Community pharmacists’ interest in and attitude to pharmacy practice research in Ethiopia: A cross-sectional study
Community pharmacists' interest in and attitude to pharmacy practice research in Ethiopia: A cross-sectional study
Editor: Meagen Rosenthal
Akshaya Srikanth Bhagavathula 0
Eyob Alemayehu Gebreyohannes 0
Begashaw Melaku Gebresillassie 0
Daniel Asfaw Erku
Chernet Tafere Negesse
Yared Belete Belay 1
0 Department of Clinical Pharmacy, University of Gondar-College of Medicine and Health Sciences, School of Pharmacy , Gondar, Amhara , Ethiopia , 2 Department of Pharmaceutical Chemistry, University of Gondar- College of Medicine and Health Sciences, School of Pharmacy , Gondar, Amhara , Ethiopia , 3 Department of Formulation Research and Development, Addis Pharmaceutical Factory , Adigrat, Tigray , Ethiopia
1 Department of Pharmacoepidemiology and Social Pharmacy, Mekelle University , Mekelle, Tigray , Ethiopia
Pharmacy practice-research became an important component in the pharmacy practice. However, limited studies were conducted in sub-Saharan Africa to understand the pharmacists' interest and attitude towards pharmacy practice-research. We aimed to assess the community pharmacists' interest and attitude towards pharmacy practice-research in Ethiopia. A cross-sectional survey was conducted among community pharmacists in eight major cities in Ethiopia. A validated 25-item self-administered questionnaire covering interest and attitude related to pharmacy practice-research was distributed. Responses were analysed using descriptive and inferential statistics. A total of 389 community pharmacists responded to the survey (response rate- 88.4%). Most of community pharmacists showed a high level of interest and positive attitude in being involved in all aspects of pharmacy practiceresearch. The median summary score for interest and attitude were 38 (IQR 20±40) (range possible 10±50) and 30 (IQR 18±39), respectively. Sixty-seven percent of the respondents thought about being involved in research, felt research is important for their career (57.6%), confident to conduct the research (56.2%), and agreed that research is a part of pharmacy practice (48.5%). However, only forty-six percent agreed that they underwent research training. A multivariate analysis showed that females were more interested in pharmacy practice research than males [AOR: 1.50, 95% CI: 0.99±2.27; p<0.05]. Community pharmacists showed high interest towards several areas of research competencies and demonstrated positive attitude towards pharmacy practice-research. Our findings suggest that providing research training to community pharmacists may contribute in undertaking research activities and build the research capacity in Ethiopia.
Funding: No financial funds were gained to
conduct this study. Addis Pharmaceutical Factory,
Adigrat, Ethiopia provided support in the form of
salary for one author [CTN], but did not have any
additional role in the study design, data collection
and analysis, decision to publish, or preparation of
the manuscript. The specific roles of this author are
articulated in the "author contributions" section.
In pharmacy, rapid advances in technology, education and practice have fostered community
pharmacists' interest in extending their practice beyond their traditional role in the healthcare
system. In order to provide these extended services, they need to adopt and establish
evidencebased practice. Evidence-based medicine (EBM) is defined as ªthe conscientious, explicit and
judicious use of current best evidence in making decisions about the care of current individual
]. Every year, several rigorous research conducted to address clinical questions
about patient outcomes and cost-effective health care. These substantive finding helped to
answer the questions from accessing, collating and interpreting results to provide best
treatment for a particular population suffering with particular condition. One classical example
would be the early studies demonstrating the value of aspirin in prevention of cardiovascular
diseases in diabetic patients [
]. However, implementing evidence-based pharmacy practice is
not easy, as pharmacists must have solid research skills.
Several studies have identified key factors such as a lack of knowledge, awareness,
experience, skills, and understanding as some of the barriers to practicing EBM [3±8]. In addition,
earlier work from developed countries such as the United Kingdom (UK), Canada, Australia,
and Qatar has shown that although pharmacists may be aware of research, they are less likely
to participate in research activities [3, 5,7±10]. This situation was also noted among physicians
and nurses [
]. However, surveys conducted with UK pharmacists report that 32 to 48%
were interested in participating in research [13±15]. Similarly, in Australia, pharmacists with
some research experience (77%) were more likely to undertake future research than those who
had never participated (34%) .
