Knowledge, Attitudes, and Willingness of community pharmacists to provide vaccination services: A web-based cross-sectional survey in Uganda

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However, little is known about CP’s willingness to offer vaccination services in Uganda. The study aimed to assess the knowledge, attitudes, and willingness (KAW) of the CPs to offer vaccination services in community pharmacy settings in Uganda Methods A nation-wide, web-based, cross-sectional survey was conducted using a snowball sampling technique to obtain responses from community pharmacists across Uganda. A pre-designed data collection form was used to obtain information regarding demographics, knowledge about vaccination, attitude, willingness, and barriers to providing vaccination services among community pharmacists. A binary and multiple logistic regression analysis was employed to identify predictors of KAW towards vaccination services. Results A total of 290 community pharmacists participated in the study. Overall, 46.55% of pharmacists demonstrated good knowledge, 65.17% positive attitude, and 87.93% were willing to provide vaccination services. Barriers like lack of authorization (95.17%), lack of training (78.96%), lack of staffing/resources (76.90%), time constraints (74.14%), and vaccine-associated safety concerns (64.83%) were expressed by the CPs to offer vaccination services. Good knowledge and positive or neutral attitudes were significantly associated with willingness to offer vaccination services. Conclusion The majority of the community pharmacists are willing to provide vaccination services, which could improve national vaccination coverage and public access. However, only half had adequate knowledge, and two-thirds showed positive attitudes. Targeted educational interventions and inclusion of community pharmacists in Uganda’s national immunization program are recommended to strengthen vaccination services. Community pharmacists vaccination services immunization awareness perception acceptance Introduction Immunization is the most powerful and cost-effective public health intervention that averts 4.4 million deaths worldwide annually [1]. About one in five children lacks access to lifesaving vaccines globally [2]. In 2024, 14.3 million children under one year old didn’t receive basic vaccines (referred to as zero-dose children) [2]. Almost all zero-dose children are living in low- and middle-income countries (LMIC), primarily in Africa and South-East Asia [2]. The percentage of children receiving a first dose of the measles vaccine was 84% in 2024, which is lower than the 2019 level of 86% [3]. Vaccine hesitancy (VH) is one of the top 10 global health threats [4]. The World Health Organization (WHO) vaccine advisory group acknowledged complacency, challenges in vaccine accessibility, and poor confidence as the key reasons for underlying VH [4]. Pharmacists are strengthening global health through offering vaccination services at community settings [5]. Their accessibility to public brands them as an essential healthcare fraternity in expanding vaccination accessibility, overcoming VH, and improving public health outcomes [6, 7]. According to the International Pharmaceutical Federation (FIP) data, as of 2024, pharmacists in 44 countries are authorized to provide vaccination services [5]. In 1983, the Ugandan National Expanded Program on Immunization (UNEPI) was established. In 2001, it received support from the Global Alliance for Vaccines and Immunization (GAVI) to protect children and women of childbearing age from vaccine-preventable diseases [8]. In Uganda, immunization services are delivered by trained healthcare workers at health facilities and through mobile community outreach programs [9]. Periodically, add-on campaigns and administration of vaccinations are also carried out during outbreaks. The immunization services are aimed at completely immunizing children against Haemophilus influenzae, Measles, Tetanus, Tuberculosis, Hepatitis B, Diphtheria, Polio, Whooping cough, and Pneumococcal Infections [9]. Furthermore, 10-year-old females and women of reproductive age are immunized against the Tetanus and the Human papillomavirus infection [9]. In Uganda, there is a 20% rise in children receiving all basic vaccinations since 2001. Additionally, under-five mortality decreased nearly 71% since 2000 [10]. Despite good progress in the reduction of under-five mortality, 69,000 children died due to variety of causes including vaccine preventable diseases in 2021 as per UN-IGME estimates [10]. According to the 2019 global burden study, 20% of under-five children deaths in Uganda were caused by the vaccine-preventable disease like measles, whooping cough, meningitis, and lower-respiratory tract infections [10]. Additionally, a report given by WHO/UNICEF national immunization coverage identified 100,096 zero-dose children in 2022 [10]. Literature indicates that maternal education, birth order, and geographic location of the child are the significant predictors of the ZD status of the children [10]. In relation to location, children living in urban slums and areas that are rural, hard-to-reach, and home to refugee populations are more linked to under- and un-vaccinated. Improved access to the immunization is the key driver to reduce the under-five mortality in developing countries [11]. Pharmacist plays a significant role in improving vaccination rates and coverage by offering convenient and accessible vaccination services through the community pharmacies. In community pharmacy-based vaccination service (CPBVS), the role of pharmacists is extended to processes related to vaccine handling, administration, storage, education of the public regarding immunization, reporting adverse events following immunization. The evidence revealed that implementation of CPBVS results in various positive outcomes such as increasing vaccine availability, speed-up of the vaccination process, improves vaccination rate and coverage, and effective patient education. These outcomes ultimately bring to prevention of new cases, reduction of the complications associated with vaccine preventable diseases, and cost saving to the healthcare system. Parallel to the positive outcomes offered by CPBVS, there are certain challenges embedded in the implementation of this new community program. The challenges include; issues related to space to provide vaccine services, physician support, reimbursement policy, knowledge and skills of CPs, available training programs, health policy frameworks, staffing, vaccine safety concerns, and records management. After analysing the significance of offering CPBVS, it is important to explore such services in the Ugandan context to strengthen the immunization system and improve the coverage. However, it is critical to understand the CPs' knowledge, attitudes, and willingness (KAW) to provide vaccination services before making policy and implementation. Our study aimed to assess the KAW of the CPs to offer vaccination services in community pharmacy settings in Uganda. Thereby, the study provides valuable insights for improving the healthcare system and vaccination services in Uganda. Materials and methods Study design A nationwide, web-based, cross-sectional analytical survey was conducted among community pharmacists to explore KAWs' for the implementation of vaccination services in their pharmacies across Uganda. Ethical consideration A nation-wide, web-based, cross-sectional survey was conducted among community pharmacists for four months from February to March 2025. The Kampala International University School of Pharmacy Research Committee approved (KIU SOPRC/079/25) the research proposal and informed consent process. Online informed consent was obtained from all community pharmacists involved in this survey. No payment was given for participation, and anonymity of the identity was maintained to ensure the confidentiality and reliability of the data. This online survey followed the ethical principles outlined in the Declaration of Helsinki for research involving human participants and was conducted according to the STROBE guidelines for reporting of observational studies. Study criteria All licensed working community pharmacists, qualified with a Bachelor of Pharmacy or higher, irrespective of pharmacy ownership, and willing to provide online consent to participate in the study, were included. The study excluded trainee pharmacists, pharmacy assistants, student pharmacists, pharmacists with a diploma in pharmacy, and licensed pharmacists who are unwilling to provide online consent to participate in the survey. Sample size determination and sampling process A single proportion population formula (n = Z^2p (1-p)/d^2) was used to determine the required sample size (n = 384) for our study, assuming 50% of the community pharmacists are willing to participate, a 95% confidence interval, a 5% margin of error, and 80% power. After determination of sample size, finite population correction formula (adj. n = n*N/n+(N-1) was used to adjust the sample size (adj. n = 286) by considering 1124 licensed pharmacists present in Uganda as the total population size (N). A 10% contingency was added as a non-response rate to the actual sample size, yielding a final sample size of 315. A snowball sampling (non-probability) technique was used to invite eligible community pharmacists to participate in this survey. Also, all invited participants were requested to share the survey tool with their fellow pharmacists working in other community pharmacy settings. Survey tool A structured, self-administered, pre-validated online questionnaire was used to obtain responses from the community pharmacists. The questionnaire was developed by reviewing studies from other countries on CPs' involvement in providing vaccination services [12–16]. Later, the questionnaire was modified according to the CPs' roles and responsibilities and vaccination policy in Uganda. The modified questionnaire was validated. The survey questionnaire was attached as a supplementary file. The questionnaire comprises four sections: 1. Characteristics of CPs and pharmacies; 2. Knowledge about vaccines and vaccination; 3. Attitudes of CPs to provide vaccination services; 4. Willingness of community pharmacists to provide vaccination services; and 5. Existing barriers among community pharmacists to provide vaccination services. Tadele, Qamar, Meraya, Thomas Characteristics of CPs and pharmacies The section covers CP's profile, including gender, age, highest pharmacy qualification, designation, experience, and weekly workload. Also, the current section covers the pharmacy's location, type, and internet accessibility. Knowledge about vaccines and vaccination A total of 10 questions were used to assess CPs' knowledge of vaccines and vaccination services. The section covers pharmacist awareness about name of vaccines (at least five) available in the routine immunization schedule, name of vaccine preventable diseases (at least five), effective strategy to prevent infections, temperature required to store vaccines, benefits of vaccination, adverse effects (at least three) associated with vaccine administration, rare occurrence of serious adverse effects, age of initiation of immunization as per schedule, and UNEPI abbreviation. Each correct response was marked as 1, and each wrong response as 0. The knowledge score expected from each respondent ranged from 0 to 10. After estimation of the knowledge score, Bloom’s cut-off criteria were used to categorize knowledge into good (80–100% correct response; score 8–10), moderate (60–79% correct response; score 6–7), and poor (< 60% correct response; score < 6) adequacy levels toward vaccination services. Attitudes of CPs to provide vaccination services We used 10 statements to assess pharmacists' attitudes toward offering vaccination services in community pharmacy settings. The attitude section comprises statements on the accessibility of community pharmacies to the public, pharmacists' comprehensive vaccine knowledge, training of the CPs to provide vaccine services, the ease of facilitating vaccination spaces at pharmacies, the