Pharmaceutical Care Adoption in Community Pharmacies: Cross-Sectional Study Assessment of Challenges and Opportunities, Wad-Madani, Sudan

Pharmaceutical Care Adoption in Community Pharmacies: Cross-Sectional Study Assessment of Challenges and Opportunities, Wad-Madani, Sudan | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Pharmaceutical Care Adoption in Community Pharmacies: Cross-Sectional Study Assessment of Challenges and Opportunities, Wad-Madani, Sudan Ismaeil Eldooma, Maha Maatoug, Wadah Osman, Wajid Syed, Mahmood Basil A. Al-Rawi, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7680249/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Community pharmacies (CPs) in Sudan are accessible and cost-effective points of healthcare. However, Pharmaceutical Care Services (PhCS) has not been widely adopted. So far, adoption depends critically on resolving challenges and effectively utilizing the available opportunities. Objective: To assess the challenges and opportunities for pharmaceutical care adoption in private community pharmacies(CPhs), Wad-Madani, Gezira State, Sudan. Methods: This cross-sectional study was conducted from December 2019 to August 2020, involving 120 community pharmacists. A pre-tested, self-administered, structured questionnaire was used for data collection. The Statistical Package for the Social Sciences (version 26) was used for the analysis of categorical data variables. The p-value (α = 0.05) is the cutoff point for determining the significance of the results. Results: The response rate among participants was 87.1%. The demographic characteristics showed younger age dominance (82.5% aged ≤ 40), with 63.3% females, less experience (< 20 years, 92.5%), and most holding a B.Pharm degree (91.7%). Over half of pharmacists (52.5%) engaged in multitasking roles, including dispensing, counseling, handling money, and managerial activities, often without a separate counseling area. Awareness regarding PhCS was high (81%). However, the main barriers included 40% as insufficient continuous professional development (CPD) and 31.7% due to public perceptions. In comparison, the top supporting factor was the presence of organized staff members (55.8%). Pharmacists prioritized CPD (61.7%) as a means of supporting PhCS adoption. Overall, the observed difference between pharmacy groups was statistically insignificant for all variables (X² and Fisher's Exact test, p-values > 0.05), indicating uniformity among community pharmacists. Conclusions: The demographic profile presents both opportunities and challenges. High awareness suggests rich ground for interventions. Interestingly, systemic barriers and discouraging factors can be overcome through coordinated strategies that involve education reform, regulatory frameworks, infrastructure design, and workforce planning. Results are essential for transforming community pharmacy practice into effective models of pharmaceutical care services. Health sciences/Health care Health sciences/Medical research Pharmaceutical Care Services Adoption Community Pharmacists Pharmaceutical Care Concept and Community Pharmacies Introduction Community pharmacists are considered pivotal healthcare providers in health systems because they collaborate with patients, other healthcare providers, and caregivers to deliver comprehensive and effective medication care services (Abrahamsen et al. 2020).While these services have been considered essential in ensuring access to appropriate medications, many countries have recognized the critical need to expand the expertise and practice of community pharmacists to achieve better medication outcomes, patient satisfaction, and preferences in service offerings. Accordingly, many pharmacists in several developed countries have transformed their practice within community pharmacies (CPs) into Pharmaceutical Care Services (PhCS) paradigm(Bates et al. 2022; Hindi et al. 2019; Sadek et al. 2016). PhCS is a philosophy that centers patients at the middle of the healthcare cycle to achieve predetermined outcomes and enhance patient and pharmacist satisfaction (Alves da Costa 2018). PhCS includes proper medication management, patient counseling, medication reviews, adherence support, and collaboration with other healthcare professionals (Al-Worafi 2023). Many developed countries in Europe, such as Poland and the United Kingdom, have adopted this concept to understand patients' preferences for personalized care services. Efforts to identify and overcome the barriers to comprehensive community pharmacy transformation have been appropriately operated (Kassam et al. 2012; Merks et al. 2014). In Sudan, a previous study conducted in Khartoum State recommended initiating PhCS offerings to patients within CPs (Ibrahim and Scott 2013). Accordingly, this current research explored the challenges and opportunities of transforming the current community pharmacy practice into the PhCS offerings. Successful transformations of current situations for any practice usually require the insights and advice of relevant stakeholders. In pharmacy practice, community pharmacists are major stakeholders in community pharmacy settings, followed by clients who utilize the services offered. However, the influence of community pharmacists is significant in this situation, as they are crucial stakeholders in driving this transformational change(Thornewill et al. 2022). In this current study, we have assessed the factors preventing pharmacists from adopting PhCS in CPs, the available opportunities, pharmacists' unique perspectives, and recommendations that could contribute valuable insights into the transformation mechanism of the current pharmacy practice in Sudan and similar developing countries. Future demand for patient-centered care and the potential of community pharmacists to contribute significantly to public health are expected to increase dramatically. Accordingly, assessing the challenges and opportunities for adopting PhCS in Sudan is currently essential. Understanding influencing factors could provide insights into the feasibility of transforming current practices and inform strategies for healthcare improvement, even in similar developing countries. This study aimed to assess the challenges and opportunities associated with adopting PhCS in CPs in Wad-Madani, Sudan. Specifically, it explored the barriers faced by community pharmacists, the potential supporters of transformation, and the perspectives of CPs on implementing PhCS, to provide evidence-based recommendations to guide future practice development in the context. Methods Study design and settings: A cross-sectional survey was conducted from December 2019 to August 2020 among community pharmacists working in Wad Madani City, Gezira State, Sudan. This study analyzed community pharmacists' insights and perceptions regarding the challenges and other factors influencing the transformation of community pharmacy practice into the PhCS. Inclusion and exclusion: One authorized pharmacist per independent community pharmacy was included. However, technicians and pharmacists in the public sector were excluded from this study. Instrument and data collection: A validated self-administered questionnaire was used. The questionnaire printout conformed to Google survey forms (Google Forms 2019). The instrument comprised demographic data and three other components: Opportunities, challenges, and recommendations. Pharmacists' recommendations were collected during piloting and summarised into six major domains. Pharmacists were asked to identify the most essential factors and recommendations regarding the provision of PhCS in CPs. Participants read and understood the research objectives and future benefits before participation. Sample frame, sampling, data processing, and analysis: The sample frame list of CPs was obtained from the General Directorate of Pharmacy in Gezira State. The frame included the names of CPs and locations. The Raosoft online software calculator was used for sample size calculation and determination, with a 95% confidence interval and a 50% distribution (Raosoft Incorporation 2004). The study sample size achieved was 139 CPs. The final data were collected from 120 CPs. Categorical data were analyzed and interpreted using the Statistical Package for the Social Sciences (SPSS version 26). The output analysis was based on the Chi-square (X2) and Fisher's Exact statistical tests for categorical data (confidence level = 95%, P-value = 0.05). Ethical consideration: The Ministry of Health in Gezira State, the Research Department, and the Health Sector Ethical Review Committee at the University of Gezira have provided ethical clearance for the conduct of this research (Reference number: 37-21). All Authors confirmed adherence to the terms of the Helsinki Agreement. We informed all participants about the research purpose through a written brief introduction (in Arabic) in the first section of the questionnaires, which illustrated the purpose and future benefits of the collected research data for both pharmacists and patients. The questionnaire contains an agreement statement: "By filling out this questionnaire, agreement to be a participant in this research is confirmed, and you are aware of what it involves." All participants provided a paper-based, self-administered questionnaire after giving verbal consent to participate. Results Table 1. Demographic characteristics (Total N=120). Variable Groups Frequency % Cumulative % Gender Male 44 36.7 36.7 Female 76 63.3 100.0 Age Range ≤21 to 40 99 82.5 82.5 41 to ≥60 21 17.5 100.0 Experience years ≤1 to 20 111 92.5 92.5 21 to ≥40 9 7.5 100.0 Scientific Qualifications B. Pharm 110 91.7 91.7 MSc, PharmD, or PhD 10 8.3 100.0 Pharmacy Group Main Market -Places 50 41.7 41.7 Near Homes 70 58.3 100.0 The demographic profile revealed a notable skew toward younger, female pharmacists with shorter experience periods (Table 1). Females comprised 63.3% (n = 76), with the majority representing 82.5% of younger-aged pharmacists (≤ 21 to 40 years). Regarding experience, an overwhelming 93.3 % (n = 112) had ≤ 20 years of professional practice. While academic graduation showed that 91.7 % (n = 110) held a basic B. Pharm degree, suggesting low advanced qualification rates. However, professional experience is limited to ≤ 20 years (92.5%). On the other hand, pharmacy distribution revealed a near-home location dominance of 58.3% (n = 70) compared with those in marketplaces. Table 2: Pharmacist activities within the pharmacy, categorized by pharmacy location group. Variable(activities) Pharmacy Group Market Places: n(%) Near Homes: n(%) Total N(%) Sig Money handlers, drug dispensers, counselors, and managers. 25(50.0) 38(54.3) 63(52.5) 0.594 Counsellor within a separate counselling area 0(0.0) 1(1.4) 1(0.8) Drug dispenser, counsellor, and cashier. 25(50.0) 29(41.4) 54(45.0) Manager (located in the office within the pharmacy). 0(0.0) 2(2.9) 2(1.7) Total 50(100.0) 70(100.0) 120(100.0) The results presented in Table 2 highlighted the distribution of pharmacist activities across different pharmacy location groups. Most pharmacists in both groups serve as money handlers, drug dispensers, and counselors, with 50% in Market Places and 54.3% in Near Homes fulfilling these roles. However, dedicated counseling areas were only found in 1.4% of nearby home pharmacies. Overall, there are statistically insignificant differences in pharmacist activities between the two location groups, indicating a similar pattern of practice regardless of pharmacy location (p = 0.594). Table 3: Pharmaceutical care concept awareness among participants: What is pharmaceutical care? Pharmacy Group Total Sig. Market Places Near Homes Dispensary practice 6(12.0) 13(18.6) 19(15.8) 0.221 Good counseling: patient-centered and outcome-oriented practice by pharmacists. 42(84.0) 55(78.6) 97(80.8) Store management practice 2(4.0) 2(2.9) 4(3.3) Total 50(100.0) 70(100.0) 120(100.0) The results in Table 3 indicate varying levels of awareness regarding the concept of pharmaceutical care among participants from different pharmacy groups. The most significant majority (80.8%) recognized the idea of patient-centered and outcome-oriented counseling provided by pharmacists. There is a statistically insignificant difference in awareness between the marketplaces and near homes (chi-square test, p = 0.221 > 0.05). Table 4: The major supporting factors for pharmaceutical care services providing and the pharmacy location group. Major supporting factors Pharmacy Group Total Sig. Market Places Near Homes The organized Pharmacy staff members take their responsibilities seriously. 