The Belief-Evidence Gap in Nutraceutical Safety and Effectiveness: Consumer Risk Perceptions Among Arabic-Speaking MENA Populations and Implications for Chemical Product Standards and Health Policy

Background: Consumer beliefs about nutraceutical safety and effectiveness frequently diverge from what the scientific and regulatory evidence supports, yet this belief-evidence gap remains unmeasured in Arabic-speaking Middle East and North Africa (MENA) populations. This study is the first to systematically quantify that gap and identify its demographic predictors in this population. Methods: A cross-sectional bilingual (Arabic/English) survey yielded a final analytical sample of n = 1,000 respondents classified into three cultural groups: Jordan (n = 726, 72.6%), Other Arabic-speaking countries (n = 237, 23.7%), and Non-Arabic countries (n = 37, 3.7%). Four belief-evidence gap indicators were examined: herbal safety belief (DV1), perceived effectiveness (DV2), certification importance (DV3), and purchase location as a proxy for verification-seeking behaviour (DV4). Ordinal logistic regression (OLR) Models A1 (demographics) and A2 (demographics plus survey language) identified predictors of each miscalibrated belief. A chi-square test of independence examined the behaviour-belief inconsistency between DV3 and DV4. A sensitivity analysis at n = 1,103 tested the robustness of primary findings. STEM-specific analyses were conducted in two subsets: those who reported a major field (n = 433; Model A3) and STEM respondents only (n = 333). Results: A majority of respondents endorsed the naturalistic fallacy that herbal supplements are safer than conventional medications (51.8%), the overcalibrated belief that nutraceuticals are effective despite weak clinical evidence (82.9%), and the near-universal view that quality certification is important (89.4%). Despite this, 76.3% purchased supplements from pharmacy channels where independent certification is least verifiable (chi-square test: χ²(4) = 2.40, p = .662, Cramér's V = 0.036), confirming a trust-without-verification gap. English-language survey completion independently predicted higher herbal safety endorsement (OR = 1.739, 95% CI [1.329, 2.276], p < .001) and lower effectiveness endorsement (OR = 0.501, 95% CI [0.350, 0.719], p < .001) — consistent with the emergence and attenuation patterns documented in Papers 2 and 3 of this series. Female gender independently predicted higher effectiveness endorsement (OR = 1.549, 95% CI [1.090, 2.201], p = .015), replicating Paper 2 (OR = 1.61) and Paper 3 (OR = 1.55). STEM education did not predict any belief outcome, consistent with Paper 2's double dissociation. Conclusions: Three systematic belief-evidence gaps exist among Arabic-speaking MENA nutraceutical consumers, each demographically patterned and consistent across cultural groups and subsamples. Closing these gaps requires product-level and regulatory action (see Section 5.5 for specific recommendations) alongside targeted pharmacy-based health communication. This paper provides the first systematic evidence base for that argument in the MENA context.