impact of vaccination on professional reputation, pharmacists' involvement in vaccination campaigns, public trust in community pharmacy services, support from other healthcare professionals in integrating vaccination services into community pharmacies, and the impact of vaccination services on patient flow. Participants' responses towards attitude statements were graded on a five-point Likert scale (Strongly agree-5 to strongly disagree-1). Statements nine and ten were reverse-coded to avoid acquiescence bias. The attitude domain score expected from each respondent ranged from 10 to 50. After determining the attitude score, we applied Bloom's cut-off criteria to divide attitude into positive (80–100% correct response; score 40–50), neutral (60–79% correct response; score 30–39), and negative (< 60% correct response; score < 30) adequacy levels toward vaccination services. Willingness of community pharmacists to provide vaccination services We assessed the willingness or acceptance of the CPs to offer vaccination services at the pharmacy setting by asking a question with a dichotomous (Are you willing to provide vaccination services in your pharmacy setup?) answer (Yes/No). Existing barriers among community pharmacists to provide vaccination services. Respondents were posed a multiple-response question, “What are the potential barriers towards offering vaccine services at your community pharmacy?”, to gather information on the barriers they perceive to providing vaccination services. We identified potential barriers towards vaccination services from the existing literature from low- and middle-income countries where such services are not yet implemented, as well as from high-income countries where community pharmacists are authorized to provide vaccination services. After collecting responses from all participants, we analyzed the data using descriptive statistics to identify the most common barriers to pharmacists offering vaccination services. Data collection The data were collected by sharing the Google Form link on social media platforms (Twitter, Instagram, and LinkedIn) and in community pharmacists' professional WhatsApp groups. The first page of the e-survey form described the purpose, primary goals, anticipated benefits, and consent to participate in the online survey. Only eligible participants were allowed to complete the survey. Participants' eligibility was screened by asking questions about nationality, professional qualifications, pharmacist registration, and type of pharmacy. To avoid duplicates, the form was accessible only to one Google account. Additionally, to address missing responses, we made all questions mandatory. To achieve an adequate sample size, the survey link was active for three months after it began. The average time to complete this questionnaire was about 5 to 10 minutes. All invited community pharmacists were requested to share the link with their fellow pharmacists working in other community pharmacy setups in Uganda. Data analysis IBM SPSS Statistics (SPSS®) software, Version 28.0 (IBM, New York, USA), was used to analyze data obtained from the CPs. We used descriptive statistics to present the respondents' demographics, the barriers to vaccination, and the CPs' KAW for providing vaccination services. An inferential statistical tool, such as binary logistic regression, was applied to identify factors associated with good knowledge, a positive attitude, and the CPs' willingness to provide vaccination services. Variables with P < 0.20 in the binary analysis were added in a multiple logistic regression model to minimize confounding by extraneous variables. We considered a two-sided P value < 0.05 to be statistically significant. Results Within the study frame, we received 350 responses from community pharmacists. Of those, 60 were either unwilling or did not meet the eligibility criteria for participation. Socio-demographics of the community pharmacists Table 1 shows the socio-demographic characteristics of the 290 community pharmacists (n = 290) who completed the questionnaire. More than half of the CPs were aged 21–30 (64.86%), male (64.83%), working as staff pharmacists (66.55%), and working for less than 10 hours per day (56.90%). Education levels varied, with the highest percentage of CPs holding a bachelor’s degree (77.59%), followed by those with a master’s degree or higher (22.41%). More than half of the pharmacies were located in cities (56.90%), and they are independently owned pharmacies (68.28%) rather than chain pharmacies (31.72%). About 79.65% of the pharmacies always had internet access. Table 1 Socio-demographic characteristics of community pharmacists (n = 290) Variable Frequency (%) Gender Male 188 (64.83) Female 102 (35.17) Age in years (Mean in years (Mean ± SD) 29.47 ± 5.78 21–30 191 (65.86) 31–40 91 (31.38) > 40 8 (2.76) Location of the pharmacy Rural 65 (22.41) Municipality 60 (20.69) City 165 (56.90) Education Bachelor 225 (77.59) Master or higher 65 (22.41) Pharmacy type Chain pharmacy 92 (31.72) Independent owned pharmacy 198 (68.28) Job title Community pharmacist 21 (7.24) Manager 34 (11.72) Owner 42 (14.48) Staff Pharmacist 193 (66.55) Work experience (Years) 1–3 205 (70.69) 4–6 58 (20.00) > 6 27 (9.31) Work hours per week < 10 165 (56.90) ≥ 10 125 (43.10) Access to the internet Always 231 (79.65) Sometimes 55 (18.97) None 4 (1.38) Knowledge about vaccines and vaccination among community pharmacists In our study, all community pharmacists (100%) were aware of the health benefits of vaccination. The majority of community pharmacists possessed knowledge of the age at which to initiate vaccination according to the Ugandan vaccination schedule (91.72%) and the UNEPI abbreviation (96.21%). A considerable proportion of the community pharmacists were aware of vaccine storage conditions (70.34%) and common routes of administration (72.41%). More than half of the community pharmacists know that vaccination provides better protection than other preventive measures (58.62%), that adverse effects associated with vaccine administration are rare (64.14%), that severe reactions attributed to vaccine administration are rare (61.72%), and that vaccine-preventable diseases are serious (56.55%). Only 47.93% of community pharmacists are aware of the names of vaccines available in Uganda's immunization schedule. Knowledge of vaccines and vaccination among community pharmacists is presented in Table 2 . Table 2 Knowledge about vaccines and vaccination programs Question Correct (%) K1 Give five vaccination preventable infectious diseases? 164 (56.55) K2 Name the five vaccines available in the routine immunization schedule of Uganda. 139 (47.93) K3 Does infection prevention offer better protection than vaccination? 170 (58.62) K4 What is the optimal temperature to store common vaccines? 204 (70.34) K5 What is the health benefit of vaccination? 290 (100.00) K6 Give three of the common adverse effects of vaccination? 186 (64.14) K7 Are serious adverse effects common with vaccines? 179 (61.72) K8: Give three common sites for the administration of vaccines? 210 (72.41) K9: At what age does vaccination start according to the Uganda vaccination schedule? 266 (91.72) K10 UNEPI in full stands for? 279 (96.21) Attitude of the community pharmacists to offer vaccination services Majority of the respondents were agreed that community pharmacies are widely accessible venues to public (80.00%), pharmacists’ have comprehensive vaccine knowledge (76.90%), a minimum training is sufficient to equip CPs to provide vaccine services (92.07%), offering vaccination services can enhance the professional reputation of the pharmacists (88.62%), the pharmacist plays essential role in vaccination campaigns (93.44%), and public trust on community pharmacy services can be utilized to facilitate the vaccination services (88.28%). About 64.48% of community pharmacists agreed with the compulsory availability of vaccination services in community pharmacy settings. About 75% of the community pharmacists agreed to accommodate the space required for the vaccination services in the pharmacy building. However, 38.97% of community pharmacists were concerned about the support from doctors and other HCPs in integrating the pharmacist role into vaccination services. Many pharmacists disagreed with the statement that offering vaccination services in pharmacy settings can lead to a loss of patients. The attitudes of community pharmacists toward offering vaccination services are presented in Table 3 . Table 3 Attitudes of the community pharmacists to offer vaccination services Statement Strongly agree Agree Neutral Disagree Strongly disagree A1 Community pharmacies are easily accessible vaccination sites that can increase vaccination coverage. 146 (50.34) 86 (29.66) 25 (8.62) 8 (2.76) 25 (8.62) A2 Community pharmacists have adequate knowledge regarding immunology and therapeutics related to vaccines. 107 (36.90) 116 (40.00) 49 (16.90) 10 (3.45) 8 (2.76) A3 Administration of vaccines is a technical skill that can be easily learned through additional training for community pharmacists. 160 (55.17) 107 (36.90) 10 (3.45) 6 (2.07) 7 (2.41) A4 Do you agree that every pharmacist must provide vaccination services in community pharmacy? 82 (28.27) 105 (36.21) 66 (22.76) 4 (1.38) 33 (11.38) A5 A separate room/space is available, or can be easily created, in the current pharmacy building to deliver vaccination services. 85 (29.31) 130 (44.83) 41 (14.14) 3 (1.03) 31 (10.69) A6 If I offer vaccination services, it can improve my professional image among the public and expand the practice. 154 (53.10) 103 (35.52) 24 (8.27) 4 (1.38) 5 (1.72) A7 Vaccination services will allow pharmacists to participate in vaccination campaigns. 156 (53.79) 115 (39.65) 10 (3.45) 4 (1.38) 5 (1.72) A8 Patients' trust in pharmacists could facilitate the introduction of vaccination services in community pharmacy setups. 132 (45.52) 124 (42.76) 16 (5.52) 4 (1.38) 14 (4.83) A9 If a community pharmacist got certified to vaccinate, it would affect the relationship between the pharmacist and other vaccinators (physicians) 47 (16.21) 66 (22.76) 103 (35.52) 4 (1.38) 70 (24.14) A10 If I start providing vaccination services in my pharmacy, I may lose my patients. 2 (0.69) 16 (5.52) 45 (15.52) 6 (2.07) 221 (76.21) Adequacy level of knowledge, attitude, and willingness among CPs towards vaccination services In our study, the majority (87.93%) of the CPs are willing to provide vaccination services in their pharmacies. However, only 46.55% of respondents had good knowledge, followed by 29.65% with moderate knowledge of vaccines and vaccination services. Nearly two-thirds (65.17%) of the respondents showed a positive attitude towards providing vaccination services at community pharmacies. Table 4 presents the distribution of the CPs' adequacy levels of knowledge, attitudes, and willingness towards vaccines and vaccination services. Table 4 Adequacy level of community pharmacists’ knowledge, attitude, and willingness towards vaccination services Adequacy level Frequency (%) Knowledge Good (8–10) 135 (46.55) Moderate (6–7) 86 (29.65) Poor (0–5) 69 (23.79) Attitude Positive (40–50) 189 (65.17) Neutral (30–39) 84 (28.97) Negative (< 30) 17 (5.86) Willingness Accepted 255 (87.93) Not accepted 35 (12.07) Willingness and barriers to offer vaccination services at community pharmacies About 87.93% of pharmacists were willing to provide vaccination services in community pharmacies in Uganda. However, respondents perceived that CPs are not officially authorized (95.17%), lack of training (78.96%), lack of adequate staffing and resources (76.90%), lack of time (74.14%), and concerns about vaccine safety (64.83%) are the prominent barriers to offering vaccination services at community pharmacy setups in Uganda. More than half of the participants reported that the lack of support from other HCPs (59.66%), concerns about legal consequences of vaccination (56.90%), and maintaining vaccine administration records (52.76%) were major barriers for offering vaccination services at community pharmacies. The distribution of barriers to providing vaccination services at community pharmacies