The social determinants of health within Belgian pharmacies: an exploratory qualitative study

The social determinants of health within Belgian pharmacies: an exploratory qualitative study | 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 The social determinants of health within Belgian pharmacies: an exploratory qualitative study Emilie Op de Beeck, Hans De Loof This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7767744/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 Pharmacists, embedded in their local communities and in frequent contact with patients, are uniquely positioned to identify and address social determinants of health (SDOH) that influence medication adherence and health outcomes. Understanding how they perceive and respond to these non-medical challenges is essential to improving patient care and reducing health inequities. Methods Semi-structured interviews were conducted to understand pharmacists’ experiences noticing SDOH in their patients during routine practice. Thematic analysis was performed following Braun and Clarke’s guidelines. Results Pharmacists described encountering a range of social needs affecting patients’ medication use and adherence. These included financial hardship, poor health literacy, and limited access to healthcare services. While the nature and visibility of these needs varied by neighbourhood, all participants acknowledged the significant influence of SDOH on patient outcomes. In response, pharmacists reported adapting their services by offering individualized support, such as delayed payment options, use of translation tools, home delivery, and patient education. However, pharmacists also noted challenges in systematically identifying and addressing these needs due to a lack of formal screening tools and structural support. Conclusions Pharmacists are well-positioned to recognize and respond to SDOH, yet their efforts often rely on informal and individualized strategies. Integrating routine screening for SDOH and enhancing collaboration with other healthcare providers could help formalise and strengthen pharmacists' roles in addressing health disparities. Policy support and resource allocation are essential to sustain these efforts and improve equity in healthcare delivery. Social determinants of health pharmacy qualitative research Introduction Health can be viewed as a fundamental aspect of an individual’s overall well-being, enabling them actively to participate in society both physically and emotionally ( 1 ). However, health is not only determined by medical factors, but also strongly influenced by social determinants of health (SDOH), which include socio-economic status, living conditions, food security, and access to affordable services ( 2 , 3 ). Unequal distributions of these determinants can result in health inequities ( 3 – 5 ). These inequities are particularly evident among individuals from minority ethnic groups or low-income backgrounds, who often encounter challenges in accessing quality healthcare services and consequently experience higher rates of chronic disease and mortality ( 6 ). The issue extends beyond the individual circumstances, as many health systems lack a clear focus of ensuring universal access to high-quality medical treatment for all citizens ( 4 , 7 , 8 ). In response, the World Health Organization (WHO) recommends a more people-centred approach, which respects patients’ cultural and socio-economic contexts and promotes the integration of services to ensure universal access and health equity ( 9 , 10 ). Given the significant impact of SDOH, it is crucial to implement interventions aimed at reducing health disparities, with a primary focus on recognising the underlying causes ( 11 , 12 ). Among healthcare professionals, pharmacists have seen a substantial evolution in their roles, moving from a product-focused model toward a more service-oriented and patient-centred approach ( 13 , 14 ). This transformation has positioned pharmacists as key contributors to primary healthcare efforts targeting health inequities. One of the core practices reflecting this shift is the medication review: a systematic evaluation of a patient's medication regimen with the goal of optimizing medication use and improving clinical outcomes ( 15 , 16 ). In countries such as Canada and England, patient-centred services in community pharmacies already encompass preventive care, urgent care ( 17 ), smoking cessation counselling, and the administration of vaccinations and injectable drugs ( 18 ). However, less attention has been given to the social needs patients face, which can profoundly affect their health status. Studies from the United States suggest that pharmacists, due to their frequent interactions with patients, are well-positioned to address SDOH ( 19 , 20 ). In contrast, the variability in pharmacy practices across Europe has limited the understanding of how pharmacists contribute to reducing health disparities ( 21 ). Given the significant influence of the SDOH on health outcomes and the limited available data addressing the social needs of patients in pharmacies in Europe, a descriptive qualitative research approach was undertaken ( 22 ). A qualitative approach was employed to obtain a comprehensive understanding of pharmacists’ perspectives of patients’ social needs and their strategies to address these needs. This first in- depth qualitative data will provide a basis for a more systemic data collection to develop tailored interventions with pharmacists to address health inequities and to optimize the role of the pharmacist in primary healthcare. Methods Study design Qualitative research was carried out involving semi-structured interviews exploring the perspective of community pharmacists on the social needs of patients and how these needs are addressed in the community pharmacy in various areas in the city of Antwerp. Selection of the participants To capture a comprehensive understanding of social needs in pharmacy practice, pharmacists from both high-income and low-income neighborhoods in Antwerp were included. Eligible participants were defined as licensed community pharmacists currently practicing in Antwerp and willing to participate in a semi-structured interview; no exclusion criteria were applied. An initial email invitation containing study information was sent to 500 pharmacists across Flanders, from which seven responses were obtained, and these pharmacists were interviewed during the following week. To further ensure perspectives from socially diverse neighborhoods, purposive sampling was employed to recruit additional pharmacists from acknowledged disadvantaged areas ( 23 ). Recruitment was continued until data saturation was reached, defined as the point at which no new insights emerged from successive interviews. In total, 14 pharmacists were interviewed, and their characteristics are presented in Table 1 . Table 1 Characteristics participants Pharmacist Age Gender Area 1 36 Female Low-income 2 29 Female High-income 3 53 Female Low-income 4 49 Female High-income 5 53 Female High-income 6 35 Female Low-income 7 48 Male Low-income 8 47 Male Low-income 9 67 Male High-income 10 50 Female Low-income 11 42 Female High-income 12 45 Female Low-income 13 56 Female High-income 14 37 Male Low-income Data collection The interviews were conducted between October 6th and October 28th, 2022, and lasted on average 40 minutes. An interview guide was developed based on the SDOH framework underwent several adaptations through collaborative efforts with two practicing pharmacists and two academic experts in pharmacy practice to ensure relevance and clarity ( 24 ). Pilot semi-structured interview was conducted with one pharmacist, resulting in minor revisions to question phrasing. The semi-structured interviews were exclusively comprised of open-ended questions, seeking insights into the manifestation of SDOH and how these are addressed within pharmacy settings by the pharmacists. The interviews commenced by exploring the participants' understanding of the definition of SDOH and the challenges encountered by pharmacists. The second part of the interviews focused on narratives and their influence on health outcomes, while the final segment provided an opportunity for participants to propose potential future solutions. Conducted by a master's student (EOdB) in Pharmaceutical Care at the University of Antwerp for her master's thesis, the interviews were conducted both face-to-face and online. All interviews were audio-recorded and transcribed verbatim. Written informed consent was obtained before each interview. Data analysis An inductive approach was undertaken to analyse the qualitative data, using the thematic analysis guidelines of Braun and Clarck ( 25 ). First, transcripts were read multiple times to ensure familiarity with the data. Initial codes were then generated during a detailed reading of the transcripts. These codes were subsequently organized into overarching themes and, where applicable, subthemes. The interviews were transcribed and primarily coded by EOdB. Additionally, three interviews were independently coded by a master's student involved in a separate qualitative study. This peer coding process, followed by critical discussions, helped broaden the interpretation of the data. The analysis was further refined through regular coding discussions with the co-author, enhancing analytical rigor and depth. This study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist, which can be found in additional file 1 ( 26 ). Ethics Approval to conduct this study was obtained from the committee for medical ethics UZA – UA, University of Antwerp (project ID 3785). All methods in this study were carried out in accordance with relevant guidelines and regulations. Results Theme description The analysis of the study uncovered two main themes, divided in various subthemes, described in Table 2 . The first theme pertains to the pharmacist’s perspective on the SDOH as observed within the community pharmacy setting. Within this first theme, a number of subthemes were identified such as financial challenges, as well as the language barriers, health literacy and transportation problems, which affect the health of the patients and their medication use. The second theme relates to the diverse roles pharmacists undertake in confronting and addressing these social issues. Table 2 Themes and subthemes Theme Subtheme The pharmacist’s perspective and role on the social determinants of health in the community pharmacy environment Pharmacists’ view on financial challenges faced by patients Language barrier leads to ineffective communication Prevalence of low health literacy is not limited to specific disadvantaged areas Transport problems Pharmacist’s role in addressing the social needs of the patients The pharmacist’s commitment to enhancing affordability of therapeutic interventions Assessing alternative communication methods for the enhancement of medical information clarity Improving health literacy Home delivery service as solution for physical access to pharmacy challenges Extra services provided by the pharmacists to help the patient in general Theme 1: The pharmacist’s perspective on the social determinants of health in the community pharmacy environment Subtheme 1.1 Pharmacists’ view on financial challenges faced by patients Pharmacists, especially those working in a low-income neighbourhood, reported that medication costs can represent a psychological and financial barrier for patients, particularly those with limited financial flexibility. They observed that affordability plays a crucial role in medication adherence, with many patients hesitating or declining to purchase necessary treatments when prices exceed a certain threshold. This price sensitivity reflects both practical financial constraints and a broader pattern of cost-driven decision-making in the pharmacy setting: “Once the amount surpasses 10 or 20 euros, they genuinely begin to question it” (pharmacist 8) While some patients may simply weigh the cost of medications against other expenses, others face far more severe forms of deprivation. Pharmacists shared encounters with individuals whose financial hardship extends beyond healthcare, describing situations where patients were forced to choose between essential needs such as food and medication. These moments reveal how pharmacists often serve as frontline witnesses to deep social and economic vulnerability within their communities. As one pharmacist stated: “People