Perceptions And Barriers Towards Provision Of Health Promotion Activities Among Community Pharmacists In The State Of Penang, MalaysiaCorrespondence Address :
Dr Mohamed Azmi Ahmad Hassali, PhD Senior Lecturer, Discipline of Social and Administrative Pharmacy,School of Pharmaceutical Sciences, Universiti Sains Malaysia,11800 Minden, Penang, Malaysia. E-mail: firstname.lastname@example.org, azmihassali@ usm.my Tel: +604-6534085.
Introduction: Health promotion is the process of enabling people to increase control over their health and to improve their health. Within this context, the community pharmacist, as one of the most accessible healthcare practitioners, plays a major role in the provision of health promotion activities to the society at large.
Objectives: To document the current level of involvement with health promotion activities among community pharmacists in the State of Penang, Malaysia
Methods: A cross-sectional study using a validated questionnaire was undertaken with a convenient sample of community pharmacists practicing in the State of Penang. The completed questionnaires were analyzed as per the study objectives.
Results: A total of 100 questionnaires were distributed to 100 community pharmacists practicing in Penang state. At the end of the survey, 80 questionnaires were collected back (response rate: 80%). The top five health promotion activities currently undertaken by community pharmacists, were weight management (n=74, 92.5%), diabetes counseling (n=73, 91.3%), traditional and complementary medicine counseling (n=67, 83.8%), nutrition and physical activity (n=66, 82.5%) and asthma counseling (n=65, 81.3%). Most of the respondents (n=60, 75.1%) either strongly agreed or agreed that lack of time is the barrier limiting them from involving in health promotion activities. Only 23 (28.8%) respondents stated lack of profitability as a reason for not taking part in health promotion activities. A majority of the respondents (n=79, 98.8%) were aware that health promotion is part of the pharmacistâ€™s responsibility. We found 62 (77.5%) respondents who provided health education and promotion programs to the public.
Conclusion: Most of the community pharmacists in Penang showed a high confidence in providing health promotion activities. Still, there are lots of obstacles for the community pharmacists to overcome in order to involve themselves in health promotion activities. Training and continual support in terms of continuing professional development and life-long learning is essential to empower the community pharmacists.
Community pharmacists, perception, barrier, health promotion activities.
The World Health Organization (WHO) defines health as the â€˜state of complete physical, mental and social well-being, and not merely the absence of disease or infirmityâ€™(1). This WHO definition emphasizes wellness and the social, environmental, and economic factors that may influence the behaviours affecting the peopleâ€™s health. Public health is defined as an organized community effort to protect, promote, improve, or restore the communityâ€™s or populationâ€™s health[ 2]. Health promotion and disease prevention technologies and interventions encompass the 3 core functions of public health, that include assessing and monitoring at-risk populations to identify health problems and priorities; formulating public policies in collaboration with community and government leaders; and assuring that people have access to appropriate and cost-effective care(2),(3). Health promotion is any combination of interventions (i.e., health education and related organizational, economic, and/or political interventions) designed to facilitate behavioural or environmental changes that will improve or protect public health (3). Health promotion strategies focus on community based interventions and partnerships to maintain wellness and to help modify individual behaviours such as unhealthy lifestyles. In other words, health promotion involves community interventions that help a person increase control over and improve his or her own health (4).
Pharmacists are knowledgeable specialists who are currently under utilized in the primary health care team. They are experts in medicines, minor illnesses and health, they have 4 years of undergraduate training and a pre-registration competency based training year, and are expected to undertake continuing professional development. Community pharmacists can be accessible sources for health promotion(5),(6),(7). Pharmacies are recognized as the most accessible healthcare services in the community, with over 90% of the population visiting them during one year(5),(6),(7),(8). Community pharmacists are patronized by both healthy and sick people, thus having access to a large proportion of the populationâ€”before a major illness or disease is evident(9).
It is well recognized that pharmacists act as health advisors to the general public (10) and they are acknowledged as highly credible sources of health information (11),(12). Because they are recognized as credible sources of information and because of their accessibility, availability and frequent contact with the public, community pharmacists could provide an important channel for the delivery of these kinds of activities(13),(14),(15). This recurring interest of pharmacists as health educators in the public health role is considerable (16),(17). Partially, because of these continuing reassessments and the ongoing changes in the health care system, professional pharmacy associations are increasingly interested in health promotion and disease prevention as a way to effectively position this profession in the 21st century (13),(14),(17).While evidence that people can do much to promote their own health is intensifying, the role of pharmacists in assisting patients is not well documented (18), (19),(20). In one of the few studies reported to date, Paluck et al (21). reported that there is considerable room for increasing pharmacist involvement in health education and disease prevention activities. Implementing changes in health behaviours among community residents is challenging. O'Loughlin et al (9). has suggested that there is less interest in prevention activities targeting smoking, diet, and physical activity, because the pharmacists may feel that these areas are too far removed from the traditional role of dispensing medication. So far, there is no study in Malaysia that has evaluated the perceptions and barriers towards the provision of health promotion activities among community pharmacists. Hence, we undertook the present study with the following objectives.
1. To identify the involvement and the types of health promotion activities provided by the community pharmacists and
2. To identify the barriers which limit the Involvement of community pharmacists in health promotion activities.
A cross-sectional survey design.