is presented in Table 5 . Table 5 Barriers to offer vaccination services at community pharmacy settings (n = 290) Barriers Frequency (%) B1: Lack of space in the pharmacy to administer and store vaccines 75 (25.86) B2: Lack of time due to a heavy workload and being unable to include vaccine services 215 (74.14) B3: Lack of adequate staffing and resources to implement vaccine services 223 (76.90) B4: Lack of knowledge and skills to deliver vaccination services 122 (42.07) B5: Lack of training to offer vaccination services 229 (78.96) B6: Lack of reimbursement 125 (43.10) B7: Lack of support from the health professionals to involve pharmacists 173 (59.66) B8: Lack of trust in pharmacist-delivered vaccine services among patients 34 (11.72) B9: Pharmacies are not authorized to provide vaccine services 276 (95.17) B10: Concern about the legal consequences connected with vaccine services 165 (56.90) B11: Concerns regarding handling, use, and disposal of the needles 125 (43.10) B12: Uncomfortable with performing procedures related to blood or seeing blood 122 (42.07) B13: Concern regarding management of vaccine-induced adverse events 188 (64.83) B14: Concern about patient privacy in the pharmacy 119 (41.03) B15: Difficulty and complexity of the management of records related to vaccines 153 (52.76) Predictors of community pharmacists’ knowledge, attitude, and willingness to provide vaccination services In our study, CPs who work 10 or more hours per day are 1.84 times more likely to have good knowledge of vaccines and vaccination services. Our study findings revealed that respondent's gender (Male: AOR 1.91; 95% CI 1.08–3.41), age (31 and 40 years: AOR 2.34; 95% CI 1.13–4.84)), job title (pharmacy manager: AOR 5.81; 95% CI 1.52–22.07, owner: AOR 4.43; 95% CI 1.29–15.22) and knowledge (good: AOR 3.41; 95% CI 1.74–6.72) were significantly associated with the positive attitude towards offering vaccine services in community pharmacies. However, the pharmacists with more than 6 years' experience had lower odds (AOR 0.13; 95% CI 0.05–0.39) of having a positive attitude towards vaccination services. Variables such as working in city regions and having four or more years of experience were associated with a lower willingness to provide vaccine services. Good knowledge levels, positive attitudes, and neutral attitudes towards vaccination services were significantly positively associated with community pharmacists' willingness. Predictors of community pharmacists' knowledge, attitudes, and willingness towards vaccination services are presented in Table 6 . The COR, AOR, and P values of the predictors associated with the knowledge, attitude, and willingness to provide vaccination services among community pharmacists were presented in supplementary Table 1, 2, and 3. Table 6 Binary and multiple logistic regression analysis of predictors of community pharmacists’ knowledge, attitude, and willingness to provide vaccination services Good knowledge Positive attitude Willing to provide vaccination Variable COR (95% CI) AOR (95% CI) COR (95% CI) AOR (95% CI) COR (95% CI) AOR (95% CI) Gender Male 1.58 (0.97–2.58) 1.54 (0.91–2.58) 1.99 (1.20–3.28) ** 1.91 (1.08–3.41) * 1.89 (0.93–3.85) 0.56 (0.16–1.91) Female Ref Ref Ref Ref Ref Ref Age (Years) 21–30 Ref Ref Ref Ref Ref 31–40 1.45 (0.88–2.40) 1.61 (0.87–2.96) 1.36 (0.80–2.32) 2.34 (1.13–4.84) * 1.37 (0.61–3.07) > 40 1.30 (0.32–5.36) 1.78 (0.41–7.68) 4.23 (0.51–35.13) 5.26 (0.54–51.01) 1.05 (0.12–8.93) Pharmacy Location Rural Ref Ref Ref Ref Ref Municipality 0.50 (0.24–1.02) 0.50 (0.24–1.05) 1.25 (0.60–2.60) 1.90 (0.33–10.78) 1.92 (0.21–17.76) City 0.69 (0.39–1.22) 0.70 (0.38–1.26) 1.22 (0.67–2.20) 0.31 (0.10–0.91) * 0.14 (0.03–0.74) * Education Bachelor Ref Ref Ref Master or higher 1.35 (0.77–2.34) 1.38 (0.76–2.53) 1.18 (0.49–2.83) Pharmacy type Chain pharmacy Ref Ref Ref Ref Independent owned pharmacy 0.87 (0.53–1.43) 1.41 (0.84–2.35) 1.59 (0.89–2.82) 1.51 (0.73–3.13) Job title Pharmacist in-charge Ref Ref Ref Ref Ref Pharmacy manager 1.33 (0.45–3.98) 5.28 (1.61–17.27) ** 5.81 (1.52–22.07) * 2.34 (0.55–9.97) 0.55 (0.03–10.32) Owner 1.10 (0.38–3.17) 5.20 (1.68–16.12) ** 4.43 (1.29–15.22) * 6.25 (1.10-35.58) 2.80 (1.67–47.43) Staff Pharmacist 1.16 (0.47–2.89) 2.85 (1.13–7.22) 2.72 (0.98–7.56) 2.20 (0.74–6.55) 0.52 (0.04–5.99) Work experience (Years) 1–3 Ref Ref Ref Ref Ref Ref 4–6 2.06 (1.14–3.74) 1.71 (0.90–3.26) 1.36 (0.71–2.59) 0.60 (0.29–1.27) 0.71 (0.30–1.71) 0.20 (0.05–0.84) * > 6 1.26 (0.56–2.81) 0.81 (0.31–2.11) 0.41 (0.18–0.93) * 0.13 (0.05–0.39) *** 0.40 (0.14–1.10) 0.09 (0.02–0.42) ** Work hours per week < 10 Ref Ref Ref Ref ≥ 10 1.65 (1.03–2.63) * 1.84 (1.13–3.01) * 1.10 (0.67–1.79) 1.52 (0.73–3.20) Access to the internet Always Ref Ref Ref Ref Sometimes 1.02 (0.57–1.84) 0.86 (0.47–1.57) 4.42 (1.03-19.00) * 2.78 (0.46–16.86) None (Rarely) 0.38 (0.04–3.70) $ (0.0E0-NV) $ (0.0E0-NV) @ (0.0E0-NV) Knowledge Good NA NA 3.18 (1.72–5.88) *** 3.41 (1.74–6.72) *** 4.41 (1.77–11.01) ** 4.69 (1.16-19.00) * Moderate 1.65 (0.87–3.14) 1.72 (0.85–3.51) 1.71 (0.74–3.95) 1.04 (0.26–4.09) Poor Ref Ref Ref Ref Attitude Positive NA NA NA NA 150.31 (33.68-670.73) *** 34.75 (4.02-300.49) ** Neutral 11.92 (3.46–41.01) *** 742.86 (58.91-9367.52) *** Negative Ref Ref Discussion Our study is the first conducted among Ugandan community pharmacists to assess the knowledge, attitudes, and willingness to provide vaccination services. Additionally, we identified barriers towards the implementation of the vaccination services and predictors of the knowledge, attitude, and willingness of the CPs towards providing vaccination services. Evidence shows that offering vaccination services in community settings could enhance vaccine availability and accessibility; hasten vaccination; improve vaccination rates and coverage; reduce the risk of infection; and promote cost savings [17–20]. Indeed, the current study findings and interpretations provide insights for the Ugandan public health practice and support advocacy efforts to implement vaccination services at community pharmacies. Knowledge of CPs about vaccination In our study, about 46.55% of CPs have good knowledge, and 29.65% have moderate knowledge about vaccines. Parallel to our study findings, a study conducted in Nigeria revealed 48.4% of the CPs had good knowledge [21]. In contrast with our study findings, a study conducted in Lebanon (96.1%), and Ethiopia (92.0%) showed a high level of good knowledge, and studies from Malaysia (12.8%) and Saudi Arabia (8.4%) revealed a low level of good knowledge compared with our study [13, 14, 22, 23]. The variations observed across studies from different countries can be explained by differences in the cut-off criteria used to categorize knowledge of vaccines, exposure to vaccine knowledge, and vaccine administration in their national pharmacy curricula, as well as by previous training on vaccination in their routine pharmacy curricula or in the practice of pharmacy. Good knowledge about vaccines is an essential component for CPs to promote awareness regarding vaccine-preventable disease and to provide education regarding importance of vaccination to the public to improve vaccine coverage of the nation [24]. Our study findings revealed that good knowledge among community pharmacists is a significant predictor of intention to provide vaccine services at community pharmacies. This finding is aligned with those of other studies by Luthin et al. and Onjpoy, which revealed a positive association between knowledge and intentions to provide pharmacy-based vaccination services [25, 26]. In our study, all respondents were aware of the health benefits of vaccination. The majority of respondents knew about the UNEPI abbreviation (96.21%), age requirements for initiating childhood vaccines (91.72%), routes of vaccine administration (72.41%), and vaccine storage requirements (70.34%). However, CPs require adequate training in vaccine administration and in short- and long-term safety monitoring to transform their knowledge into skills and build confidence in offering vaccination services at community pharmacies. Attitude of CPs about vaccination Regarding the attitude domain, nearly two-thirds (65.17%) of the CPs showed a positive attitude towards providing vaccination services in community pharmacies. In contrast to our findings, community pharmacists showed high positive attitudes in Malaysia (95.5%) and Italy (91.7%), whereas the Ethiopian study reported a low positive attitude to offer vaccination services (55.8%) [13, 14, 23, 24]. The high positive attitude levels observed in Malaysian and Italian studies were greatly linked with the pivotal role pharmacists played as vaccinators during COVID-19 [27, 28]. When pharmacists are authorized and trained to administer vaccines, they develop a positive attitude towards their roles and responsibilities in providing vaccination services. In Uganda, health authorities did not integrate vaccination services into community pharmacies. As a result, pharmacists lack training opportunities and institutional support to improve their knowledge and skills in offering vaccination services. These factors might have contributed to the pharmacist's hesitancy to provide vaccination services. Additionally, differences in the pharmacy curriculum, health policies, and roles and responsibilities of the pharmacists across countries justify the variations observed in the findings. In our study, 80% of respondents agreed that community pharmacies are easily accessible vaccination sites and that CPs can improve vaccination coverage. The Malaysian research results matched these findings. The evidence supports the idea that, as vaccine providers, pharmacists and the accessibility of pharmacies improved vaccination rates and coverage [18, 19, 29, 30]. Accessibility of the vaccination site is a key determinant of public access convenience, which can increase vaccination rates. It is essential for rural and underserved communities, where it is challenging to reach the health facilities in low-income countries like Uganda. A study reported that patients choose community pharmacies as vaccination sites because they are convenient to reach [31]. About 92.07% of the CPs believed that vaccination is a technical skill and can be easily learned through additional training. A study conducted in Malaysia revealed that the majority of the CPs were neutral to this statement [13]. However, evidence indicates that patients were delighted with CP’s injection technique [32, 33]. Additionally, a study reported that the trained pharmacists administered 343 vaccine doses within two months without any reported adverse events [34]. These findings confirm that trained pharmacists can safely administer vaccines. Only 25.52% of respondents were favourable, and 35.52% were neutral about the relationship between CPs and vaccine providers if the pharmacist is certified as a vaccinator. Conflicting evidence existed about practitioners' support for integrating pharmacists into vaccination services. In one study, most of the physicians agreed with the pharmacist's support as a vaccinator in the healthcare system [35]. In contrast, another study found that practitioners were concerned about the quality and safety of vaccine recipients, as well as potential financial losses for pharmacists, which led them to not support pharmacy-based vaccination services [36]. The findings from the literature show that the preparedness of community and healthcare practitioners, who are existing vaccinators, is essential for integrating community pharmacists into vaccination services. In our study, variables like gender, age, job title, work experience, and knowledge levels were significantly associated with positive attitudes of the CPs to offer vaccination services. Evidence shows that knowledge [14], qualification [13, 37], area of the pharmacy [15], and working hours [15] were significantly associated with the attitudes of the CPs relation to vaccination services. The variations observed in predictors across studies was attributed with diversity in the participants characteristics. However, knowledge is the significant predictor for the positive attitude