tell me that they haven’t been able to eat that day because they don’t have enough money.” (pharmacist 3) Pharmacists further noted that many medications for chronic conditions, such as prostate treatment, are not reimbursed by the government, leaving patients to cover the full cost themselves. This lack of financial support causes medication expenses to accumulate monthly, creating a significant economic strain. As a result, some patients consciously decide to delay essential treatments due to these prohibitive costs, risking deterioration in their health, as one pharmacist indicated: "When it comes to prostate medication, there are many people who need to take it, and it does come at a cost. Some individuals find it too expensive, so they choose not to take it." (pharmacist 2) Although the report of pharmacists seeing signs of poverty within their pharmacies, other pharmacists expressed awareness of the socioeconomic challenges in their local communities but did not perceive it affecting the medication dispensing process: "In this village, there is the highest child poverty rate, and I don't notice it, so that doesn't add up. This implies that much is being hidden." (pharmacist 7) Subtheme 1.2 Language barrier leads to ineffective communication In specific areas of Antwerp, especially low-income neighbourhoods, diverse communities from multiple countries coexist, creating a rich but linguistically complex environment ( 23 ). Pharmacists recognize the challenges involved in communicating effectively across a variety of languages. Although many pharmacists are proficient in Dutch, English, and French, they acknowledge that language barriers can hinder detailed communication, especially when it comes to asking in-depth questions or providing comprehensive guidance, as one pharmacist noted: "I believe that our proficiency in Dutch, English, and French is quite adequate, and often, we can grasp a few concepts in other languages as well. However, yes, asking questions is rather challenging, and even providing guidance becomes difficult." (pharmacist 3) Subtheme 1.3 Prevalence of low health literacy is not limited to specific disadvantaged areas Pharmacists emphasized that low health literacy is not only linked to socioeconomic factors, such as financial hardship or language barriers. Instead, they highlighted that certain patient groups, particularly older adults or those with specific health conditions, often struggle to understand medical information regardless of their socio-economic background. This decline in comprehension can significantly affect patients' ability to manage their health effectively: "This has nothing to do with money or language, but it's related to certain conditions and aging; eventually, they just don't know and understand it anymore." (pharmacist 10) Pharmacists also observed that patients’ limited understanding of their health conditions and available care pathways often leads to delayed help-seeking. Many individuals wait too long to consult healthcare providers, resulting in worsening symptoms and increased reliance on emergency services. This pattern not only strains emergency care but also reflects gaps in patient education and support, as one pharmacist indicated: “We are currently observing a trend where individuals wait too long before seeking care, subsequently turn to emergency services.” (pharmacist 13) Compounding these challenges, frequent medication shortages in Belgium, ( 27 ) require patients to switch between different drug brands, which can cause confusion, especially for those who rely on visual cues for medication recognition. Pharmacists in both low income and high-income areas noted that such switches can severely impact adherence, resulting in either duplicated doses or missed medications altogether. " If I continually switch to different brands, adherence will truly be subpar; it will result in excessive duplication, or the medication will not be taken at all." (pharmacist 3) Subtheme 1.4 Transport problems Pharmacists across all locations consistently recognized transportation as a significant physical barrier impacting patients’ ability to access pharmacy services. For some individuals, especially those with mobility issues or physical incapacities, traveling to healthcare providers or pharmacies can be extremely challenging, limiting their ability to obtain necessary medications in a timely manner. “Additionally, the issue extends to situations where individuals, due to physical incapacities, find themselves unable to visit healthcare providers or retrieve their prescribed medications from the pharmacy.” (pharmacist 14) Theme 2: Pharmacist’s role in addressing the social needs of the patients Subtheme 2.1 The pharmacists’ commitment to enhancing affordability of therapeutic interventions All pharmacists in the sample strive to reduce expenses by recommending affordable medicines if they aware of financial struggles of patients: "We always strive to find the most cost-effective option for individuals facing financial challenges." (pharmacist 4) When the expense is prohibitively high and the payment is impossible, pharmacists declared the collaboration with general practitioners to mutually decide reducing the quantity of prescribed medications and only the most essential medications, can still be taken, which are affordable for the patient: "I had a gentleman for whom 8 medications were prescribed, but that was financially unfeasible. We reduced it from 8 medications to 3, and in the meantime, the man is doing well." (pharmacist 8) Although the efforts to reduce financial burdens, the interviewed pharmacists in the low-income area told that affordability remains an issue for patients. They mentioned that patients occasionally request delayed payment as they do not have money available and that they agree to it with clear agreements made: "Our established policy includes the provision of certain items on credit, subject to the formulation of satisfactory agreements." (pharmacist 1) One pharmacist, working in a specific disadvantaged area of Antwerp, reported that she proposed by herself the deferred payment when she see that patients are not able to pay for their medicines. Despite the risks associated with proposing deferred payment, as the money might not be recovered, the pharmacist emphasized the importance of ensuring that patients can take their medication to prevent regression of their health: “I suggest paying later myself, as I quickly notice that they are unable to pay for the medication.” (pharmacist 3) Subtheme 2.2 Assessing alternative communication methods for the enhancement of medical information clarity The pharmacists, who are working in a multicultural setting, they try to employ a diverse staff to effectively bridge divides, thereby minimizing the occurrence of language barriers within the pharmacy setting: "Having a pharmacist on staff who possesses fluent Arabic-speaking abilities is advantageous for us, especially given that our patient demographic primarily consists of Arabic-speaking individuals." (pharmacist 1) Pharmacists with diverse backgrounds, locating in low-income area in the sample indicated that they provide support to patients as translators for letters they receive in their letterbox and cannot read them. This highlights the role of pharmacists as trustworthy care partners for patients, offering timely assistance due to their accessibility: "Significantly, within our environment, there exists a pronounced trend of elderly Moroccan immigrants who purposefully traverse substantial distances to access our services due to our language proficiency. Their motivation for selecting our locale lies in the prospect of meaningful communication, prompting us to provide comprehensive assistance encompassing various domains." (pharmacist 8) Some interviewed pharmacies were not able to hire staff with diverse backgrounds. They explained that they address language barriers by utilizing google translate, visual tools and pictograms to clearly communicate pharmaceutical information to patients with language barriers to ensure that patients are provided with accurate information about their medications: "Until now, we have managed on our own, resorting to tools such as Google Translate. Our commitment is to exhaust all available means in order to effectively convey information, including written documentation and the creation of visual aids." (pharmacist 14) Subtheme 2.3 Improving health literacy The pharmacists in the sample all indicated that they try to give the pharmaceutical information on an uncomplicated way to ensure that patients have a clear understanding of how to take their medications. ‘I sincerely make every possible effort to make everything understandable..” (pharmacist 13) One pharmacist from a low-income area indicated that they invite all their patients with diabetes to explain their medication and the risks of diabetes to increase their health literacy: “We are currently inviting all our diabetic patients to review their medicines and clarify when each medicine should be taken, depending on the time schedule from the patient.” (pharmacist 10) Pharmacists situated within the low-income neighbourhoods of Antwerp engage in the automatic dose dispensing (ADD) preparation of medication dispensers for patients living with chronic illness, enabling access to prescribed medications throughout the day. Those working with individuals with limited financial resources reported that it was not feasible to charge for this service, as they would otherwise refuse the service: “I regularly prepare medication blister packs for patients, and I provide this service free of charge. It is not viable to request payment for this service in this context, as patients would decline to utilize it if a fee were introduced.” (pharmacist 1) Pharmacists employ standardized dosage instructions in common language on medication packaging, where explicit guidance for medication consumption is provided with clarity: “I employ clear instructions in the specific language of the patient that guarantees the foundational information remains consistently evident of medication packaging.” (pharmacist 9) Subtheme 2.4 Home delivery service as solution for physical access to pharmacy challenges Each pharmacist who participated in the interviews expressed their willingness to facilitate medication delivery to patient’s homes in situations where visiting the pharmacy becomes unfeasible. We registered that all interviewed pharmacists offer this service without seeking compensation, underscoring their commitment to patient care: "In instances of transportation challenges, we undertake the delivery process autonomously, meticulously preparing the necessary arrangements and subsequently personally delivering the medications.” (pharmacist 2) Subtheme 2.5 Extra services provided by the pharmacists to help the patient in general The accessibility of pharmacies encourages individuals, especially those who live in low-income neighbourhoods with limited proficiency in the Dutch language, to seek guidance for administrative inquiries. Pharmacists in the sample assist them by translating documents, organising paperwork and facilitating communication with relevant agencies through phone calls: “Patients seek assistance regularly with translating letters, making phone calls or other administrative matters. I assist them; they are my patients, and I am familiar with them, committed to offering support.”