26(52.0) 41(58.6) 67(55.8) The helpfulness of the pharmacy environment and structure. 11(22.0) 17(24.3) 28(23.3) 0.449 The strong desire and willingness of pharmacists. 12(24.0) 9(12.9) 21(17.5) The practical and helpful regulatory bodies. 1(2.0) 3(4.3) 4(3.3) Total 50(100.0) 70(100.0) 120(100.0) Table 4 indicates varying levels of supporting factors for the provision of pharmaceutical care services across different pharmacy location groups. Particularly, 55.8% of the organized pharmacy staff members who committed to their responsibilities are perceived as a crucial element in enhancing pharmaceutical care. In contrast, factors such as the pharmacists' desire and the regulatory bodies showed minimal influence. Overall, there is a weak association between the pharmacy group and the addressed supporting factors, indicating a statistically insignificant difference between groups (p = 0.449 > 0.05). Table 5: Major barriers towards pharmaceutical care services provision in community pharmacies: The major barriers Pharmacy Group Total Sig. Market Places Near Homes Lack of training and continuous professional development 19(38.0) 29(41.4) 48(40.0) 0.154 Lack of knowledge and curriculum development problems 17(34.0) 12(17.1) 29(24.2) Lack of time 8(16.0) 14(20.0) 22(18.3) Lack of confidence and communication skills 6(12.0) 15(21.4) 21(17.5) Total 50(100.0) 70(100.0) 120(100.0) Table 5 shows an analysis of the significant barriers to PhCS provision among pharmacy groups. The most frequently addressed barrier was the lack of training and continuous professional development (40.0%), particularly prominent in Near Home pharmacies (41.4%). Furthermore, the "lack of knowledge and curriculum development problems" showed a substantial disparity between groups (34.0% in Market Places vs. 17.1% Near Homes). Despite observed disparities, there is no statistically significant difference between pharmacy groups (p = 0.159 > 0.05). Table 6: Main factors discouraging pharmacists from providing pharmaceutical care services in community pharmacies: The main discouraging factors Pharmacy Group Total Sig. Market Places Near Homes Patients' perceptions and backgrounds 15(30.0) 23(32.9) 38(31.7) 0.120 Community pharmacy structure and design 11(22.0) 18(25.7) 29(24.2) Lack of information technology 6(12.0) 14(20.0) 20(16.7) Pharmacy staff and Other health care providers 12(24.0) 5(7.1) 17(14.2) Absence of reimbursement for the provided service 6(12.0) 10(14.3) 16(13.3) Total 50(100.0) 70(100.0) 120(100.0) Table 6 illustrates the primary factors that prevent pharmacists from providing pharmaceutical care services in CPs. The most frequently addressed discouraging factors were the patients' perceptions and backgrounds (31.7% overall), followed by inadequacies in pharmacy structure and design (24.2%), and further deficiencies in information technology (16.7%) among participants. Although observed differences exist between market and home pharmacies, the difference is statistically insignificant (p = 0.120 > 0.05). Table 7: Pharmacists' recommendations to utilize supporting factors and overcome barriers: Recommendations Pharmacy Group Total Sig Market Places Near Homes Pharmacists should be well-trained and updated through CPD lectures and workshop programs. 32(64.0) 42(60.0) 74(61.7) 0.438 Regulatory bodies must help implement effective pharmaceutical care practices. 12(24.0) 13(18.6) 25(20.8) Pharmacists' professional relationships with other healthcare providers should be improved and maintained. 6(12.0) 12(17.1) 18(15.0) The pharmacy layout must include a separate counseling area and a fully staffed, well-organized team. 0(0.0) 3(4.3) 3(2.5) Total 50(100.0) 70(100.0) 120(100.0) Table 7 shows that the majority of pharmacists (61.7%) emphasized the importance of continuous professional development (CPD) through training, lectures, and workshops as the key strategy to support the adoption of pharmaceutical care. However, a smaller proportion (20.8%) highlighted the role of regulatory bodies in enforcing and facilitating effective practice. Furthermore, (2.5%) stressed the need for structural changes, such as designated counseling areas and well-organized pharmacy teams. The findings showed a statistically insignificant difference between pharmacies located near markets and those near homes (p = 0.438>0.05), suggesting that pharmacists across different practice settings share similar perspectives on the essential factors for overcoming barriers and promoting pharmaceutical care services. Discussion In recent years, particularly since the COVID-19 pandemic, pharmacists working in community pharmacies have gained significant importance in healthcare systems. Their roles have evolved from focusing on dispensing medications to providing pharmaceutical care services(PhCS). This importance has been highlighted by their easy accessibility and low-cost consultation services (as a first point of contact). Healthcare services provided by community pharmacists include blood pressure, cholesterol, and glucose monitoring, immunization services, health education, and health promotion (counseling on lifestyle modifications, smoking cessation, dietary improvement, and general health awareness campaigns), and integration with existing healthcare systems (collaborative care and telehealth services) (Eldooma et al. 2023). In general, the development of pharmacy in the community pharmacy sector could have a positive economic impact on the pharmacy profession (cost-effective care and the creation of new jobs for pharmacists). Furthermore, pharmacists working in CPs have played a crucial role during the COVID-19 pandemic by providing a frontline healthcare environment, providing advice and essential medications that have significantly contributed to containing the spread of the pandemic (Pantasri 2022). Based on this, it can be argued that the appropriate distribution of CPs and the strategic development of the workforce, linking them to pharmacists' qualifications, experience, and generational competencies, could significantly enhance the transition of current practice to PhCS (Alanazi et al. 2016). This study explores the opportunities and challenges related to this transition in Wad Medani City and the current situation in Sudan. This assessment could be helpful when developing plans to transform traditional practice into PhCS models that could effectively contribute to achieving the desired outcomes from medication use and pharmaceutical consultations. The demographic characteristics: The geographical distribution of CPs and the characteristics of pharmacists provided valuable information regarding the opportunities and challenges of adopting a pharmaceutical care delivery system. This result clarifies the strategies we can plan to shape the shift from traditional practice to the provision of PhCS. There is a noticeable skew toward younger, female pharmacists with shorter experience (Table 1). Females constituted 63.3% of the total research participants, with the majority (82.5%) representing younger pharmacists. Classification by academic qualification showed that 91.7% held a basic Bachelor of Pharmacy degree(B.Pharm), indicating low rates of advanced qualifications. However, 92.5% of participants had 20 years or less of professional experience. Furthermore, the distribution of pharmacies revealed a balance between locations close to home and markets (58.3% of pharmacies were located close to residential areas). Overall, this pattern is consistent with a previous study conducted in Khartoum State, Sudan, where over 60% of community pharmacists were female, and nearly 75% were under the age of 40. Over 90% of them held only a Bachelor of Pharmacy degree (Mohamed et al. 2015). On the other hand, younger pharmacists with limited advanced qualifications may be limited in their adoption of the pharmaceutical care model, influenced by the high-traffic pharmacy market focused on product sales. They may therefore exhibit different awareness, motivations, or institutional constraints. In particular, the scarcity of pharmacists with advanced degrees reduces the analytical capacity to explore how formal academic qualifications influence openness to clinical PhCS models in particular. In conclusion, demographic factors, such as age, gender, experience, education level, and community identity, represent both opportunities and challenges. These factors can impact the provision and quality of pharmaceutical care in pharmacies. Previous research has shown that barriers to providing a patient-care model are associated with pharmacists' age and length of experience(Kiflu et al. 2024a). Furthermore, a study in the United Arab Emirates concluded that factors such as gender, age, pharmacy type, experience, and training are determinants of appropriate dispensing practices in CPs. Another survey in Poland indicated that trust in pharmacists increases with age and education. However, in Ethiopia, pharmacists' quality of life was found to be related to their educational level and the presence of other staff, which impacts their job satisfaction, retention, and continuity (Kiflu et al. 2024a; Wrześniewska-Wal et al. 2025). Opportunities and Challenges Regarding the Current Situation: Challenges of multitasking and performing professional duties for pharmacists: In CPs, pharmacists often face the need to undertake multiple tasks. This multitasking can lead to frequent overlaps, often due to a lack of other support staff. This multitasking can lead to poor performance and increased risk during pharmacy consultations and prescription verification (Lea et al. 2015). The results of the current study highlighted the multitasking and roles of pharmacists within CPs (Table 2). More than half of community pharmacists (52.5%) assume multiple responsibilities, including handling and receiving cash during medication dispensing, dispensing medications, providing consultations, and managing pharmacy operations. In comparison, nearly 45% of pharmacists perform a hybrid role that includes dispensing, consulting, and collecting cash, while only 0.8% of pharmacists identified work from a separate consulting area to perform pharmaceutical care. However, 1.7% of pharmacists perform only administrative duties in an office within the pharmacy. This situation reflects a virtual product-centric workflow, without the space, time, or organizational support to provide private, in-depth consultation interactions. Previous studies have shown that the absence of a dedicated consultation space hinders expert communication and comprehensive medication reviews, which are essential for effective PhCS. Furthermore, multiple tasks can impose cognitive strain and increase the risk of error, leading to reduced ability to provide clinical services, such as medication management or chronic disease monitoring (Kiflu et al. 2024a; Reddy et al. 2019). Nevertheless, the current study revealed consistent patterns across both community pharmacy groups, with a statistically insignificant difference in the distribution of pharmacist roles by pharmacy location or group (p=0.594 > 0.05). This result provides an opportunity to demonstrate that, once dedicated consultation spaces are provided and non-clinical tasks are delegated to other staff, the same model could be applied across all groups included in the current study. Furthermore, the emergence of pharmacists providing para-clinical services in a separate, dedicated space points to a stepping stone towards advanced pharmaceutical care offerings spread in the near future. Pharmacists' awareness towards the pharmaceutical care concept: Although awareness of the pharmaceutical care concept is high, with 81% of participants defining it as "patient‑centered, outcome‑oriented counseling role" (Table 3), the rest considered it to be part of "dispensary practice and store management." However, the