in our study and elsewhere reported. Studies conducted in the United States and New Zealand reported that poor knowledge was significantly associated with a negative attitude among HCPs [38, 39]. These findings highlight the importance of filling knowledge gaps to improve CPs' positive attitudes toward vaccination services. Building on this, it is imperative to plan training and educational programs based on the predictors identified in this study to improve CPs' positive attitudes toward vaccination services. Willingness of CPs to provide vaccination services In our study, 87.93% of pharmacists were willing to offer vaccination services in community pharmacies in Uganda. Our study findings were aligned with the findings of the study conducted in Jordan (86.6%) [40]. The high willingness of the CPs is a foundation for the future health policy and practice changes in Uganda, aligned with the other regions where CPs expanded their role as vaccinators [16, 31, 38]. In low-income countries, Ethiopia has taken a step forward in implementing the “Pharmacy-Based Immunization Delivery Research-Based Pilot Project” by signing an MoU between the Ministry of Health and Population Services International and the FIP member organization, the Ethiopian Pharmaceutical Association [41]. Community pharmacists' good knowledge and positive attitudes were significantly correlated with their intention to provide vaccination services. Additionally, the location of the pharmacy and the CPs' experience were significantly associated with the CPs' willingness to offer vaccination services. These associations provide insights for developing educational interventions to address knowledge gaps and negative perceptions among community pharmacists, thereby increasing the acceptance rate. Evidence supports that the CPs who engaged in vaccination-related education programs expressed a high willingness to offer the vaccine-related activities [42]. The high willingness observed in our study suggests public health authorities and professional associations can utilize community pharmacists in vaccination services, especially in underserved and hard-to-reach areas. Furthermore, they are the most accessible and well-trusted healthcare professionals among the public. By considering these aspects, health authorities can utilize the CPs in vaccination campaigns to promote vaccination rates and coverage. However, before integration of this health fraternity in providing vaccination services, it is essential to address the perceived potential barriers towards vaccination practice in community pharmacy setups. Barriers to offering vaccination services at community pharmacies Lack of authorization (95.17%) is the most common barrier to providing vaccination services at community pharmacies in Uganda. This finding was consistent with the results of various studies conducted in Ethiopia, Malaysia, and Jordan [13, 14, 40]. According to national guidance, pharmacists are not authorized to provide vaccination services in Uganda, which is allowed in many countries such as Argentina, Australia, Canada, Costa Rica, Denmark, Ireland, New Zealand, the Philippines, Portugal, South Africa, Switzerland, the UK, and the USA [43]. These countries recognized the potential benefits of pharmacists as community vaccinators. Lack of training (78.96%) is the second top perceived barrier for the CPs to provide vaccination services in the present study. A Polish study reported that pharmacists who completed training had a significant association with the willingness to offer vaccination services [12–14, 40]. A Polish study reported that pharmacists who completed training had a significant association with the willingness to provide vaccination services [44]. The previous literature and current study findings underscore the importance of continuous educational and training programs to promote pharmacy-based vaccination services. Lack of adequate staffing and resources availability (76.90%) is the top third perceived barrier among CPs to offer vaccination services. In line with our study findings, previous studies have underscored that insufficient resources are a major barrier to offering vaccination services in community pharmacies [13, 14]. Additionally, in connection with previous findings, many CPs expressed that the lack of time was a barrier to introducing vaccination services in community pharmacy setups. Building on this, pharmacists were also expressed concerns about vaccine safety, lack of support from other HCPs, legal concerns with offering vaccine services, lack of reimbursement, complexity in the records management, and concerns about handling needles and performing procedures related to blood. Health authorities need to address all major barriers by providing continuous educational and training programs on the delivery of vaccination services at community settings, recognizing and authorizing CPs' services, and making investments in improving the resources and staff requirements at community pharmacies to integrate pharmacists in providing vaccination services. Structured, targeted, systematic training sessions focusing on the administration of vaccines, monitoring short-term and long-term adverse events upon vaccination, handling of blood and blood-related products, prevention of contamination, and good records management practice can address the existing barriers among CPs. Furthermore, HCPs' preparedness and cooperation are essential to incorporate CPs in vaccination services and implement services nationwide successfully. Strengths and limitations The major strength of our study lies in the inclusion of a large sample size that increases the robustness and reliability of the study findings. This paper is the new evidence to the scientific community regarding community pharmacists' knowledge, attitude, and willingness (KAW) to provide vaccination services aimed at strengthening the vaccine delivery system in Uganda. Our study findings offer valuable insights to all stakeholders involved in the Uganda National Expanded Program on Immunization (UNEPI) for expanding vaccination services within community settings. Furthermore, our study provides guidance for researchers to design mixed-method studies to gain in-depth insights about CPs' perspectives and develop educational interventional studies to improve their KAW to offer vaccination services. The health authorities, researchers, policymakers, and other stakeholders of the vaccination program should view our findings in light of the following possible limitations. Firstly, a cross-sectional design used in our study can't establish time-relationship between predictor and dependent variable. Secondly, self-reported data collection method have high risk of social desirability bias, where participants provide responses based on their intentions rather than their actual beliefs or practices. Thirdly, the sampling method used in our study may cause sample bias because participants were invited through referrals, which can affect the generalizability of the findings. Further, this sampling procedure has the risk of community bias due to the influence of the initial participants. Lastly, the online mode of data collection may result in selection bias and affect the generalizability of the study findings. Building on this, the online data collection mode doesn't allow us to estimate the response rate of the CPs. Conclusion The study concludes that the majority of CPs are willing to offer vaccination services at community pharmacies. This could help to improve nationwide vaccination rates and coverage, and enhance public access to vaccination services for the community. However, only about half of the respondents had adequate knowledge, and two-thirds had positive attitudes towards providing vaccination services. It is essential to provide targeted educational interventions that address barriers to vaccination and predictors of KAW among CPs to improve vaccination services at the community level. The health authorities, policymakers, and professional associations may consider including community pharmacists as vaccinators in the national immunization program to enhance vaccination services in Uganda. Declarations Authors Contribution E.F.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. R.L.: conceptualization and design; interpretation of findings; critical revision of the manuscript. B.R.B.: data acquisition; interpretation of findings; critical revision of the manuscript. M.J.S.M.: data acquisition; interpretation of findings; critical revision of the manuscript. V.E.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. S.P.N.B.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. T.M.Y.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. N.G.: data acquisition; interpretation of findings; critical revision of the manuscript. Consent for publication Not applicable. No individual-level data are presented in this manuscript Funding: NIL Author Contribution E.F.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. R.L.: conceptualization and design; interpretation of findings; critical revision of the manuscript. B.R.B.: data acquisition; interpretation of findings; critical revision of the manuscript. M.J.S.M.: data acquisition; interpretation of findings; critical revision of the manuscript. V.E.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. S.P.N.B.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. T.M.Y.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. 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About one in five children lacks access to lifesaving vaccines globally [2]. In 2024, 14.3\u0026nbsp;million children under one year old didn\u0026rsquo;t receive basic vaccines (referred to as zero-dose children) [2]. Almost all zero-dose children are living in low- and middle-income countries (LMIC), primarily in Africa and South-East Asia [2]. The percentage of children receiving a first dose of the measles vaccine was 84% in 2024, which is lower than the 2019 level of 86% [3]. Vaccine hesitancy (VH) is one of the top 10 global health threats [4]. The World Health Organization (WHO) vaccine advisory group acknowledged complacency, challenges in vaccine accessibility, and poor confidence as the key reasons for underlying VH [4]. Pharmacists are strengthening global health through offering vaccination services at community settings [5]. Their accessibility to public brands them as an essential healthcare fraternity in expanding vaccination accessibility, overcoming VH, and improving public health outcomes [6, 7]. According to the International Pharmaceutical Federation (FIP) data, as of 2024, pharmacists in 44 countries are authorized to provide vaccination services [5].\u003c/p\u003e\u003cp\u003eIn 1983, the Ugandan National Expanded Program on Immunization (UNEPI) was established. In 2001, it received support from the Global Alliance for Vaccines and Immunization (GAVI) to protect children and women of childbearing age from vaccine-preventable diseases [8]. In Uganda, immunization services are delivered by trained healthcare workers at health facilities and through mobile community outreach programs [9]. Periodically, add-on campaigns and administration of vaccinations are also carried out during outbreaks. The immunization services are aimed at completely immunizing children against Haemophilus influenzae, Measles, Tetanus, Tuberculosis, Hepatitis B, Diphtheria, Polio, Whooping cough, and Pneumococcal Infections [9]. Furthermore, 10-year-old females and women of reproductive age are immunized against the Tetanus and the Human papillomavirus infection [9].