Community pharmacists can make a significant contribution to future research initiatives
from small scale local projects to large scale treatment effectiveness of new services [
Professional pharmacy organizations in developed countries have devoted much effort to
developing and supporting pharmacy practice research [
]. Further, developing countries such as
], Saudi Arabia  and Thailand [
] also assessed the extent of interest and
exposure to research processes among pharmacists [19±22]. All these studies aimed to
investigate the importance of pharmacy practice research in different practice levels as a potential
area of improvement in the current era. Till date, no studies have addressed the need of
pharmacy practice research in community pharmacists and pharmacy technicians in Ethiopia. Due
to its widespread implications, this study assessed the level of interest and attitude of
community pharmacists and pharmacy technicians in a sub-Saharan country: Ethiopia. The aim of
this study is, therefore, to assess community pharmacists' and pharmacy technicians' interest
in, and attitude towards pharmacy practice research in Ethiopia.
Materials and methods
In this cross-sectional survey, a questionnaire was distributed to all community pharmacists
and pharmacy technicians practicing in community medicine retail outlets (CMROs) in
Ethiopia from September±December 2015. The CMROs in Ethiopia are divided into pharmacy and
drug stores based on the kind of medications they are supposed to dispense and the
qualification of service providers. Pharmacies run only by a pharmacist having a qualification of a
university degree or above and drug stores run by pharmacy technicians with qualification of
diploma in pharmacy. As the roles and responsibilities of pharmacy technicians in pharmacy
practice and pharmacy-based research is significant in Ethiopia, we included pharmacy
technicians in the survey. A simple random sampling technique was applied and stratified into two
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city administrations (Dire Dawa and Addis Ababa), three historically advantaged regions
(Gondar, Jimma, and Mekelle) and three historically disadvantaged regions (Adama, Hawassa,
and Dessie). Each community pharmacist was directly approached at their place of work and
given 20±30 minutes to complete the questionnaire.
The single proportion formula was used to estimate the study sample size . Based on the
Federal Ministry of Health (FMOH) Health Sector Development Program (HSDP) IV (2010±
2015), there were a total of 661 active community pharmacists at the end of 2010 [
Accordingly, 440 participants were selected and the questionnaires were equally distributed across the
eight cities and regions as there was no available data on the proportion of pharmacists and
pharmacy technicians currently practicing in each of the cities and regions.
We used a validated questionnaire developed in the Stewart et al. [
] study related to
pharmacy practice research among hospital pharmacists in Qatar. It was pretested in all areas of
pharmacy practice and appropriate modifications were made. The questionnaire consisted of
25 items that were divided into three sub-sections as follows: Part 1 related to
sociodemographic and practice information (5 items). Part 2 consisted of closed, 5-point Likert scale
(1 = no interest, 2 = little interest, 3 = some interest, 4 = moderate interest, 5 = very interested)
statements related to community pharmacists' interest in research activities (10 items). Part 3
contained 10 closed items related to research and were assessed using a 5-point Likert scale
(1 = strongly agree to 5 = strongly disagree) (S1 Questionnaire). Scores for research interest
(range 10±50) and attitude (range 10±50) were summed. We used median scores from the data
to establish a cut-off score as there were no previous guidelines on how to interpret these
scores. Accordingly, scores greater than 38 (research interest) and 30 (attitude) were
considered as positive, <38 was consisted as negative for interest, and <30 negative for attitude.
On the Likert scale, five out of the ten attitudinal statements were positively worded and the remainders were negatively worded (2, 4±6 and 9). These negative statements were reverse scored so that higher scores reflected a more positive attitude.
Responses from each site were manually entered into SPSS software (Cary, NC version 21.0)
and were double-checked for accuracy. Descriptive and inferential analyses were performed
for sociodemographic, attitude and practice information. The mean, standard deviation,
median, interquartile range (IQR) and percentages were computed for all interest and attitude
statements. A bivariate analysis was carried out, and variables with a p-value less than 0.2 were
included in a multivariate logistic regression analysis. Odds ratios with a 95% confidence
interval (95% CI) were also computed, along with the corresponding p-value.