(pharmacist 6) A pharmacist working in a low-income neighbourhood explained that she empathised with the financial difficulties faced by patients. She reported that she provided food for patients, as she has seen that they often lack adequate access to food. “Sometimes, I buy bread, cheese and milk for patients when I know they do not have food for themselves and their children. I know, this is not the best way to help them, but I feel compassion for them.” (pharmacist 3) Discussion This study employed a qualitative approach to examine how SDOH manifest in different areas of Antwerp and how pharmacists respond to these challenges. The findings reveal that social needs exist in both low- and high-income areas but vary in scope and visibility. In low-income neighbourhoods, pharmacists encountered a broader spectrum of social needs. Patients were more likely to approach pharmacists not only for medication-related issues, but also for social issues, including financial concerns. The frequent use of the pharmacy as a first point of contact fostered ongoing interactions, which in turn strengthened trust between patients and pharmacists. Through this trusted relationship, pharmacists were able to identify and address barriers including medication affordability, limited health literacy, and mobility problems. These findings are consistent with literature showing that disadvantaged populations face greater obstacles to medication adherence and health outcomes ( 28 ). This highlights the importance of pharmacists’ accessibility as healthcare providers for individuals with complex social needs. Although pharmacists in high-income areas witnessed the social needs of their patients, such as low health literacy and mobility challenges, financial challenges were less visible and more difficult to address. This supports evidence that social challenges in affluent communities are often hidden due to assumptions about economic security ( 29 , 30 ). The lack of systematic SDOH screening may contribute to under recognition, potentially resulting in unmet needs even in wealthier areas ( 31 ). Regardless of visibility, financial issues, language barriers, and health literacy can significantly impact adherence to treatment ( 32 ). Pharmacists, as accessible and trust healthcare providers, are well-positioned to identify and respond to these needs. Their regular contact allows them to bridge clinical care with social support, especially in structurally vulnerable communities ( 33 ). Pharmacists in the low-income study areas, demonstrated a proactive and compassionate approach. To improve access, they offered flexible payment options and recommend affordable medications combinations. These actions reflect findings from prior research emphasizing the pharmacist’s role in reducing financial burdens ( 34 ). Medication reviews, in particular, have been shown to lower costs, decrease healthcare use, and enhance adherence ( 35 ). To overcome communication barriers, pharmacists employed diverse strategies: hiring multilingual staff, using translational tools, and incorporating visuals aids. These efforts align with studies on culturally competent care. However, ad hoc solutions, such as google translate, raise safety concerns due to the risk of inaccurate translations ( 36 ). These strategies were common in pharmacies serving linguistically diverse populations. By contrast, pharmacies in high-income areas, reported fewer language challenges, often due to lower population heterogeneity, which can reduce the urgency or perceived need for culturally tailored communication, as illustrated in existing literature ( 37 ). Beyond these efforts, pharmacists in underserved areas often extended support informally. In some cases, they translated medical documents, made phone calls for patients, or provided food to those in need. Studies have shown that pharmacists frequently act as accessible points of care for marginalized communities, offering both medical and non-medical support ( 38 , 39 ). While these actions are not formally required or reimbursed, they reflect the trusted position pharmacists hold in their communities and highlight their potential as key actors in reducing health disparities ( 40 ). Across neighbourhoods, pharmacists’ accessibility facilitated regular interactions, allowing them to recognize and address social factors that influence treatment adherence. This positions them as essential advisors in optimizing medication use. These findings suggest that further integration of pharmacists into healthcare teams is necessary to enhance patient care ( 41 ). Despite this important role, the range of services pharmacists provide to address these needs often goes underrecognized ( 42 ). This study highlights how they adapt care beyond dispensing, tailoring support to individual circumstances. Given their frontline role and trusted relationships, pharmacists are well-placed to identify and respond to SDOH. However, formal recognition and compensation through supportive policy frameworks are necessary. Further research, particularly quantitative studies, is needed to evaluate the impact of these patient-centred contributions. Strengths and limitations This study presents several strengths that contribute to its significance in understanding the role of pharmacists in healthcare. First, it highlights the differences in the roles pharmacists play in high- versus low-income areas, providing insight into varying patient needs. Second, it represents the first documentation of the social value that pharmacists bring to patients regarding their medication use, thereby expanding the existing literature on the impact of pharmacy services in Europe. However, limitations must be acknowledged. The sample may be biased and not representative, limiting generalizability. Additionally, as a cross-sectional study, it captures a single point in time, rather than examining these dynamics over an extended period. Consequently, the findings may not fully reflect changes in patient needs or the evolving role of pharmacists in addressing these needs over time. Future research should consider longitudinal designs and more diverse sampling methods to better capture the complexities of pharmacists' contributions to patient care. Conclusion This study highlights the crucial role community pharmacists play in addressing patients’ social needs, particularly in socioeconomically disadvantaged areas. Daily interactions enable pharmacists to gain a deeper understanding social needs of their patients. In low-income areas, pharmacists go beyond dispensing medications by offering additional support such as financial guidance, assistance with language barriers, home delivery, and help with medication intake, all aimed at improving adherence. In high-income areas, while fewer social needs were observed, pharmacists contribute to better adherence through services such as home delivery and enhancing patients' health literacy. Given the breadth of support pharmacists offer beyond dispensing, greater recognition of their contributions is warranted. Their accessibility, trustworthiness, and proactive engagement make them integral to improving health outcomes. Healthcare policies should formally acknowledge and compensate these expanded roles, and future research should explore structured interventions, such as screening SDOH, within pharmacy settings. Abbreviations ADD Automatic Dose Dispensing SDOH Social Determinants of Health WHO World Health Organisation COREQ Consolidated Criteria for Reporting Qualitative Research Declarations Conflicts of interest None. Funding No funding for this work. Acknowledgements The author wishes to thank Pauline Bleys, who, like the author, was a student in Pharmaceutical Sciences at the time of the study. Her insightful discussions and shared reflections on the analysis of qualitative research were a valuable contribution to the development of this work. Declaration of interest Ethics approval and consent to participate Informed consent was obtained from the participants of this study. Approval to conduct this study was obtained from the committee for medical ethics UZA – UA, University of Antwerp. All methods in this study were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Author Contribution EODB and HDL contributed to the development of the interview guide. EODB conducted the interviews. Both EODB and HDL were involved in the data analysis and manuscript preparation. EODB and HCL reviewed and approved the final version of the manuscript for submission. Data Availability Data will be available on request. References Defining health and health inequalities. | Elsevier Enhanced Reader [Internet]. [cited 2023 May 16]. Available from: https://reader.elsevier.com/reader/sd/pii/S0033350619301076?token=3BF3FD34F1006B8177BC86A75A803A2D59DE98C7F9B2FF09B908A97D602B145CCEECBC2AF0BBFA72C5F604D69CD5E966&originRegion=eu-west-1&originCreation=20230516104738 Braveman P, Gottlieb L. The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Rep [Internet]. 2014 Jan [cited 2023 May 16];129(1_suppl2):19–31. Available from: http://journals.sagepub.com/doi/ 10.1177/00333549141291S206 Marmot M. Social determinants of health inequalities. Public Health. 2005;365. The time is now. Fostering relationship-centered discussions about patients’ social determinants of health | Elsevier Enhanced Reader [Internet]. [cited 2023 Mar 9]. Available from: https://reader.elsevier.com/reader/sd/pii/S0738399118303598?token=2D8F3E8DE3A81F41707B8E21BD289226E2719F76E98D2BADF1E2EE0763AF91C51853A2FAD3802F3D11F7F30BA5D2FB8C&originRegion=eu-west-1&originCreation=20230309154833 Saunders M, Control C of, Barr D, McHale B, Hamelmann P. C. Key Policies for Addressing the Social Determinants of Health and Health Inequities. World Health Organization; 2017. 92 p. Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol [Internet]. 2006 Dec [cited 2024 Mar 26];6(1):35. Available from: https://bmcmedresmethodol.biomedcentral.com/articles/ 10.1186/1471-2288-6-35 Tzenios N. The Determinants of Access to Healthcare: A Review of Individual, Structural, and Systemic Factors. Open Access. Calandra J, Shukla S, Grandy R. Addressing equity and access to care: How an academic family medicine practice manages human immunodeficiency virus, hepatitis C, and substance use disorders. rural Appalachia. Vol. 5, JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY. 111 RIVER ST, HOBOKEN 07030 – 5774. NJ USA: WILEY; 2022. pp. 921–7. Goodman RA, Bunnell R, Posner SF. What is community health? Examining the meaning of an evolving field in public health. Prev Med [Internet]. 2014 Oct [cited 2023 May 17];67(Suppl 1):S58–61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771402/ Pestka DL, Espersen C, Sorge LA, Funk KA. Incorporating social determinants of health into comprehensive medication management: Insights from the field. JACCP J Am Coll Clin Pharm [Internet]. 2020 Sept [cited 2024 Mar 26];3(6):1038–47. Available from: https://accpjournals.onlinelibrary.wiley.com/doi/ 10.1002/jac5.1254 Andermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. Can Med Assoc J [Internet]. 2016 Dec 6 [cited 2023 Mar 15];188(17–18):E474–83. Available from: http://www.cmaj.ca/lookup/doi/ 10.1503/cmaj.160177 Williams DR, Costa MV, Odunlami AO, Mohammed SA. Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities. J Public Health Manag Pract JPHMP [Internet]. 2008 Nov [cited 2023 Mar 15];14(Suppl):S8-17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431152/ Curtiss FR, Fry RN, Avey SG. Framework for Pharmacy Services Quality Improvement— A Bridge to Cross the Quality Chasm. Campeau Calfat A, Duval C, Laberge M, Savard AM, Sirois C. Clinical services in community pharmacies: a scoping review of policy and social implications. Int J Pharm Pract [Internet]. 2021 Mar 17 [cited 2025 June 30];29(2):116–25. Available from: https://academic.oup.com/ijpp/article/29/2/116/6029092 Robberechts A, Brumer M, Garcia-Cardenas V, Dupotey NM, Steurbaut S, De Meyer GRY et al. Medication Review: What’s in a Name and What Is It about? Pharmacy [Internet]. 2024 Feb 19 [cited 2025 June 30];12(1):39. Available from: https://www.mdpi.com/2226-4787/12/1/39 Kiles T, Jasmin H, Nichols B, Haddad R, Renfro CP. A Scoping Review of Active-Learning Strategies for Teaching Social Determinants of Health in Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION. 1426 PRINCE STREET, ALEXANDRIA, VA 22314 – 2815. Volume 84. USA: AMER ASSOC COLL PHARMACY; 2020. pp. 1482–90. Anderson C, Sharma R. Primary health care policy and vision for community pharmacy and pharmacists in England. Pharm Pract [Internet]. 2020 Mar 31 [cited 2025 June 30];18(1):1870. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/1870 Raiche T, Pammett R, Dattani S, Dolovich L, Hamilton K, Kennie-Kaulbach N et al. Community pharmacists’ evolving role in Canadian primary health care: a vision of harmonization in a patchwork system. Pharm Pract [Internet]. 2020 Oct 18 [cited 2025 June 30];18(4):2171. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/2171 Thomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med [Internet]. 2019 July 1 [cited 2023 Mar 15];124:98–109. Available from: https://www.sciencedirect.com/science/article/pii/S0091743519301276 Osae SP, Chastain DB, Young HN. Pharmacists role in addressing health disparities-Part 1: Social determinants of health and their intersectionality with medication use, health care utilization, and health outcomes. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY. 111 RIVER ST, HOBOKEN 07030 – 5774. Volume 5. NJ USA: WILEY; 2022. pp. 533–40. Martins SF, Van Mil JWF, Da Costa FA. The organizational framework of community pharmacies in Europe. Int J Clin Pharm [Internet]. 2015 Oct [cited 2023 May 17];37(5):896–905. Available from: http://link.springer.com/ 10.1007/s11096-015-0140-1 Kalabalik-Hoganson J, Ozdener-Poyraz AE, Rizzolo D. Call to Action: Addressing Social Determinants of Health in Pharmacy Practice. Ann Pharmacother [Internet]. 2022 June 1 [cited 2025 June 30];56(6):740–5. Available from: https://doi.org/10.1177/10600280211040895 Stad. in Cijfers - Databank - Stad in Cijfers - Databank - Postzones [Internet]. [cited 2023 Apr 28]. Available from: https://stadincijfers.antwerpen.be/databank World Health Organization. A conceptual framework for action on the social determinants of health. 2010 [cited 2023 Mar 20];76. Available from: https://apps.who.int/iris/handle/10665/44489 Maguire M, Delahunt B. Doing a Thematic Analysis: A Practical, Step-by-Step Guide for Learning and Teaching Scholars. 2017;8(3). Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care [Internet]. 2007 Sept 16 [cited 2025 Aug 5];19(6):349–57. Available from: https://academic.oup.com/intqhc/article-lookup/doi/ 10.1093/intqhc/mzm042 (Un)availability. of medicines | FAMHP [Internet]. [cited 2025 June 30]. Available from: https://www.famhp.be/en/items-HOME/unavailability_of_medicinal_products Ma Y, Xiang Q, Yan C, Liao H, Wang J. Poverty Vulnerability and Health Risk Action Path of Families of Rural Elderly With Chronic Diseases: Empirical Analysis of 1,852 Families in Central and Western China. Front Public Health [Internet]. 2022 Feb 14 [cited 2025 Apr 23];10:776901. Available from: https://www.frontiersin.org/articles/ 10.3389/fpubh.2022.776901/full Job C, Adenipekun B, Cleves A, Gill P, Samuriwo R. Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review. BMJ Open [Internet]. 2024 July [cited 2025 Apr 23];14(7):e081723. Available from: https://bmjopen.bmj.com/lookup/doi/ 10.1136/bmjopen-2023-081723 Cooper RA, Cooper MA, McGinley EL, Fan X, Rosenthal JT. Poverty, Wealth, and Health Care Utilization: A Geographic Assessment. J Urban Health [Internet]. 2012 Oct [cited 2025 June 30];89(5):828–47. Available from: http://link.springer.com/ 10.1007/s11524-012-9689-3 Browne J, Mccurley JL, Fung V, Levy DE, Clark CR, Thorndike AN. Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study. J Prim Care Community Health [Internet]. 2021 Jan [cited 2025 Apr 23];12:2150132721993651. Available from: https://journals.sagepub.com/doi/ 10.1177/2150132721993651 Chelak K, Chakole S. The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. Cureus [Internet]. 2023 Jan 5 [cited 2025 Apr 23]; Available from: https://www.cureus.com/articles/119651-the-role-of-social-determinants-of-health-in-promoting-health-equality-a-narrative-review Wilder ME, Kulie P, Jensen C, Levett P, Blanchard J, Dominguez LW et al. The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med [Internet]. 2021 May [cited 2025 Apr 23];36(5):1359–70. Available from: https://link.springer.com/ 10.1007/s11606-020-06447-0 Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract [Internet]. 2017 Jan [cited 2025 July 1];Volume 6:37–46. Available from: https://www.dovepress.com/role-of-the-pharmacist-in-reducing-healthcare-costs-current-insights-peer-reviewed-article-IPRP Jänese J, Žēpers L, Lublóy Á. Cost savings from medication reviews in community pharmacies for nursing home residents in Estonia: a case study. BMC Health Serv Res [Internet]. 2024 Sept 27 [cited 2025 July 1];24(1):1119. Available from: https://bmchealthservres.biomedcentral.com/articles/ 10.1186/s12913-024-11504-z Alhamad H, Patel N, Donyai P, Chaudary R, Herrera H. 0050 Defining the reuse of unwanted and returned medicines and eliciting salient beliefs about this behaviour through psychological research methods. Klein J, Von Dem Knesebeck O. Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review. Int J Equity Health [Internet]. 2018 Dec [cited 2024 June 26];17(1):160. Available from: https://equityhealthj.biomedcentral.com/articles/ 10.1186/s12939-018-0876-z Thomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med [Internet]. 2019 July [cited 2025 July 1];124:98–109. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0091743519301276 Todd A, Copeland A, Husband A, Kasim A, Bambra C. The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England. BMJ Open [Internet]. 2014 Aug [cited 2025 July 1];4(8):e005764. Available from: https://bmjopen.bmj.com/lookup/doi/ 10.1136/bmjopen-2014-005764 Antwerp GV, Bogus S, Overman J, Elsner N, Keita M. The role community pharmacies can play in reducing health inequities. Tinelli M, Bond C, Blenkinsopp A, Jaffray M, Watson M, Hannaford P. Patient Evaluation of a Community Pharmacy Medications Management Service. Ann Pharmacother [Internet]. 2007 Dec [cited 2024 June 26];41(12):1962–70. Available from: http://journals.sagepub.com/doi/ 10.1345/aph.1K242 Piquer-Martinez C, Urionagüena A, Benrimoj SI, Calvo B, Martinez-Martinez F, Fernandez-Llimos F et al. Integration of community pharmacy in primary health care: The challenge. Res Soc Adm Pharm [Internet]. 2022 Aug [cited 2025 Apr 23];18(8):3444–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1551741121004046 Additional Declarations No competing interests reported. Supplementary Files Additionalfile1COREQchecklist.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. 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However, health is not only determined by medical factors, but also strongly influenced by social determinants of health (SDOH), which include socio-economic status, living conditions, food security, and access to affordable services (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Unequal distributions of these determinants can result in health inequities (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese inequities are particularly evident among individuals from minority ethnic groups or low-income backgrounds, who often encounter challenges in accessing quality healthcare services and consequently experience higher rates of chronic disease and mortality (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The issue extends beyond the individual circumstances, as many health systems lack a clear focus of ensuring universal access to high-quality medical treatment for all citizens (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In response, the World Health Organization (WHO) recommends a more people-centred approach, which respects patients’ cultural and socio-economic contexts and promotes the integration of services to ensure universal access and health equity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven the significant impact of SDOH, it is crucial to implement interventions aimed at reducing health disparities, with a primary focus on recognising the underlying causes (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Among healthcare professionals, pharmacists have seen a substantial evolution in their roles, moving from a product-focused model toward a more service-oriented and patient-centred approach (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This transformation has positioned pharmacists as key contributors to primary healthcare efforts targeting health inequities. One of the core practices reflecting this shift is the medication review: a systematic evaluation of a patient's medication regimen with the goal of optimizing medication use and improving clinical outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn countries such as Canada and England, patient-centred services in community pharmacies already encompass preventive care, urgent care (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), smoking cessation counselling, and the administration of vaccinations and injectable drugs (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, less attention has been given to the social needs patients face, which can profoundly affect their health status. Studies from the United States suggest that pharmacists, due to their frequent interactions with patients, are well-positioned to address SDOH (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In contrast, the variability in pharmacy practices across Europe has limited the understanding of how pharmacists contribute to reducing health disparities (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven the significant influence of the SDOH on health outcomes and the limited available data addressing the social needs of patients in pharmacies in Europe, a descriptive qualitative research approach was undertaken (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). A qualitative approach was employed to obtain a comprehensive understanding of pharmacists’ perspectives of patients’ social needs and their strategies to address these needs. This first in- depth qualitative data will provide a basis for a more systemic data collection to develop tailored interventions with pharmacists to address health inequities and to optimize the role of the pharmacist in primary healthcare.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design\u003c/p\u003e\u003cp\u003eQualitative research was carried out involving semi-structured interviews exploring the perspective of community pharmacists on the social needs of patients and how these needs are addressed in the community pharmacy in various areas in the city of Antwerp.\u003c/p\u003e\u003cp\u003eSelection of the participants\u003c/p\u003e\u003cp\u003eTo capture a comprehensive understanding of social needs in pharmacy practice, pharmacists from both high-income and low-income neighborhoods in Antwerp were included. Eligible participants were defined as licensed community pharmacists currently practicing in Antwerp and willing to participate in a semi-structured interview; no exclusion criteria were applied. An initial email invitation containing study information was sent to 500 pharmacists across Flanders, from which seven responses were obtained, and these pharmacists were interviewed during the following week. To further ensure perspectives from socially diverse neighborhoods, purposive sampling was employed to recruit additional pharmacists from acknowledged disadvantaged areas (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Recruitment was continued until data saturation was reached, defined as the point at which no new insights emerged from successive interviews. In total, 14 pharmacists were interviewed, and their characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" 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\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\u003eCharacteristics participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacist\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eArea\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow-income\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eData collection\u003c/p\u003e\u003cp\u003eThe interviews were conducted between October 6th and October 28th, 2022, and lasted on average 40 minutes. An interview guide was developed based on the SDOH framework underwent several adaptations through collaborative efforts with two practicing pharmacists and two academic experts in pharmacy practice to ensure relevance and clarity (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Pilot semi-structured interview was conducted with one pharmacist, resulting in minor revisions to question phrasing. The semi-structured interviews were exclusively comprised of open-ended questions, seeking insights into the manifestation of SDOH and how these are addressed within pharmacy settings by the pharmacists. The interviews commenced by exploring the participants' understanding of the definition of SDOH and the challenges encountered by pharmacists. The second part of the interviews focused on narratives and their influence on health outcomes, while the final segment provided an opportunity for participants to propose potential future solutions. Conducted by a master's student (EOdB) in Pharmaceutical Care at the University of Antwerp for her master's thesis, the interviews were conducted both face-to-face and online. All interviews were audio-recorded and transcribed verbatim. Written informed consent was obtained before each interview.