\u003c/p\u003e\u003cp\u003eIn Uganda, there is a 20% rise in children receiving all basic vaccinations since 2001. Additionally, under-five mortality decreased nearly 71% since 2000 [10]. Despite good progress in the reduction of under-five mortality, 69,000 children died due to variety of causes including vaccine preventable diseases in 2021 as per UN-IGME estimates [10]. According to the 2019 global burden study, 20% of under-five children deaths in Uganda were caused by the vaccine-preventable disease like measles, whooping cough, meningitis, and lower-respiratory tract infections [10]. Additionally, a report given by WHO/UNICEF national immunization coverage identified 100,096 zero-dose children in 2022 [10]. Literature indicates that maternal education, birth order, and geographic location of the child are the significant predictors of the ZD status of the children [10]. In relation to location, children living in urban slums and areas that are rural, hard-to-reach, and home to refugee populations are more linked to under- and un-vaccinated. Improved access to the immunization is the key driver to reduce the under-five mortality in developing countries [11].\u003c/p\u003e\u003cp\u003ePharmacist plays a significant role in improving vaccination rates and coverage by offering convenient and accessible vaccination services through the community pharmacies. In community pharmacy-based vaccination service (CPBVS), the role of pharmacists is extended to processes related to vaccine handling, administration, storage, education of the public regarding immunization, reporting adverse events following immunization. The evidence revealed that implementation of CPBVS results in various positive outcomes such as increasing vaccine availability, speed-up of the vaccination process, improves vaccination rate and coverage, and effective patient education. These outcomes ultimately bring to prevention of new cases, reduction of the complications associated with vaccine preventable diseases, and cost saving to the healthcare system. Parallel to the positive outcomes offered by CPBVS, there are certain challenges embedded in the implementation of this new community program. The challenges include; issues related to space to provide vaccine services, physician support, reimbursement policy, knowledge and skills of CPs, available training programs, health policy frameworks, staffing, vaccine safety concerns, and records management.\u003c/p\u003e\u003cp\u003eAfter analysing the significance of offering CPBVS, it is important to explore such services in the Ugandan context to strengthen the immunization system and improve the coverage. However, it is critical to understand the CPs' knowledge, attitudes, and willingness (KAW) to provide vaccination services before making policy and implementation. Our study aimed to assess the KAW of the CPs to offer vaccination services in community pharmacy settings in Uganda. Thereby, the study provides valuable insights for improving the healthcare system and vaccination services in Uganda.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eA nationwide, web-based, cross-sectional analytical survey was conducted among community pharmacists to explore KAWs' for the implementation of vaccination services in their pharmacies across Uganda.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003eA nation-wide, web-based, cross-sectional survey was conducted among community pharmacists for four months from February to March 2025. The Kampala International University School of Pharmacy Research Committee approved (KIU SOPRC/079/25) the research proposal and informed consent process. Online informed consent was obtained from all community pharmacists involved in this survey. No payment was given for participation, and anonymity of the identity was maintained to ensure the confidentiality and reliability of the data. This online survey followed the ethical principles outlined in the Declaration of Helsinki for research involving human participants and was conducted according to the STROBE guidelines for reporting of observational studies.\u003c/p\u003e\n\u003ch3\u003eStudy criteria\u003c/h3\u003e\n\u003cp\u003eAll licensed working community pharmacists, qualified with a Bachelor of Pharmacy or higher, irrespective of pharmacy ownership, and willing to provide online consent to participate in the study, were included. The study excluded trainee pharmacists, pharmacy assistants, student pharmacists, pharmacists with a diploma in pharmacy, and licensed pharmacists who are unwilling to provide online consent to participate in the survey.\u003c/p\u003e\n\u003ch3\u003eSample size determination and sampling process\u003c/h3\u003e\n\u003cp\u003eA single proportion population formula (n\u0026thinsp;=\u0026thinsp;Z^2p (1-p)/d^2) was used to determine the required sample size (n\u0026thinsp;=\u0026thinsp;384) for our study, assuming 50% of the community pharmacists are willing to participate, a 95% confidence interval, a 5% margin of error, and 80% power. After determination of sample size, finite population correction formula (adj. n\u0026thinsp;=\u0026thinsp;n*N/n+(N-1) was used to adjust the sample size (adj. n\u0026thinsp;=\u0026thinsp;286) by considering 1124 licensed pharmacists present in Uganda as the total population size (N). A 10% contingency was added as a non-response rate to the actual sample size, yielding a final sample size of 315. A snowball sampling (non-probability) technique was used to invite eligible community pharmacists to participate in this survey. Also, all invited participants were requested to share the survey tool with their fellow pharmacists working in other community pharmacy settings.\u003c/p\u003e\n\u003ch3\u003eSurvey tool\u003c/h3\u003e\n\u003cp\u003eA structured, self-administered, pre-validated online questionnaire was used to obtain responses from the community pharmacists. The questionnaire was developed by reviewing studies from other countries on CPs' involvement in providing vaccination services [12\u0026ndash;16]. Later, the questionnaire was modified according to the CPs' roles and responsibilities and vaccination policy in Uganda. The modified questionnaire was validated. The survey questionnaire was attached as a \u003cb\u003esupplementary file.\u003c/b\u003e The questionnaire comprises four sections: 1. Characteristics of CPs and pharmacies; 2. Knowledge about vaccines and vaccination; 3. Attitudes of CPs to provide vaccination services; 4. Willingness of community pharmacists to provide vaccination services; and 5. Existing barriers among community pharmacists to provide vaccination services. Tadele, Qamar, Meraya, Thomas\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCharacteristics of CPs and pharmacies\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eThe section covers CP's profile, including gender, age, highest pharmacy qualification, designation, experience, and weekly workload. Also, the current section covers the pharmacy's location, type, and internet accessibility.\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eKnowledge about vaccines and vaccination\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eA total of 10 questions were used to assess CPs' knowledge of vaccines and vaccination services. The section covers pharmacist awareness about name of vaccines (at least five) available in the routine immunization schedule, name of vaccine preventable diseases (at least five), effective strategy to prevent infections, temperature required to store vaccines, benefits of vaccination, adverse effects (at least three) associated with vaccine administration, rare occurrence of serious adverse effects, age of initiation of immunization as per schedule, and UNEPI abbreviation. Each correct response was marked as 1, and each wrong response as 0. The knowledge score expected from each respondent ranged from 0 to 10. After estimation of the knowledge score, Bloom\u0026rsquo;s cut-off criteria were used to categorize knowledge into good (80\u0026ndash;100% correct response; score 8\u0026ndash;10), moderate (60\u0026ndash;79% correct response; score 6\u0026ndash;7), and poor (\u0026lt;\u0026thinsp;60% correct response; score\u0026thinsp;\u0026lt;\u0026thinsp;6) adequacy levels toward vaccination services.\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAttitudes of CPs to provide vaccination services\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eWe used 10 statements to assess pharmacists' attitudes toward offering vaccination services in community pharmacy settings. The attitude section comprises statements on the accessibility of community pharmacies to the public, pharmacists' comprehensive vaccine knowledge, training of the CPs to provide vaccine services, the ease of facilitating vaccination spaces at pharmacies, the impact of vaccination on professional reputation, pharmacists' involvement in vaccination campaigns, public trust in community pharmacy services, support from other healthcare professionals in integrating vaccination services into community pharmacies, and the impact of vaccination services on patient flow. Participants' responses towards attitude statements were graded on a five-point Likert scale (Strongly agree-5 to strongly disagree-1). Statements nine and ten were reverse-coded to avoid acquiescence bias. The attitude domain score expected from each respondent ranged from 10 to 50. After determining the attitude score, we applied Bloom's cut-off criteria to divide attitude into positive (80\u0026ndash;100% correct response; score 40\u0026ndash;50), neutral (60\u0026ndash;79% correct response; score 30\u0026ndash;39), and negative (\u0026lt;\u0026thinsp;60% correct response; score\u0026thinsp;\u0026lt;\u0026thinsp;30) adequacy levels toward vaccination services.\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWillingness of community pharmacists to provide vaccination services\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eWe assessed the willingness or acceptance of the CPs to offer vaccination services at the pharmacy setting by asking a question with a dichotomous (Are you willing to provide vaccination services in your pharmacy setup?) answer (Yes/No).\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eExisting barriers among community pharmacists to provide vaccination services.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eRespondents were posed a multiple-response question, \u0026ldquo;What are the potential barriers towards offering vaccine services at your community pharmacy?\u0026rdquo;, to gather information on the barriers they perceive to providing vaccination services. We identified potential barriers towards vaccination services from the existing literature from low- and middle-income countries where such services are not yet implemented, as well as from high-income countries where community pharmacists are authorized to provide vaccination services. After collecting responses from all participants, we analyzed the data using descriptive statistics to identify the most common barriers to pharmacists offering vaccination services.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData collection\u003c/h2\u003e\u003cp\u003eThe data were collected by sharing the Google Form link on social media platforms (Twitter, Instagram, and LinkedIn) and in community pharmacists' professional WhatsApp groups. The first page of the e-survey form described the purpose, primary goals, anticipated benefits, and consent to participate in the online survey. Only eligible participants were allowed to complete the survey. Participants' eligibility was screened by asking questions about nationality, professional qualifications, pharmacist registration, and type of pharmacy. To avoid duplicates, the form was accessible only to one Google account. Additionally, to address missing responses, we made all questions mandatory. To achieve an adequate sample size, the survey link was active for three months after it began. The average time to complete this questionnaire was about 5 to 10 minutes. All invited community pharmacists were requested to share the link with their fellow pharmacists working in other community pharmacy setups in Uganda.