Perspectives on Siting Community Pharmacies at Fuel Stations in Nigeria: A Cross- Sectional Survey

Perspectives on Siting Community Pharmacies at Fuel Stations in Nigeria: A Cross- Sectional Survey | 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 Research Article Perspectives on Siting Community Pharmacies at Fuel Stations in Nigeria: A Cross- Sectional Survey Margaret Olubunmi Afolabi, Maduabuchi Romanus Ihekoronye, Omoniyi Joseph Ola-Olorun, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8013231/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Community pharmacies remain key access points for pharmaceutical care, while fuel stations have become convenient commercial hubs. In some countries, pharmacies can be sited within fuel stations but in Nigeria, this model is neither permitted nor expressly prohibited by law. Objectives This study explored stakeholder perceptions of co-locating pharmacies and fuel stations, and implications for service and regulation. Materials and Methods A cross-sectional, mixed-method survey was conducted among 615 pharmacists, 37 industry regulators, 524 fuel station customers, and 27 fuel station managers across Nigeria’s six geo-political zones and the nation’s capital. Using a multistage sampling of respondents, primary data were collected between June and August 2023 with a validated questionnaire. Relevant statute documents were reviewed while 14 regulators were interviewed using an interview guide. Quantitative data were analysed using descriptive statistics, Kruskal–Wallis, Mann–Whitney U and Chi-square tests at p < 0.05. Qualitative data were thematically analysed using inductive coding. Result Pharmacists expressed positive perception of co-locating pharmacies and fuel stations, expressing concern for medicines’ integrity (H = 590.66 (df = 3), p = 0.000*). Customers and managers supported the innovation, perceiving no disruptions to workflow (X 2 = 11.450, df = 4, p = 0.022). Regulators expressed willingness to explore the model, noting international precedence, foreseeing no significant regulatory conflicts (H = 7.851, df = 2, p = 0.02), but demanded strict safety measures and operational guidelines. Conclusion Stakeholders supported co-locating community pharmacies and fuel stations, though with safety concerns. Policy reforms, a fit-for-context regulatory framework, and safety guidelines are recommended before implementation in Nigeria. Fuel stations community pharmacy pharmacy location stakeholder perception policy reforms Nigeria Introduction In most built environments, community pharmacies and fuel stations are essential elements of daily life. A community pharmacy (also called retail pharmacy, drug store, or simply pharmacy) is a healthcare facility under the statutory oversight of a registered pharmacist which provides pharmaceutical products and services to people in their local settings [ 1 ]. Community pharmacies are typically located in the hearts of communities, close to where people live, work, shop and relax [ 2 ]. Fuel stations (also called filling stations, or gas stations) are retail facilities that store and dispense fuels such as petrol (gasoline), diesel, kerosene, and alternative energy sources for motor vehicles [ 3 ]. Over time, fuel stations have evolved into locations that offer a wider range of related products and services. Often, as in Nigeria, they are one-stop commercial centres providing access to household daily needs, boutiques, barbing salons, supermarkets, among others, which are complementary to the traditional automobile repair services, lube bays, car washes, vulcaniser services and cooking gas refill services [ 4 , 5 ]. Location analysis and regulatory evaluation for siting a community pharmacy usually entails considerations of easy accessibility, wide visibility, patient safety, and sufficient customer traffic [ 6 ]. Many fuel stations offer these unique features. Although community pharmacies are business concerns, they are primarily professional healthcare practice settings, and their operations are usually regulated by statutory government agencies [ 7 ]. In Nigeria, the Pharmacy Council of Nigeria (PCN) regulates pharmacy practice in all its ramifications [ 8 ]. Hitherto, the PCN has not granted regulatory authorisation for the establishment of community pharmacies within fuel stations. A critical review of extant laws reveals that there are no specific provisions regarding the propriety or otherwise of implementing such a practice innovation. Available literature provides insufficient empirical evidence to inform any policy reform in this regard given the need to balance the retail focus of a typical fuel station environment with the healthcare outlook of a community pharmacy [ 9 ]. Siting community pharmacies within fuel stations would entail regulatory compliance beyond the dictates of PCN, to include the Petroleum Industry Act alongside its Nigeria Midstream and Downstream Petroleum Regulatory Agency (NMDPRA), and the National Environmental Standards and Regulations Enforcement Agency [ 10 , 11 ]. The environment must not be deemed to exert a deleterious effect on the health of the personnel or integrity of the health commodities on offer, while the pharmacy operations must not be seen to contribute significantly to environmental pollution and climate change [ 12 ]. Considering the potential for confusion and conflict among these regulatory bodies in the effective oversight of community pharmacies located in fuel stations, there is an unmet need for evidence to guide policy development in this regard. Evidence from other health systems including Spain (with a strictly regulated practice) and the United Kingdom (where community pharmacy practice is relatively liberalised) indicate that regulatory authorisation for siting community pharmacies in the built environment is influenced by considerations of access, equity, and efficiency as the key underpinnings of the quality of pharmacy services to patients [ 13 ]. Access to community pharmacy products and services comprises elements of availability (of service points), affordability (financial costs to patients), accessibility (geographical distribution), and acceptability (rational selection and use) [ 14 ]. Equity in community pharmacy distribution aims to reduce health disparities between affluent and disadvantaged communities, avoid clustering of service points, and improve community pharmacist per capita indices, as well as geographical balance in the distribution of available service points [ 15 ]. Operational efficiency of the pharmacies is determined by operational costs, speed, workflow, and visibility of the locations [ 16 ]. Quality in community pharmacy may be examined in terms of improvements in patient outcomes (health), system performance (patient care) and professional development (learning) [ 17 ]. The success and sustainability of any policy and practice innovation to co-locate community pharmacies and fuel stations will require the engagement of critical stakeholders. A stakeholder is “any group or individual who can affect or is affected by the achievement of the organization’s objectives [ 18 ].” This study assessed perceptions of stakeholders regarding the siting of community pharmacies in fuel stations and evaluated the potential influence of such practice innovation on service quality, with a view to proposing a regulatory framework for possible reforms. Materials and Methods Study Design The study was a cross-sectional survey of stakeholders (including community pharmacists, fuel station customers, fuel station owners/managers, and industry regulators) using a mixed method for primary data collection. A set of validated questionnaires was administered to selected stakeholders, while in-depth interviews were conducted with leaders of regulatory bodies. Additionally, document reviews were conducted on relevant laws guiding pharmacy practice and fuel station operations. Study Setting The study was conducted among registered community pharmacists in their practice settings, fuel stations, and regulators of the petroleum and pharmaceutical industries. The area of study covered the six geopolitical zones of Nigeria. Six States were selected by a stratified sampling technique representing the six geopolitical zones of the country, namely Gombe (Northeast), Kano (Northwest), Kwara (Northcentral), Lagos (Southwest), Enugu (Southeast), Rivers (Southsouth), as well as Abuja FCT (nation’s capital purposively selected). These States were selected due to their high populations of community pharmacies and fuel stations, high urbanisation, as well as high feasibility of data collection. Study Participants The study participants comprised community pharmacists, fuel station Managers and customers, principal officers of the Pharmacy Council of Nigeria (PCN) and the Nigerian Midstream and Downstream Petroleum Regulatory Authority (NMDPRA) in selected States and Abuja FCT. Sample size determination The sample size of community pharmacists was calculated from their population in the register of PCN using the Taro Yamane (1967) sample size formula for finite populations. There were 18432 community pharmacists in Nigeria as of December 31, 2022. This population of interest was used to calculate the sample size (377) for participants with an overage of 10% added (in anticipation of possible non-responders), giving a total sample size of 415. Due to perceived difficulty in reaching fuel station owners while their managers would likely decline taking the surveys, the sample size for this group was purposively set at 3 per State, giving a total of 18, provided each selected State was represented. The sample size for fuel station customers was determined using Leslie Fischer’s Formula for a population with an unknown size, with an added overage of 10% for non-respondents to yield a sample size of 106. The target sample size for regulators (for questionnaire surveys/in-depth interviews) was 14, comprising the principal officers for the two key regulatory agencies (PCN and NMDPRA) in selected States (plus Abuja FCT). Sampling technique Multistage sampling was applied in this study. First, stratified sampling was used in which the 36 States were divided into six strata in line with the six geopolitical zones of Nigeria. Then, one State was purposively selected per geopolitical zone based on considerations of the presence of larger cities, expectedly with more fuel stations, feasibility of data collection, and security perceptions. Simple random sampling was used to select pharmacist respondents, while accidental sampling was applied for fuel station managers and customers based on those present and consenting at the time research assistants visited the outlets. Purposive sampling technique was used to select regulators who were principal officers in charge of their States. Development and validation of Instruments Items on the questionnaire were developed from a detailed review of relevant literature as well as evidence from other health systems [ 13 – 17 ]. The questionnaires comprised two sections: Section 1 sought information on relevant demographic characteristics of respondents, such as age, sex, educational qualifications, and practice setting. Section 2 contained items designed to elicit information on the perception of four stakeholders (pharmacists, customers, fuel station managers and regulators) on a five-point Likert scale of agreement with response weights of 1–5, regarding the appropriateness of siting community pharmacies in fuel stations. The same literature sources were used to develop items on the structured interview guide but adapted to suit the interview format for qualitative data collection. The draft instruments were interrogated at two sequential brainstorming sessions of the research team and thereafter subjected to the expert scrutiny of two senior faculty members who have significant expertise in pharmacy services development research. Further validation was carried out using a pilot study. Ethical considerations Ethical approval (Ref. No. IPH/OAU/12/2387) was obtained from the Health Research Ethics Committee of the Institute of Public Health at Obafemi Awolowo University, Ile-Ife, Nigeria. The study was carried out in line with the principles of the 1975 Helsinki declaration as revised in 2000, ensuring respondents’ confidentiality, while written informed consents were obtained from all respondents. Pilot Study The research instruments were deployed in two Local Government Areas (one in an urban, and the other in a rural setting) in Osun State for a pilot study to validate the instruments. A total of 40 community pharmacists and 12 customers were surveyed in the pilot study. The dataset from this pilot test yielded a Cronbach’s alpha reliability coefficient of 0.78 for the perception scale. Data collection For the quantitative data, a mix of paper questionnaires and online Google Forms was used to survey the selected respondents. A default setting of “limit to 1 response” was applied to the online forms to prevent double responses from participants. While selected pharmacists and regulators were surveyed or interviewed at their work settings, meeting venues and via their verified telephone numbers, fuel station customers were surveyed by accidental sampling, depending on who was present at the fuel stations at the time of visit by research assistants. Six Research Assistants were recruited and trained in data collection for one day (4 hours) and worked under the direct supervision of the principal investigator and the Deans of Pharmacy Schools in public universities in the selected States, as these were the PCN-accredited Pharmacy Schools at the time of study. For qualitative data, interview guides were used to conduct semi-structured interviews with eleven (11) purposively selected regulators, namely State Officers of the Pharmacy Council of Nigeria (PCN) and the Nigeria Midstream and Downstream Petroleum Regulatory Authority (NMDPRA), as these were the principal officers in charge of their States. The items on the interview guides were carefully drafted in line with the study objectives and presented in open-ended question formats. Two of the researchers (Author 2(Ph.D., male), Author 4 (PharmD., female)) conducted the face-to-face interviews in the privacy of the respondents’ offices, with three refusing to be interviewed. Both interviewers are pharmacists with considerable experience in qualitative research. Respondents were first