apparent positive skew in conceptual understanding, paired with a statistically insignificant difference between pharmacy groups (p = 0.221 > 0.05), reveals both an opportunity and a challenge for the adoption of pharmaceutical care delivery. On the one hand, the widespread appreciation for counseling provides a solid entry point for enhancing patient-centered services. However, on the other hand, the narrow prevalence of pharmaceutical care service models suggests an insufficient recognition of its broader components, such as medication therapy review, monitoring, follow-up, and interprofessional collaboration, which are critical for providing adequate pharmaceutical care services. Since concept awareness does not differ significantly by pharmacy location or type, interventions to correct knowledge gaps can be applied uniformly across both marketplace and near-home pharmacy settings. Supporting factors significance ranking: The key supporting factors assessment for pharmaceutical care provision across different community pharmacy locations illustrated strengths and contextual differences. Overall, the most influential factor reported by respondents was the "seriousness and responsibility of organized pharmacy staff members", which was addressed by over 55% of participants, with a slightly higher proportion in residential-area pharmacies (58.6%) compared to marketplace outlets (52.0%). This finding highlights the crucial role of human resource organization and teamwork in delivering pharmacy care-oriented services, regardless of the setting. Notably, "physical environment and pharmacy structure" was identified as a second helpful factor by 23.3% of respondents. This result, which aligns with a previous study, highlights the importance of pharmacy layout and design in enhancing specialized services and client satisfaction(Dhital et al. 2022). However, pharmacists' willingness and motivation were acknowledged as a supportive factor by 17.5% of the total. Overall, although the p-value (0.449 > 0.05) indicates a statistically insignificant difference between groups, the result still highlights opportunities for organized staff commitment and environment design, while also underscoring persistent challenges related to governance, policy support, and motivational disparities. Barriers and discouraging factors: Although there are human resources and supporting factors, participants identified some significant barriers and discouraging variables (Table 5). In this study,40.0% of respondents reported the lack of training and continuous professional development (CPD) as the most influential barrier to pharmaceutical care services (PhCS). However, knowledge gaps and curriculum deficiencies were noted significantly more in marketplaces pharmacies (34.0%) compared with those near home (only 17.1%). Interestingly, the difference was statistically insignificant (p = 0.159 > 0.05), suggesting that the educational shortfalls are shared uniformly across both pharmacy groups. Accordingly, consistency presents an opportunity to implement broad‑based, curriculum‑informed CPD programs. Nevertheless, there are some challenges, such as pharmacists' lack of protected learning time, limited institutional support, and curricula still focused on product dispensing rather than holistic patient care, which remain as obstacles. These constraints are not unique to this study; globally, including in settings like Ethiopia, lack of clinical education, documentation, and communication skills are among the top-rated barriers to PhCS implementation(Kiflu et al. 2024b). Furthermore, in Malaysia, scholars have emphasised that structured CPD programs are vital for strengthening the capacity to deliver appropriate pharmaceutical care services(Loh et al. 2021). Forbidding curriculum reform and supportive workplace policies, and building on motivational improvement from training alone, may result in practice change. However, because the training gap does not vary by pharmacy location, a coordinated national or chain-level educational strategy has the potential to enhance PhCS readiness across all community pharmacists, regardless of whether they work in market-site or near-home settings. In addition to constraints, participants identified major discouraging factors that demotivate them from advancing practice towards pharmaceutical care models (Table 6). Around one-third of community pharmacists (31 to 33%) indicated that patients' perceptions and backgrounds (such as viewing the pharmacy as just a drug shop or expecting retail-only services) were significant demotivating factors for offering pharmaceutical care. However, the current physical structure and design of pharmacies, such as the absence of consultation rooms or inadequate layout, are the second limiting factors. Furthermore, the lack of technology, inadequate pharmacy staffing, and the absence of reimbursement factors resulted in lower percentages. Statistically, there are insignificant differences between pharmacists regarding pharmacy groups (p-value = 0.120 > 0.05), which suggests that these differences are broadly shared across types of pharmacies or locations. Interestingly, these findings align with some globally reported barriers, such as the perceptions and attitudes of the public and other health professionals, which are widely reported in Ethiopia and Rwanda, discouraging factors that prevent people from receiving services as they demand(Nsengimana et al. 2022). Also, Numerous discouraging factors face community pharmacists, including limited private space for counseling, inadequate IT systems for electronic prescriptions, and insufficient staff. A significant barrier is that financial models often do not reimburse clinical services, with 82-93% of pharmacists in New Zealand and Ethiopia citing lack of reimbursement as a key issue. However, the financial factor did not seem as strong a discourager (Dunlop and Shaw 2002). However, these challenges could also raise opportunities towards changes through public‑education campaigns to reshape patient perceptions from medication orientation to counselling. Furthermore, redesigning the community pharmacy structure to include consultation rooms supported by digital tools, such as e-prescribing, could also improve workflow. Organized staffing models and interprofessional guidance, linked with consistent training programs, could motivate pharmacists to work collaboratively with physicians to resolve critical issues. On the other hand, introducing structured reimbursement, as in Germany, where a recent reimbursement for pharmacy services supported by advanced training showed an improvement in financial incentives and pharmacist satisfaction.(Kroenert and Bertsche 2024) Overall, the barriers and discouraging factors are modifiable through aligned policy, education, pharmacy design, and economic strategies to become enablers of pharmaceutical care growth. Participants' Recommendations to Overcome Challenges and Opportunities Utilization: Community pharmacists' recommendations in prioritizing professional development, continuous learning, engaging with regulatory bodies, and fostering interprofessional relationships are essential in enhancing the transformation from traditional dispensing to comprehensive pharmaceutical care. The findings of the current study revealed that continuous professional development (CPD) was the high-priority recommendation, with 61.7% support across both the marketplace and near-home pharmacies (Table 7). Accordingly, it could be considered a key facilitator of pharmaceutical care services. Notably, the difference between pharmacy groups was statistically insignificant (p = 0.438 > 0.05), indicating a broadly shared insight for enhancing skill competency. Furthermore, regulatory bodies' engagement is the next-ranked recommendation, at 20.8%, suggesting the development of supportive policies, guidelines, and legal frameworks to disseminate pharmaceutical care into routine practice. However, interprofessional relationships and pharmacy infrastructure were lower-prioritized in the ranking, even though globally it is evident that separate counseling areas and an organized team structure are essential for providing appropriate pharmaceutical care. Accordingly, pharmacists are willing to grow through education and regulation, but pharmacy design and regulatory bodies remain neglected factors. These gaps could be overcome through policymakers and stakeholders who can support the willingness for CPD and policy change, accompanied by structural investments and interprofessional bonds that facilitate adequate pharmaceutical care provision. Conclusion Demographic characteristics of pharmacists are pivotal and influential factors that can support the transformation of community pharmacy practice toward an evolved model. Challenges can be addressed by embracing patient-centered models through CPD initiatives, training, reimbursement, pharmacy structure, and staff organization. The observed difference between pharmacy groups is not significant, so the interventions to resolve challenges could be designed based on the null hypothesis. Furthermore, bridging gaps in awareness and fostering interprofessional teamwork could motivate pharmacists and decrease multitasking pressures. Overall, aligning workforce development with demographic realities presents a strategic pathway to transforming CPs in Sudan and similar countries into accessible, trusted, and effective providers of pharmaceutical care within community pharmacy settings. Abbreviations PhCS Pharmaceutical Care Service CPs Community Pharmacies CPD: Continuous Professional Development. Declarations Conflict of Interest Statement We declare that we have no conflicts of interest regarding this work. Funding declaration: This study was supported by the Ongoing Research Funding Program (ORF), King Saud University, Riyadh, Saudi Arabia, under grant number [ORF-2025-1099]. All authors declare that the funding body had no role in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript. Data Availability All data supporting the findings of this study are included within the manuscript and its supplementary files. Additional datasets generated or analyzed during the study are available from the corresponding author upon reasonable request . References Abrahamsen B, Burghle A H and Rossing C (2020). "Pharmaceutical care services available in Danish community pharmacies." Int J Clin Pharm 42(2): 315-320 http://doi.org/10.1007/s11096-020-00985-7 Al-Worafi Y M (2023). Pharmaceutical Care. Handbook of Medical and Health Sciences in Developing Countries : Education, Practice, and Research. Y. M. Al-Worafi. Springer International Publishing, Cham : 1-23. Alanazi A S, Alfadl A A and Hussain A S (2016). "Pharmaceutical Care in the Community Pharmacies of Saudi Arabia: Present Status and Possibilities for Improvement." Saudi J Med Med Sci 4(1): 9-14 http://doi.org/10.4103/1658-631x.170881 Alves Da Costa F (2018). Pharmaceutical Care in Europe. The Pharmacist Guide to Implementing Pharmaceutical Care. Springer : 159-171. Bates I, Meilianti S, Bader L, Gandhi R, Leng R and Galbraith K (2022). "Strengthening Primary Healthcare through accelerated advancement of the global pharmacy workforce: a cross-sectional survey of 88 countries." BMJ Open 12(5): e061860 http://doi.org/10.1136/bmjopen-2022-061860 Dhital R, Sakulwach S, Robert G, Vasilikou C and Sin J (2022). "Systematic review on the effects of the physical and social aspects of community pharmacy spaces on service users and staff." Perspect Public Health 142(2): 77-93 http://doi.org/10.1177/17579139221080608 Dunlop J A and Shaw J P (2002). "Community pharmacists' perspectives on pharmaceutical care implementation in New Zealand." Pharm World Sci 24(6): 224-230 http://doi.org/10.1023/a:1021526425458 Eldooma I, Maatoug M and Yousif M (2023). "Outcomes of Pharmacist-Led Pharmaceutical Care Interventions Within Community Pharmacies: Narrative Review." Integr Pharm Res Pract 12: 113-126 http://doi.org/10.2147/iprp.S408340 Hindi A M K, Jacobs S and Schafheutle E I (2019). "Solidarity or dissonance? A systematic review of pharmacist and GP views on community pharmacy services in the UK." Health Soc Care Community 27(3): 565-598 