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eAn inductive approach was undertaken to analyse the qualitative data, using the thematic analysis guidelines of Braun and Clarck (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). First, transcripts were read multiple times to ensure familiarity with the data. Initial codes were then generated during a detailed reading of the transcripts. These codes were subsequently organized into overarching themes and, where applicable, subthemes.\u003c/p\u003e\u003cp\u003eThe interviews were transcribed and primarily coded by EOdB. Additionally, three interviews were independently coded by a master's student involved in a separate qualitative study. This peer coding process, followed by critical discussions, helped broaden the interpretation of the data. The analysis was further refined through regular coding discussions with the co-author, enhancing analytical rigor and depth. This study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist, which can be found in additional file 1 (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEthics\u003c/p\u003e\u003cp\u003e Approval to conduct this study was obtained from the committee for medical ethics UZA – UA, University of Antwerp (project ID 3785). All methods in this study were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTheme description\u003c/p\u003e\u003cp\u003eThe analysis of the study uncovered two main themes, divided in various subthemes, described in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The first theme pertains to the pharmacist\u0026rsquo;s perspective on the SDOH as observed within the community pharmacy setting. Within this first theme, a number of subthemes were identified such as financial challenges, as well as the language barriers, health literacy and transportation problems, which affect the health of the patients and their medication use. The second theme relates to the diverse roles pharmacists undertake in confronting and addressing these social issues.\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\u003eThemes and subthemes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eThe pharmacist\u0026rsquo;s perspective and role on the social determinants of health in the community pharmacy environment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePharmacists\u0026rsquo; view on financial challenges faced by patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLanguage barrier leads to ineffective communication\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrevalence of low health literacy is not limited to specific disadvantaged areas\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransport problems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003ePharmacist\u0026rsquo;s role in addressing the social needs of the patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe pharmacist\u0026rsquo;s commitment to enhancing affordability of therapeutic interventions\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAssessing alternative communication methods for the enhancement of medical information clarity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImproving health literacy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHome delivery service as solution for physical access to pharmacy challenges\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExtra services provided by the pharmacists to help the patient in general\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: The pharmacist\u0026rsquo;s perspective on the social determinants of health in the community pharmacy environment\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003eSubtheme 1.1 Pharmacists’ view on financial challenges faced by patients\u003c/h3\u003e\n\u003cp\u003ePharmacists, especially those working in a low-income neighbourhood, reported that medication costs can represent a psychological and financial barrier for patients, particularly those with limited financial flexibility. They observed that affordability plays a crucial role in medication adherence, with many patients hesitating or declining to purchase necessary treatments when prices exceed a certain threshold. This price sensitivity reflects both practical financial constraints and a broader pattern of cost-driven decision-making in the pharmacy setting:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Once the amount surpasses 10 or 20 euros, they genuinely begin to question it\u0026rdquo; (pharmacist 8)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhile some patients may simply weigh the cost of medications against other expenses, others face far more severe forms of deprivation. Pharmacists shared encounters with individuals whose financial hardship extends beyond healthcare, describing situations where patients were forced to choose between essential needs such as food and medication. These moments reveal how pharmacists often serve as frontline witnesses to deep social and economic vulnerability within their communities. As one pharmacist stated:\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;People tell me that they haven\u0026rsquo;t been able to eat that day because they don\u0026rsquo;t have\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003eenough money.” (pharmacist 3)\u003c/h3\u003e\n\u003cp\u003ePharmacists further noted that many medications for chronic conditions, such as prostate treatment, are not reimbursed by the government, leaving patients to cover the full cost themselves. This lack of financial support causes medication expenses to accumulate monthly, creating a significant economic strain. As a result, some patients consciously decide to delay essential treatments due to these prohibitive costs, risking deterioration in their health, as one pharmacist indicated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"When it comes to prostate medication, there are many people who need to take it, and it does come at a cost. Some individuals find it too expensive, so they choose not to take it.\" (pharmacist 2)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAlthough the report of pharmacists seeing signs of poverty within their pharmacies, other pharmacists expressed awareness of the socioeconomic challenges in their local communities but did not perceive it affecting the medication dispensing process:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"In this village, there is the highest child poverty rate, and I don't notice it, so that doesn't add up. This implies that much is being hidden.\" (pharmacist 7)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSubtheme 1.2 Language barrier leads to ineffective communication\u003c/p\u003e\u003cp\u003eIn specific areas of Antwerp, especially low-income neighbourhoods, diverse communities from multiple countries coexist, creating a rich but linguistically complex environment (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Pharmacists recognize the challenges involved in communicating effectively across a variety of languages. Although many pharmacists are proficient in Dutch, English, and French, they acknowledge that language barriers can hinder detailed communication, especially when it comes to asking in-depth questions or providing comprehensive guidance, as one pharmacist noted:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"I believe that our proficiency in Dutch, English, and French is quite adequate, and often, we can grasp a few concepts in other languages as well. However, yes, asking questions is rather challenging, and even providing guidance becomes difficult.\" (pharmacist 3)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSubtheme 1.3 Prevalence of low health literacy is not limited to specific disadvantaged areas\u003c/h3\u003e\n\u003cp\u003ePharmacists emphasized that low health literacy is not only linked to socioeconomic factors, such as financial hardship or language barriers. Instead, they highlighted that certain patient groups, particularly older adults or those with specific health conditions, often struggle to understand medical information regardless of their socio-economic background. This decline in comprehension can significantly affect patients' ability to manage their health effectively:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"This has nothing to do with money or language, but it's related to certain conditions and aging; eventually, they just don't know and understand it anymore.\" (pharmacist 10)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePharmacists also observed that patients\u0026rsquo; limited understanding of their health conditions and available care pathways often leads to delayed help-seeking. Many individuals wait too long to consult healthcare providers, resulting in worsening symptoms and increased reliance on emergency services. This pattern not only strains emergency care but also reflects gaps in patient education and support, as one pharmacist indicated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We are currently observing a trend where individuals wait too long before seeking care, subsequently turn to emergency services.\u0026rdquo; (pharmacist 13)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCompounding these challenges, frequent medication shortages in Belgium, (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) require patients to switch between different drug brands, which can cause confusion, especially for those who rely on visual cues for medication recognition. Pharmacists in both low income and high-income areas noted that such switches can severely impact adherence, resulting in either duplicated doses or missed medications altogether.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\" If I continually switch to different brands, adherence will truly be subpar; it will result in excessive duplication, or the medication will not be taken at all.\" (pharmacist 3)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSubtheme 1.4 Transport problems\u003c/p\u003e\u003cp\u003ePharmacists across all locations consistently recognized transportation as a significant physical barrier impacting patients\u0026rsquo; ability to access pharmacy services. For some individuals, especially those with mobility issues or physical incapacities, traveling to healthcare providers or pharmacies can be extremely challenging, limiting their ability to obtain necessary medications in a timely manner.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Additionally, the issue extends to situations where individuals, due to physical incapacities, find themselves unable to visit healthcare providers or retrieve their prescribed medications from the pharmacy.\u0026rdquo; (pharmacist 14)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eTheme 2: Pharmacist’s role in addressing the social needs of the patients\u003c/h3\u003e\n\u003cp\u003eSubtheme 2.1 The pharmacists\u0026rsquo; commitment to enhancing affordability of therapeutic interventions\u003c/p\u003e\u003cp\u003eAll pharmacists in the sample strive to reduce expenses by recommending affordable medicines if they aware of financial struggles of patients:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"We always strive to find the most cost-effective option for individuals facing financial challenges.\" (pharmacist 4)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen the expense is prohibitively high and the payment is impossible, pharmacists declared the collaboration with general practitioners to mutually decide reducing the quantity of prescribed medications and only the most essential medications, can still be taken, which are affordable for the patient:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"I had a gentleman for whom 8 medications were prescribed, but that was financially unfeasible. We reduced it from 8 medications to 3, and in the meantime, the man is doing well.\" (pharmacist 8)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAlthough the efforts to reduce financial burdens, the interviewed pharmacists in the low-income area told that affordability remains an issue for patients. They mentioned that patients occasionally request delayed payment as they do not have money available and that they agree to it with clear agreements made:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Our established policy includes the provision of certain items on credit, subject to the formulation of satisfactory agreements.