contacted via telephone, given a brief description of the study and the interviewers, and they all gave their consents before interviews were conducted. One of the interviewers asked the questions while the other provided prompts and took notes. Interview sessions, which lasted approximately 30–45 minutes each, were tape-recorded, with permission, and transcribed verbatim for data analysis. Document reviews, focused on specifications regarding PCN requirements for the approval of locations for community pharmacies, as contained in the Pharmacy Council of Nigeria Act, 2022; as well as specific aspects of the NMDPRA Act, 2021, relevant to the study. Data analysis Demographic data of respondents were summarised using descriptive statistics, including median and range, frequency, and percentages. Respondents’ perceptions of appropriateness of siting community pharmacies in fuel stations were measured on a 5-point Likert scale in which scores of 1 to 5 were sequentially assigned to responses of “Strongly Disagree”, “Disagree”, “Unsure”, “Agree”, and “Strongly Agree” respectively, with 3 (the mid-point) as the cut-off score between positive (˃3) and negative (< 3) perceptions. Median (interquartile range) perception scores were computed while a Kruskal-Wallis H test was used to compare scores across the respondent groups (with Mann–Whitney U test for 2-group comparisons) at the P < 0.05 level of significance. Pairwise comparisons using the Mann–Whitney U test were performed following the significant Kruskal–Wallis test. Bonferroni correction was applied to adjust for multiple comparisons. The Pearson Chi-Square test was used to examine the association of perceptions with demographic characteristics of respondents. IBM-SPSS version 26 software was used for quantitative data analysis. Qualitative data from in-depth interviews with selected regulators were subjected to thematic analysis guided by Braun and Clarke’s six steps: familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining, and naming themes, and generating the final report [ 19 ]. ATLAS.ti version 9 software was used for qualitative data analysis, applying the inductive coding method (Appendix I) to identify and categorise themes and patterns. Two members of the research team (Authors 2 and 3) read through the transcript and did a quality check to ensure fidelity. They also independently developed codes for three transcripts while the Principal Investigator (Author 1) refined the codes and developed the coding framework that was subsequently applied to all the transcripts. Results Enrolment analysis A total of 615, 524, 37 and 27 participants were enrolled for the pharmacists, customers, regulators, and fuel station managers, respectively while 11 principal officers of the regulating agencies (including those from FCT) were interviewed. Demographic characteristics of Respondents With respect to respondents’ sex, Table 1 shows that the males were dominant for three groups of stakeholders, including the pharmacists (390, 63.4%), regulators (22, 59.5%) and fuel station managers (25, 92.6%), but not for the customers (196, 37.4%). The fuel station managers have the highest median age (39 years) and the customers the lowest (34 years). The modal highest educational qualification for all the stakeholders is the tertiary-bachelor with 74.1%, 66.2%, 60.2% and 51.4% for fuel station managers, customers, pharmacists, and the regulators, respectively. Only the customers and fuel station managers have more than 20% in the secondary educational qualification level and only the pharmacists (245, 39.8%) and regulators (14, 37.8%) have among them those in possession of tertiary-postgraduate certificates. Majority of the pharmacists (413, 87.7%) and fuel station managers (20, 74.1%) reside in urban centres with pharmacists in the Southwestern geopolitical zone having the modal value (155, 25.2%). Table 1 Demographic Characteristics of Respondents Variable Categories Pharmacists f (%) Customers f (%) FS Managers f (%) Regulators f (%) Sex Male 390 (63.4) 196 (37.4) 25 (92.6) 22 (59.5) Female 225 (36.6) 328 (62.6) 2 (7.4) 15 (40.5) Total 615 524 27 37 Age (Yrs.) Median (Min-Max) 37 (24–69) 34.5(21–72) 39 (24–55) NA Highest Educ. Qual. Primary 0 (0.0) 0 (0.0) 1 (3.7) 0 (0.0) Secondary 0 (0.0) 117 (33.8) 6 (22.2) 0 (0.0) Tertiary- Diploma 0 (0.0) 0 (0.0) 0 (0.0) 4 (10.8) Tertiary-Bachelor 370 (60.2) 347 (66.2) 20 (74.1) 19 (51.4) Tertiary-Postgrad 245 (39.8) 0 (0.0) 0 (0.0) 14 (37.8) Total 615 524 27 37 Length of Practice Experience (years) Median (Min-Max) 5.5 (1–31) 4 (1–16) 2.5 (1–5) 3.5 (1–7) Geopolitical zone Southwest 155 (25.2) 129 (24.6) 9 (33.3) 13 (35.1) Southeast 43 (7.0) 43 (8.2) 4 (14.8) 6 (16.2) Southsouth 72 (11.7) 69 (13.2) 4 (14.8) 4 (10.8) Northeast 95 (15.5) 64 (12.2) 2 (7.4) 4 (10.8) Northwest 78 (12.7) 47 (9.0) 2 (7.4) 2 (5.4) Northcentral 71 (11.5) 79 (15.1) 2 (7.4) 3 (8.1) Abuja FCT 101 (16.4) 93 (17.7) 4 (14.8) 5 (13.5) Total 615 (100) 524 (100) 27 (100) 37 (100) Location of Practice/Residence Urban 413 (87.7) NA 20 (74.1) NA Rural 58 (12.3) 7 (26.0) Total 471 27 F = frequency, NA = Not available INSERT Table 1 HERE Stakeholders’ perception on appropriateness of siting Community Pharmacies in Fuel Stations The responses of the stakeholders to the questionnaire items are presented in Table 2 . The results of the Kruskal-Wallis H tests to compare median perception scores of the groups, including the asymptotic significance (2-sided test) and the post hoc pair-wise comparisons using the Mann–Whitney U test with Bonferroni corrections for multiple comparisons (α = 0.05/6 = 0.0083), are presented in the last two columns. The first two items (i - ii) had all four stakeholders interrogated. Whereas two of the groups (the pharmacists and customers) reported “can’t say” (Mdn 3), the other two groups (the fuel station managers and regulators “agree” (Mdn 4) with the item “ There is nothing wrong with siting community pharmacies within fuel stations.” The Kruskal-Wallis H test shows that there were significant differences across the groups (H (3) = 20.097, p = 0.000) while the post hoc U tests show that the pharmacists reported significantly different agreement scores compared with only that of the managers’ group (U = 4494.5, p = .000). Furthermore, only the pharmacists “agree” (Mdn 4) that “ The environment of a fuel station will pose a significant risk to the integrity of pharmaceutical products”. All the three others, including the customers, fuel station managers and the regulators reported “can’t say” (Mdn 3). The Kruskal-Wallis H tests comparing median perception scores show that there were significant differences (H (3) = 590.66, p = 0.000) in perceptions across the groups while the post hoc tests show that the pharmacists reported significantly higher agreement scores compared with the other three groups of managers (U = 5816.5, z = -8.122, p = .000), customers (U = 99923, z = -24.081, p = .000) and the regulators (U = 6481, z = -4.522, p = .000), indicating greater concern among pharmacists. The next six items (iii-viii) had three of the four groups of stakeholders interrogated, while the last five (ix-xiii) had only two of the stakeholders interrogated. Table 2 Stakeholders’ Perception on Siting Community Pharmacies in Fuel Stations S/N Statement Mdn (IQR) Perception Scores Kruskal-Wallis H [H(df), p-value] Post Hoc Test results Pharmacists Customers FS Managers Regulators ii. There is nothing wrong with siting CPs within FSs 3 (3–4) 3 (3–4) 4 (4–5) 4 (4–5) Asymptotic Sig. (2-sided test), H (3) = 20.097, p = 0.000 The pharmacists reported significantly different agreement scores compared with the FS managers’ group (U = 4494.5, z = -4.136, p = .000). Comparison with those of customers (U = 158269, z = -0.53, p = 0.596) and the regulators (U = 9356.5, z = -0.178, p = 0.859) was not significant. iii. The environment of an FS will pose a significant risk to the integrity of pharmaceutical products 4 (4–5) 3 (3–4) 3 (2–4) 3 (3–4) Asymptotic Sig. (2-sided test), H (3) = 590.66, p = 0.000 The pharmacists reported significantly higher agreement scores compared with the other three groups of managers (U = 5816.5, z = -8.122, p = .000), customers (U = 99923, z = -24.081, p = .000) and the regulators (U = 6481, z = -4.522, p = .000). iii Siting Pharmacies at Fuel Stations will improve Community access to pharmacy services 4 (4–5) 4 (4–5) 4 (4–5) NI Asymptotic Sig. (2-sided test), H = 5.579, df = 2, p = 0.061; N = 1113 Post hoc tests are not performed since the overall test does not show significant differences across samples. iv. Siting of CPs in FSs will make medicines less affordable to patients 3 (3–4) 4 (4–5) 4 (3–4) NI Asymptotic Sig. (2-sided test), (H = 44.513, df = 2, p = 0.000), N = 834 Mann-Whitney Post hoc test shows that the significant difference is between the pharmacists and the managers (U = 2523, p = 0.002, N = 312) v. CPs in FSs can open for longer hours and on weekends 4 (4–5) 4 (4–5) 4 (4–5) NI Asymptotic Sig. (2-sided test), H = 12.995, df = 2, p = 0.002, N = 1166 Mann-Whitney Post hoc test shows significant differences between pharmacists and managers (U = 5366.5, p = 0.001, N = 642) and between the managers and customers (U = 4419, p = 0.000, N = 551) but not between the pharmacists and the customers (U = 154041, p = 0.183, N = 1139) vi. Siting CPs within FSs will likely cause conflicts between regulators of the pharmaceutical and petroleum industries 3 (2–4) NI 3 (2–4) 4 (4–5) Asymptotic Sig. (2-sided test), N = 642, (H = 7.851, df = 2, p = 0.02). A multiple comparisons Mann-Whitney Post hoc test shows that significant differences exist between pharmacists and regulators (U = 6026, p = 0.013) and between managers and regulators (U = 208.5, p = 0.005). The result of the test between the pharmacists and the managers was not significant (U = 7215.5, p = 0.237) vii. Special safety measures are necessary for the safe operation of Community Pharmacies within Fuel Stations 5 (4–5) 4 (4–5) NI 5 (4–5) No significant difference in the Kruskal-Wallis’s test (H = 0.801, df = 2, p = 0.67) Post hoc tests are not performed since the overall test does not show significant differences across samples. viii. I support that Pharmacies should be sited at fuel Stations NI 4 (4–5) 4 (4–5) 4 (2–4) Asymptotic Sig. (2-sided test), N = 642, (H = 23.131, df = 2, p = 0.000). Multiple comparisons using the Mann-Whitney U Test show that there is a significant difference between customers and managers (U = 3300.5, p = 0.000) and between managers and regulators (U = 279, p = 0.008). Post hoc test for customers and regulators was not significant (U = 8420, p = 0.807 ix. Siting CPs in FSs will improve customer convenience 4 (2–4) NI 4 (4–4) NI A Mann-Whitney U Test of the difference between the pharmacists and managers shows a significant difference between them (U = 6434.5, p = 0.042) x. The environment of a Fuel Station will not affect the quality of care given by my pharmacist 3 (2–4) 3 (3–4) NI NI A Mann-Whitney U Test shows a significant difference (U = 144489, p = 0.002, N = 1139) xi. Siting of CPs in FSs will reduce the quality of patient care rendered by the pharmacist 3 (2–4) 3(3–4) NI NI A Mann-Whitney U Test shows a significant difference (U = 144489, p = 0.002). xii. The presence of a pharmacy will not disturb the normal operations of my fuel station NI NI 4 (4–4) 4 (2–4) A Pearson Chi-Square Test of difference between the managers and regulators shows that the difference is significant (X 2 = 11.450, df = 4, p = 0.022) xiii. The environment of a FS will pose a significant risk to the quality of pharmaceutical products 4 (4–5) 3(2–4) NI NI A Chi-square test shows a significant difference N = 32, X 2 = 12.808, df = 4, p = 0.012 H = Kruskal Wallis-H test statistic; U = Mann Whitney U test statistic; X 2 = Chi square; CP = Community Pharmacy; FS – Fuel Station; NI = Not Interrogated INSERT Table 2 HERE Association of demographic characteristics with stakeholders’ perceptions A summary of the Chi-square test of differences for the effects of the demographic variables on the main objective items is presented in Table 3 . Only four of the items have their scores significantly affected by demographic variables. Table 3 Significant associations of respondents’ perceptions with their demographic characteristics Item Demographics Chi-Square outputs There is nothing wrong with siting CPs within FSs Male vs Female pharmacists Χ 2 = 10.161, df = 4, p = 0.038* The environment of a FS will pose a health risk to CP Highest Educational Qualification of pharmacists X 2 = 72.151, df = 28, p = 0.000* Siting CPs in FSs will reduce the quality of patient care rendered by the pharmacist Highest Educational Qualification of pharmacists X 2 = 43.107, df = 28, p = 0.034* The presence of a Pharmacy will not disturb the normal operations of the fuel station FS managers vs regulators X 2 = 11.450, df = 4, p = 0.022* H = Kruskal Wallis-H test statistic; U = Mann Whitney U test statistic; X 2 = Chi square; CP = community pharmacy; FS – Fuel Station INSERT Table 3 HERE Qualitative data from semi-structured interviews with Regulators The qualitative component of the research is presented in line with the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework (Appendix II). Thematic analysis of the interview data from selected regulators emphasized the following common themes: General impressions Sub-themes here were excitement, indifference, and surprise. Many of the respondents were struck by the novelty of the idea of co-locating community pharmacies and fuel stations and there were varied impressions of such an innovation. “It will be interesting to see how the stakeholders will receive such an innovation in Nigeria” …. A respondent from PCN. “There is nothing wrong with siting community pharmacies within fuel stations” ……… Two respondents from PCN, and one from NMDPRA. “I do not foresee any significant conflict of interest between PCN and NMDPRA in terms of regulating community pharmacies sited in fuel stations. Issues that may arise can easily be resolved by discussions among the regulators” ……………. Many respondents from both PCN and NMDPRA “I support the idea of siting community pharmacies within fuel stations” ………. Three respondents from PCN and two from NMDPRA Impact on product and service quality Sub-themes here include varied impact (uncertainty, curiosity), and improved access to pharmacy products and services. Most respondents agreed that siting community pharmacies in fuel