http://doi.org/10.1111/hsc.12618 Ibrahim A and Scott J (2013). "Community pharmacists in Khartoum State, Sudan: their current roles and perspectives on pharmaceutical care implementation." Int J Clin Pharm 35(2): 236-243 http://doi.org/10.1007/s11096-012-9736-x Kassam R, Collins J B and Berkowitz J (2012). "Patient satisfaction with pharmaceutical care delivery in community pharmacies." Patient Prefer Adherence 6: 337-348 http://doi.org/10.2147/ppa.S29606 Kiflu M, Tsega S S, Alem H A, Gedif A A, Getachew M, Dagnew F N, Haimanot A B, Mihiretie E A and Moges T A (2024a). "Barriers to pharmaceutical care provision in the community and hospital pharmacies of Motta town, Northwest Ethiopia: a cross-sectional study." BMC Health Services Research 24(1): 1082 http://doi.org/10.1186/s12913-024-11538-3 Kiflu M, Tsega S S, Alem H A, Gedif A A, Getachew M, Dagnew F N, Haimanot A B, Mihiretie E A and Moges T A (2024b). "Barriers to pharmaceutical care provision in the community and hospital pharmacies of Motta town, Northwest Ethiopia: a cross-sectional study." BMC Health Serv Res 24(1): 1082 http://doi.org/10.1186/s12913-024-11538-3 Kroenert A-C and Bertsche T (2024). "Implementation, barriers, solving strategies and future perspectives of reimbursed community pharmacy services - a nationwide survey for community pharmacies in Germany." BMC Health Services Research 24(1): 1463 http://doi.org/10.1186/s12913-024-11745-y Lea V M, Corlett S A and Rodgers R M (2015). "Describing interruptions, multi-tasking and task-switching in community pharmacy: a qualitative study in England." Int J Clin Pharm 37(6): 1086-1094 http://doi.org/10.1007/s11096-015-0155-7 Loh P, Chua S S and Karuppannan M (2021). "The extent and barriers in providing pharmaceutical care services by community pharmacists in Malaysia: a cross-sectional study." BMC Health Services Research 21(1): 822 http://doi.org/10.1186/s12913-021-06820-7 Merks P, Kaźmierczak J, Olszewska A E and Kołtowska-Häggström M (2014). "Comparison of factors influencing patient choice of community pharmacy in Poland and in the UK, and identification of components of pharmaceutical care." Patient Prefer Adherence 8: 715-726 http://doi.org/10.2147/ppa.S53829 Mohamed S S, Mahmoud A A and Ali A a J I J O P P (2015). "Sudanese community pharmacy practice and its readiness for change to patient care." 23(4): 266-273, Nsengimana A, Biracyaza E, Hategekimana J C, Tuyishimire J, Nyiligira J and Rutembesa E (2022). "Attitudes, perceptions, and barriers of community pharmacists in Rwanda towards health promotion: a cross sectional study." Arch Public Health 80(1): 157 http://doi.org/10.1186/s13690-022-00912-4 Pantasri T (2022). "Expanded roles of community pharmacists in COVID-19: A scoping literature review." J Am Pharm Assoc (2003) 62(3): 649-657 http://doi.org/10.1016/j.japh.2021.12.013 Raosoft Incorporation. (2004). "Raosoft Sample Size Calculator." Retrieved 2/6/2022, 2022,available from http://www.raosoft.com/. Reddy A, Abebe E, Rivera A J, Stone J A and Chui M A (2019). "Interruptions in community pharmacies: Frequency, sources, and mitigation strategies." Res Social Adm Pharm 15(10): 1243-1250 http://doi.org/10.1016/j.sapharm.2018.10.030 Sadek M M, Elnour A A, Al Kalbani N M, Bhagavathula A S, Baraka M A, Aziz A M and Shehab A (2016). "Community pharmacy and the extended community pharmacist practice roles: The UAE experiences." Saudi Pharm J 24(5): 563-570 http://doi.org/10.1016/j.jsps.2015.03.023 Thornewill J, Antimisiaris D, Ezekekwu E and Esterhay R (2022). "Transformational strategies for optimizing use of medications and related therapies through us pharmacists and pharmacies: Findings from a national study." J Am Pharm Assoc (2003) 62(2): 450-460 http://doi.org/10.1016/j.japh.2021.10.018 Wrześniewska-Wal I, Grudziąż-Sękowska J, Sękowski K, Pinkas J and Jankowski M (2025). "Sociodemographic factors determining the choice of pharmacy and the level of trust in pharmacists – a 2024 cross-sectional pilot survey in Poland." BMC Health Services Research 25(1): 708 http://doi.org/10.1186/s12913-025-12709-6 Additional Declarations No competing interests reported. Supplementary Files Suplementarymaterialdatacollected.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 12 May, 2026 Reviews received at journal 07 May, 2026 Reviews received at journal 25 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers invited by journal 02 Feb, 2026 Editor invited by journal 01 Oct, 2025 Editor assigned by journal 30 Sep, 2025 Submission checks completed at journal 29 Sep, 2025 First submitted to journal 22 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7680249","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":584128818,"identity":"30fd401e-70ff-4f9f-8f15-68c434800c50","order_by":0,"name":"Ismaeil Eldooma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYJACCQjFfADEliFFC1sCiM1DihYeAzBJUDk//+nEGx8qtsmbt/d8fnWjxoKHgf3w0Q34tEjOyN1sOePMbcM5Z85us845BnQYT1raDXxaDG7wbpPmbbvNOEMid5txDhtQiwSPGV4t9ufPgrXYz5B/88w45x8RWgwYcsFaEmdI8DA/zm0jQovEDYhfkmfwpJkx5/ZJ8LAR8gt//9mNwBC7bTuD/fDjzznf6uT42Q8fw6sFGbCBI4iNWOUgwPyBFNWjYBSMglEwcgAAkItHcEM+E8cAAAAASUVORK5CYII=","orcid":"","institution":"National Health Insurance Fund","correspondingAuthor":true,"prefix":"","firstName":"Ismaeil","middleName":"","lastName":"Eldooma","suffix":""},{"id":584128819,"identity":"f45f63f2-db14-4566-bc45-a43af54a8f8c","order_by":1,"name":"Maha Maatoug","email":"","orcid":"","institution":"University of Gezira","correspondingAuthor":false,"prefix":"","firstName":"Maha","middleName":"","lastName":"Maatoug","suffix":""},{"id":584128820,"identity":"3d8a911b-f9a7-4221-846c-fa695c64b64e","order_by":2,"name":"Wadah Osman","email":"","orcid":"","institution":"University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Wadah","middleName":"","lastName":"Osman","suffix":""},{"id":584128821,"identity":"e602b18e-01e3-4b9d-855f-e0f097989869","order_by":3,"name":"Wajid Syed","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Wajid","middleName":"","lastName":"Syed","suffix":""},{"id":584128822,"identity":"ea279b58-1f05-4bb7-81d0-9caf987fd2ab","order_by":4,"name":"Mahmood Basil A. Al-Rawi","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Mahmood","middleName":"Basil A.","lastName":"Al-Rawi","suffix":""},{"id":584128823,"identity":"d4395714-ad12-414a-8596-97da4db2646a","order_by":5,"name":"Ayesha Iqbal","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Ayesha","middleName":"","lastName":"Iqbal","suffix":""},{"id":584128824,"identity":"6843fc7d-3ea5-4c56-aa41-52a6fbec16e1","order_by":6,"name":"Mohamed A. Hussain","email":"","orcid":"","institution":"International University of Africa","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"A.","lastName":"Hussain","suffix":""},{"id":584128825,"identity":"d68690ed-cbe3-4362-815f-f43c427e0a58","order_by":7,"name":"Mirghani Yousif","email":"","orcid":"","institution":"University of Gezira","correspondingAuthor":false,"prefix":"","firstName":"Mirghani","middleName":"","lastName":"Yousif","suffix":""}],"badges":[],"createdAt":"2025-09-22 15:23:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7680249/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7680249/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102404085,"identity":"d4c6e8a5-85be-4383-8c67-81ae917781d4","added_by":"auto","created_at":"2026-02-11 10:59:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":850778,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7680249/v1/3c146f68-3c0e-485e-99f2-74b3ee3782c5.pdf"},{"id":101806246,"identity":"6410b04b-9b4a-49ba-a239-64104535ac7d","added_by":"auto","created_at":"2026-02-03 19:50:13","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":26665,"visible":true,"origin":"","legend":"","description":"","filename":"Suplementarymaterialdatacollected.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7680249/v1/ea40f9f61c70af0f6d89576f.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pharmaceutical Care Adoption in Community Pharmacies: Cross-Sectional Study Assessment of Challenges and Opportunities, Wad-Madani, Sudan","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCommunity pharmacists are considered pivotal healthcare providers in health systems because they collaborate with patients, other healthcare providers, and caregivers to deliver comprehensive and effective medication care services\u0026nbsp;(Abrahamsen et al. 2020).While these services have been considered essential in ensuring access to appropriate medications, many countries have recognized the critical need to expand the expertise and practice of community pharmacists to achieve better medication outcomes, patient satisfaction, and preferences in service offerings. Accordingly, many pharmacists in several developed countries have transformed their practice within community pharmacies (CPs) into Pharmaceutical Care Services (PhCS) paradigm(Bates et al. 2022; Hindi et al. 2019; Sadek et al. 2016). PhCS is a philosophy that centers patients at the middle of the healthcare cycle to achieve predetermined outcomes and enhance patient and pharmacist satisfaction\u0026nbsp;(Alves da Costa 2018). PhCS includes proper medication management, patient counseling, medication reviews, adherence support, and collaboration with other healthcare professionals\u0026nbsp;(Al-Worafi 2023). Many developed countries in Europe, such as Poland and the United Kingdom, have adopted this concept to understand patients' preferences for personalized care services. Efforts to identify and overcome the barriers to comprehensive community pharmacy transformation have been appropriately operated\u0026nbsp;(Kassam et al. 2012; Merks et al. 2014).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Sudan, a previous study conducted in Khartoum State recommended initiating PhCS offerings to patients within CPs (Ibrahim and Scott 2013). Accordingly, this current research explored the challenges and opportunities of transforming the current community pharmacy practice into the PhCS offerings. Successful transformations of current situations for any practice usually require the insights and advice of relevant stakeholders. In pharmacy practice, community pharmacists are major stakeholders in community pharmacy settings, followed by clients who utilize the services offered. However, the influence of community pharmacists is significant in this situation, as they are crucial stakeholders in driving this transformational change(Thornewill et al. 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this current study, we have assessed the factors preventing pharmacists from adopting PhCS in CPs, the available opportunities, pharmacists' unique perspectives, and recommendations that could contribute valuable insights into the transformation mechanism of the current pharmacy practice in Sudan and similar developing countries.\u003c/p\u003e\n\u003cp\u003eFuture demand for patient-centered care and the potential of community pharmacists to contribute significantly to public health are expected to increase dramatically. Accordingly, assessing the challenges and opportunities for adopting PhCS in Sudan is currently essential. Understanding influencing factors could provide insights into the feasibility of transforming current practices and inform strategies for healthcare improvement, even in similar developing countries. This study aimed to assess the challenges and opportunities associated with adopting PhCS in CPs in Wad-Madani, Sudan. Specifically, it explored the barriers faced by community pharmacists, the potential supporters of transformation, and the perspectives of CPs on implementing PhCS, to provide evidence-based recommendations to guide future practice development in the context.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design and settings:\u003c/h2\u003e\n\u003cp\u003eA cross-sectional survey was conducted from December 2019 to August 2020 among community pharmacists working in Wad Madani City, Gezira State, Sudan. This study analyzed community pharmacists' insights and perceptions regarding the challenges and other factors influencing the transformation of community pharmacy practice into the PhCS.