The study protocol was reviewed and approved by the Institutional Research Board of the
School of Pharmacy at the University of Gondar, Ethiopia. The purpose and importance of the study was explained, and written consent was obtained from each study participant. Confidentiality was maintained by not disclosing personal information, and questionnaires were anonymized.
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Out of 440 community pharmacists who were approached, 389 completed the survey (88.4%
response rate). Among the study participants, 244 (62.7%) were males, with a mean age of 29.8
years (SD ± 7.6 years). Two hundred and eighty (72%) of the respondents held Bachelor's
degrees in pharmacy (B. Pharm) and 56.3% had less than five years' experience in community
pharmacy practice. More than two-thirds worked in independent pharmacies (35.7%) or drug
stores (33%). More than half of participants were from Amhara (25.4%; Dessie and Gondar)
and Oromia regions (25.4%; Jimma and Adama), followed by Mekelle (14.1%), Addis Ababa
(11.6%) and other cities (Table 1).
Responses to questions about interest in research are summarized in Table 2. Most
respondents expressed their interest in all aspects of pharmacy practice research, specifically:
`research advances within the field' (70%; n = 272); `generating research ideas' (64.3%; n = 250);
`analysis and interpretation of results' (62%; n = 24); `giving an oral presentation' (e.g., national
or international conferences) (60.1%; n = 234); `reviewing the scientific literature' (60.1%; n =
234); `using qualitative research methods' (59.3%; n = 231); `writing and publishing research in
academic journals' (58.3%; n = 227); and `writing research proposals' (56.8%; n = 221). The
median score for interest was 38 (IQR 20±40) (possible range 10±50).
Median and interquartile ranges for attitude scores are shown in Table 3. Overall, more than half of respondents had positive attitude, with a median of 30 (IQR 18±39), in a potential
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No interest = 1,
range of 10±50. With respect to questions about research involvement, 66.8% (n = 260) of
respondents had thought about being involved in research; more than half felt research was
important for their career (57.6%; n = 224); were confident in their ability to conduct research
(56.2%; n = 219); and agreed that research was a part of pharmacy practice (48.5%; n = 189).
However, only 45.7% (n = 178) agreed that they had received training in research. More than
fifty percent disagreed with the statements: `research is of little importance in Ethiopia' (62%;
n = 241); `research is of little importance for community pharmacists' (58.6%; n = 228);
`research is irrelevant to their profession' (55.7%; n = 217); `I have no time to think about
disagree = 1,
< 5 years
> 5 years
< 5 years
> 5 years
research' (55.2%, n = 215); and `research is more suitable for academics than community
pharmacists' (44.7%, n = 174) respectively.
Table 4 shows the associations between sociodemographic and practice information, and
interest and attitude. A multivariate logistic regression found that only sex was significantly
associated with interest. Females were more likely to be interested in research activities than
males [AOR: 1.50, 95% CI: 0.99±2.27]. Those with more than five years' experience were twice
as likely to be interested in research activities [AOR 2.05, 95% CI: 0.70±1.57]. With regard to
attitude, there was no significant association for sex, educational qualifications and years of
experience in both bivariate and multivariate logistic regressions.
To the best of our knowledge, this study is the first to investigate interest in, and attitudes to
research among community pharmacists in Ethiopia. Our results show that community
pharmacists in Ethiopia have a positive interest and attitude towards pharmacy practice research.
Overall, they recognize its value in advancing their career, and express a high level of interest
in research activities. In general, respondents who expressed a positive attitude were more
likely to be involved in it. Pharmacy practice research is an important way to generate new
knowledge and improve pharmacists' skills using evidence-based practice and rational
decision-making in patient care. Community pharmacists play a crucial role in research as they are
directly involved in patient care and are better placed to implement evidence-based
pharmaceutical care in the community.
Research has shown that in developed countries, a large proportion of pharmacists express
an interest in pharmacy practice research, but their involvement in research activities is
limited. Similarly, in our study, a high number of community pharmacists agreed that research
was important in their practice, but only a limited number (46%) had research training. This
reflects their desire to contribute to research that can advance the practice in Ethiopia.