Sample Size And Sampling Method
Using the convenience sampling method, 100 community pharmacists in Penang State were approached by the researchers and were invited to participate in the research. Face-to-face and individual interviews were carried out in the workplace of the pharmacists and the questionnaires distributed were collected immediately to minimize the bias that might occur. At the end of the study period, a total of 80 respondents participated in the study (Response rate: 80%).
(Table/Fig 1)The questionnaire used, was divided into four domains. The first domain consisted of the demographic details of the respondents. The second domain consisted of questions related to the degree of involvement in health promotion activities. The third domain consisted of questions relating to the types of health promotion activities that were currently provided by respondents. The final domain consisted of questions pertaining to the barriers that limited the involvement of community pharmacists in health promotion activities.
All the data obtained was then examined and the responses were coded. The data was then descriptively analysed and an appropriate non-parametric test (Chi-square tests) was applied, using the Statistical Package for the Social Sciences software (SPSS version 15.0). A P-value of less than 0.05 was considered as statistically significant.
A total of 80 community pharmacists were interviewed. Among the 80, 43 (53.8%) were males and 37 (46.3%) were females. The demographic characteristics of the respondents are listed in (Table/Fig 2).
Involvement Of Community Pharmacists In Health Promotion Activities
Pharmacists were found to be involved in health promotion activities at variable degrees, but the activity that most pharmacists were very involved in, was diabetes counseling (n = 6, 32.5%). The details regarding the involvement of the community pharmacists in health promotion are listed in (Table/Fig 3).
Types Of Health Promotion Activities That Community Pharmacists Provide
Most community pharmacists were found to provide diabetes counseling (n = 53, 66.3%), but very few provided immunization and special population counseling. The various types of health promotional activities that are provided by the community pharmacists are listed in (Table/Fig 4).
Barriers That Limit The Involvement Of Community Pharmacists In Health Promotion Activities
Most community pharmacists (n = 60, 75.1%) identified lack of time as the barrier that limited their involvement in conducting health promotion activities. The barriers that limited the involvement of community pharmacists in health promotion activities are listed in (Table/Fig 5).
Recently, there has been an increased interest in broadening the role of community pharmacists beyond the traditional product-oriented functions of dispensing and distributing medication, to involve them in a greater role in public health. More specifically, counseling with the objective of providing patients with risk-management information or of improving compliance with prescribed medication, are viewed as tasks particularly well suited to pharmacists(8). Because they are recognized as credible sources of information8 and because of their accessibility, availability, and frequent contact with the public, community pharmacists could provide an important channel for the delivery of these kinds of activities(12),(22),(23).
There are many case reports describing the engaging of community pharmacists in nontraditional tasks including patient education(16),(23),(24),(25),(26), counseling(27),(28),(29),(30), follow-up to detect noncompliance (32), referral (33) and screening for risk factors of chronic diseases (31),(32),(33). However, there are almost no systematic studies documenting the level of participation by pharmacists in health education and disease prevention activities. In one of the few studies reported to date, Paluck et al (21). surveyed a random representative sample of 485 community pharmacists (one-quarter of all the communities in British Columbia), concerning their level of participation in health education and disease prevention activities.
In the present study, there are no statistically significant differences noted between the sociodemographic aspects and the barriers that limit the community pharmacists from providing health promotion.
It was observed that most of the respondents (n=60, 75.1%) agreed that lack of time was a barrier that limited them from involving in health promotion activities. However, Hidalgo Cabrera et al. noticed that the â€˜â€˜lack of timeâ€™â€™ priority diminished with increasing knowledge in pharmaceutical care issues. These issues have only recently been incorporated in pharmaceutical education (34).
The non-availability of standard guidelines for offering health education was also highly agreed by the respondents as a barrier, which limited them from providing health promotion activities. This was followed by insufficient management support which has also hindered community pharmacists from not involving themselves in health promotion activities. The total numbers of respondents that agreed with the statement was 42 (52.5%). The fourth and fifth barriers that have a higher number of respondents, agreed with them as barriers that limit pharmacists from involving in health promotion activities are lack of training 38 (47.6%) and lack of reimbursement for health promotion activities from consumers 29 (36.3%). There were a small number of respondents (n=23.28.8 %) who agreed that lack of profitability was the barrier that limited them from involving in health promotion activities. At the international level, â€˜â€˜lack of timeâ€™â€™ and â€˜â€˜lack of specific trainingâ€™â€™ are ranked as major barriers (34),(35),(36),(37).
Limitations Of Our Study
Our study had a few limitations. The survey that was conducted, was only confined to the community pharmacists in the state of Penang. Thus, the findings that were obtained only show the perceptions of community pharmacists in the state of Penang, which might not be generalized to community pharmacists in other states of Malaysia.
A majority of the community pharmacists participated in diabetes counseling. The study showed that lack of time is the major barrier that limits the community pharmacists to remain active in health promotion activities. A majority of the respondents were aware that health promotion is part of the pharmacistâ€™s responsibility. Most of the community pharmacists have provided health education and promotion programs for the public.
The authors acknowledge YS Law, BH Lee, MK Lee, SF Lee, PH Lim, WY Lim, MF Hayati, MI Shuhairi, MM Zaman, MS Sharif, NM Saffie, the pharmacy undergraduates from the School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia, for helping them to carry out the data collection.
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