stations will significantly improve visibility and access to community pharmacy products and services. They felt that evidence of the impact of such an innovation can only be known after some reasonable period of implementation. “Only fuel stations with adequate space between the tank farm/pump island and sales rooms should be authorised to host community pharmacies” ……………. Three respondents from NMDPRA “Dispensing tablets in unsealed multiple dose ‘counting’ forms should be discouraged in community pharmacies within fuel stations. All tablets should be dispensed in strips or blister packs, protected from direct exposure to the air” Four respondents from PCN “Siting community pharmacies in fuel stations will significantly improve customers’ access to pharmaceutical products and services” ……Most respondents from both PCN and NMDPRA “All community pharmacies within fuel stations must have functional air conditioners with the room doors always closed to ensure good air quality at all times” ……………. Three respondents from PCN “Special safety arrangements such as fire extinguishers, safety drills, back doors for emergency exit, and muster points must be put in place for community pharmacies to operate within fuel stations” …Two respondents from NMDPRA Comparison with other Health Systems Sub-themes here include changing business models, and willingness to explore. Some of the respondents expressed awareness of similar situations in some other health systems. The majority were willing to explore, noting that changing business models was an inevitable part of national development. “I know that community pharmacies are sited within fuel stations in some other climes such as the United States, United Kingdom, and Saudi Arabia” …………………. One respondent from PCN and two from NMDPRA “I do not see why we cannot explore this novel business model in Nigeria.” - a respondent from PCN Summary output of document reviews A detailed review of relevant extant laws, namely the Poison and Pharmacy Act Cap 535 LFN 1990; Food, Drugs, and related Products Registration Act 19 of 1993 (Cap F. 33 LFN, 2004); Dangerous drugs Act Cap D. 1 LFN 2004; Foods and drugs Act Cap F.33 LFN, 2004; National Agency for Food and Drug Administration and Control (NAFDAC) Act 15 of 1993 (Cap N. 1 LFN, 2004); Pharmacy Council of Nigeria (PCN) Act 2022, revealed that they all made no provisions for siting community pharmacies in fuel stations. None of these statutes specifically prohibits co-locating community pharmacies and fuel stations but in practice there is a ban on such initiative in practice guidelines. Discussion This study aggregated perspectives from multiple stakeholders in examining the feasibility of siting community pharmacies in fuel stations in Nigeria, as multi-stakeholder engagement has been shown to provide a robust evidence base in policy and practice reform initiatives [ 18 ]. The number of respondents was well above the minimum calculated sample sizes for the various stakeholder categories, thereby ensuring data saturation for possible generalisation of the findings [ 20 ]. The demographic characteristics of pharmacist respondents in this study were mostly in line with extant evidence regarding the distribution of pharmacists in Nigeria [ 21 ]. The pharmacists demonstrated a positive perception of the co-location of community pharmacies and fuel stations, yet with concerns for integrity of pharmaceutical products. This positive perception is significant as it suggests a certain readiness to accept a possible reform to the long-standing ban on siting community pharmacies in fuel stations, a norm probably reflecting concerns for professional standards and safety, particularly regarding the storage and handling of medications in environments where inflammable materials are present [ 22 ]. Stakeholders’ perspectives on the influence of the fuel station environment on quality and integrity of pharmaceutical products and hence patient safety, largely aligned with their different technical expertise as shown in the significant difference in their median scores. However, the greatest concern among pharmacists is not surprising but rather aligns with emerging trends in global literature in which community pharmacists currently emphasize quality in terms of access, environment, safety, person-centered care, competence, and integration within local healthcare systems [ 23 ]. Pharmacists, customers, and regulators were unanimous in emphasizing the need for special safety measures to ensure the safe operations of community pharmacies within fuel stations. These concerns align with a growing global awareness and attention to health, safety, and environmental (HSE) practices in community pharmacy settings as these have been shown to directly impact patient safety [ 24 , 25 ]. It also suggests that Nigeria community pharmacists will be willing to adopt any additional safety measures proposed by regulators in the likely event that approval is given for siting community pharmacies in fuel stations. Hence, in weighing the evidence adduced by this study, there is need to pay close attention to these safety concerns. Though there are reports of community pharmacies within fuel stations in some other countries such as the USA [ 26 ], South Africa [ 27 ], among others, the unique contextual realities of the Nigeria practice environment must be considered. While the different regulatory bodies envisage no significant conflicts (beyond what mutual dialogue can resolve) in executing their oversight mandates, their positive perceptions must be seen, not as an end but as an impetus to understudy the regulatory guidelines that underpin the successful co-location of community pharmacies and fuel stations in other climes. At the end, the ultimate measure of the relevance of regulations, as applicable in Europe and elsewhere, remains the guarantee of improved economic, clinical, and humanistic outcomes for the consumers [ 28 ], and in the present scenario, the responsibility lies with the pharmacists and their regulators [ 29 ]. There was convergence of quantitative and qualitative evidence from pharmacists, regulators, and customers to the effect that “there was nothing wrong in co-locating community pharmacies and fuel stations”. As demonstrated in similar patient-centred studies [ 30 , 31 ], this consensus signals a likely successful uptake of the practice innovation. This finding is strengthened by the evidence that pharmacists, customers, and fuel station managers all strongly agreed that siting community pharmacies in fuel stations would increase consumer access to pharmacy products and services, a critical consideration in location analysis and regulatory authorization for siting community pharmacies globally [ 13 , 14 ]. The stakeholders agreed that fuel stations will give greater visibility to community pharmacies and did not see how siting community pharmacies in fuel stations would increase operational costs or disturb normal operational workflows. This finding can be said to strengthen the argument for enhanced operational efficiency of community pharmacies located in fuel stations [ 16 ]. It is noteworthy that there was no significant difference in the opinions of urban and rural-based respondents which seems to suggest that siting community pharmacies in fuel stations would ultimately contribute to reducing the disparity in customers’ access to pharmacy products and services [ 15 ]. The significant associations between higher educational qualifications of the pharmacists and their sensitivity to environmental health risks and service quality seems to suggest that specialization tends to align their practice priorities with global trends and best practices. A recent report found that most health systems currently place emphasis on patient safety, reduced medication errors and improved service quality with pharmacists assuming central roles in driving these goals within the medicines ecosystem [ 32 ]. Limitations of the Study This study did not collect and analyse air and particulate samples from fuel stations to enable definite scientific determination of the possible reactions with different pharmacological classes of medicines and human subjects who will operate the pharmacy premises located within fuel stations. Conclusion From the findings of this study, it can be concluded that relevant stakeholders demonstrated a positive perception of the siting of community pharmacies in fuel stations, though with safety concerns. Policy reforms backed by a fit-for-context regulatory framework and enhanced health, safety, and environmental guidelines are recommended before implementation in Nigeria. Declarations Clinical Trial Number Not applicable Conflicts of Interest All the Authors declare no competing interests Ethical Approval and Accordance Ethical approval (Ref. No. IPH/OAU/12/2387) was obtained from the Health Research Ethics Committee of the Institute of Public Health at Obafemi Awolowo University, Ile-Ife, Nigeria. The study was carried out in line with the principles of the 1975 Helsinki declaration as revised in 2000, ensuring respondents’ confidentiality, while written informed consents were obtained from all respondents. Funding Statement This study was partially supported by funding from the Pharmacy Council of Nigeria. Author Contribution MOA: conceptualization, investigation, supervision, writing- review and editing, fund acquisition, project administration.MRI: methodology, investigation, data curation, writing-original draft, review and editingOJO: formal analysis, validation, data curation, writing- review and editingMOO: investigation, writing- review and editing Acknowledgement The authors wish to acknowledge the cooperation of the Deans of pharmacy schools in the selected States, which not only enhanced quality assurance in the research process but also improved the credibility of the study with stakeholders Data Availability All datasets related to this study are either embedded in the report or may be accessed upon reasonable request to the corresponding author References Melton BL, Lai Z. Review of community pharmacy services: what is being performed, and where are the opportunities for improvement? Integr Pharm Res Pract. 2017;6:79–89. 10.2147/iprp.s107612 . International Pharmaceutical Federation (FIP). Vision of a Community-based Pharmacist: Community Pharmacy Section. International Pharmaceutical Federation. 2015. Available at https://www.fip.org/community-pharmacy . Accessed October 2, 2022. Cornillier F, Boctor F, Renaud J. Heuristics for the multi-depot petrol station replenishment problem with time windows. Eur J Oper Res. 2012;220:361–9. Onyeizugbe CU, Orogbu OL, Onyilofor TU, Ugbomhe OU. Business development and sustainability of selected petrol stations in Anambra state of Nigeria. Afr J Bus Manage. 2018;12(1):11–20. https://doi.org/10.5897/AJBM2017.8456 . Ulakpa RO, Ulakpa WC, Eyankware OE. Petroleum Filling Stations and Their Impact on the Environment in Nigeria. J Environ Earth Sci. 2022;04(1). https://doi.org/10.30564/jees.v4i1.4073 . Chijioke-Nwauche I, Ogoro M. Distribution Pattern of Community Pharmacies in Port Harcourt Metropolis, Niger Delta, Nigeria. J Pharm Pharmacol Res. 2021;5:188–99. Berenbrok LA, Tang S, Gabriel N, Guo J, Sharareh N, Patel N, Dickson S, Hernandez I. Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis. J Am Pharm Assoc. 2022;62(6):1816–e18222. https://doi.org/10.1016/j.japh.2022.07.003 . Ediru ME. Community Pharmacy Practice in Nigeria: The Dilemma of Regulation. Int J Humanit Soc Stud. 2021;9(11). https://doi.org/10.24940/theijhss/2021/v9/i11/HS2111-041 . Pharmacy Council of Nigeria (PCN). Pharmacy Council of Nigeria Act. 2022. Available at https://www.pcn.gov.ng/ . accessed 10th October, 2022. Petroleum Industry Act, (PIA) No.6, 2021: Midstream and Downstream Petroleum Environmental Regulations. 2023. Available at https://alps.blob.core.windows.net/nmdprawebsite/Regulation/Upload-65b0b26a-607d-4e7a-b264-84388c4c1a28.pdf , accessed 7th January, 2024. National Environmental Standards and Regulations Enforcement Agency (Establishment) Act. 2007. Available online at http://lawsofnigeria.placng.org/laws/nesrea.pdf ; accessed 8th October, 2022. Roy C. The pharmacist’s role in climate change: a call to action. Can Pharm J (Ott). 2021;154(2):74–5. https://doi.org/10.1177%2F1715163521990408. Lluch M, Kanavos P. Impact of regulation of Community Pharmacies on efficiency, access and equity. Evidence from the UK and Spain. Health Policy. 2010;95(2–3):245–54. https://doi.org/10.1016/j.healthpol.2009.11.002 . Bigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B, Van Damme W. Access to medicines from a health system perspective. Health Policy Plan. 2013;28(7):692–704. 10.1093/heapol/czs108 . Wagner A, Hann M, Noyce P, Ashcroft D. Equity in the distribution of community pharmacies in England: impact of regulatory reform. J Health Serv Res Policy. 2009;14(4):243–8. http://www.jstor.org/stable/26751181 . Papalexi M, Bamford D, Breen L. Key sources of operational inefficiency in the pharmaceutical supply chain. Supply Chain Manag, 20202; 25 (6),617–35, http://dx.doi.org/10.1108/SCM-02-2019-0076 Alhusein N, Watson MC. Quality indicators and community pharmacy services: a scoping review. Int J Pharm Pract. 2019;27(6):490–500. 10.1111/ijpp.12561 . Kazadi K, Lievens A, Mahr D. Stakeholder co-creation during the innovation process: Identifying capabilities for knowledge creation among multiple stakeholders. J Bus Res. 2016;69(2):525–40. https://doi.org/10.1016/j.jbusres.2015.05.009 . Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol, 2006; 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa . Ahmed SK. Sample size for saturation in qualitative research: Debates, definitions, and strategies. J Med Surg Public Health. 2025;5(100171). https://doi.org/10.1016/j.glmedi.2024.100171 . Oseni YO. Pharmacists’ Distribution in Nigeria; Implication in the Provision of Safe Medicines and Pharmaceutical Care. Int J Pharm Pharm Sci. 2017;9(10):49–54. https://doi.org/10.22159/ijpps.2017v9i10.20454 . Perie M, Ulakpa WC, Eyankware O. Petroleum Filling Stations and Their Impact on the Environment in Nigeria. J Environ Earth Sci. 2022;4. 10.30564/jees.v4i1.4073 . Hindi AMK, Campbell SM, Jacobs S, et al. Developing a quality framework for community pharmacy: a systematic review of international literature. BMJ Open. 2024;14:e079820. 