based on MDPs are often ruled by market demand and are a good source of employment and income generation to poor rural communities. Therefore, an appropriate framework and technologies promoting the cultivation of MDPs is a critical factor to ensure a continuous and regular supply of MDPs for the pharmaceutical industry and to prevent degradation of the natural resource base. In this context, participatory action research would be helpful to all interesting parts (i.e., farmers, traders, scientists, and policy planners) for developing sustainable livelihoods of the subsistence rural communities. Despite the well-defined policy at a top governmental level in Iran, our analysis showed ‘limited support of MDPs’ as a disfavouring factor of MPDs acceptance at local and regional level. Therefore, some recommendations are made aiming to promote a suitable balance between cultivation, conservation, and consumption of MDPs. Overall, a robust sector for MDPs policy in Iran should be people-centered, livelihood-focused, knowledge-based, and biodiversity-enriching. The policy philosophy should be based on a long-term vision of providing equitable access, a fair share of benefits, and conservation of MDPs through sustainable use. In this context, the following issues should be taken into account.

information. However, it is important that information strategies provide a well-balanced message with reliable information tailored to the specific local context. Consumers are increasingly curious about MDPs and often think that their consumption has only negligible side-effects (Pai and Skeels, 2010). However, new customers are curious, but remain vigilant, despite a growing interest in finding natural ways of healing and avoiding strong chemical medication (Chandra, 2016). In general, consumer curiosity for new tastes raises the demand for product diversity. A study from Italy found that some consumers tried functional products just out of curiosity or even without a specific reason (Annunziata and Vecchio, 2010). Social factors affect the buying behaviour of consumers because the reference groups, their role and status in the society have a real potential in forming a personal attitude. The lower prices of MDPs than common chemical medicines also played a significant role in the promotion of MDPs demand. Of major concern is the fact that a significant part of wild harvested material is traded commercially. Consequently, prices are too low to make cultivation attractive. However, it is difficult to generalize regarding prices of MDPs because of the wide range of products and materials included as medicinal plants. MDPs are often cultivated under contract, given the higher cost of the cultivated material than the non-cultivated material (Schippman et al., 2002). In the majority of cases, companies tend to cultivate only those plant species they use in large quantities or in the production of derivatives and isolates, for which standardization is essential and quality is a prerequisite. Lately, growers’ cooperatives or collaborative projects have been set up to enable growers in some countries to achieve great negotiating power and thus high prices for their products. When choosing a traditional Chinese medicine outlet, customers considered price and quality to be important factors, while trust in good storage was also identified as a key determinant of store choice (Tan and Freathy, 2011). The lack of insurance coverage of MDPs consumers was the most important factor hindering the demand for MDPs. The lack of regulation is probably the biggest factor affecting the reliability of commercial herbal products or herbal medicines in many countries. Because many of today’s pharmaceuticals are already plant-derived, one may wonder why the pharmaceutical industry is so tightly regulated, while the herbal industry is not. The answer to this question can be based primarily on economics. Clinical trials to demonstrate safety and efficacy of a drug are costly and time-consuming. Currently, the drug approval process takes from 8 years to as many as 18 years, with costs in hundreds of millions of dollars. Because of great expenses, companies want to patent their product to recover their investment and make a profit. However, natural products, such as those derived from MDPs, cannot be patented. Hence, no economic incentive exists and only limited research on whole plants or their crude extracts is conducted by pharmaceutical manufacturers. The insurance coverage of medicinal herbs and the easy access to these products could boost their consumption (Rashidi et al., 2012). The lack of proper processing and packaging of MDPs was found to be an important inhibiting factor of MDPs demand. Cultivation of medicinal plants faces a number of problems, partly due to the typically small scale of the operations (Schippman et al., 2002). Problems with packaging, storage, transportation, and quality control persist and often are neglected, even if cultivation technologies are developed. Processed medicinal plant material should be packaged quickly to prevent damages of the product and to protect against unnecessary exposure to potential pest attacks and contamination. A label to the packaging material should clearly indicate the scientific name of the medicinal plant and other information. The label should also contain information indicating quality and compliance with other national and/or regional labelling requirements. Lack of adequate information about MDPs use by the authorities was the third most important inhibiting factors of consumers’ demand for MDPs. A previous study from Iran found that the majority of consumers were at a medium awareness level about the use of MDPs 323

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Acknowledgements

First, national policies for the integration of complementary and alternative medicine with national health care systems should be developed and implemented. Second, the MDPs policy needs to fully appreciate the importance of the traditional knowledge and practices followed by local communities. Third, the selection of species to be cultivated should be driven by commercial potential and not by environmental threat alone. Fourth, any intervention should take into account that conservation is closely linked to the livelihood options of the local communities and, to be effective, any conservation strategy must involve these communities and provide income generation opportunities to them. Fifth, as linkages between the various actors associated with the MDPs chain are weak, regular interaction should be organized to build these linkages, e.g., by organizing training and research activities as well as supporting technology development related to MDPs, as suggested above. The results of the study do not come without certain limitations. First, an important limitation is that the survey was conducted in a limited geographical area, but with a high production of MDPs. Future research should investigate the views of respondents in a wider geographical area. Second, a purposive sampling method was used with the main goal to focus on particular characteristics of a population of interest. However, a purposive sample cannot be considered representative of the entire population. Thus, generalizing the research findings is difficult. However, this is not a problem where sampling for proportionality is not a concern. On the other hand, purposive samples, by definition, target a specific population of interest, which can help gain detailed insights into their characteristics. Also, the study aimed to provide a useful snapshot of the factors affecting the demand for MDPs in Rasht of northern Iran and not to create generalizations pertaining to the entire population.

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5. Conclusion This study explored consumers’ attitudes affecting MDPs demand in northern Iran. The main promoters of the demand were the low complication by the consumption of MDPs, the consumers’ recommendation to others about the use of MDPs, and the lower prices of MDPs than common chemical medicines. By contrast, the lack of insurance coverage of MDPs consumers, the lack of proper processing and packaging of MDPs, and the lack of adequate information about MDPs use by the authorities were the most important inhibiting factors of consumers’ demand for MDPs. Efforts must be geared towards measures that will promote the rational use of MDPs, especially through the integration into national, regional, and local health policies and programs. Policy makers should pay due attention to the existence and contributions of the indirect roles of agriculture and integrate social values into their decision-making. Policy responses should take due account of the changing roles of agriculture in the course of development. Given the economic importance of MDPs and their benefits to human health, the MDPs sector can have great significance for the development of the country, especially since it can account for a considerable part of the exports in addition to other non-oil exports. Of course, supporting the MDPs industry is not limited to just financial support, but also issues related to education (people, doctors, businessmen), technology development, marketing, economics, management, etc. also encompass rules and regulations. Thus, various ministries and departments involved in this issue should participate. For example, The Ministry of Agriculture, the Ministry of Health and Medical Education, the Ministry of Science, Research and Technology, the Ministry of Economic Affairs and Finance, the Ministry of Commerce, the Ministry of Industries and Mines, the Department of the Environment, Management and Planning Organization and even insurance companies should participate. From a methodological point of view, the study could constitute a base for the formation of a theory for the demand of MDPs in future research. 324

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