A qualitative study exploring public perceptions on the role of community pharmacists in Dubai

This work is licensed under Creative Commons Attribution-NonCommercial-ShareAlike 3.0 International.

Pharmaceutical care has passed through 3 major redefinitions over the last 2 decades.1 The “compounding” era was replaced by the “count-and-pour” era which was, over a period of time, overtaken by the clinical pharmacy movement.2 Most recently, pharmaceutical care has adopted a new set of assumptions, concepts, and values that have made the pharmacy practice patient-centered rather than merely product-oriented.3,4,5

Pharmacists have an important role in healthcare delivery because of their expertise and location within communities that gives them close proximity to patients, such that they are sometimes the first respondents in the healthcare system.6 This interaction between patients and pharmacists has been extensively studied in many developed countries and values like patient satisfaction with pharmaceutical care type or with specific disease management services were thoroughly assessed.7,8,9,10 However, these values are often not generalizable to developing countries such as the Middle East where the first priority is still traditional pharmacy practice.11 While there have been some efforts to gauge patients’ satisfaction level in some Middle East countries12,13,14, there have not been many research papers that explored concepts such as public perceptions and expectations towards the role of community pharmacists in Dubai, United Arab Emirates (UAE). UAE is one of rich Gulf Cooperation Council countries in the Middle East and has gross domestic product (GDP), per capita, of around USD52,435.15,16 The UAE has a diverse and a fast expanding population which was estimated to break the mark of 8 million in 2010.10 However, UAE nationals are considerably few compared to expatriates (other Arab countries, Iran, South East and South Asia) who constitute approximately 88.5% of the total population.17 Dubai is the economic capital of the country where the healthcare system is well developed. It is controlled by a unique governmental body called Dubai Health Authority. This Authority is responsible of licensing medical professionals as well as controlling medical and pharmaceutical organizations within the boundaries of Dubai.

The objective of this study is to better understand the way the public perceives pharmacists as a part of the healthcare professionals’ team in Dubai, UAE in order to improve community pharmacy services and image among the general public in Dubai.

This paper presents an in-depth, phenomenological study exploring the perceptions and expectations of the general public on the role of community pharmacists in Dubai, UAE. It is a part of a larger qualitative as well as quantitative study which is done to explore the perceptions of general public on the role of community pharmacists in Dubai. Semi-structured focus group interviews were conducted with a convenience sample of 25 participants from different geographic settings, varying age and gender, and different education levels within the boundaries of Dubai. The source of information about potential participants was gathered from the data base of Ajman University of Science and Technology. A total number of 143 Students and ex-students were approached by emails asking them to participate in open discussion about their perceptions on the role of pharmacists in Dubai. The age range of participants was 19 to 48 years old.

Four different focus groups were separately held in a private rented hall in Dubai. The mean age ranges in the focus groups from 1 to 4 were 27, 26, 28, and 37 years old respectively. The fact that most of participants were young can be justified by taking into consideration that 50.74% of Dubai population’s age range between 20 and 34 years old.18 The discussions took an average of 1 to 1.5 hours and were conducted by a trained and well experienced interviewer (IKR). Appropriate probing questions were used when necessary to get more in-depth views from the participants (Interested readers may obtain a copy of the question guide and probes used).19 To obtain more complete ideas; participants were given freedom to express additional views on the topic at the end of the group discussion session. Group discussions were digitally recorded, transcribed verbatim, and the transcripts were supplemented with field notes that were taken during the discussions and immediately after. Two of the authors (IKR and ARA) listened to all audio recordings and IKR analyzed the transcripts for relevant content and themes. The thematic framework contained dominant themes that were refined as associations were made in order to provide explanations for findings.20,21

This study was approved by the Ajman University of Science and Technology Human Research Ethics Committee in the UAE. The study was carried out over a period of 1 month (April 01, 2013 to April 30, 2013) with an interval of 1 week between different focus groups.

Out of 143 individuals who were invited to attend the focus groups, 25 agreed to participate. They were randomly divided into 4 separate groups. The demographic characteristics of the pooled participants are summarized in Table 1. The main themes identified were related to pharmacists in the public mind, psychological perceptions, determinants of pharmacists, effect of the pharmacy as a healthcare unit on the pharmacist, and control over pharmacies.

Table 1

Demographic details of focus group participants.

Table 2 outlines the various themes and sub-themes along with examples of data excerpts. The following description presents all 5 themes in decreasing order of prevalence. The frequency of participant commentary on factors and the number of codes collated to form themes are included to give readers a sense of the predominant factors that were identified during analysis.

Table 2

Themes and sub themes identified (with examples from raw data)

The findings of this study developed a defining standard for the perceptions of the general public on the role of community pharmacists in Dubai, UAE. As such, it was the first time the term “pharmacist” was explored in a discussion session in Dubai. Interestingly, 10 participants commented that a pharmacist is a medicine seller. This phenomenon of under-estimation must be further studied in future to know its relation with factors that might affect the perception of public on the role of community pharmacists in Dubai. Some of the factors that can be studied are the effect of media, the patient’s background, previous experience, and/or the pharmacist’s interpersonal skills.22 In one similar study that was conducted in Australia, community pharmacists’ roles perceived by public were similar to their colleagues in Dubai in many aspects, with minor differences like an elevated trust level in Australia compared to Dubai.23 Larger scale quantitative studies must measure the extent to which the public trusts and respects pharmacists’ instructions and guidance in Dubai, taking into consideration that most of the registered pharmacists in the UAE are expatriates with different levels of background, experience, and training.24,25

As mentioned in theme 3, there are other factors that further contribute to the public’s acceptance of the role of community pharmacists in Dubai. Pharmacists wearing shirts have more acceptance than pharmacists wearing t-shirts. In the same context, pharmacists wearing a tie and a white coat added more respect in their patients’ minds compared to wearing a white coat without a tie. It should be mentioned that the attire of pharmacists has been extensively studied elsewhere in the literature.26 Moreover, the pharmacist’s nationality was important to 9 participants. They argued that pharmacists coming from certain nationalities might have a language barrier that could result in dispensing or prescribing wrong or unnecessary medications due to miscommunication or their business orientation. This can be the situation in many Gulf Cooperation Council countries where most of the registered pharmacists are expatriates.27,28 In addition, more than half of the participants (13) pointed out that the older the pharmacist, the more they granted trust to him/her.

Moreover, the pharmacy as a drug shop was an additional determinant that could play a crucial role in shaping the relationship between pharmacists and their patients. Factors such as the ease with which the neighborhood pharmacy could be reached and adequate space and light inside the pharmacy were mentioned about 7 times. The least common theme that arose illustrated public perception of the extent to which health authorities control and regulate private pharmacies in Dubai.

The previous points suggest that the general public perceives community pharmacists in Dubai positively. Factors that play roles in building an image of pharmacists in Dubai include health authorities, pharmacist’s knowledge level, attire, nationality, age, and pharmacy location.

In conclusion, this study provided insight into the way the public perceives community pharmacists in Dubai, UAE. Our findings can be used to promote discussion in the profession and with stakeholders about the future role of the community pharmacist in patient care in Dubai. Future studies should focus on providing significant data about the perception of the general public on the expected enhanced role of community pharmacists in the country.