10.1136/bmjopen-2023-079820 . White A, Thompson EL, Kim S, Osei JA, Fulda KG, Xiao Y. Enhancing the Role of Community Pharmacists in Medication Safety: A Qualitative Study of Voices from the Frontline. Pharm (Basel). 2025;13(4):94. 10.3390/pharmacy13040094 . Kwon K-E, Nam DR, Lee M-S, et al. Status of patient safety culture in community pharmacy settings: a systematic review. J Patient Saf. 2023;19(6):353–61. 10.1097/pts.0000000000001147 . Rudresh P, Dillip D, Jigyasa J, Kajal V, Nikhil N, Tin Q, Daisy K, Tan M, Roselin X, Looi Q. Factors Influencing Organization Success: A Case Study of Walmart. Int J Tourism Hospitality Asia Pasific. 2021;4:112–23. 10.32535/ijthap.v4i2.1059 . Pharmashop24. and Shell South Africa have partnered to offer a unique 24/7 Pharmacy vending solution to more than half of their Select stores around the country. Available online: Pharmashop 24 | Shell South Africa. Accessed 14 August 2025. Todorova A, Ivanova M, Pesheva M, Miceva D, Angelovska B. Analysis of Legislative and Regulatory Frameworks Governing Community Pharmacy in Bulgaria and North Macedonia. Pharmacy. 2025;13(4):108. https://doi.org/10.3390/pharmacy13040108 . Brown L, Johnson A. Community pharmacies and their role in healthcare delivery. J Pharm Health Serv Res. 2018;9(2):103–7. Okoro R. The Increasing Sustainability Threats to Community Pharmacies in Low-and Middle-Income Countries: Insurance Coverage Barriers and Policy Recommendations. Indian J Pharm Pract. 2022;15(3):1–5. http://dx.doi.org/10.5530/ijopp.15.3.43 . Segarra-Oña M, Peiró-Signes A, Verma R. Fostering innovation through stakeholders’ engagement at the healthcare industry: Tapping the right key. Health Policy. 2020;124(8):895–901. https://doi.org/10.1016/j.healthpol.2020.05.013 . Chavan A, Kumbhar S, Shinde V, Thorat A, Jadhav P, Jadhav A, Honrao J, Shaikh S, Raysing S, More V, Kumbhar D. Role of pharmacist in healthcare system. GSC Biol Pharm Sci. 2023;24:036–45. 10.30574/gscbps.2023.24.1.0261 . Additional Declarations No competing interests reported. Supplementary Files STROBEchecklistv4combinedPlosMedicine.docx ISSMCOREQChecklist.docx CodebookforDataAnalysis.docx Cite Share Download PDF Status: Posted Version 1 posted 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-8013231","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":560630748,"identity":"bb9d2c02-8d09-43d5-af6d-e73847c57810","order_by":0,"name":"Margaret Olubunmi Afolabi","email":"","orcid":"","institution":"Obafemi Awolowo University","correspondingAuthor":false,"prefix":"","firstName":"Margaret","middleName":"Olubunmi","lastName":"Afolabi","suffix":""},{"id":560630749,"identity":"d7d8da0e-c1f1-43a8-8fe3-662be8e9e4e4","order_by":1,"name":"Maduabuchi Romanus Ihekoronye","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYDACZh4GxgYIk/EBkOBhB/F4iNTCbABSzHOAkBYGhBY2CTCfkBbzdt6DD2dU3JMzl0g+VvGh5rAM0GWMD962MeTJO2DXInOYL9lww5liY8sZaWk3Zxw7zAN0GbPh3DaGYsMD2LVIMPOYST5sS0jccCPH7DYP22Eee4kENmneNobEjQ04tZj/hGjJ/1bM8w9oi/wD9t8EtJgxboTYwsbM2wbUIsEAYjAkzsfhfaAWY8kZZxKMDc48M5ac2ZcO9Etis+SccxKJG3Bp4T9j+LGnIkHO4Hjyww8fvlnb87AfPvjhTZlN4nwcDkMAgQQYCxxPEgwGBwhp4UdXIU/QllEwCkbBKBghAABp5FdkJ88H1wAAAABJRU5ErkJggg==","orcid":"","institution":"Obafemi Awolowo University","correspondingAuthor":true,"prefix":"","firstName":"Maduabuchi","middleName":"Romanus","lastName":"Ihekoronye","suffix":""},{"id":560630751,"identity":"2a0066d1-77f2-458d-96ff-5c3680dc5b3b","order_by":2,"name":"Omoniyi Joseph Ola-Olorun","email":"","orcid":"","institution":"Obafemi Awolowo University","correspondingAuthor":false,"prefix":"","firstName":"Omoniyi","middleName":"Joseph","lastName":"Ola-Olorun","suffix":""},{"id":560630754,"identity":"3107d3e7-4384-41de-b38f-9c6d49ef14f6","order_by":3,"name":"Moteehat Olubukola Olu-Lawal","email":"","orcid":"","institution":"Osun State Hospitals Management Board","correspondingAuthor":false,"prefix":"","firstName":"Moteehat","middleName":"Olubukola","lastName":"Olu-Lawal","suffix":""}],"badges":[],"createdAt":"2025-11-02 21:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8013231/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8013231/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98439538,"identity":"cbea32f3-0b16-477c-831d-3c646ad5934b","added_by":"auto","created_at":"2025-12-17 17:02:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":78701,"visible":true,"origin":"","legend":"","description":"","filename":"MainManuscript2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/01aaac616ff8c2168b071fef.docx"},{"id":98440489,"identity":"7cf20bec-f3a2-420f-8ad8-9dc640600663","added_by":"auto","created_at":"2025-12-17 17:03:56","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6594,"visible":true,"origin":"","legend":"","description":"","filename":"c2a18660071145f68998975b2431e9ea.json","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/f8428f21822e4bec9e65ee5d.json"},{"id":98440210,"identity":"daf95010-7f62-40ca-8402-8805aa067851","added_by":"auto","created_at":"2025-12-17 17:03:31","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":13897,"visible":true,"origin":"","legend":"","description":"","filename":"CodebookforDataAnalysis.docx","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/8646a755e5c529b0840e5577.docx"},{"id":98440487,"identity":"4e173af7-5faa-49ef-a0b9-9494db85ad0e","added_by":"auto","created_at":"2025-12-17 17:03:55","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":99367,"visible":true,"origin":"","legend":"","description":"","filename":"ISSMCOREQChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/ee1987a2d71c97bfdd432b7f.docx"},{"id":98440965,"identity":"b5b30f70-0170-4205-b65b-96d0130f35b8","added_by":"auto","created_at":"2025-12-17 17:04:43","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35639,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistv4combinedPlosMedicine.docx","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/6c81026ebbb1c06a89e0cd12.docx"},{"id":98440285,"identity":"a40a60b2-2139-4f4f-af85-17c44df78766","added_by":"auto","created_at":"2025-12-17 17:03:40","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":120945,"visible":true,"origin":"","legend":"","description":"","filename":"c2a18660071145f68998975b2431e9ea1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/86792444179b0558c1a0c02f.xml"},{"id":98440502,"identity":"b02faa8e-1673-47e9-8f5d-c5ceda231df4","added_by":"auto","created_at":"2025-12-17 17:03:56","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":117125,"visible":true,"origin":"","legend":"","description":"","filename":"c2a18660071145f68998975b2431e9ea1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/ae23f1aee1b1f92f10dc78c7.xml"},{"id":98381002,"identity":"84eb6e58-e61f-4b72-9978-ad8f1dadf9ca","added_by":"auto","created_at":"2025-12-17 07:43:44","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":131486,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/a10810cad6eb267c9e3b9764.html"},{"id":103904353,"identity":"42a99325-2b30-4684-97d7-4456d1a457b0","added_by":"auto","created_at":"2026-03-04 10:28:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1342342,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/b0e0006e-2cfe-484b-ad2e-52d379498e1b.pdf"},{"id":98439552,"identity":"fe596606-63c5-4a7f-88bb-e009e0ebe8f9","added_by":"auto","created_at":"2025-12-17 17:02:05","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":35639,"visible":true,"origin":"","legend":"","description":"","filename":"STROBEchecklistv4combinedPlosMedicine.docx","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/5f03bed34b5d7768428a6999.docx"},{"id":98440324,"identity":"360a1798-95b9-4f1d-a2f0-f1b45705d054","added_by":"auto","created_at":"2025-12-17 17:03:43","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":99367,"visible":true,"origin":"","legend":"","description":"","filename":"ISSMCOREQChecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/df753a500cf592fe9b4ae401.docx"},{"id":98441239,"identity":"2f84dda0-4724-4027-92ce-e5338bdfa00c","added_by":"auto","created_at":"2025-12-17 17:05:06","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":13897,"visible":true,"origin":"","legend":"","description":"","filename":"CodebookforDataAnalysis.docx","url":"https://assets-eu.researchsquare.com/files/rs-8013231/v1/6b4b56b7948be79bbc99778a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perspectives on Siting Community Pharmacies at Fuel Stations in Nigeria: A Cross- Sectional Survey","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn most built environments, community pharmacies and fuel stations are essential elements of daily life. A community pharmacy (also called retail pharmacy, drug store, or simply pharmacy) is a healthcare facility under the statutory oversight of a registered pharmacist which provides pharmaceutical products and services to people in their local settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Community pharmacies are typically located in the hearts of communities, close to where people live, work, shop and relax [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Fuel stations (also called filling stations, or gas stations) are retail facilities that store and dispense fuels such as petrol (gasoline), diesel, kerosene, and alternative energy sources for motor vehicles [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Over time, fuel stations have evolved into locations that offer a wider range of related products and services. Often, as in Nigeria, they are one-stop commercial centres providing access to household daily needs, boutiques, barbing salons, supermarkets, among others, which are complementary to the traditional automobile repair services, lube bays, car washes, vulcaniser services and cooking gas refill services [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLocation analysis and regulatory evaluation for siting a community pharmacy usually entails considerations of easy accessibility, wide visibility, patient safety, and sufficient customer traffic [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Many fuel stations offer these unique features. Although community pharmacies are business concerns, they are primarily professional healthcare practice settings, and their operations are usually regulated by statutory government agencies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Nigeria, the Pharmacy Council of Nigeria (PCN) regulates pharmacy practice in all its ramifications [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Hitherto, the PCN has not granted regulatory authorisation for the establishment of community pharmacies within fuel stations. A critical review of extant laws reveals that there are no specific provisions regarding the propriety or otherwise of implementing such a practice innovation. Available literature provides insufficient empirical evidence to inform any policy reform in this regard given the need to balance the retail focus of a typical fuel station environment with the healthcare outlook of a community pharmacy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSiting community pharmacies within fuel stations would entail regulatory compliance beyond the dictates of PCN, to include the Petroleum Industry Act alongside its Nigeria Midstream and Downstream Petroleum Regulatory Agency (NMDPRA), and the National Environmental Standards and Regulations Enforcement Agency [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The environment must not be deemed to exert a deleterious effect on the health of the personnel or integrity of the health commodities on offer, while the pharmacy operations must not be seen to contribute significantly to environmental pollution and climate change [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Considering the potential for confusion and conflict among these regulatory bodies in the effective oversight of community pharmacies located in fuel stations, there is an unmet need for evidence to guide policy development in this regard.\u003c/p\u003e \u003cp\u003eEvidence from other health systems including Spain (with a strictly regulated practice) and the United Kingdom (where community pharmacy practice is relatively liberalised) indicate that regulatory authorisation for siting community pharmacies in the built environment is influenced by considerations of access, equity, and efficiency as the key underpinnings of the quality of pharmacy services to patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Access to community pharmacy products and services comprises elements of availability (of service points), affordability (financial costs to patients), accessibility (geographical distribution), and acceptability (rational selection and use) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Equity in community pharmacy distribution aims to reduce health disparities between affluent and disadvantaged communities, avoid clustering of service points, and improve community pharmacist per capita indices, as well as geographical balance in the distribution of available service points [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Operational efficiency of the pharmacies is determined by operational costs, speed, workflow, and visibility of the locations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Quality in community pharmacy may be examined in terms of improvements in patient outcomes (health), system performance (patient care) and professional development (learning) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe success and sustainability of any policy and practice innovation to co-locate community pharmacies and fuel stations will require the engagement of critical stakeholders. A stakeholder is \u0026ldquo;any group or individual who can affect or is affected by the achievement of the organization\u0026rsquo;s objectives [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u0026rdquo; This study assessed perceptions of stakeholders regarding the siting of community pharmacies in fuel stations and evaluated the potential influence of such practice innovation on service quality, with a view to proposing a regulatory framework for possible reforms.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThe study was a cross-sectional survey of stakeholders (including community pharmacists, fuel station customers, fuel station owners/managers, and industry regulators) using a mixed method for primary data collection. A set of validated questionnaires was administered to selected stakeholders, while in-depth interviews were conducted with leaders of regulatory bodies. Additionally, document reviews were conducted on relevant laws guiding pharmacy practice and fuel station operations.