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eInclusion and exclusion:\u003c/h2\u003e\n\u003cp\u003eOne authorized pharmacist per independent community pharmacy was included. However, technicians and pharmacists in the public sector were excluded from this study.\u003c/p\u003e\n\u003ch2\u003eInstrument and data collection:\u003c/h2\u003e\n\u003cp\u003eA validated self-administered questionnaire was used. The questionnaire printout conformed to Google survey forms (Google Forms 2019). The instrument comprised demographic data and three other components: Opportunities, challenges, and recommendations. Pharmacists' recommendations were collected during piloting and summarised into six major domains. Pharmacists were asked to identify the most essential factors and recommendations regarding the provision of PhCS in CPs. Participants read and understood the research objectives and future benefits before participation.\u003c/p\u003e\n\u003ch2\u003eSample frame, sampling, data processing, and analysis:\u003c/h2\u003e\n\u003cp\u003eThe sample frame list of CPs was obtained from the General Directorate of Pharmacy in Gezira State. The frame included the names of CPs and locations. The Raosoft online software calculator was used for sample size calculation and determination, with a 95% confidence interval and a 50% distribution (Raosoft Incorporation 2004). The study sample size achieved was 139 CPs. The final data were collected from 120 CPs. Categorical data were analyzed and interpreted using the Statistical Package for the Social Sciences (SPSS version 26). The output analysis was based on the Chi-square (X2) and Fisher's Exact statistical tests for categorical data (confidence level = 95%, P-value = 0.05).\u003c/p\u003e\n\u003ch2\u003eEthical consideration:\u003c/h2\u003e\n\u003cp\u003eThe Ministry of Health in Gezira State, the Research Department, and the Health Sector Ethical Review Committee at the University of Gezira have provided ethical clearance for the conduct of this research (Reference number: 37-21). All Authors confirmed adherence to the terms of the Helsinki Agreement. We informed all participants about the research purpose through a written brief introduction (in Arabic) in the first section of the questionnaires, which illustrated the purpose and future benefits of the collected research data for both pharmacists and patients. The questionnaire contains an agreement statement: \"By filling out this questionnaire, agreement to be a participant in this research is confirmed, and you are aware of what it involves.\" All participants provided a paper-based, self-administered questionnaire after giving verbal consent to participate.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Demographic characteristics (Total N=120).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 13px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003eCumulative %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e63.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eAge Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026le;21 to 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e82.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e82.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e41 to \u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eExperience years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026le;1 to 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e21 to \u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eScientific Qualifications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eB. Pharm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eMSc, PharmD, or PhD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003ePharmacy Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eMain Market -Places\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eNear Homes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe demographic profile revealed a notable skew toward younger, female pharmacists with shorter experience periods (Table 1). Females comprised 63.3% (n = 76), with the majority representing 82.5% of younger-aged pharmacists (\u0026le; 21 to 40 years). Regarding experience, an overwhelming 93.3 % (n = 112) had \u0026le; 20 years of professional practice. While academic graduation showed that 91.7 % (n = 110) held a basic B. Pharm degree, suggesting low advanced qualification rates. However, professional experience is limited to \u0026le; 20 years (92.5%). On the other hand, pharmacy distribution revealed a near-home location dominance of 58.3% (n = 70) compared with those in marketplaces.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Pharmacist activities within the pharmacy, categorized by pharmacy location group.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eVariable(activities)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 28px;\"\u003e\n \u003cp\u003ePharmacy Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eMarket Places: n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eNear Homes: n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eTotal N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003eSig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eMoney handlers, drug dispensers, counselors, and managers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e25(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e38(54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e63(52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eCounsellor within a separate counselling area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1(0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eDrug dispenser, counsellor, and cashier.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e25(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e29(41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e54(45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eManager (located in the office within the pharmacy).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e2(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2(1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e50(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e70(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e120(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe results presented in Table 2 highlighted the distribution of pharmacist activities across different pharmacy location groups. Most pharmacists in both groups serve as money handlers, drug dispensers, and counselors, with 50% in Market Places and 54.3% in Near Homes fulfilling these roles. However, dedicated counseling areas were only found in 1.4% of nearby home pharmacies. Overall, there are statistically insignificant differences in pharmacist activities between the two location groups, indicating a similar pattern of practice regardless of pharmacy location (p = 0.594).\u003c/p\u003e\n\u003cp\u003eTable 3: Pharmaceutical care concept awareness among participants:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003eWhat is pharmaceutical care?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003ePharmacy Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMarket Places\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eNear Homes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003eDispensary practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e13(18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e19(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003eGood counseling: patient-centered and outcome-oriented practice by pharmacists.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e42(84.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e55(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e97(80.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003eStore management practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e2(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e4(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e50(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e70(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e120(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe results in Table 3 indicate varying levels of awareness regarding the concept of pharmaceutical care among participants from different pharmacy groups. The most significant majority (80.8%) recognized the idea of patient-centered and outcome-oriented counseling provided by pharmacists. There is a statistically insignificant difference in awareness between the marketplaces and near homes (chi-square test, p = 0.221 \u0026gt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: The major supporting factors for pharmaceutical care services providing and the pharmacy location group. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003eMajor supporting factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 23px;\"\u003e\n \u003cp\u003ePharmacy Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMarket Places\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eNear Homes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003eThe organized Pharmacy staff members take their responsibilities seriously.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26(52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e41(58.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e67(55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003eThe helpfulness of the pharmacy environment and structure.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e11(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e17(24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e28(23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003eThe strong desire and willingness of pharmacists.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e12(24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e9(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e21(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003eThe practical and helpful regulatory bodies.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e1(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e3(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e50(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e70(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e120(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 indicates varying levels of supporting factors for the provision of pharmaceutical care services across different pharmacy location groups. Particularly, 55.8% of the organized pharmacy staff members who committed to their responsibilities are perceived as a crucial element in enhancing pharmaceutical care. In contrast, factors such as the pharmacists\u0026apos; desire and the regulatory bodies showed minimal influence. Overall, there is a weak association between the pharmacy group and the addressed supporting factors, indicating a statistically insignificant difference between groups (p = 0.449 \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Major barriers towards pharmaceutical care services provision in community pharmacies:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eThe major barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 25px;\"\u003e\n \u003cp\u003ePharmacy Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eMarket Places\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eNear Homes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eLack of training and continuous professional development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e19(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e29(41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e48(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eLack of knowledge and curriculum development problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e17(34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e12(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e29(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eLack of time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e8(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e14(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e22(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eLack of confidence and communication skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e15(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e21(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e50(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e70(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e120(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5 shows an analysis of the significant barriers to PhCS provision among pharmacy groups. The most frequently addressed barrier was the lack of training and continuous professional development (40.0%), particularly prominent in Near Home pharmacies (41.4%). Furthermore, the \u0026quot;lack of knowledge and curriculum development problems\u0026quot; showed a substantial disparity between groups (34.0% in Market Places vs. 17.1% Near Homes). Despite observed disparities, there is no statistically significant difference between pharmacy groups (p = 0.159 \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u003c/strong\u003e Main factors discouraging pharmacists from providing pharmaceutical care services in community pharmacies:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003eThe main discouraging factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003ePharmacy Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eMarket Places\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eNear Homes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003ePatients\u0026apos; perceptions and backgrounds\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e15(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e23(32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e38(31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eCommunity pharmacy structure and design\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e11(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e18(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e29(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eLack of information technology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e14(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e20(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003ePharmacy staff and Other health care providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12(24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e5(7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e17(14.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eAbsence of reimbursement for the provided service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e10(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e16(13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 47px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e50(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e70(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e120(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6 illustrates the primary factors that prevent pharmacists from providing pharmaceutical care services in CPs. The most frequently addressed discouraging factors were the patients\u0026apos; perceptions and backgrounds (31.7% overall), followed by inadequacies in pharmacy structure and design (24.2%), and further deficiencies in information technology (16.7%) among participants. Although observed differences exist between market and home pharmacies, the difference is statistically insignificant (p = 0.120 \u0026gt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u003c/strong\u003e Pharmacists\u0026apos; recommendations to utilize supporting factors and overcome barriers:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003eRecommendations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 24px;\"\u003e\n \u003cp\u003ePharmacy Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003eSig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eMarket Places\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eNear Homes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003ePharmacists should be well-trained and updated through CPD lectures and workshop programs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e32(64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e42(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e74(61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eRegulatory bodies must help implement effective pharmaceutical care practices.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e12(24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e13(18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e25(20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003ePharmacists\u0026apos; professional relationships with other healthcare providers should be improved and maintained.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e6(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e12(17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e18(15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eThe pharmacy layout must include a separate counseling area and a fully staffed, well-organized team.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e3(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e50(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e70(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e120(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 7 shows that the majority of pharmacists (61.7%) emphasized the importance of continuous professional development (CPD) through training, lectures, and workshops as the key strategy to support the adoption of pharmaceutical care. However, a smaller proportion (20.8%) highlighted the role of regulatory bodies in enforcing and facilitating effective practice. Furthermore, (2.5%) stressed the need for structural changes, such as designated counseling areas and well-organized pharmacy teams. The findings showed a statistically insignificant difference between pharmacies located near markets and those near homes (p = 0.438\u0026gt;0.05), suggesting that pharmacists across different practice settings share similar perspectives on the essential factors for overcoming barriers and promoting pharmaceutical care services.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years, particularly since the COVID-19 pandemic, pharmacists working in community pharmacies have gained significant importance in healthcare systems. Their roles have evolved from focusing on dispensing medications to providing pharmaceutical care services(PhCS). This importance has been highlighted by their easy accessibility and low-cost consultation services (as a first point of contact). Healthcare services provided by community pharmacists include blood pressure, cholesterol, and glucose monitoring, immunization services, health education, and health promotion (counseling on lifestyle modifications, smoking cessation, dietary improvement, and general health awareness campaigns), and integration with existing healthcare systems (collaborative care and telehealth services)\u0026nbsp;(Eldooma et al. 2023). In general, the development of pharmacy in the community pharmacy sector could have a positive economic impact on the pharmacy profession (cost-effective care and the creation of new jobs for pharmacists).\u003c/p\u003e\n\u003cp\u003eFurthermore, pharmacists working in CPs have played a crucial role during the COVID-19 pandemic by providing a frontline healthcare environment, providing advice and essential medications that have significantly contributed to containing the spread of the pandemic\u0026nbsp;(Pantasri 2022). Based on this, it can be argued that the appropriate distribution of CPs and the strategic development of the workforce, linking them to pharmacists' qualifications, experience, and generational competencies, could significantly enhance the transition of current practice to PhCS\u0026nbsp;(Alanazi et al. 2016).\u0026nbsp;This study explores the opportunities and challenges related to this transition in Wad Medani City and the current situation in Sudan. This assessment could be helpful when developing plans to transform traditional practice into PhCS models that could effectively contribute to achieving the desired outcomes from medication use and pharmaceutical consultations.\u003c/p\u003e\n\u003ch2\u003eThe demographic characteristics:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe geographical distribution of CPs and the characteristics of pharmacists provided valuable information regarding the opportunities and challenges of adopting a pharmaceutical care delivery system. This result clarifies the strategies we can plan to shape the shift from traditional practice to the provision of PhCS. There is a noticeable skew toward younger, female pharmacists with shorter experience (Table 1). Females constituted 63.3% of the total research participants, with the majority (82.5%) representing younger pharmacists. Classification by academic qualification showed that 91.7% held a basic Bachelor of Pharmacy degree(B.Pharm), indicating low rates of advanced qualifications. However, 92.5% of participants had 20 years or less of professional experience.\u003c/p\u003e\n\u003cp\u003eFurthermore, the distribution of pharmacies revealed a balance between locations close to home and markets (58.3% of pharmacies were located close to residential areas). Overall, this pattern is consistent with a previous study conducted in Khartoum State, Sudan, where over 60% of community pharmacists were female, and nearly 75% were under the age of 40. Over 90% of them held only a Bachelor of Pharmacy degree (Mohamed et al. 2015). On the other hand, younger pharmacists with limited advanced qualifications may be limited in their adoption of the pharmaceutical care model, influenced by the high-traffic pharmacy market focused on product sales. They may therefore exhibit different awareness, motivations, or institutional constraints. In particular, the scarcity of pharmacists with advanced degrees reduces the analytical capacity to explore how formal academic qualifications influence openness to clinical PhCS models in particular.\u003c/p\u003e\n\u003cp\u003eIn conclusion, demographic factors, such as age, gender, experience, education level, and community identity, represent both opportunities and challenges. These factors can impact the provision and quality of pharmaceutical care in pharmacies. Previous research has shown that barriers to providing a patient-care model are associated with pharmacists' age and length of experience(Kiflu et al. 2024a). Furthermore, a study in the United Arab Emirates concluded that factors such as gender, age, pharmacy type, experience, and training are determinants of appropriate dispensing practices in CPs. Another survey in Poland indicated that trust in pharmacists increases with age and education. However, in Ethiopia, pharmacists' quality of life was found to be related to their educational level and the presence of other staff, which impacts their job satisfaction, retention, and continuity\u0026nbsp;(Kiflu et al. 2024a; Wrześniewska-Wal et al. 2025).\u003c/p\u003e\n\u003ch2\u003eOpportunities and Challenges Regarding the Current Situation:\u003c/h2\u003e\n\u003ch3\u003e\u003cem\u003eChallenges of multitasking and performing professional duties for pharmacists:\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eIn CPs, pharmacists often face the need to undertake multiple tasks. This multitasking can lead to frequent overlaps, often due to a lack of other support staff. This multitasking can lead to poor performance and increased risk during pharmacy consultations and prescription verification (Lea et al. 2015). The results of the current study highlighted the multitasking and roles of pharmacists within CPs (Table 2). More than half of community pharmacists (52.5%) assume multiple responsibilities, including handling and receiving cash during medication dispensing, dispensing medications, providing consultations, and managing pharmacy operations.