Food supplement use, knowledge and perceptions among adults in Malta

Abstract

Background: Dietary supplement use is widespread globally, yet Malta lacks context specific evidence on who uses supplements, which products are taken, why they are used, and how risks and regulation are perceived. This thesis addresses that gap by profiling use, knowledge, and perceptions among Maltese adults and by testing how these relate to demographics and health behaviours, with the aim of informing education and proportionate regulation. Methodology: A quantitative, cross-sectional online survey targeted adults (≥18 years) residing in Malta. The instrument—adapted from established surveys and culturally tailored— captured demographics; supplement use (types, duration, concomitant use, purchasing and information sources); and Likert-scale perceptions (safety, benefits, necessity, substitutability, labelling, regulation, harm from misuse). After normality checks (Shapiro–Wilk and Kolmogorov–Smirnov), non-parametric analyses were applied: Chi-squared and Fisher’s exact tests for associations between categorical variables; Mann–Whitney U for two-group comparisons on Likert outcomes; Kruskal–Wallis for multi-group comparisons; and Kendall’s correlations among attitudinal scales (α=0.05). Ethical and data-protection standards were observed. Results: Supplement use among Maltese adults is widespread (66–70%) and primarily preventive. In the sample (n=449), use was highest among women (69.9%) and post-graduates (73.5%). Vitamins were most common (33.7%), followed by minerals (16.6%), sports products (14.6%), and fish oils (13.9%). Pharmacies and health shops dominated purchasing (88.8%), while physicians (26.1%), pharmacists (≈12%), and personal research were key information sources. The main motives were improving health/preventing problems (39.4%), supplementing the diet (14.9%), and boosting immunity (14.0%). Participants generally viewed supplements as safe and beneficial, rejected diet replacement, agreed labels were clear, and were uncertain about regulatory adequacy. Women were more likely to use supplements (p=0.005) and to consult health professionals before use (p<0.01). Use increased with education (p=0.001). Consultation varied by education (p=0.037) and physical activity (p=0.020). Information sources differed by gender (p=0.002; women: physicians, men: social media), age (p=0.009), and activity level (p=0.001), with more active individuals referencing nutritionists, academic sources, or social media. Purchasing channel also varied by age (p=0.038) and activity level (p=0.006), with more active users more inclined to buy through social media or physicians. Compared with non-users, users more strongly agreed that supplements are safe, beneficial, and necessary (all p<0.01), rejected diet replacement (p=0.024), and acknowledged misuse risks (p=0.044). Older adults (51–80 yrs) perceived lower necessity but greater label clarity and regulatory adequacy than younger adults. Consultation status influenced beliefs about safety, benefits, necessity, diet replacement, and harm. Belief in adequate regulation correlated with perceptions of safety, benefit, necessity, diet replacement, and label clarity, while safety correlated strongly with perceived health benefit and necessity. Conclusion: Users hold favourable yet discerning views: benefits are recognised, substitution for diet is overwhelmingly denied, and uncertainty about regulatory adequacy persists. Inferential results show that gender, education, and activity shape both uptake and attitudes; consultation pursuit and age further modulate perceptions in predictable ways. These findings suggest leverage points for policy and practice: strengthen pharmacist-led counselling, tailor public-health messaging to high-use groups (e.g., active and highly educated adults), and communicate regulatory safeguards more clearly—especially around concomitant use and product quality. Limitations include self-reporting, non-probability online sampling, and cross-sectional design; future mixed-methods and longitudinal work should link behaviours to clinical outcomes to guide proportionate regulation and education in Malta.