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted among registered community pharmacists in their practice settings, fuel stations, and regulators of the petroleum and pharmaceutical industries. The area of study covered the six geopolitical zones of Nigeria. Six States were selected by a stratified sampling technique representing the six geopolitical zones of the country, namely Gombe (Northeast), Kano (Northwest), Kwara (Northcentral), Lagos (Southwest), Enugu (Southeast), Rivers (Southsouth), as well as Abuja FCT (nation\u0026rsquo;s capital purposively selected). These States were selected due to their high populations of community pharmacies and fuel stations, high urbanisation, as well as high feasibility of data collection.\u003c/p\u003e\n\u003ch3\u003eStudy Participants\u003c/h3\u003e\n\u003cp\u003eThe study participants comprised community pharmacists, fuel station Managers and customers, principal officers of the Pharmacy Council of Nigeria (PCN) and the Nigerian Midstream and Downstream Petroleum Regulatory Authority (NMDPRA) in selected States and Abuja FCT.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size of community pharmacists was calculated from their population in the register of PCN using the Taro Yamane (1967) sample size formula for finite populations. There were 18432 community pharmacists in Nigeria as of December 31, 2022. This population of interest was used to calculate the sample size (377) for participants with an overage of 10% added (in anticipation of possible non-responders), giving a total sample size of 415. Due to perceived difficulty in reaching fuel station owners while their managers would likely decline taking the surveys, the sample size for this group was purposively set at 3 per State, giving a total of 18, provided each selected State was represented. The sample size for fuel station customers was determined using Leslie Fischer\u0026rsquo;s Formula for a population with an unknown size, with an added overage of 10% for non-respondents to yield a sample size of 106. The target sample size for regulators (for questionnaire surveys/in-depth interviews) was 14, comprising the principal officers for the two key regulatory agencies (PCN and NMDPRA) in selected States (plus Abuja FCT).\u003c/p\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003eMultistage sampling was applied in this study. First, stratified sampling was used in which the 36 States were divided into six strata in line with the six geopolitical zones of Nigeria. Then, one State was purposively selected per geopolitical zone based on considerations of the presence of larger cities, expectedly with more fuel stations, feasibility of data collection, and security perceptions. Simple random sampling was used to select pharmacist respondents, while accidental sampling was applied for fuel station managers and customers based on those present and consenting at the time research assistants visited the outlets. Purposive sampling technique was used to select regulators who were principal officers in charge of their States.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment and validation of Instruments\u003c/h2\u003e \u003cp\u003eItems on the questionnaire were developed from a detailed review of relevant literature as well as evidence from other health systems [\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The questionnaires comprised two sections: Section 1 sought information on relevant demographic characteristics of respondents, such as age, sex, educational qualifications, and practice setting. Section 2 contained items designed to elicit information on the perception of four stakeholders (pharmacists, customers, fuel station managers and regulators) on a five-point Likert scale of agreement with response weights of 1\u0026ndash;5, regarding the appropriateness of siting community pharmacies in fuel stations. The same literature sources were used to develop items on the structured interview guide but adapted to suit the interview format for qualitative data collection. The draft instruments were interrogated at two sequential brainstorming sessions of the research team and thereafter subjected to the expert scrutiny of two senior faculty members who have significant expertise in pharmacy services development research. Further validation was carried out using a pilot study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e Ethical approval\u003c/strong\u003e (Ref. No. IPH/OAU/12/2387) was obtained from the Health Research Ethics Committee of the Institute of Public Health at Obafemi Awolowo University, Ile-Ife, Nigeria. The study was carried out in line with the principles of the 1975 Helsinki declaration as revised in 2000, ensuring respondents\u0026rsquo; confidentiality, while written informed consents were obtained from all respondents.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003ePilot Study\u003c/h3\u003e\n\u003cp\u003eThe research instruments were deployed in two Local Government Areas (one in an urban, and the other in a rural setting) in Osun State for a pilot study to validate the instruments. A total of 40 community pharmacists and 12 customers were surveyed in the pilot study. The dataset from this pilot test yielded a Cronbach\u0026rsquo;s alpha reliability coefficient of 0.78 for the perception scale.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eFor the quantitative data, a mix of paper questionnaires and online Google Forms was used to survey the selected respondents. A default setting of \u0026ldquo;limit to 1 response\u0026rdquo; was applied to the online forms to prevent double responses from participants. While selected pharmacists and regulators were surveyed or interviewed at their work settings, meeting venues and via their verified telephone numbers, fuel station customers were surveyed by accidental sampling, depending on who was present at the fuel stations at the time of visit by research assistants. Six Research Assistants were recruited and trained in data collection for one day (4 hours) and worked under the direct supervision of the principal investigator and the Deans of Pharmacy Schools in public universities in the selected States, as these were the PCN-accredited Pharmacy Schools at the time of study.\u003c/p\u003e \u003cp\u003eFor qualitative data, interview guides were used to conduct semi-structured interviews with eleven (11) purposively selected regulators, namely State Officers of the Pharmacy Council of Nigeria (PCN) and the Nigeria Midstream and Downstream Petroleum Regulatory Authority (NMDPRA), as these were the principal officers in charge of their States. The items on the interview guides were carefully drafted in line with the study objectives and presented in open-ended question formats. Two of the researchers (Author 2(Ph.D., male), Author 4 (PharmD., female)) conducted the face-to-face interviews in the privacy of the respondents\u0026rsquo; offices, with three refusing to be interviewed. Both interviewers are pharmacists with considerable experience in qualitative research. Respondents were first contacted via telephone, given a brief description of the study and the interviewers, and they all gave their consents before interviews were conducted. One of the interviewers asked the questions while the other provided prompts and took notes. Interview sessions, which lasted approximately 30\u0026ndash;45 minutes each, were tape-recorded, with permission, and transcribed verbatim for data analysis.\u003c/p\u003e \u003cp\u003eDocument reviews, focused on specifications regarding PCN requirements for the approval of locations for community pharmacies, as contained in the Pharmacy Council of Nigeria Act, 2022; as well as specific aspects of the NMDPRA Act, 2021, relevant to the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDemographic data of respondents were summarised using descriptive statistics, including median and range, frequency, and percentages. Respondents\u0026rsquo; perceptions of appropriateness of siting community pharmacies in fuel stations were measured on a 5-point Likert scale in which scores of 1 to 5 were sequentially assigned to responses of \u0026ldquo;Strongly Disagree\u0026rdquo;, \u0026ldquo;Disagree\u0026rdquo;, \u0026ldquo;Unsure\u0026rdquo;, \u0026ldquo;Agree\u0026rdquo;, and \u0026ldquo;Strongly Agree\u0026rdquo; respectively, with 3 (the mid-point) as the cut-off score between positive (˃3) and negative (\u0026lt;\u0026thinsp;3) perceptions. Median (interquartile range) perception scores were computed while a Kruskal-Wallis H test was used to compare scores across the respondent groups (with Mann\u0026ndash;Whitney U test for 2-group comparisons) at the \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level of significance. Pairwise comparisons using the Mann\u0026ndash;Whitney U test were performed following the significant Kruskal\u0026ndash;Wallis test. Bonferroni correction was applied to adjust for multiple comparisons. The Pearson Chi-Square test was used to examine the association of perceptions with demographic characteristics of respondents. IBM-SPSS version 26 software was used for quantitative data analysis.\u003c/p\u003e \u003cp\u003eQualitative data from in-depth interviews with selected regulators were subjected to thematic analysis guided by Braun and Clarke\u0026rsquo;s six steps: familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining, and naming themes, and generating the final report [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. ATLAS.ti version 9 software was used for qualitative data analysis, applying the inductive coding method (Appendix I) to identify and categorise themes and patterns. Two members of the research team (Authors 2 and 3) read through the transcript and did a quality check to ensure fidelity. They also independently developed codes for three transcripts while the Principal Investigator (Author 1) refined the codes and developed the coding framework that was subsequently applied to all the transcripts.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEnrolment analysis\u003c/h2\u003e \u003cp\u003eA total of 615, 524, 37 and 27 participants were enrolled for the pharmacists, customers, regulators, and fuel station managers, respectively while 11 principal officers of the regulating agencies (including those from FCT) were interviewed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of Respondents\u003c/h2\u003e \u003cp\u003eWith respect to respondents\u0026rsquo; sex, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that the males were dominant for three groups of stakeholders, including the pharmacists (390, 63.4%), regulators (22, 59.5%) and fuel station managers (25, 92.6%), but not for the customers (196, 37.4%). The fuel station managers have the highest median age (39 years) and the customers the lowest (34 years). The modal highest educational qualification for all the stakeholders is the tertiary-bachelor with 74.1%, 66.2%, 60.2% and 51.4% for fuel station managers, customers, pharmacists, and the regulators, respectively. Only the customers and fuel station managers have more than 20% in the secondary educational qualification level and only the pharmacists (245, 39.8%) and regulators (14, 37.8%) have among them those in possession of tertiary-postgraduate certificates. Majority of the pharmacists (413, 87.7%) and fuel station managers (20, 74.1%) reside in urban centres with pharmacists in the Southwestern geopolitical zone having the modal value (155, 25.2%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of Respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePharmacists\u003c/p\u003e \u003cp\u003ef (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCustomers\u003c/p\u003e \u003cp\u003ef (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFS Managers\u003c/p\u003e \u003cp\u003ef (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRegulators \u003c/p\u003e \u003cp\u003ef (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e390 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (92.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (59.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e328 (62.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (40.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e615\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e524\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Yrs.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (Min-Max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (24\u0026ndash;69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.5(21\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (24\u0026ndash;55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eHighest Educ. Qual.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (33.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary- Diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary-Bachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e370 (60.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e347 (66.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (51.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary-Postgrad\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e245 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (37.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e615\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e524\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of Practice Experience (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (Min-Max)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5 (1\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.5 (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.5 (1\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eGeopolitical zone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouthwest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (35.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSoutheast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (16.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouthsouth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNortheast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorthwest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorthcentral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbuja FCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (13.