\u003c/p\u003e\n\u003cp\u003eIn comparison, nearly 45% of pharmacists perform a hybrid role that includes dispensing, consulting, and collecting cash, while only 0.8% of pharmacists identified work from a separate consulting area to perform pharmaceutical care. However, 1.7% of pharmacists perform only administrative duties in an office within the pharmacy. This situation reflects a virtual product-centric workflow, without the space, time, or organizational support to provide private, in-depth consultation interactions. Previous studies have shown that the absence of a dedicated consultation space hinders expert communication and comprehensive medication reviews, which are essential for effective PhCS. Furthermore, multiple tasks can impose cognitive strain and increase the risk of error, leading to reduced ability to provide clinical services, such as medication management or chronic disease monitoring (Kiflu et al. 2024a;\u0026nbsp;Reddy et al. 2019).\u003c/p\u003e\n\u003cp\u003eNevertheless, the current study revealed consistent patterns across both community pharmacy groups, with a statistically insignificant difference in the distribution of pharmacist roles by pharmacy location or group (p=0.594 \u0026gt; 0.05). This result provides an opportunity to demonstrate that, once dedicated consultation spaces are provided and non-clinical tasks are delegated to other staff, the same model could be applied across all groups included in the current study. Furthermore, the emergence of pharmacists providing para-clinical services in a separate, dedicated space points to a stepping stone towards advanced pharmaceutical care offerings spread in the near future.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003ePharmacists' awareness towards the pharmaceutical care concept:\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eAlthough awareness of the pharmaceutical care concept is high, with 81% of participants defining it as \"patient‑centered, outcome‑oriented counseling role\" (Table 3), the rest considered it to be part of \"dispensary practice and store management.\" However, the apparent positive skew in conceptual understanding, paired with a statistically insignificant difference between pharmacy groups (p = 0.221 \u0026gt; 0.05), reveals both an opportunity and a challenge for the adoption of pharmaceutical care delivery. On the one hand, the widespread appreciation for counseling provides a solid entry point for enhancing patient-centered services. However, on the other hand, the narrow prevalence of pharmaceutical care service models suggests an insufficient recognition of its broader components, such as medication therapy review, monitoring, follow-up, and interprofessional collaboration, which are critical for providing adequate pharmaceutical care services. Since concept awareness does not differ significantly by pharmacy location or type, interventions to correct knowledge gaps can be applied uniformly across both marketplace and near-home pharmacy settings.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eSupporting factors significance ranking:\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe key supporting factors assessment for pharmaceutical care provision across different community pharmacy locations illustrated strengths and contextual differences. Overall, the most influential factor reported by respondents was the \"seriousness and responsibility of organized pharmacy staff members\", which was addressed by over 55% of participants, with a slightly higher proportion in residential-area pharmacies (58.6%) compared to marketplace outlets (52.0%). This finding highlights the crucial role of human resource organization and teamwork in delivering pharmacy care-oriented services, regardless of the setting. Notably, \"physical environment and pharmacy structure\" was identified as a second helpful factor by 23.3% of respondents. This result, which aligns with a previous study, highlights the importance of pharmacy layout and design in enhancing specialized services and client satisfaction(Dhital et al. 2022). However, pharmacists' willingness and motivation were acknowledged as a supportive factor by 17.5% of the total. Overall, although the p-value (0.449 \u0026gt; 0.05) indicates a statistically insignificant difference between groups, the result still highlights opportunities for organized staff commitment and environment design, while also underscoring persistent challenges related to governance, policy support, and motivational disparities.\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eBarriers and discouraging factors:\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eAlthough there are human resources and supporting factors, participants identified some significant barriers and discouraging variables (Table 5). In this study,40.0% of respondents reported the lack of training and continuous professional development (CPD) as the most influential barrier to pharmaceutical care services (PhCS). However, knowledge gaps and curriculum deficiencies were noted significantly more in marketplaces pharmacies (34.0%) compared with those near home (only 17.1%). Interestingly, the difference was statistically insignificant (p = 0.159 \u0026gt; 0.05), suggesting that the educational shortfalls are shared uniformly across both pharmacy groups. Accordingly, consistency presents an opportunity to implement broad‑based, curriculum‑informed CPD programs. Nevertheless, there are some challenges, such as pharmacists' lack of protected learning time, limited institutional support, and curricula still focused on product dispensing rather than holistic patient care, which remain as obstacles. These constraints are not unique to this study; globally, including in settings like Ethiopia, lack of clinical education, documentation, and communication skills are among the top-rated barriers to PhCS implementation(Kiflu et al. 2024b). Furthermore, in Malaysia, scholars have emphasised that structured CPD programs are vital for strengthening the capacity to deliver appropriate pharmaceutical care services(Loh et al. 2021). Forbidding curriculum reform and supportive workplace policies, and building on motivational improvement from training alone, may result in practice change. However, because the training gap does not vary by pharmacy location, a coordinated national or chain-level educational strategy has the potential to enhance PhCS readiness across all community pharmacists, regardless of whether they work in market-site or near-home settings.\u003c/p\u003e\n\u003cp\u003eIn addition to constraints, participants identified major discouraging factors that demotivate them from advancing practice towards pharmaceutical care models (Table 6). Around one-third of community pharmacists (31 to 33%) indicated that patients' perceptions and backgrounds (such as viewing the pharmacy as just a drug shop or expecting retail-only services) were significant demotivating factors for offering pharmaceutical care. However, the current physical structure and design of pharmacies, such as the absence of consultation rooms or inadequate layout, are the second limiting factors. Furthermore, the lack of technology, inadequate pharmacy staffing, and the absence of reimbursement factors resulted in lower percentages. Statistically, there are insignificant differences between pharmacists regarding pharmacy groups (p-value = 0.120 \u0026gt; 0.05), which suggests that these differences are broadly shared across types of pharmacies or locations. Interestingly, these findings align with some globally reported barriers, such as the perceptions and attitudes of the public and other health professionals, which are widely reported in Ethiopia and Rwanda, discouraging factors that prevent people from receiving services as they demand(Nsengimana et al. 2022). Also, Numerous discouraging factors face community pharmacists, including limited private space for counseling, inadequate IT systems for electronic prescriptions, and insufficient staff. A significant barrier is that financial models often do not reimburse clinical services, with 82-93% of pharmacists in New Zealand and Ethiopia citing lack of reimbursement as a key issue. However, the financial factor did not seem as strong a discourager (Dunlop and Shaw 2002). However, these challenges could also raise opportunities towards changes through public‑education campaigns to reshape patient perceptions from medication orientation to counselling. Furthermore, redesigning the community pharmacy structure to include consultation rooms supported by digital tools, such as e-prescribing, could also improve workflow. Organized staffing models and interprofessional guidance, linked with consistent training programs, could motivate pharmacists to work collaboratively with physicians to resolve critical issues. On the other hand, introducing structured reimbursement, as in Germany, where a recent reimbursement for pharmacy services supported by advanced training showed an improvement in financial incentives and pharmacist satisfaction.(Kroenert and Bertsche 2024)\u0026nbsp;Overall, the barriers and discouraging factors are modifiable through aligned policy, education, pharmacy design, and economic strategies to become enablers of pharmaceutical care growth.\u003c/p\u003e\n\u003ch2\u003eParticipants' Recommendations to Overcome Challenges and Opportunities Utilization:\u003c/h2\u003e\n\u003cp\u003eCommunity pharmacists' recommendations in prioritizing professional development, continuous learning, engaging with regulatory bodies, and fostering interprofessional relationships are essential in enhancing the transformation from traditional dispensing to comprehensive pharmaceutical care. The findings of the current study revealed that continuous professional development (CPD) was the high-priority recommendation, with 61.7% support across both the marketplace and near-home pharmacies (Table 7). Accordingly, it could be considered a key facilitator of pharmaceutical care services. Notably, the difference between pharmacy groups was statistically insignificant (p = 0.438 \u0026gt; 0.05), indicating a broadly shared insight for enhancing skill competency. Furthermore, regulatory bodies' engagement is the next-ranked recommendation, at 20.8%, suggesting the development of supportive policies, guidelines, and legal frameworks to disseminate pharmaceutical care into routine practice. However, interprofessional relationships and pharmacy infrastructure were lower-prioritized in the ranking, even though globally it is evident that separate counseling areas and an organized team structure are essential for providing appropriate pharmaceutical care. Accordingly, pharmacists are willing to grow through education and regulation, but pharmacy design and regulatory bodies remain neglected factors. These gaps could be overcome through policymakers and stakeholders who\u0026nbsp;can support the willingness for CPD and policy change, accompanied by structural investments and interprofessional bonds that facilitate adequate pharmaceutical care provision.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDemographic characteristics of pharmacists are pivotal and influential factors that can support the transformation of community pharmacy practice toward an evolved model. Challenges can be addressed by embracing patient-centered models through CPD initiatives, training, reimbursement, pharmacy structure, and staff organization. The observed difference between pharmacy groups is not significant, so the interventions to resolve challenges could be designed based on the null hypothesis. Furthermore, bridging gaps in awareness and fostering interprofessional teamwork could motivate pharmacists and decrease multitasking pressures. Overall, aligning workforce development with demographic realities presents a strategic pathway to transforming CPs in Sudan and similar countries into accessible, trusted, and effective providers of pharmaceutical care within community pharmacy settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePhCS \u0026nbsp; \u0026nbsp;Pharmaceutical Care Service\u003c/p\u003e\n\u003cp\u003eCPs \u0026nbsp; \u0026nbsp;Community Pharmacies\u003c/p\u003e\n\u003cp\u003eCPD: Continuous Professional Development.