\" (pharmacist 1)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOne pharmacist, working in a specific disadvantaged area of Antwerp, reported that she proposed by herself the deferred payment when she see that patients are not able to pay for their medicines. Despite the risks associated with proposing deferred payment, as the money might not be recovered, the pharmacist emphasized the importance of ensuring that patients can take their medication to prevent regression of their health:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I suggest paying later myself, as I quickly notice that they are unable to pay for the medication.\u0026rdquo; (pharmacist 3)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSubtheme 2.2 Assessing alternative communication methods for the enhancement of medical information clarity\u003c/p\u003e\u003cp\u003eThe pharmacists, who are working in a multicultural setting, they try to employ a diverse staff to effectively bridge divides, thereby minimizing the occurrence of language barriers within the pharmacy setting:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Having a pharmacist on staff who possesses fluent Arabic-speaking abilities is advantageous for us, especially given that our patient demographic primarily consists of Arabic-speaking individuals.\" (pharmacist 1)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePharmacists with diverse backgrounds, locating in low-income area in the sample indicated that they provide support to patients as translators for letters they receive in their letterbox and cannot read them. This highlights the role of pharmacists as trustworthy care partners for patients, offering timely assistance due to their accessibility:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Significantly, within our environment, there exists a pronounced trend of elderly Moroccan immigrants who purposefully traverse substantial distances to access our services due to our language proficiency. Their motivation for selecting our locale lies in the prospect of meaningful communication, prompting us to provide comprehensive assistance encompassing various domains.\" (pharmacist 8)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSome interviewed pharmacies were not able to hire staff with diverse backgrounds. They explained that they address language barriers by utilizing google translate, visual tools and pictograms to clearly communicate pharmaceutical information to patients with language barriers to ensure that patients are provided with accurate information about their medications:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Until now, we have managed on our own, resorting to tools such as Google Translate. Our commitment is to exhaust all available means in order to effectively convey information, including written documentation and the creation of visual aids.\" (pharmacist 14)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSubtheme 2.3 Improving health literacy\u003c/p\u003e\u003cp\u003eThe pharmacists in the sample all indicated that they try to give the pharmaceutical information on an uncomplicated way to ensure that patients have a clear understanding of how to take their medications.\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026lsquo;I sincerely make every possible effort to make everything understandable..\u0026rdquo; (pharmacist 13)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOne pharmacist from a low-income area indicated that they invite all their patients with diabetes to explain their medication and the risks of diabetes to increase their health literacy:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;We are currently inviting all our diabetic patients to review their medicines and clarify when each medicine should be taken, depending on the time schedule from the patient.\u0026rdquo; (pharmacist 10)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePharmacists situated within the low-income neighbourhoods of Antwerp engage in the\u003c/p\u003e\u003cp\u003eautomatic dose dispensing (ADD) preparation of medication dispensers for patients living with chronic illness, enabling access to prescribed medications throughout the day. Those working with individuals with limited financial resources reported that it was not feasible to charge for this service, as they would otherwise refuse the service:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I regularly prepare medication blister packs for patients, and I provide this service free of charge. It is not viable to request payment for this service in this context, as patients would decline to utilize it if a fee were introduced.\u0026rdquo; (pharmacist 1)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePharmacists employ standardized dosage instructions in common language on medication packaging, where explicit guidance for medication consumption is provided with clarity:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I employ clear instructions in the specific language of the patient that guarantees the foundational information remains consistently evident of medication packaging.\u0026rdquo; (pharmacist 9)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSubtheme 2.4 Home delivery service as solution for physical access to pharmacy challenges\u003c/p\u003e\u003cp\u003eEach pharmacist who participated in the interviews expressed their willingness to facilitate medication delivery to patient\u0026rsquo;s homes in situations where visiting the pharmacy becomes unfeasible. We registered that all interviewed pharmacists offer this service without seeking compensation, underscoring their commitment to patient care:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"In instances of transportation challenges, we undertake the delivery process autonomously, meticulously preparing the necessary arrangements and subsequently personally delivering the medications.\u0026rdquo; (pharmacist 2)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSubtheme 2.5 Extra services provided by the pharmacists to help the patient in general\u003c/p\u003e\u003cp\u003eThe accessibility of pharmacies encourages individuals, especially those who live in low-income neighbourhoods with limited proficiency in the Dutch language, to seek guidance for administrative inquiries. Pharmacists in the sample assist them by translating documents, organising paperwork and facilitating communication with relevant agencies through phone calls:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Patients seek assistance regularly with translating letters, making phone calls or other administrative matters. I assist them; they are my patients, and I am familiar with them, committed to offering support.\u0026rdquo;(pharmacist 6)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA pharmacist working in a low-income neighbourhood explained that she empathised with the financial difficulties faced by patients. She reported that she provided food for patients, as she has seen that they often lack adequate access to food.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes, I buy bread, cheese and milk for patients when I know they do not have food for themselves and their children. I know, this is not the best way to help them, but I feel compassion for them.\u0026rdquo; (pharmacist 3)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study employed a qualitative approach to examine how SDOH manifest in different areas of Antwerp and how pharmacists respond to these challenges. The findings reveal that social needs exist in both low- and high-income areas but vary in scope and visibility.\u003c/p\u003e\u003cp\u003eIn low-income neighbourhoods, pharmacists encountered a broader spectrum of social needs. Patients were more likely to approach pharmacists not only for medication-related issues, but also for social issues, including financial concerns.\u003c/p\u003e\u003cp\u003eThe frequent use of the pharmacy as a first point of contact fostered ongoing interactions, which in turn strengthened trust between patients and pharmacists. Through this trusted relationship, pharmacists were able to identify and address barriers including medication affordability, limited health literacy, and mobility problems. These findings are consistent with literature showing that disadvantaged populations face greater obstacles to medication adherence and health outcomes (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This highlights the importance of pharmacists\u0026rsquo; accessibility as healthcare providers for individuals with complex social needs.\u003c/p\u003e\u003cp\u003eAlthough pharmacists in high-income areas witnessed the social needs of their patients, such as low health literacy and mobility challenges, financial challenges were less visible and more difficult to address. This supports evidence that social challenges in affluent communities are often hidden due to assumptions about economic security (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The lack of systematic SDOH screening may contribute to under recognition, potentially resulting in unmet needs even in wealthier areas (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegardless of visibility, financial issues, language barriers, and health literacy can significantly impact adherence to treatment (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Pharmacists, as accessible and trust healthcare providers, are well-positioned to identify and respond to these needs. Their regular contact allows them to bridge clinical care with social support, especially in structurally vulnerable communities (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePharmacists in the low-income study areas, demonstrated a proactive and compassionate approach. To improve access, they offered flexible payment options and recommend affordable medications combinations. These actions reflect findings from prior research emphasizing the pharmacist\u0026rsquo;s role in reducing financial burdens (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Medication reviews, in particular, have been shown to lower costs, decrease healthcare use, and enhance adherence (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo overcome communication barriers, pharmacists employed diverse strategies: hiring multilingual staff, using translational tools, and incorporating visuals aids. These efforts align with studies on culturally competent care. However, ad hoc solutions, such as google translate, raise safety concerns due to the risk of inaccurate translations (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). These strategies were common in pharmacies serving linguistically diverse populations. By contrast, pharmacies in high-income areas, reported fewer language challenges, often due to lower population heterogeneity, which can reduce the urgency or perceived need for culturally tailored communication, as illustrated in existing literature (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBeyond these efforts, pharmacists in underserved areas often extended support informally.\u003c/p\u003e\u003cp\u003eIn some cases, they translated medical documents, made phone calls for patients, or provided food to those in need. Studies have shown that pharmacists frequently act as accessible points of care for marginalized communities, offering both medical and non-medical support (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). While these actions are not formally required or reimbursed, they reflect the trusted position pharmacists hold in their communities and highlight their potential as key actors in reducing health disparities (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAcross neighbourhoods, pharmacists\u0026rsquo; accessibility facilitated regular interactions, allowing them to recognize and address social factors that influence treatment adherence. This positions them as essential advisors in optimizing medication use. These findings suggest that further integration of pharmacists into healthcare teams is necessary to enhance patient care (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite this important role, the range of services pharmacists provide to address these needs often goes underrecognized (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). This study highlights how they adapt care beyond dispensing, tailoring support to individual circumstances. Given their frontline role and trusted relationships, pharmacists are well-placed to identify and respond to SDOH. However, formal recognition and compensation through supportive policy frameworks are necessary. Further research, particularly quantitative studies, is needed to evaluate the impact of these patient-centred contributions.