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e615 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e524 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e27 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e37 (100)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLocation of Practice/Residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e413 (87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e471\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eF\u0026thinsp;=\u0026thinsp;frequency, NA\u0026thinsp;=\u0026thinsp;Not available\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eINSERT\u003c/b\u003e Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cb\u003eHERE\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStakeholders\u0026rsquo; perception on appropriateness of siting Community Pharmacies in Fuel Stations\u003c/h2\u003e \u003cp\u003eThe responses of the stakeholders to the questionnaire items are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The results of the Kruskal-Wallis H tests to compare median perception scores of the groups, including the asymptotic significance (2-sided test) and the post hoc pair-wise comparisons using the Mann\u0026ndash;Whitney U test with Bonferroni corrections for multiple comparisons (α\u0026thinsp;=\u0026thinsp;0.05/6\u0026thinsp;=\u0026thinsp;0.0083), are presented in the last two columns. The first two items (i - ii) had all four stakeholders interrogated. Whereas two of the groups (the pharmacists and customers) reported \u0026ldquo;can\u0026rsquo;t say\u0026rdquo; (Mdn 3), the other two groups (the fuel station managers and regulators \u0026ldquo;agree\u0026rdquo; (Mdn 4) with the item \u0026ldquo;\u003cem\u003eThere is nothing wrong with siting\u003c/em\u003e community pharmacies \u003cem\u003ewithin\u003c/em\u003e fuel stations.\u0026rdquo; The Kruskal-Wallis H test shows that there were significant differences across the groups (H (3)\u0026thinsp;=\u0026thinsp;20.097, p\u0026thinsp;=\u0026thinsp;0.000) while the post hoc U tests show that the pharmacists reported significantly different agreement scores compared with only that of the managers\u0026rsquo; group (U\u0026thinsp;=\u0026thinsp;4494.5, p\u0026thinsp;=\u0026thinsp;.000). Furthermore, only the pharmacists \u0026ldquo;agree\u0026rdquo; (Mdn 4) that \u0026ldquo;\u003cem\u003eThe environment of a\u003c/em\u003e fuel station \u003cem\u003ewill pose a significant risk to the integrity of pharmaceutical products\u0026rdquo;.\u003c/em\u003e All the three others, including the customers, fuel station managers and the regulators reported \u0026ldquo;can\u0026rsquo;t say\u0026rdquo; (Mdn 3). The Kruskal-Wallis H tests comparing median perception scores show that there were significant differences (H (3)\u0026thinsp;=\u0026thinsp;590.66, p\u0026thinsp;=\u0026thinsp;0.000) in perceptions across the groups while the post hoc tests show that the pharmacists reported significantly higher agreement scores compared with the other three groups of managers (U\u0026thinsp;=\u0026thinsp;5816.5, z = -8.122, p\u0026thinsp;=\u0026thinsp;.000), customers (U\u0026thinsp;=\u0026thinsp;99923, z = -24.081, p\u0026thinsp;=\u0026thinsp;.000) and the regulators (U\u0026thinsp;=\u0026thinsp;6481, z = -4.522, p\u0026thinsp;=\u0026thinsp;.000), indicating greater concern among pharmacists. The next six items (iii-viii) had three of the four groups of stakeholders interrogated, while the last five (ix-xiii) had only two of the stakeholders interrogated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStakeholders\u0026rsquo; Perception on Siting Community Pharmacies in Fuel Stations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eS/N\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStatement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eMdn (IQR) Perception Scores\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKruskal-Wallis H [H(df), p-value]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePost Hoc Test results\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePharmacists\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCustomers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFS Managers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eRegulators\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eii.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThere is nothing wrong with siting CPs within FSs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAsymptotic Sig. (2-sided test), H (3)\u0026thinsp;=\u0026thinsp;20.097, p\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eThe pharmacists reported significantly different agreement scores compared with the FS managers\u0026rsquo; group (U\u0026thinsp;=\u0026thinsp;4494.5, z = -4.136, p\u0026thinsp;=\u0026thinsp;.000). Comparison with those of customers (U\u0026thinsp;=\u0026thinsp;158269, z = -0.53, p\u0026thinsp;=\u0026thinsp;0.596) and the regulators (U\u0026thinsp;=\u0026thinsp;9356.5, z = -0.178, p\u0026thinsp;=\u0026thinsp;0.859) was not significant.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eiii.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe environment of an FS will pose a significant risk to the integrity of pharmaceutical products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAsymptotic Sig. (2-sided test), H (3)\u0026thinsp;=\u0026thinsp;590.66, p\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eThe pharmacists reported significantly higher agreement scores compared with the other three groups of managers (U\u0026thinsp;=\u0026thinsp;5816.5, z = -8.122, p\u0026thinsp;=\u0026thinsp;.000), customers (U\u0026thinsp;=\u0026thinsp;99923, z = -24.081, p\u0026thinsp;=\u0026thinsp;.000) and the regulators (U\u0026thinsp;=\u0026thinsp;6481, z = -4.522, p\u0026thinsp;=\u0026thinsp;.000).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eiii\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSiting Pharmacies at Fuel Stations will improve Community access to pharmacy services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAsymptotic Sig. (2-sided test), H\u0026thinsp;=\u0026thinsp;5.579, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.061; N\u0026thinsp;=\u0026thinsp;1113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePost hoc tests are not performed since the overall test does not show significant differences across samples.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eiv.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSiting of CPs in FSs will make medicines less affordable to patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAsymptotic Sig. (2-sided test), (H\u0026thinsp;=\u0026thinsp;44.513, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.000), N\u0026thinsp;=\u0026thinsp;834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMann-Whitney Post hoc test shows that the significant difference is between the pharmacists and the managers (U\u0026thinsp;=\u0026thinsp;2523, p\u0026thinsp;=\u0026thinsp;0.002, N\u0026thinsp;=\u0026thinsp;312)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ev.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPs in FSs can open for longer hours and on weekends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAsymptotic Sig. (2-sided test), H\u0026thinsp;=\u0026thinsp;12.995, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.002, N\u0026thinsp;=\u0026thinsp;1166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMann-Whitney Post hoc test shows significant differences between pharmacists and managers\u003c/p\u003e \u003cp\u003e(U\u0026thinsp;=\u0026thinsp;5366.5, p\u0026thinsp;=\u0026thinsp;0.001, N\u0026thinsp;=\u0026thinsp;642) and between the managers and customers (U\u0026thinsp;=\u0026thinsp;4419, p\u0026thinsp;=\u0026thinsp;0.000, N\u0026thinsp;=\u0026thinsp;551) but not between the pharmacists and the customers (U\u0026thinsp;=\u0026thinsp;154041, p\u0026thinsp;=\u0026thinsp;0.183, N\u0026thinsp;=\u0026thinsp;1139)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evi.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSiting CPs within FSs will likely cause conflicts between regulators of the pharmaceutical and petroleum industries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAsymptotic Sig. (2-sided test), N\u0026thinsp;=\u0026thinsp;642, (H\u0026thinsp;=\u0026thinsp;7.851, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA multiple comparisons Mann-Whitney Post hoc test shows that significant differences exist between pharmacists and regulators (U\u0026thinsp;=\u0026thinsp;6026, p\u0026thinsp;=\u0026thinsp;0.013) and between managers and regulators (U\u0026thinsp;=\u0026thinsp;208.5, p\u0026thinsp;=\u0026thinsp;0.005). The result of the test between the pharmacists and the managers was not significant (U\u0026thinsp;=\u0026thinsp;7215.5, p\u0026thinsp;=\u0026thinsp;0.237)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003evii.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecial safety measures are necessary for the safe operation of Community Pharmacies within Fuel Stations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo significant difference in the Kruskal-Wallis\u0026rsquo;s test (H\u0026thinsp;=\u0026thinsp;0.801, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePost hoc tests are not performed since the overall test does not show significant differences across samples.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eviii.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI support that Pharmacies should be sited at fuel Stations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAsymptotic Sig. (2-sided test), N\u0026thinsp;=\u0026thinsp;642, (H\u0026thinsp;=\u0026thinsp;23.131, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMultiple comparisons using the Mann-Whitney U Test show that there is a significant difference between customers and managers (U\u0026thinsp;=\u0026thinsp;3300.5, p\u0026thinsp;=\u0026thinsp;0.000) and between managers and regulators (U\u0026thinsp;=\u0026thinsp;279, p\u0026thinsp;=\u0026thinsp;0.008). Post hoc test for customers and regulators was not significant (U\u0026thinsp;=\u0026thinsp;8420, p\u0026thinsp;=\u0026thinsp;0.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eix.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSiting CPs in FSs will improve customer convenience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (4\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA Mann-Whitney U Test of the difference between the pharmacists and managers shows a significant difference between them (U\u0026thinsp;=\u0026thinsp;6434.5, p\u0026thinsp;=\u0026thinsp;0.042)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ex.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe environment of a Fuel Station will not affect the quality of care given by my pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA Mann-Whitney U Test shows a significant difference (U\u0026thinsp;=\u0026thinsp;144489, p\u0026thinsp;=\u0026thinsp;0.002, N\u0026thinsp;=\u0026thinsp;1139)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003exi.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSiting of CPs in FSs will reduce the quality of patient care rendered by the pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(3\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA Mann-Whitney U Test shows a significant difference (U\u0026thinsp;=\u0026thinsp;144489, p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003exii.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe presence of a pharmacy will not disturb the normal operations of my fuel station\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (4\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA Pearson Chi-Square Test of difference between the managers and regulators shows that the difference is significant (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;11.450, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.022)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003exiii.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe environment of a FS will pose a significant risk to the quality of pharmaceutical products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eA Chi-square test shows a significant difference N\u0026thinsp;=\u0026thinsp;32, X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.808, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eH\u0026thinsp;=\u0026thinsp;Kruskal Wallis-H test statistic; U\u0026thinsp;=\u0026thinsp;Mann Whitney U test statistic; X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;Chi square; CP\u0026thinsp;=\u0026thinsp;Community Pharmacy; FS \u0026ndash; Fuel Station; NI\u0026thinsp;=\u0026thinsp;Not Interrogated\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eINSERT\u003c/b\u003e Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003eHERE\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAssociation of demographic characteristics with stakeholders\u0026rsquo; perceptions\u003c/h2\u003e \u003cp\u003eA summary of the Chi-square test of differences for the effects of the demographic variables on the main objective items is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Only four of the items have their scores significantly affected by demographic variables.