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However, lack of adequate research training and skills are potential barriers that have already
been identified in several previous studies [
A substantial proportion of the community pharmacists who participated in our study had
graduate level training and showed a high level of interest in research activities such as
analyzing results, reviewing the literature, qualitative research, writing manuscripts, publishing in
journals, and writing protocols. This implies that pharmacists with a graduate level of
education consider research as an important part of their career. This should be compared to several
previous studies conducted in Australia, the UK, and Qatar where a large number of
non-postgraduates showed little, if any interest at all, in conducting research [
]. The possible
explanation for this difference in our study may be due to the integration and promotion of
pharmacy practice research in the undergraduate curriculum in 2008. Furthermore, in
Ethiopia, undergraduates benefit from the same facilities as more advanced students. These factors
are key to creating a research environment, encouraging a research culture and supporting
pharmacy practice research.
In our study, majority of community pharmacists expressed a positive attitude towards
pharmacy practice research. This reflects their interest in integrating research into their
professional life and practice. Community pharmacists are better placed to engage in research that
will ultimately have an impact on practice. About 57% of participants reported that engaging
in research is a professional duty, and nearly half believed that research is part of pharmacy
practice. Similar findings were noted by Elkaseem et al. in their study of Qatari pharmacists±
almost all participants agreed that it was their duty to contribute to pharmacy practice research
Over half (56%) of our community pharmacists believed that they were competent to
conduct research. These numbers are lower than those reported by Elkaseem et al. [
] and Awaisu
et al. [
] in their studies on Qatari hospital pharmacists (70%) [
], but higher than in
Perreault et al.'s study of critical care pharmacists in Canada (51%) [
], and Kanjanrach et al.'s
(>50%) study of hospital pharmacists in Thailand [
]. Similar numbers have been reported in
previous studies, and limited exposure to pharmacy practice research is perceived to be the
8, 28, 29
]. National and international organizations should support Ethiopian
pharmacists, who already possess a positive attitude to research, in overcoming these barriers and
engaging in research that will improve patient outcomes.
No significant association was found between a positive attitude to research and any of the
sociodemographic or practice-related variables. This suggests that all respondents give equal
importance to research activities and supporting research. However, in Stewart et al.'s [
study on Qatari hospital pharmacists only those with postgraduate qualifications were
significantly interested in participating in research. Therefore, the aspirations of individuals must be
taken into consideration to overcome the belief that research is only for postgraduates. Future
studies could investigate the barriers and outcomes for different categories of pharmacy
professionals. Finally, qualitative research based on in-depth interviews would help to understand
the real-life barriers faced by community pharmacists in Ethiopia.
The study has some limitations that should be considered while interpreting the results.
Firstly, it was a cross-sectional study conducted in eight Ethiopian cities and the findings
cannot be generalized to other cities in the country. Second, our use of a self-administered
questionnaire that relied upon respondents providing honest answers and the fact that the
questionnaire was not specifically validated in Ethiopian setting might subjected to social
desirability bias as some respondents may have provided more extreme responses than others,
due to their motivations and beliefs, and might subjected to social desirability bias., and their
answers might be subject to recall bias.
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A large proportion of community pharmacists in Ethiopia showed a high level of interest in
several areas of research and a positive attitude towards pharmacy practice research. Female
pharmacists were significantly more interested in participating in research than their male
counterparts. These findings suggest that providing training to community pharmacists may
be useful in encouraging them to undertake research activities and develop research capacity
to implement evidence-based practice in Ethiopia.
S1 Questionnaire. Study questionnaire.
S1 Dataset. Data underlying this study.
Conceptualization: ASB EAG.
Data curation: ASB EAG BMG DAE CTN YBB.
Formal analysis: ASB EAG.
Investigation: ASB EAG BMG DAE CTN YBB.
Methodology: ASB EAG BMG.
Project administration: ASB EAG BMG DAE CTN YBB.
Resources: ASB EAG BMG DAE CTN YBB.
Software: ASB EAG.
Supervision: ASB EAG BMG DAE CTN YBB.
Visualization: ASB EAG BMG.
Writing ± original draft: ASB EAG.
Writing ± review & editing: ASB EAG DAE.
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