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003e IBM SPSS Statistics (SPSS\u0026reg;) software, Version 28.0 (IBM, New York, USA), was used to analyze data obtained from the CPs. We used descriptive statistics to present the respondents' demographics, the barriers to vaccination, and the CPs' KAW for providing vaccination services. An inferential statistical tool, such as binary logistic regression, was applied to identify factors associated with good knowledge, a positive attitude, and the CPs' willingness to provide vaccination services. Variables with P\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in the binary analysis were added in a multiple logistic regression model to minimize confounding by extraneous variables. We considered a two-sided P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 to be statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWithin the study frame, we received 350 responses from community pharmacists. Of those, 60 were either unwilling or did not meet the eligibility criteria for participation.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographics of the community pharmacists\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the socio-demographic characteristics of the 290 community pharmacists (n\u0026thinsp;=\u0026thinsp;290) who completed the questionnaire. More than half of the CPs were aged 21\u0026ndash;30 (64.86%), male (64.83%), working as staff pharmacists (66.55%), and working for less than 10 hours per day (56.90%). Education levels varied, with the highest percentage of CPs holding a bachelor\u0026rsquo;s degree (77.59%), followed by those with a master\u0026rsquo;s degree or higher (22.41%). More than half of the pharmacies were located in cities (56.90%), and they are independently owned pharmacies (68.28%) rather than chain pharmacies (31.72%). About 79.65% of the pharmacies always had internet access.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of community pharmacists (n\u0026thinsp;=\u0026thinsp;290)\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e188 (64.83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e102 (35.17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years (Mean in years (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e191 (65.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e91 (31.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (2.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation of the pharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65 (22.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMunicipality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60 (20.69)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e165 (56.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e225 (77.59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaster or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65 (22.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacy type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChain pharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e92 (31.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndependent owned pharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e198 (68.28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21 (7.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eManager\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34 (11.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOwner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42 (14.48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaff Pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e193 (66.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork experience (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e205 (70.69)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58 (20.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (9.31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork hours per week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e165 (56.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125 (43.10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to the internet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e231 (79.65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSometimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55 (18.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (1.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge about vaccines and vaccination among community pharmacists\u003c/h2\u003e\u003cp\u003eIn our study, all community pharmacists (100%) were aware of the health benefits of vaccination. The majority of community pharmacists possessed knowledge of the age at which to initiate vaccination according to the Ugandan vaccination schedule (91.72%) and the UNEPI abbreviation (96.21%). A considerable proportion of the community pharmacists were aware of vaccine storage conditions (70.34%) and common routes of administration (72.41%). More than half of the community pharmacists know that vaccination provides better protection than other preventive measures (58.62%), that adverse effects associated with vaccine administration are rare (64.14%), that severe reactions attributed to vaccine administration are rare (61.72%), and that vaccine-preventable diseases are serious (56.55%). Only 47.93% of community pharmacists are aware of the names of vaccines available in Uganda's immunization schedule. Knowledge of vaccines and vaccination among community pharmacists is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\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\u003eKnowledge about vaccines and vaccination programs\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrect (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK1 Give five vaccination preventable infectious diseases?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e164 (56.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK2 Name the five vaccines available in the routine immunization schedule of Uganda.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e139 (47.93)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK3 Does infection prevention offer better protection than vaccination?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e170 (58.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK4 What is the optimal temperature to store common vaccines?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e204 (70.34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK5 What is the health benefit of vaccination?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e290 (100.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK6 Give three of the common adverse effects of vaccination?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e186 (64.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK7 Are serious adverse effects common with vaccines?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e179 (61.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK8: Give three common sites for the administration of vaccines?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e210 (72.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK9: At what age does vaccination start according to the Uganda vaccination schedule?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e266 (91.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK10 UNEPI in full stands for?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e279 (96.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAttitude of the community pharmacists to offer vaccination services\u003c/h2\u003e\u003cp\u003eMajority of the respondents were agreed that community pharmacies are widely accessible venues to public (80.00%), pharmacists\u0026rsquo; have comprehensive vaccine knowledge (76.90%), a minimum training is sufficient to equip CPs to provide vaccine services (92.07%), offering vaccination services can enhance the professional reputation of the pharmacists (88.62%), the pharmacist plays essential role in vaccination campaigns (93.44%), and public trust on community pharmacy services can be utilized to facilitate the vaccination services (88.28%). About 64.48% of community pharmacists agreed with the compulsory availability of vaccination services in community pharmacy settings. About 75% of the community pharmacists agreed to accommodate the space required for the vaccination services in the pharmacy building. However, 38.97% of community pharmacists were concerned about the support from doctors and other HCPs in integrating the pharmacist role into vaccination services. Many pharmacists disagreed with the statement that offering vaccination services in pharmacy settings can lead to a loss of patients. The attitudes of community pharmacists toward offering vaccination services are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAttitudes of the community pharmacists to offer vaccination services\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly agree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrongly disagree\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA1 Community pharmacies are easily accessible vaccination sites that can increase vaccination coverage.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e146 (50.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86 (29.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25 (8.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8 (2.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e25 (8.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA2 Community pharmacists have adequate knowledge regarding immunology and therapeutics related to vaccines.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107 (36.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e116 (40.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49 (16.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10 (3.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8 (2.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA3 Administration of vaccines is a technical skill that can be easily learned through additional training for community pharmacists.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e160 (55.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e107 (36.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (3.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6 (2.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7 (2.41)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA4 Do you agree that every pharmacist must provide vaccination services in community pharmacy?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82 (28.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e105 (36.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66 (22.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4 (1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e33 (11.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA5 A separate room/space is available, or can be easily created, in the current pharmacy building to deliver vaccination services.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e85 (29.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e130 (44.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41 (14.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3 (1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e31 (10.69)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA6 If I offer vaccination services, it can improve my professional image among the public and expand the practice.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e154 (53.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103 (35.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24 (8.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4 (1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5 (1.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA7 Vaccination services will allow pharmacists to participate in vaccination campaigns.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e156 (53.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e115 (39.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (3.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4 (1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5 (1.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA8 Patients' trust in pharmacists could facilitate the introduction of vaccination services in community pharmacy setups.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e132 (45.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e124 (42.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16 (5.