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSignificant associations of respondents\u0026rsquo; perceptions with their demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChi-Square outputs\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThere is nothing wrong with siting CPs within FSs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale vs Female pharmacists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eΧ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;10.161, df\u0026thinsp;=\u0026thinsp;4,\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.038*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe environment of a FS will pose a health risk to CP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighest Educational Qualification of pharmacists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;72.151, df\u0026thinsp;=\u0026thinsp;28, p\u0026thinsp;=\u0026thinsp;0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSiting CPs in FSs will reduce the quality of patient care rendered by the pharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHighest Educational Qualification of pharmacists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;43.107, df\u0026thinsp;=\u0026thinsp;28, p\u0026thinsp;=\u0026thinsp;0.034*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe presence of a Pharmacy will not disturb the normal operations of the fuel station\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFS managers vs regulators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;11.450, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.022*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eH\u0026thinsp;=\u0026thinsp;Kruskal Wallis-H test statistic; U\u0026thinsp;=\u0026thinsp;Mann Whitney U test statistic; X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;Chi square; CP\u0026thinsp;=\u0026thinsp;community pharmacy; FS \u0026ndash; Fuel Station\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eINSERT\u003c/b\u003e Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003eHERE\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eQualitative data from semi-structured interviews with Regulators\u003c/h2\u003e \u003cp\u003eThe qualitative component of the research is presented in line with the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework (Appendix II). Thematic analysis of the interview data from selected regulators emphasized the following common themes:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eGeneral impressions\u003c/h2\u003e \u003cp\u003eSub-themes here were excitement, indifference, and surprise.\u003c/p\u003e \u003cp\u003eMany of the respondents were struck by the novelty of the idea of co-locating community pharmacies and fuel stations and there were varied impressions of such an innovation.\u003c/p\u003e \u003cp\u003e\u0026ldquo;It will be interesting to see how the stakeholders will receive such an innovation in Nigeria\u0026rdquo; \u0026hellip;. A respondent from PCN.\u003c/p\u003e \u003cp\u003e\u0026ldquo;There is nothing wrong with siting community pharmacies within fuel stations\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip; Two respondents from PCN, and one from NMDPRA.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I do not foresee any significant conflict of interest between PCN and NMDPRA in terms of regulating community pharmacies sited in fuel stations. Issues that may arise can easily be resolved by discussions among the regulators\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Many respondents from both PCN and NMDPRA\u003c/p\u003e \u003cp\u003e\u0026ldquo;I support the idea of siting community pharmacies within fuel stations\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;. Three respondents from PCN and two from NMDPRA\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImpact on product and service quality\u003c/h2\u003e \u003cp\u003eSub-themes here include varied impact (uncertainty, curiosity), and improved access to pharmacy products and services.\u003c/p\u003e \u003cp\u003eMost respondents agreed that siting community pharmacies in fuel stations will significantly improve visibility and access to community pharmacy products and services. They felt that evidence of the impact of such an innovation can only be known after some reasonable period of implementation.\u003c/p\u003e \u003cp\u003e\u0026ldquo;Only fuel stations with adequate space between the tank farm/pump island and sales rooms should be authorised to host community pharmacies\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Three respondents from NMDPRA\u003c/p\u003e \u003cp\u003e\u0026ldquo;Dispensing tablets in unsealed multiple dose \u0026lsquo;counting\u0026rsquo; forms should be discouraged in community pharmacies within fuel stations. All tablets should be dispensed in strips or blister packs, protected from direct exposure to the air\u0026rdquo; Four respondents from PCN\u003c/p\u003e \u003cp\u003e\u0026ldquo;Siting community pharmacies in fuel stations will significantly improve customers\u0026rsquo; access to pharmaceutical products and services\u0026rdquo; \u0026hellip;\u0026hellip;Most respondents from both PCN and NMDPRA\u003c/p\u003e \u003cp\u003e\u0026ldquo;All community pharmacies within fuel stations must have functional air conditioners with the room doors always closed to ensure good air quality at all times\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. Three respondents from PCN\u003c/p\u003e \u003cp\u003e\u0026ldquo;Special safety arrangements such as fire extinguishers, safety drills, back doors for emergency exit, and muster points must be put in place for community pharmacies to operate within fuel stations\u0026rdquo; \u0026hellip;Two respondents from NMDPRA\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eComparison with other Health Systems\u003c/h2\u003e \u003cp\u003eSub-themes here include changing business models, and willingness to explore.\u003c/p\u003e \u003cp\u003eSome of the respondents expressed awareness of similar situations in some other health systems. The majority were willing to explore, noting that changing business models was an inevitable part of national development.\u003c/p\u003e \u003cp\u003e\u0026ldquo;I know that community pharmacies are sited within fuel stations in some other climes such as the United States, United Kingdom, and Saudi Arabia\u0026rdquo; \u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;. One respondent from PCN and two from NMDPRA\u003c/p\u003e \u003cp\u003e\u0026ldquo;I do not see why we cannot explore this novel business model in Nigeria.\u0026rdquo; - a respondent from PCN\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSummary output of document reviews\u003c/h2\u003e \u003cp\u003eA detailed review of relevant extant laws, namely the Poison and Pharmacy Act Cap 535 LFN 1990; Food, Drugs, and related Products Registration Act 19 of 1993 (Cap F. 33 LFN, 2004); Dangerous drugs Act Cap D. 1 LFN 2004; Foods and drugs Act Cap F.33 LFN, 2004; National Agency for Food and Drug Administration and Control (NAFDAC) Act 15 of 1993 (Cap N. 1 LFN, 2004); Pharmacy Council of Nigeria (PCN) Act 2022, revealed that they all made no provisions for siting community pharmacies in fuel stations. None of these statutes specifically prohibits co-locating community pharmacies and fuel stations but in practice there is a ban on such initiative in practice guidelines.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aggregated perspectives from multiple stakeholders in examining the feasibility of siting community pharmacies in fuel stations in Nigeria, as multi-stakeholder engagement has been shown to provide a robust evidence base in policy and practice reform initiatives [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The number of respondents was well above the minimum calculated sample sizes for the various stakeholder categories, thereby ensuring data saturation for possible generalisation of the findings [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The demographic characteristics of pharmacist respondents in this study were mostly in line with extant evidence regarding the distribution of pharmacists in Nigeria [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe pharmacists demonstrated a positive perception of the co-location of community pharmacies and fuel stations, yet with concerns for integrity of pharmaceutical products. This positive perception is significant as it suggests a certain readiness to accept a possible reform to the long-standing ban on siting community pharmacies in fuel stations, a norm probably reflecting concerns for professional standards and safety, particularly regarding the storage and handling of medications in environments where inflammable materials are present [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Stakeholders\u0026rsquo; perspectives on the influence of the fuel station environment on quality and integrity of pharmaceutical products and hence patient safety, largely aligned with their different technical expertise as shown in the significant difference in their median scores. However, the greatest concern among pharmacists is not surprising but rather aligns with emerging trends in global literature in which community pharmacists currently emphasize quality in terms of access, environment, safety, person-centered care, competence, and integration within local healthcare systems [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePharmacists, customers, and regulators were unanimous in emphasizing the need for special safety measures to ensure the safe operations of community pharmacies within fuel stations. These concerns align with a growing global awareness and attention to health, safety, and environmental (HSE) practices in community pharmacy settings as these have been shown to directly impact patient safety [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It also suggests that Nigeria community pharmacists will be willing to adopt any additional safety measures proposed by regulators in the likely event that approval is given for siting community pharmacies in fuel stations. Hence, in weighing the evidence adduced by this study, there is need to pay close attention to these safety concerns.\u003c/p\u003e \u003cp\u003eThough there are reports of community pharmacies within fuel stations in some other countries such as the USA [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], South Africa [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], among others, the unique contextual realities of the Nigeria practice environment must be considered. While the different regulatory bodies envisage no significant conflicts (beyond what mutual dialogue can resolve) in executing their oversight mandates, their positive perceptions must be seen, not as an end but as an impetus to understudy the regulatory guidelines that underpin the successful co-location of community pharmacies and fuel stations in other climes. At the end, the ultimate measure of the relevance of regulations, as applicable in Europe and elsewhere, remains the guarantee of improved economic, clinical, and humanistic outcomes for the consumers [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and in the present scenario, the responsibility lies with the pharmacists and their regulators [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere was convergence of quantitative and qualitative evidence from pharmacists, regulators, and customers to the effect that \u0026ldquo;there was nothing wrong in co-locating community pharmacies and fuel stations\u0026rdquo;. As demonstrated in similar patient-centred studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], this consensus signals a likely successful uptake of the practice innovation. This finding is strengthened by the evidence that pharmacists, customers, and fuel station managers all strongly agreed that siting community pharmacies in fuel stations would increase consumer access to pharmacy products and services, a critical consideration in location analysis and regulatory authorization for siting community pharmacies globally [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The stakeholders agreed that fuel stations will give greater visibility to community pharmacies and did not see how siting community pharmacies in fuel stations would increase operational costs or disturb normal operational workflows. This finding can be said to strengthen the argument for enhanced operational efficiency of community pharmacies located in fuel stations [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. It is noteworthy that there was no significant difference in the opinions of urban and rural-based respondents which seems to suggest that siting community pharmacies in fuel stations would ultimately contribute to reducing the disparity in customers\u0026rsquo; access to pharmacy products and services [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe significant associations between higher educational qualifications of the pharmacists and their sensitivity to environmental health risks and service quality seems to suggest that specialization tends to align their practice priorities with global trends and best practices. A recent report found that most health systems currently place emphasis on patient safety, reduced medication errors and improved service quality with pharmacists assuming central roles in driving these goals within the medicines ecosystem [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eThis study did not collect and analyse air and particulate samples from fuel stations to enable definite scientific determination of the possible reactions with different pharmacological classes of medicines and human subjects who will operate the pharmacy premises located within fuel stations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFrom the findings of this study, it can be concluded that relevant stakeholders demonstrated a positive perception of the siting of community pharmacies in fuel stations, though with safety concerns. Policy reforms backed by a fit-for-context regulatory framework and enhanced health, safety, and environmental guidelines are recommended before implementation in Nigeria.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eClinical Trial Number\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflicts of Interest\u003c/strong\u003e \u003cp\u003eAll the Authors declare no competing interests\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Approval and Accordance\u003c/b\u003e \u003c/p\u003e \u003c/p\u003e \u003cp\u003eEthical approval\u003c/strong\u003e (Ref. No. IPH/OAU/12/2387) was obtained from the Health Research Ethics Committee of the Institute of Public Health at Obafemi Awolowo University, Ile-Ife, Nigeria. The study was carried out in line with the principles of the 1975 Helsinki declaration as revised in 2000, ensuring respondents\u0026rsquo; confidentiality, while written informed consents were obtained from all respondents.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Statement\u003c/h2\u003e \u003cp\u003eThis study was partially supported by funding from the Pharmacy Council of Nigeria.