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest Statement\u003c/h2\u003e\n\u003cp\u003eWe declare that we have no conflicts of interest regarding this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Ongoing Research Funding Program (ORF), King Saud University, Riyadh, Saudi Arabia, under grant number [ORF-2025-1099]. All authors declare that the funding body had no role in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eAll data supporting the findings of this study are included within the manuscript and its supplementary files. Additional datasets generated or analyzed during the study are available from the corresponding author upon reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbrahamsen B, Burghle A H and Rossing C (2020). \u0026quot;Pharmaceutical care services available in Danish community pharmacies.\u0026quot; Int J Clin Pharm 42(2): 315-320 http://doi.org/10.1007/s11096-020-00985-7\u003c/li\u003e\n\u003cli\u003eAl-Worafi Y M (2023). Pharmaceutical Care. Handbook of Medical and Health Sciences in Developing Countries : Education, Practice, and Research. Y. M. Al-Worafi. Springer International Publishing, Cham\u003cstrong\u003e: \u003c/strong\u003e1-23.\u003c/li\u003e\n\u003cli\u003eAlanazi A S, Alfadl A A and Hussain A S (2016). \u0026quot;Pharmaceutical Care in the Community Pharmacies of Saudi Arabia: Present Status and Possibilities for Improvement.\u0026quot; Saudi J Med Med Sci 4(1): 9-14 http://doi.org/10.4103/1658-631x.170881\u003c/li\u003e\n\u003cli\u003eAlves Da Costa F (2018). Pharmaceutical Care in Europe. The Pharmacist Guide to Implementing Pharmaceutical Care. Springer\u003cstrong\u003e: \u003c/strong\u003e159-171.\u003c/li\u003e\n\u003cli\u003eBates I, Meilianti S, Bader L, Gandhi R, Leng R and Galbraith K (2022). \u0026quot;Strengthening Primary Healthcare through accelerated advancement of the global pharmacy workforce: a cross-sectional survey of 88 countries.\u0026quot; BMJ Open 12(5): e061860 http://doi.org/10.1136/bmjopen-2022-061860\u003c/li\u003e\n\u003cli\u003eDhital R, Sakulwach S, Robert G, Vasilikou C and Sin J (2022). \u0026quot;Systematic review on the effects of the physical and social aspects of community pharmacy spaces on service users and staff.\u0026quot; Perspect Public Health 142(2): 77-93 http://doi.org/10.1177/17579139221080608\u003c/li\u003e\n\u003cli\u003eDunlop J A and Shaw J P (2002). \u0026quot;Community pharmacists\u0026apos; perspectives on pharmaceutical care implementation in New Zealand.\u0026quot; Pharm World Sci 24(6): 224-230 http://doi.org/10.1023/a:1021526425458\u003c/li\u003e\n\u003cli\u003eEldooma I, Maatoug M and Yousif M (2023). \u0026quot;Outcomes of Pharmacist-Led Pharmaceutical Care Interventions Within Community Pharmacies: Narrative Review.\u0026quot; Integr Pharm Res Pract 12: 113-126 http://doi.org/10.2147/iprp.S408340\u003c/li\u003e\n\u003cli\u003eHindi A M K, Jacobs S and Schafheutle E I (2019). \u0026quot;Solidarity or dissonance? A systematic review of pharmacist and GP views on community pharmacy services in the UK.\u0026quot; Health Soc Care Community 27(3): 565-598 http://doi.org/10.1111/hsc.12618\u003c/li\u003e\n\u003cli\u003eIbrahim A and Scott J (2013). \u0026quot;Community pharmacists in Khartoum State, Sudan: their current roles and perspectives on pharmaceutical care implementation.\u0026quot; Int J Clin Pharm 35(2): 236-243 http://doi.org/10.1007/s11096-012-9736-x\u003c/li\u003e\n\u003cli\u003eKassam R, Collins J B and Berkowitz J (2012). \u0026quot;Patient satisfaction with pharmaceutical care delivery in community pharmacies.\u0026quot; Patient Prefer Adherence 6: 337-348 http://doi.org/10.2147/ppa.S29606\u003c/li\u003e\n\u003cli\u003eKiflu M, Tsega S S, Alem H A, Gedif A A, Getachew M, Dagnew F N, Haimanot A B, Mihiretie E A and Moges T A (2024a). \u0026quot;Barriers to pharmaceutical care provision in the community and hospital pharmacies of Motta town, Northwest Ethiopia: a cross-sectional study.\u0026quot; BMC Health Services Research 24(1): 1082 http://doi.org/10.1186/s12913-024-11538-3\u003c/li\u003e\n\u003cli\u003eKiflu M, Tsega S S, Alem H A, Gedif A A, Getachew M, Dagnew F N, Haimanot A B, Mihiretie E A and Moges T A (2024b). \u0026quot;Barriers to pharmaceutical care provision in the community and hospital pharmacies of Motta town, Northwest Ethiopia: a cross-sectional study.\u0026quot; BMC Health Serv Res 24(1): 1082 http://doi.org/10.1186/s12913-024-11538-3\u003c/li\u003e\n\u003cli\u003eKroenert A-C and Bertsche T (2024). \u0026quot;Implementation, barriers, solving strategies and future perspectives of reimbursed community pharmacy services - a nationwide survey for community pharmacies in Germany.\u0026quot; BMC Health Services Research 24(1): 1463 http://doi.org/10.1186/s12913-024-11745-y\u003c/li\u003e\n\u003cli\u003eLea V M, Corlett S A and Rodgers R M (2015). \u0026quot;Describing interruptions, multi-tasking and task-switching in community pharmacy: a qualitative study in England.\u0026quot; Int J Clin Pharm 37(6): 1086-1094 http://doi.org/10.1007/s11096-015-0155-7\u003c/li\u003e\n\u003cli\u003eLoh P, Chua S S and Karuppannan M (2021). \u0026quot;The extent and barriers in providing pharmaceutical care services by community pharmacists in Malaysia: a cross-sectional study.\u0026quot; BMC Health Services Research 21(1): 822 http://doi.org/10.1186/s12913-021-06820-7\u003c/li\u003e\n\u003cli\u003eMerks P, Kaźmierczak J, Olszewska A E and Kołtowska-H\u0026auml;ggstr\u0026ouml;m M (2014). \u0026quot;Comparison of factors influencing patient choice of community pharmacy in Poland and in the UK, and identification of components of pharmaceutical care.\u0026quot; Patient Prefer Adherence 8: 715-726 http://doi.org/10.2147/ppa.S53829\u003c/li\u003e\n\u003cli\u003eMohamed S S, Mahmoud A A and Ali A a J I J O P P (2015). \u0026quot;Sudanese community pharmacy practice and its readiness for change to patient care.\u0026quot; 23(4): 266-273, \u003c/li\u003e\n\u003cli\u003eNsengimana A, Biracyaza E, Hategekimana J C, Tuyishimire J, Nyiligira J and Rutembesa E (2022). \u0026quot;Attitudes, perceptions, and barriers of community pharmacists in Rwanda towards health promotion: a cross sectional study.\u0026quot; Arch Public Health 80(1): 157 http://doi.org/10.1186/s13690-022-00912-4\u003c/li\u003e\n\u003cli\u003ePantasri T (2022). \u0026quot;Expanded roles of community pharmacists in COVID-19: A scoping literature review.\u0026quot; J Am Pharm Assoc (2003) 62(3): 649-657 http://doi.org/10.1016/j.japh.2021.12.013\u003c/li\u003e\n\u003cli\u003eRaosoft Incorporation. (2004). \u0026quot;Raosoft Sample Size Calculator.\u0026quot; Retrieved 2/6/2022, 2022,available from http://www.raosoft.com/.\u003c/li\u003e\n\u003cli\u003eReddy A, Abebe E, Rivera A J, Stone J A and Chui M A (2019). \u0026quot;Interruptions in community pharmacies: Frequency, sources, and mitigation strategies.\u0026quot; Res Social Adm Pharm 15(10): 1243-1250 http://doi.org/10.1016/j.sapharm.2018.10.030\u003c/li\u003e\n\u003cli\u003eSadek M M, Elnour A A, Al Kalbani N M, Bhagavathula A S, Baraka M A, Aziz A M and Shehab A (2016). \u0026quot;Community pharmacy and the extended community pharmacist practice roles: The UAE experiences.\u0026quot; Saudi Pharm J 24(5): 563-570 http://doi.org/10.1016/j.jsps.2015.03.023\u003c/li\u003e\n\u003cli\u003eThornewill J, Antimisiaris D, Ezekekwu E and Esterhay R (2022). \u0026quot;Transformational strategies for optimizing use of medications and related therapies through us pharmacists and pharmacies: Findings from a national study.\u0026quot; J Am Pharm Assoc (2003) 62(2): 450-460 http://doi.org/10.1016/j.japh.2021.10.018\u003c/li\u003e\n\u003cli\u003eWrześniewska-Wal I, Grudziąż-Sękowska J, Sękowski K, Pinkas J and Jankowski M (2025). \u0026quot;Sociodemographic factors determining the choice of pharmacy and the level of trust in pharmacists \u0026ndash; a 2024 cross-sectional pilot survey in Poland.\u0026quot; BMC Health Services Research 25(1): 708 http://doi.org/10.1186/s12913-025-12709-6\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pharmaceutical Care Services Adoption, Community Pharmacists, Pharmaceutical Care Concept, and Community Pharmacies","lastPublishedDoi":"10.21203/rs.3.rs-7680249/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7680249/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Community pharmacies (CPs) in Sudan are accessible and cost-effective points of healthcare. However, Pharmaceutical Care Services (PhCS) has not been widely adopted. So far, adoption depends critically on resolving challenges and effectively utilizing the available opportunities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To assess the challenges and opportunities for pharmaceutical care adoption in private community pharmacies(CPhs), Wad-Madani, Gezira State, Sudan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This cross-sectional study was conducted from December 2019 to August 2020, involving 120 community pharmacists. A pre-tested, self-administered, structured questionnaire was used for data collection. The Statistical Package for the Social Sciences (version 26) was used for the analysis of categorical data variables. The p-value (α = 0.05) is the cutoff point for determining the significance of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The response rate among participants was 87.1%. The demographic characteristics showed younger age dominance (82.5% aged ≤ 40), with 63.3% females, less experience (\u0026lt; 20 years, 92.5%), and most holding a B.Pharm degree (91.7%). Over half of pharmacists (52.5%) engaged in multitasking roles, including dispensing, counseling, handling money, and managerial activities, often without a separate counseling area. Awareness regarding PhCS was high (81%). However, the main barriers included 40% as insufficient continuous professional development (CPD) and 31.7% due to public perceptions. In comparison, the top supporting factor was the presence of organized staff members (55.8%). Pharmacists prioritized CPD (61.7%) as a means of supporting PhCS adoption. Overall, the observed difference between pharmacy groups was statistically insignificant for all variables (X² and Fisher's Exact test, p-values \u0026gt; 0.05), indicating uniformity among community pharmacists.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The demographic profile presents both opportunities and challenges. High awareness suggests rich ground for interventions. Interestingly, systemic barriers and discouraging factors can be overcome through coordinated strategies that involve education reform, regulatory frameworks, infrastructure design, and workforce planning. Results are essential for transforming community pharmacy practice into effective models of pharmaceutical care services.\u003c/p\u003e","manuscriptTitle":"Pharmaceutical Care Adoption in Community Pharmacies: Cross-Sectional Study Assessment of Challenges and Opportunities, Wad-Madani, Sudan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 19:50:07","doi":"10.21203/rs.3.rs-7680249/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-12T18:42:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T04:26:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-25T22:19:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170120026534669274641667059576426441446","date":"2026-04-13T04:52:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"165044621016814740724266493508785658692","date":"2026-04-08T08:50:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71329976828126592995204938337995026797","date":"2026-02-10T02:42:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-02T08:03:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-01T14:50:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-30T08:29:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-30T02:49:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-22T11:01:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b698f1c-ea7d-4ff4-aaf6-8edc9dacca02","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-12T18:42:38+00:00","index":86,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T04:26:08+00:00","index":85,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":62138804,"name":"Health sciences/Health care"},{"id":62138805,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-02-03T19:50:07+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 19:50:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7680249","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7680249","identity":"rs-7680249","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}