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4 (1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14 (4.83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA9 If a community pharmacist got certified to vaccinate, it would affect the relationship between the pharmacist and other vaccinators (physicians)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47 (16.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e66 (22.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e103 (35.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4 (1.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e70 (24.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA10 If I start providing vaccination services in my pharmacy, I may lose my patients.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2 (0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16 (5.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45 (15.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6 (2.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e221 (76.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eAdequacy level of knowledge, attitude, and willingness among CPs towards vaccination services\u003c/h2\u003e\u003cp\u003eIn our study, the majority (87.93%) of the CPs are willing to provide vaccination services in their pharmacies. However, only 46.55% of respondents had good knowledge, followed by 29.65% with moderate knowledge of vaccines and vaccination services. Nearly two-thirds (65.17%) of the respondents showed a positive attitude towards providing vaccination services at community pharmacies. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the distribution of the CPs' adequacy levels of knowledge, attitudes, and willingness towards vaccines and vaccination services.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAdequacy level of community pharmacists\u0026rsquo; knowledge, attitude, and willingness towards vaccination services\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdequacy level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood (8\u0026ndash;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e135 (46.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate (6\u0026ndash;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86 (29.65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor (0\u0026ndash;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69 (23.79)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive (40\u0026ndash;50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e189 (65.17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutral (30\u0026ndash;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e84 (28.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative (\u0026lt;\u0026thinsp;30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (5.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWillingness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e255 (87.93)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot accepted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35 (12.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eWillingness and barriers to offer vaccination services at community pharmacies\u003c/h2\u003e\u003cp\u003eAbout 87.93% of pharmacists were willing to provide vaccination services in community pharmacies in Uganda. However, respondents perceived that CPs are not officially authorized (95.17%), lack of training (78.96%), lack of adequate staffing and resources (76.90%), lack of time (74.14%), and concerns about vaccine safety (64.83%) are the prominent barriers to offering vaccination services at community pharmacy setups in Uganda. More than half of the participants reported that the lack of support from other HCPs (59.66%), concerns about legal consequences of vaccination (56.90%), and maintaining vaccine administration records (52.76%) were major barriers for offering vaccination services at community pharmacies. The distribution of barriers to providing vaccination services at community pharmacies is presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBarriers to offer vaccination services at community pharmacy settings (n\u0026thinsp;=\u0026thinsp;290)\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarriers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB1: Lack of space in the pharmacy to administer and store vaccines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75 (25.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB2: Lack of time due to a heavy workload and being unable to include vaccine services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e215 (74.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB3: Lack of adequate staffing and resources to implement vaccine services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e223 (76.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB4: Lack of knowledge and skills to deliver vaccination services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e122 (42.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB5: Lack of training to offer vaccination services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e229 (78.96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB6: Lack of reimbursement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125 (43.10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB7: Lack of support from the health professionals to involve pharmacists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e173 (59.66)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB8: Lack of trust in pharmacist-delivered vaccine services among patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34 (11.72)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB9: Pharmacies are not authorized to provide vaccine services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e276 (95.17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB10: Concern about the legal consequences connected with vaccine services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e165 (56.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB11: Concerns regarding handling, use, and disposal of the needles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125 (43.10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB12: Uncomfortable with performing procedures related to blood or seeing blood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e122 (42.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB13: Concern regarding management of vaccine-induced adverse events\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e188 (64.83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB14: Concern about patient privacy in the pharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e119 (41.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB15: Difficulty and complexity of the management of records related to vaccines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e153 (52.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePredictors of community pharmacists\u0026rsquo; knowledge, attitude, and willingness to provide vaccination services\u003c/h2\u003e\u003cp\u003eIn our study, CPs who work 10 or more hours per day are 1.84 times more likely to have good knowledge of vaccines and vaccination services. Our study findings revealed that respondent's gender (Male: AOR 1.91; 95% CI 1.08\u0026ndash;3.41), age (31 and 40 years: AOR 2.34; 95% CI 1.13\u0026ndash;4.84)), job title (pharmacy manager: AOR 5.81; 95% CI 1.52\u0026ndash;22.07, owner: AOR 4.43; 95% CI 1.29\u0026ndash;15.22) and knowledge (good: AOR 3.41; 95% CI 1.74\u0026ndash;6.72) were significantly associated with the positive attitude towards offering vaccine services in community pharmacies. However, the pharmacists with more than 6 years' experience had lower odds (AOR 0.13; 95% CI 0.05\u0026ndash;0.39) of having a positive attitude towards vaccination services. Variables such as working in city regions and having four or more years of experience were associated with a lower willingness to provide vaccine services. Good knowledge levels, positive attitudes, and neutral attitudes towards vaccination services were significantly positively associated with community pharmacists' willingness. Predictors of community pharmacists' knowledge, attitudes, and willingness towards vaccination services are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. The COR, AOR, and P values of the predictors associated with the knowledge, attitude, and willingness to provide vaccination services among community pharmacists were presented in supplementary Table\u0026nbsp;1, 2, and 3.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinary and multiple logistic regression analysis of predictors of community pharmacists\u0026rsquo; knowledge, attitude, and willingness to provide vaccination services\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGood knowledge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePositive attitude\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eWilling to provide vaccination\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAOR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.58 (0.97\u0026ndash;2.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.54 (0.91\u0026ndash;2.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.99 (1.20\u0026ndash;3.28) **\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.91 (1.08\u0026ndash;3.41) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.89 (0.93\u0026ndash;3.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.56 (0.16\u0026ndash;1.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.45 (0.88\u0026ndash;2.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.61 (0.87\u0026ndash;2.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.36 (0.80\u0026ndash;2.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.34 (1.13\u0026ndash;4.84) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.37 (0.61\u0026ndash;3.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.30 (0.32\u0026ndash;5.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.78 (0.41\u0026ndash;7.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.23 (0.51\u0026ndash;35.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.26 (0.54\u0026ndash;51.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05 (0.12\u0026ndash;8.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacy Location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMunicipality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.50 (0.24\u0026ndash;1.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.50 (0.24\u0026ndash;1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.25 (0.60\u0026ndash;2.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.90 (0.33\u0026ndash;10.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.92 (0.21\u0026ndash;17.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.69 (0.39\u0026ndash;1.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.70 (0.38\u0026ndash;1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.22 (0.67\u0026ndash;2.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.31 (0.10\u0026ndash;0.91) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.14 (0.03\u0026ndash;0.74) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBachelor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaster or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.35 (0.77\u0026ndash;2.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.38 (0.76\u0026ndash;2.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.18 (0.49\u0026ndash;2.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacy type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChain pharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndependent owned pharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.87 (0.53\u0026ndash;1.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.41 (0.84\u0026ndash;2.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.59 (0.89\u0026ndash;2.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.51 (0.73\u0026ndash;3.