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMOA: conceptualization, investigation, supervision, writing- review and editing, fund acquisition, project administration.MRI: methodology, investigation, data curation, writing-original draft, review and editingOJO: formal analysis, validation, data curation, writing- review and editingMOO: investigation, writing- review and editing\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors wish to acknowledge the cooperation of the Deans of pharmacy schools in the selected States, which not only enhanced quality assurance in the research process but also improved the credibility of the study with stakeholders\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll datasets related to this study are either embedded in the report or may be accessed upon reasonable request to the corresponding author\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMelton BL, Lai Z. Review of community pharmacy services: what is being performed, and where are the opportunities for improvement? Integr Pharm Res Pract. 2017;6:79\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/iprp.s107612\u003c/span\u003e\u003cspan address=\"10.2147/iprp.s107612\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Pharmaceutical Federation (FIP). Vision of a Community-based Pharmacist: Community Pharmacy Section. International Pharmaceutical Federation. 2015. Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.fip.org/community-pharmacy\u003c/span\u003e\u003cspan address=\"https://www.fip.org/community-pharmacy\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed October 2, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCornillier F, Boctor F, Renaud J. Heuristics for the multi-depot petrol station replenishment problem with time windows. Eur J Oper Res. 2012;220:361\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOnyeizugbe CU, Orogbu OL, Onyilofor TU, Ugbomhe OU. Business development and sustainability of selected petrol stations in Anambra state of Nigeria. Afr J Bus Manage. 2018;12(1):11\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5897/AJBM2017.8456\u003c/span\u003e\u003cspan address=\"10.5897/AJBM2017.8456\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlakpa RO, Ulakpa WC, Eyankware OE. Petroleum Filling Stations and Their Impact on the Environment in Nigeria. J Environ Earth Sci. 2022;04(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.30564/jees.v4i1.4073\u003c/span\u003e\u003cspan address=\"10.30564/jees.v4i1.4073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChijioke-Nwauche I, Ogoro M. Distribution Pattern of Community Pharmacies in Port Harcourt Metropolis, Niger Delta, Nigeria. J Pharm Pharmacol Res. 2021;5:188\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerenbrok LA, Tang S, Gabriel N, Guo J, Sharareh N, Patel N, Dickson S, Hernandez I. Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis. J Am Pharm Assoc. 2022;62(6):1816\u0026ndash;e18222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.japh.2022.07.003\u003c/span\u003e\u003cspan address=\"10.1016/j.japh.2022.07.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdiru ME. Community Pharmacy Practice in Nigeria: The Dilemma of Regulation. Int J Humanit Soc Stud. 2021;9(11). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.24940/theijhss/2021/v9/i11/HS2111-041\u003c/span\u003e\u003cspan address=\"10.24940/theijhss/2021/v9/i11/HS2111-041\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePharmacy Council of Nigeria (PCN). Pharmacy Council of Nigeria Act. 2022. Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pcn.gov.ng/\u003c/span\u003e\u003cspan address=\"https://www.pcn.gov.ng/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. accessed 10th October, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetroleum Industry Act, (PIA) No.6, 2021: Midstream and Downstream Petroleum Environmental Regulations. 2023. Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://alps.blob.core.windows.net/nmdprawebsite/Regulation/Upload-65b0b26a-607d-4e7a-b264-84388c4c1a28.pdf\u003c/span\u003e\u003cspan address=\"https://alps.blob.core.windows.net/nmdprawebsite/Regulation/Upload-65b0b26a-607d-4e7a-b264-84388c4c1a28.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, accessed 7th January, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Environmental Standards and Regulations Enforcement Agency (Establishment) Act. 2007. Available online at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://lawsofnigeria.placng.org/laws/nesrea.pdf\u003c/span\u003e\u003cspan address=\"http://lawsofnigeria.placng.org/laws/nesrea.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; accessed 8th October, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoy C. The pharmacist\u0026rsquo;s role in climate change: a call to action. Can Pharm J (Ott). 2021;154(2):74\u0026ndash;5. https://doi.org/10.1177%2F1715163521990408.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLluch M, Kanavos P. Impact of regulation of Community Pharmacies on efficiency, access and equity. Evidence from the UK and Spain. Health Policy. 2010;95(2\u0026ndash;3):245\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.healthpol.2009.11.002\u003c/span\u003e\u003cspan address=\"10.1016/j.healthpol.2009.11.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B, Van Damme W. Access to medicines from a health system perspective. Health Policy Plan. 2013;28(7):692\u0026ndash;704. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/heapol/czs108\u003c/span\u003e\u003cspan address=\"10.1093/heapol/czs108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagner A, Hann M, Noyce P, Ashcroft D. Equity in the distribution of community pharmacies in England: impact of regulatory reform. J Health Serv Res Policy. 2009;14(4):243\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.jstor.org/stable/26751181\u003c/span\u003e\u003cspan address=\"http://www.jstor.org/stable/26751181\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapalexi M, Bamford D, Breen L. Key sources of operational inefficiency in the pharmaceutical supply chain. Supply Chain Manag, 20202; 25 (6),617\u0026ndash;35, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1108/SCM-02-2019-0076\u003c/span\u003e\u003cspan address=\"10.1108/SCM-02-2019-0076\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlhusein N, Watson MC. Quality indicators and community pharmacy services: a scoping review. Int J Pharm Pract. 2019;27(6):490\u0026ndash;500. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ijpp.12561\u003c/span\u003e\u003cspan address=\"10.1111/ijpp.12561\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKazadi K, Lievens A, Mahr D. Stakeholder co-creation during the innovation process: Identifying capabilities for knowledge creation among multiple stakeholders. J Bus Res. 2016;69(2):525\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jbusres.2015.05.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jbusres.2015.05.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol, 2006; 3(2), 77\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1191/1478088706qp063oa\u003c/span\u003e\u003cspan address=\"10.1191/1478088706qp063oa\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed SK. Sample size for saturation in qualitative research: Debates, definitions, and strategies. J Med Surg Public Health. 2025;5(100171). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.glmedi.2024.100171\u003c/span\u003e\u003cspan address=\"10.1016/j.glmedi.2024.100171\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOseni YO. Pharmacists\u0026rsquo; Distribution in Nigeria; Implication in the Provision of Safe Medicines and Pharmaceutical Care. Int J Pharm Pharm Sci. 2017;9(10):49\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.22159/ijpps.2017v9i10.20454\u003c/span\u003e\u003cspan address=\"10.22159/ijpps.2017v9i10.20454\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerie M, Ulakpa WC, Eyankware O. Petroleum Filling Stations and Their Impact on the Environment in Nigeria. J Environ Earth Sci. 2022;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.30564/jees.v4i1.4073\u003c/span\u003e\u003cspan address=\"10.30564/jees.v4i1.4073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHindi AMK, Campbell SM, Jacobs S, et al. Developing a quality framework for community pharmacy: a systematic review of international literature. BMJ Open. 2024;14:e079820. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2023-079820\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2023-079820\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhite A, Thompson EL, Kim S, Osei JA, Fulda KG, Xiao Y. Enhancing the Role of Community Pharmacists in Medication Safety: A Qualitative Study of Voices from the Frontline. Pharm (Basel). 2025;13(4):94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/pharmacy13040094\u003c/span\u003e\u003cspan address=\"10.3390/pharmacy13040094\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKwon K-E, Nam DR, Lee M-S, et al. Status of patient safety culture in community pharmacy settings: a systematic review. J Patient Saf. 2023;19(6):353\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/pts.0000000000001147\u003c/span\u003e\u003cspan address=\"10.1097/pts.0000000000001147\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRudresh P, Dillip D, Jigyasa J, Kajal V, Nikhil N, Tin Q, Daisy K, Tan M, Roselin X, Looi Q. Factors Influencing Organization Success: A Case Study of Walmart. Int J Tourism Hospitality Asia Pasific. 2021;4:112\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.32535/ijthap.v4i2.1059\u003c/span\u003e\u003cspan address=\"10.32535/ijthap.v4i2.1059\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePharmashop24. and Shell South Africa have partnered to offer a unique 24/7 Pharmacy vending solution to more than half of their Select stores around the country. Available online: Pharmashop 24 | Shell South Africa. Accessed 14 August 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTodorova A, Ivanova M, Pesheva M, Miceva D, Angelovska B. Analysis of Legislative and Regulatory Frameworks Governing Community Pharmacy in Bulgaria and North Macedonia. Pharmacy. 2025;13(4):108. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/pharmacy13040108\u003c/span\u003e\u003cspan address=\"10.3390/pharmacy13040108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown L, Johnson A. Community pharmacies and their role in healthcare delivery. J Pharm Health Serv Res. 2018;9(2):103\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkoro R. The Increasing Sustainability Threats to Community Pharmacies in Low-and Middle-Income Countries: Insurance Coverage Barriers and Policy Recommendations. Indian J Pharm Pract. 2022;15(3):1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.5530/ijopp.15.3.43\u003c/span\u003e\u003cspan address=\"10.5530/ijopp.15.3.43\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSegarra-O\u0026ntilde;a M, Peir\u0026oacute;-Signes A, Verma R. Fostering innovation through stakeholders\u0026rsquo; engagement at the healthcare industry: Tapping the right key. Health Policy. 2020;124(8):895\u0026ndash;901. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.healthpol.2020.05.013\u003c/span\u003e\u003cspan address=\"10.1016/j.healthpol.2020.05.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChavan A, Kumbhar S, Shinde V, Thorat A, Jadhav P, Jadhav A, Honrao J, Shaikh S, Raysing S, More V, Kumbhar D. Role of pharmacist in healthcare system. GSC Biol Pharm Sci. 2023;24:036\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.30574/gscbps.2023.24.1.0261\u003c/span\u003e\u003cspan address=\"10.30574/gscbps.2023.24.1.0261\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fuel stations, community pharmacy, pharmacy location, stakeholder perception, policy reforms, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-8013231/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8013231/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCommunity pharmacies remain key access points for pharmaceutical care, while fuel stations have become convenient commercial hubs. In some countries, pharmacies can be sited within fuel stations but in Nigeria, this model is neither permitted nor expressly prohibited by law.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study explored stakeholder perceptions of co-locating pharmacies and fuel stations, and implications for service and regulation.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eA cross-sectional, mixed-method survey was conducted among 615 pharmacists, 37 industry regulators, 524 fuel station customers, and 27 fuel station managers across Nigeria\u0026rsquo;s six geo-political zones and the nation\u0026rsquo;s capital. Using a multistage sampling of respondents, primary data were collected between June and August 2023 with a validated questionnaire. Relevant statute documents were reviewed while 14 regulators were interviewed using an interview guide. Quantitative data were analysed using descriptive statistics, Kruskal\u0026ndash;Wallis, Mann\u0026ndash;Whitney U and Chi-square tests at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Qualitative data were thematically analysed using inductive coding.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003ePharmacists expressed positive perception of co-locating pharmacies and fuel stations, expressing concern for medicines\u0026rsquo; integrity (H\u0026thinsp;=\u0026thinsp;590.66 (df\u0026thinsp;=\u0026thinsp;3), p\u0026thinsp;=\u0026thinsp;0.000*). Customers and managers supported the innovation, perceiving no disruptions to workflow (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;11.450, df\u0026thinsp;=\u0026thinsp;4, p\u0026thinsp;=\u0026thinsp;0.022). Regulators expressed willingness to explore the model, noting international precedence, foreseeing no significant regulatory conflicts (H\u0026thinsp;=\u0026thinsp;7.851, df\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;=\u0026thinsp;0.02), but demanded strict safety measures and operational guidelines.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eStakeholders supported co-locating community pharmacies and fuel stations, though with safety concerns. Policy reforms, a fit-for-context regulatory framework, and safety guidelines are recommended before implementation in Nigeria.\u003c/p\u003e","manuscriptTitle":"Perspectives on Siting Community Pharmacies at Fuel Stations in Nigeria: A Cross- Sectional Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 07:43:38","doi":"10.21203/rs.3.rs-8013231/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"729cd11b-e56e-4e16-aa1b-98ae395d17a2","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T10:27:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 07:43:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8013231","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8013231","identity":"rs-8013231","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}