\u003c/p\u003e\u003cp\u003eStrengths and limitations\u003c/p\u003e\u003cp\u003eThis study presents several strengths that contribute to its significance in understanding the role of pharmacists in healthcare. First, it highlights the differences in the roles pharmacists play in high- versus low-income areas, providing insight into varying patient needs.\u003c/p\u003e\u003cp\u003eSecond, it represents the first documentation of the social value that pharmacists bring to patients regarding their medication use, thereby expanding the existing literature on the impact of pharmacy services in Europe.\u003c/p\u003e\u003cp\u003eHowever, limitations must be acknowledged. The sample may be biased and not representative, limiting generalizability. Additionally, as a cross-sectional study, it captures a single point in time, rather than examining these dynamics over an extended period. Consequently, the findings may not fully reflect changes in patient needs or the evolving role of pharmacists in addressing these needs over time. Future research should consider longitudinal designs and more diverse sampling methods to better capture the complexities of pharmacists' contributions to patient care.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the crucial role community pharmacists play in addressing patients\u0026rsquo; social needs, particularly in socioeconomically disadvantaged areas. Daily interactions enable pharmacists to gain a deeper understanding social needs of their patients. In low-income areas, pharmacists go beyond dispensing medications by offering additional support such as financial guidance, assistance with language barriers, home delivery, and help with medication intake, all aimed at improving adherence.\u003c/p\u003e\u003cp\u003eIn high-income areas, while fewer social needs were observed, pharmacists contribute to better adherence through services such as home delivery and enhancing patients' health literacy.\u003c/p\u003e\u003cp\u003eGiven the breadth of support pharmacists offer beyond dispensing, greater recognition of their contributions is warranted. Their accessibility, trustworthiness, and proactive engagement make them integral to improving health outcomes. Healthcare policies should formally acknowledge and compensate these expanded roles, and future research should explore structured interventions, such as screening SDOH, within pharmacy settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADD Automatic Dose Dispensing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSDOH Social Determinants of Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO World Health Organisation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOREQ Consolidated Criteria for Reporting Qualitative Research\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflicts of interest\u003c/h2\u003e\u003cp\u003eNone.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding for this work.\u003c/p\u003e\u003cp\u003eAcknowledgements\u003c/p\u003e\u003cp\u003eThe author wishes to thank Pauline Bleys, who, like the author, was a student in Pharmaceutical Sciences at the time of the study. Her insightful discussions and shared reflections on the analysis of qualitative research were a valuable contribution to the development of this work.\u003c/p\u003e\u003cp\u003eDeclaration of interest\u003c/p\u003e\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\u003cp\u003eInformed consent was obtained from the participants of this study.\u003c/p\u003e\u003cp\u003eApproval to conduct this study was obtained from the committee for medical ethics UZA \u0026ndash; UA, University of Antwerp. All methods in this study were carried out in accordance\u003c/p\u003e\u003cp\u003ewith relevant guidelines and regulations.\u003c/p\u003e\u003cp\u003e Consent for publication\u003c/p\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEODB and HDL contributed to the development of the interview guide. EODB conducted the interviews. Both EODB and HDL were involved in the data analysis and manuscript preparation. EODB and HCL reviewed and approved the final version of the manuscript for submission.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData will be available on request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDefining health and health inequalities. | Elsevier Enhanced Reader [Internet]. [cited 2023 May 16]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://reader.elsevier.com/reader/sd/pii/S0033350619301076?token=3BF3FD34F1006B8177BC86A75A803A2D59DE98C7F9B2FF09B908A97D602B145CCEECBC2AF0BBFA72C5F604D69CD5E966\u0026amp;originRegion=eu-west-1\u0026amp;originCreation=20230516104738\u003c/span\u003e\u003cspan address=\"https://reader.elsevier.com/reader/sd/pii/S0033350619301076?token=3BF3FD34F1006B8177BC86A75A803A2D59DE98C7F9B2FF09B908A97D602B145CCEECBC2AF0BBFA72C5F604D69CD5E966\u0026amp;originRegion=eu-west-1\u0026amp;originCreation=20230516104738\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBraveman P, Gottlieb L. The Social Determinants of Health: It\u0026rsquo;s Time to Consider the Causes of the Causes. Public Health Rep [Internet]. 2014 Jan [cited 2023 May 16];129(1_suppl2):19\u0026ndash;31. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://journals.sagepub.com/doi/\u003c/span\u003e\u003cspan address=\"http://journals.sagepub.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00333549141291S206\u003c/span\u003e\u003cspan address=\"10.1177/00333549141291S206\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarmot M. Social determinants of health inequalities. Public Health. 2005;365.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe time is now. Fostering relationship-centered discussions about patients\u0026rsquo; social determinants of health | Elsevier Enhanced Reader [Internet]. [cited 2023 Mar 9]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://reader.elsevier.com/reader/sd/pii/S0738399118303598?token=2D8F3E8DE3A81F41707B8E21BD289226E2719F76E98D2BADF1E2EE0763AF91C51853A2FAD3802F3D11F7F30BA5D2FB8C\u0026amp;originRegion=eu-west-1\u0026amp;originCreation=20230309154833\u003c/span\u003e\u003cspan address=\"https://reader.elsevier.com/reader/sd/pii/S0738399118303598?token=2D8F3E8DE3A81F41707B8E21BD289226E2719F76E98D2BADF1E2EE0763AF91C51853A2FAD3802F3D11F7F30BA5D2FB8C\u0026amp;originRegion=eu-west-1\u0026amp;originCreation=20230309154833\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaunders M, Control C of, Barr D, McHale B, Hamelmann P. C. Key Policies for Addressing the Social Determinants of Health and Health Inequities. World Health Organization; 2017. 92 p.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol [Internet]. 2006 Dec [cited 2024 Mar 26];6(1):35. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcmedresmethodol.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcmedresmethodol.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2288-6-35\u003c/span\u003e\u003cspan address=\"10.1186/1471-2288-6-35\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTzenios N. The Determinants of Access to Healthcare: A Review of Individual, Structural, and Systemic Factors. Open Access.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCalandra J, Shukla S, Grandy R. Addressing equity and access to care: How an academic family medicine practice manages human immunodeficiency virus, hepatitis C, and substance use disorders. rural Appalachia. Vol. 5, JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY. 111 RIVER ST, HOBOKEN 07030\u0026thinsp;\u0026ndash;\u0026thinsp;5774. NJ USA: WILEY; 2022. pp. 921\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoodman RA, Bunnell R, Posner SF. What is community health? Examining the meaning of an evolving field in public health. Prev Med [Internet]. 2014 Oct [cited 2023 May 17];67(Suppl 1):S58\u0026ndash;61. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771402/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771402/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePestka DL, Espersen C, Sorge LA, Funk KA. Incorporating social determinants of health into comprehensive medication management: Insights from the field. JACCP J Am Coll Clin Pharm [Internet]. 2020 Sept [cited 2024 Mar 26];3(6):1038\u0026ndash;47. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://accpjournals.onlinelibrary.wiley.com/doi/\u003c/span\u003e\u003cspan address=\"https://accpjournals.onlinelibrary.wiley.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jac5.1254\u003c/span\u003e\u003cspan address=\"10.1002/jac5.1254\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAndermann A. Taking action on the social determinants of health in clinical practice: a framework for health professionals. Can Med Assoc J [Internet]. 2016 Dec 6 [cited 2023 Mar 15];188(17\u0026ndash;18):E474\u0026ndash;83. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.cmaj.ca/lookup/doi/\u003c/span\u003e\u003cspan address=\"http://www.cmaj.ca/lookup/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1503/cmaj.160177\u003c/span\u003e\u003cspan address=\"10.1503/cmaj.160177\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliams DR, Costa MV, Odunlami AO, Mohammed SA. Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities. J Public Health Manag Pract JPHMP [Internet]. 2008 Nov [cited 2023 Mar 15];14(Suppl):S8-17. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431152/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431152/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurtiss FR, Fry RN, Avey SG. Framework for Pharmacy Services Quality Improvement\u0026mdash; A Bridge to Cross the Quality Chasm.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCampeau Calfat A, Duval C, Laberge M, Savard AM, Sirois C. Clinical services in community pharmacies: a scoping review of policy and social implications. Int J Pharm Pract [Internet]. 2021 Mar 17 [cited 2025 June 30];29(2):116\u0026ndash;25. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://academic.oup.com/ijpp/article/29/2/116/6029092\u003c/span\u003e\u003cspan address=\"https://academic.oup.com/ijpp/article/29/2/116/6029092\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobberechts A, Brumer M, Garcia-Cardenas V, Dupotey NM, Steurbaut S, De Meyer GRY et al. Medication Review: What\u0026rsquo;s in a Name and What Is It about? Pharmacy [Internet]. 2024 Feb 19 [cited 2025 June 30];12(1):39. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/2226-4787/12/1/39\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/2226-4787/12/1/39\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKiles T, Jasmin H, Nichols B, Haddad R, Renfro CP. A Scoping Review of Active-Learning Strategies for Teaching Social Determinants of Health in Pharmacy. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION. 1426 PRINCE STREET, ALEXANDRIA, VA 22314\u0026thinsp;\u0026ndash;\u0026thinsp;2815. Volume 84. USA: AMER ASSOC COLL PHARMACY; 2020. pp. 1482\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnderson C, Sharma R. Primary health care policy and vision for community pharmacy and pharmacists in England. Pharm Pract [Internet]. 2020 Mar 31 [cited 2025 June 30];18(1):1870. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pharmacypractice.org/index.php/pp/article/view/1870\u003c/span\u003e\u003cspan address=\"https://www.pharmacypractice.org/index.php/pp/article/view/1870\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaiche T, Pammett R, Dattani S, Dolovich L, Hamilton K, Kennie-Kaulbach N et al. Community pharmacists\u0026rsquo; evolving role in Canadian primary health care: a vision of harmonization in a patchwork system. Pharm Pract [Internet]. 2020 Oct 18 [cited 2025 June 30];18(4):2171. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pharmacypractice.org/index.php/pp/article/view/2171\u003c/span\u003e\u003cspan address=\"https://www.pharmacypractice.org/index.php/pp/article/view/2171\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med [Internet]. 2019 July 1 [cited 2023 Mar 15];124:98\u0026ndash;109. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0091743519301276\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0091743519301276\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOsae SP, Chastain DB, Young HN. Pharmacists role in addressing health disparities-Part 1: Social determinants of health and their intersectionality with medication use, health care utilization, and health outcomes. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY. 111 RIVER ST, HOBOKEN 07030\u0026thinsp;\u0026ndash;\u0026thinsp;5774. Volume 5. NJ USA: WILEY; 2022. pp. 533\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMartins SF, Van Mil JWF, Da Costa FA. The organizational framework of community pharmacies in Europe. Int J Clin Pharm [Internet]. 2015 Oct [cited 2023 May 17];37(5):896\u0026ndash;905. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://link.springer.com/\u003c/span\u003e\u003cspan address=\"http://link.springer.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11096-015-0140-1\u003c/span\u003e\u003cspan address=\"10.1007/s11096-015-0140-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalabalik-Hoganson J, Ozdener-Poyraz AE, Rizzolo D. Call to Action: Addressing Social Determinants of Health in Pharmacy Practice. Ann Pharmacother [Internet]. 2022 June 1 [cited 2025 June 30];56(6):740\u0026ndash;5. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/10600280211040895\u003c/span\u003e\u003cspan address=\"10.1177/10600280211040895\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStad. in Cijfers - Databank - Stad in Cijfers - Databank - Postzones [Internet]. [cited 2023 Apr 28]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://stadincijfers.antwerpen.be/databank\u003c/span\u003e\u003cspan address=\"https://stadincijfers.antwerpen.be/databank\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. A conceptual framework for action on the social determinants of health. 2010 [cited 2023 Mar 20];76. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://apps.who.int/iris/handle/10665/44489\u003c/span\u003e\u003cspan address=\"https://apps.who.int/iris/handle/10665/44489\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaguire M, Delahunt B. Doing a Thematic Analysis: A Practical, Step-by-Step Guide for Learning and Teaching Scholars. 2017;8(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care [Internet]. 2007 Sept 16 [cited 2025 Aug 5];19(6):349\u0026ndash;57. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://academic.oup.com/intqhc/article-lookup/doi/\u003c/span\u003e\u003cspan address=\"https://academic.oup.com/intqhc/article-lookup/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/intqhc/mzm042\u003c/span\u003e\u003cspan address=\"10.1093/intqhc/mzm042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e(Un)availability. of medicines | FAMHP [Internet]. [cited 2025 June 30]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.famhp.be/en/items-HOME/unavailability_of_medicinal_products\u003c/span\u003e\u003cspan address=\"https://www.famhp.be/en/items-HOME/unavailability_of_medicinal_products\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa Y, Xiang Q, Yan C, Liao H, Wang J. Poverty Vulnerability and Health Risk Action Path of Families of Rural Elderly With Chronic Diseases: Empirical Analysis of 1,852 Families in Central and Western China. Front Public Health [Internet]. 2022 Feb 14 [cited 2025 Apr 23];10:776901. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/articles/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpubh.2022.776901/full\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2022.776901/full\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJob C, Adenipekun B, Cleves A, Gill P, Samuriwo R. Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review. BMJ Open [Internet]. 2024 July [cited 2025 Apr 23];14(7):e081723. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmjopen.bmj.com/lookup/doi/\u003c/span\u003e\u003cspan address=\"https://bmjopen.bmj.com/lookup/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2023-081723\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2023-081723\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCooper RA, Cooper MA, McGinley EL, Fan X, Rosenthal JT. Poverty, Wealth, and Health Care Utilization: A Geographic Assessment. J Urban Health [Internet]. 2012 Oct [cited 2025 June 30];89(5):828\u0026ndash;47. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://link.springer.com/\u003c/span\u003e\u003cspan address=\"http://link.springer.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11524-012-9689-3\u003c/span\u003e\u003cspan address=\"10.1007/s11524-012-9689-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrowne J, Mccurley JL, Fung V, Levy DE, Clark CR, Thorndike AN. Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study. J Prim Care Community Health [Internet]. 2021 Jan [cited 2025 Apr 23];12:2150132721993651. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.sagepub.com/doi/\u003c/span\u003e\u003cspan address=\"https://journals.sagepub.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2150132721993651\u003c/span\u003e\u003cspan address=\"10.1177/2150132721993651\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChelak K, Chakole S. The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. Cureus [Internet]. 2023 Jan 5 [cited 2025 Apr 23]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cureus.com/articles/119651-the-role-of-social-determinants-of-health-in-promoting-health-equality-a-narrative-review\u003c/span\u003e\u003cspan address=\"https://www.cureus.com/articles/119651-the-role-of-social-determinants-of-health-in-promoting-health-equality-a-narrative-review\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilder ME, Kulie P, Jensen C, Levett P, Blanchard J, Dominguez LW et al. The Impact of Social Determinants of Health on Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med [Internet]. 2021 May [cited 2025 Apr 23];36(5):1359\u0026ndash;70. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/\u003c/span\u003e\u003cspan address=\"https://link.springer.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11606-020-06447-0\u003c/span\u003e\u003cspan address=\"10.1007/s11606-020-06447-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. Integr Pharm Res Pract [Internet]. 2017 Jan [cited 2025 July 1];Volume 6:37\u0026ndash;46. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.dovepress.com/role-of-the-pharmacist-in-reducing-healthcare-costs-current-insights-peer-reviewed-article-IPRP\u003c/span\u003e\u003cspan address=\"https://www.dovepress.com/role-of-the-pharmacist-in-reducing-healthcare-costs-current-insights-peer-reviewed-article-IPRP\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJ\u0026auml;nese J, Žēpers L, Lubl\u0026oacute;y \u0026Aacute;. Cost savings from medication reviews in community pharmacies for nursing home residents in Estonia: a case study. BMC Health Serv Res [Internet]. 2024 Sept 27 [cited 2025 July 1];24(1):1119. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmchealthservres.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmchealthservres.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-024-11504-z\u003c/span\u003e\u003cspan address=\"10.1186/s12913-024-11504-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlhamad H, Patel N, Donyai P, Chaudary R, Herrera H. 0050 Defining the reuse of unwanted and returned medicines and eliciting salient beliefs about this behaviour through psychological research methods.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlein J, Von Dem Knesebeck O. Inequalities in health care utilization among migrants and non-migrants in Germany: a systematic review. Int J Equity Health [Internet]. 2018 Dec [cited 2024 June 26];17(1):160. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://equityhealthj.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://equityhealthj.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12939-018-0876-z\u003c/span\u003e\u003cspan address=\"10.1186/s12939-018-0876-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med [Internet]. 2019 July [cited 2025 July 1];124:98\u0026ndash;109. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkinghub.elsevier.com/retrieve/pii/S0091743519301276\u003c/span\u003e\u003cspan address=\"https://linkinghub.elsevier.com/retrieve/pii/S0091743519301276\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTodd A, Copeland A, Husband A, Kasim A, Bambra C. The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England. BMJ Open [Internet]. 2014 Aug [cited 2025 July 1];4(8):e005764. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmjopen.bmj.com/lookup/doi/\u003c/span\u003e\u003cspan address=\"https://bmjopen.bmj.com/lookup/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2014-005764\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2014-005764\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAntwerp GV, Bogus S, Overman J, Elsner N, Keita M. The role community pharmacies can play in reducing health inequities.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTinelli M, Bond C, Blenkinsopp A, Jaffray M, Watson M, Hannaford P. Patient Evaluation of a Community Pharmacy Medications Management Service. Ann Pharmacother [Internet]. 2007 Dec [cited 2024 June 26];41(12):1962\u0026ndash;70. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://journals.sagepub.com/doi/\u003c/span\u003e\u003cspan address=\"http://journals.sagepub.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1345/aph.1K242\u003c/span\u003e\u003cspan address=\"10.1345/aph.1K242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePiquer-Martinez C, Urionag\u0026uuml;ena A, Benrimoj SI, Calvo B, Martinez-Martinez F, Fernandez-Llimos F et al. Integration of community pharmacy in primary health care: The challenge. Res Soc Adm Pharm [Internet]. 2022 Aug [cited 2025 Apr 23];18(8):3444\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://linkinghub.elsevier.com/retrieve/pii/S1551741121004046\u003c/span\u003e\u003cspan address=\"https://linkinghub.elsevier.com/retrieve/pii/S1551741121004046\" targettype=\"URL\" 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":"Social determinants of health, pharmacy, qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-7767744/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7767744/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePharmacists, embedded in their local communities and in frequent contact with patients, are uniquely positioned to identify and address social determinants of health (SDOH) that influence medication adherence and health outcomes. Understanding how they perceive and respond to these non-medical challenges is essential to improving patient care and reducing health inequities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eSemi-structured interviews were conducted to understand pharmacists\u0026rsquo; experiences noticing SDOH in their patients during routine practice. Thematic analysis was performed following Braun and Clarke\u0026rsquo;s guidelines.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePharmacists described encountering a range of social needs affecting patients\u0026rsquo; medication use and adherence. These included financial hardship, poor health literacy, and limited access to healthcare services. While the nature and visibility of these needs varied by neighbourhood, all participants acknowledged the significant influence of SDOH on patient outcomes. In response, pharmacists reported adapting their services by offering individualized support, such as delayed payment options, use of translation tools, home delivery, and patient education. However, pharmacists also noted challenges in systematically identifying and addressing these needs due to a lack of formal screening tools and structural support.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePharmacists are well-positioned to recognize and respond to SDOH, yet their efforts often rely on informal and individualized strategies. Integrating routine screening for SDOH and enhancing collaboration with other healthcare providers could help formalise and strengthen pharmacists' roles in addressing health disparities. Policy support and resource allocation are essential to sustain these efforts and improve equity in healthcare delivery.\u003c/p\u003e","manuscriptTitle":"The social determinants of health within Belgian pharmacies: an exploratory qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-05 11:58:49","doi":"10.21203/rs.3.rs-7767744/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":"32d8398c-59c4-4141-9fff-25775ed560c9","owner":[],"postedDate":"November 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T10:27:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-05 11:58:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7767744","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7767744","identity":"rs-7767744","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}