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJob title\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacist in-charge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacy manager\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.33 (0.45\u0026ndash;3.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e5.28 (1.61\u0026ndash;17.27) **\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e5.81 (1.52\u0026ndash;22.07) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.34 (0.55\u0026ndash;9.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.55 (0.03\u0026ndash;10.32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOwner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.10 (0.38\u0026ndash;3.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e5.20 (1.68\u0026ndash;16.12) **\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e4.43 (1.29\u0026ndash;15.22) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.25 (1.10-35.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.80 (1.67\u0026ndash;47.43)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStaff Pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.16 (0.47\u0026ndash;2.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.85 (1.13\u0026ndash;7.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.72 (0.98\u0026ndash;7.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.20 (0.74\u0026ndash;6.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.52 (0.04\u0026ndash;5.99)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork experience (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.06 (1.14\u0026ndash;3.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.71 (0.90\u0026ndash;3.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.36 (0.71\u0026ndash;2.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.60 (0.29\u0026ndash;1.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.71 (0.30\u0026ndash;1.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.20 (0.05\u0026ndash;0.84) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.26 (0.56\u0026ndash;2.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.81 (0.31\u0026ndash;2.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.41 (0.18\u0026ndash;0.93) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.13 (0.05\u0026ndash;0.39) ***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.40 (0.14\u0026ndash;1.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.09 (0.02\u0026ndash;0.42) **\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork hours per week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1.65 (1.03\u0026ndash;2.63) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.84 (1.13\u0026ndash;3.01) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.10 (0.67\u0026ndash;1.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.52 (0.73\u0026ndash;3.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to the internet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSometimes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.02 (0.57\u0026ndash;1.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.86 (0.47\u0026ndash;1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e4.42 (1.03-19.00) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.78 (0.46\u0026ndash;16.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone (Rarely)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.38 (0.04\u0026ndash;3.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e (0.0E0-NV)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cspan\u003e$\u003c/span\u003e (0.0E0-NV)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e@ (0.0E0-NV)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e3.18 (1.72\u0026ndash;5.88)\u003c/b\u003e ***\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.41 (1.74\u0026ndash;6.72) ***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e4.41 (1.77\u0026ndash;11.01) **\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e4.69 (1.16-19.00) *\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.65 (0.87\u0026ndash;3.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.72 (0.85\u0026ndash;3.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.71 (0.74\u0026ndash;3.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.04 (0.26\u0026ndash;4.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAttitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e150.31 (33.68-670.73) ***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e34.75 (4.02-300.49) **\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e11.92 (3.46\u0026ndash;41.01) ***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e742.86 (58.91-9367.52) ***\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study is the first conducted among Ugandan community pharmacists to assess the knowledge, attitudes, and willingness to provide vaccination services. Additionally, we identified barriers towards the implementation of the vaccination services and predictors of the knowledge, attitude, and willingness of the CPs towards providing vaccination services. Evidence shows that offering vaccination services in community settings could enhance vaccine availability and accessibility; hasten vaccination; improve vaccination rates and coverage; reduce the risk of infection; and promote cost savings [17\u0026ndash;20]. Indeed, the current study findings and interpretations provide insights for the Ugandan public health practice and support advocacy efforts to implement vaccination services at community pharmacies.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge of CPs about vaccination\u003c/h2\u003e\u003cp\u003eIn our study, about 46.55% of CPs have good knowledge, and 29.65% have moderate knowledge about vaccines. Parallel to our study findings, a study conducted in Nigeria revealed 48.4% of the CPs had good knowledge [21]. In contrast with our study findings, a study conducted in Lebanon (96.1%), and Ethiopia (92.0%) showed a high level of good knowledge, and studies from Malaysia (12.8%) and Saudi Arabia (8.4%) revealed a low level of good knowledge compared with our study [13, 14, 22, 23]. The variations observed across studies from different countries can be explained by differences in the cut-off criteria used to categorize knowledge of vaccines, exposure to vaccine knowledge, and vaccine administration in their national pharmacy curricula, as well as by previous training on vaccination in their routine pharmacy curricula or in the practice of pharmacy. Good knowledge about vaccines is an essential component for CPs to promote awareness regarding vaccine-preventable disease and to provide education regarding importance of vaccination to the public to improve vaccine coverage of the nation [24]. Our study findings revealed that good knowledge among community pharmacists is a significant predictor of intention to provide vaccine services at community pharmacies. This finding is aligned with those of other studies by Luthin et al. and Onjpoy, which revealed a positive association between knowledge and intentions to provide pharmacy-based vaccination services [25, 26].\u003c/p\u003e\u003cp\u003eIn our study, all respondents were aware of the health benefits of vaccination. The majority of respondents knew about the UNEPI abbreviation (96.21%), age requirements for initiating childhood vaccines (91.72%), routes of vaccine administration (72.41%), and vaccine storage requirements (70.34%). However, CPs require adequate training in vaccine administration and in short- and long-term safety monitoring to transform their knowledge into skills and build confidence in offering vaccination services at community pharmacies.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eAttitude of CPs about vaccination\u003c/h2\u003e\u003cp\u003eRegarding the attitude domain, nearly two-thirds (65.17%) of the CPs showed a positive attitude towards providing vaccination services in community pharmacies. In contrast to our findings, community pharmacists showed high positive attitudes in Malaysia (95.5%) and Italy (91.7%), whereas the Ethiopian study reported a low positive attitude to offer vaccination services (55.8%) [13, 14, 23, 24]. The high positive attitude levels observed in Malaysian and Italian studies were greatly linked with the pivotal role pharmacists played as vaccinators during COVID-19 [27, 28]. When pharmacists are authorized and trained to administer vaccines, they develop a positive attitude towards their roles and responsibilities in providing vaccination services. In Uganda, health authorities did not integrate vaccination services into community pharmacies. As a result, pharmacists lack training opportunities and institutional support to improve their knowledge and skills in offering vaccination services. These factors might have contributed to the pharmacist's hesitancy to provide vaccination services. Additionally, differences in the pharmacy curriculum, health policies, and roles and responsibilities of the pharmacists across countries justify the variations observed in the findings.\u003c/p\u003e\u003cp\u003eIn our study, 80% of respondents agreed that community pharmacies are easily accessible vaccination sites and that CPs can improve vaccination coverage. The Malaysian research results matched these findings. The evidence supports the idea that, as vaccine providers, pharmacists and the accessibility of pharmacies improved vaccination rates and coverage [18, 19, 29, 30]. Accessibility of the vaccination site is a key determinant of public access convenience, which can increase vaccination rates. It is essential for rural and underserved communities, where it is challenging to reach the health facilities in low-income countries like Uganda. A study reported that patients choose community pharmacies as vaccination sites because they are convenient to reach [31].\u003c/p\u003e\u003cp\u003eAbout 92.07% of the CPs believed that vaccination is a technical skill and can be easily learned through additional training. A study conducted in Malaysia revealed that the majority of the CPs were neutral to this statement [13]. However, evidence indicates that patients were delighted with CP\u0026rsquo;s injection technique [32, 33]. Additionally, a study reported that the trained pharmacists administered 343 vaccine doses within two months without any reported adverse events [34]. These findings confirm that trained pharmacists can safely administer vaccines.\u003c/p\u003e\u003cp\u003eOnly 25.52% of respondents were favourable, and 35.52% were neutral about the relationship between CPs and vaccine providers if the pharmacist is certified as a vaccinator. Conflicting evidence existed about practitioners' support for integrating pharmacists into vaccination services. In one study, most of the physicians agreed with the pharmacist's support as a vaccinator in the healthcare system [35]. In contrast, another study found that practitioners were concerned about the quality and safety of vaccine recipients, as well as potential financial losses for pharmacists, which led them to not support pharmacy-based vaccination services [36]. The findings from the literature show that the preparedness of community and healthcare practitioners, who are existing vaccinators, is essential for integrating community pharmacists into vaccination services.\u003c/p\u003e\u003cp\u003eIn our study, variables like gender, age, job title, work experience, and knowledge levels were significantly associated with positive attitudes of the CPs to offer vaccination services. Evidence shows that knowledge [14], qualification [13, 37], area of the pharmacy [15], and working hours [15] were significantly associated with the attitudes of the CPs relation to vaccination services. The variations observed in predictors across studies was attributed with diversity in the participants characteristics. However, knowledge is the significant predictor for the positive attitude in our study and elsewhere reported. Studies conducted in the United States and New Zealand reported that poor knowledge was significantly associated with a negative attitude among HCPs [38, 39]. These findings highlight the importance of filling knowledge gaps to improve CPs' positive attitudes toward vaccination services. Building on this, it is imperative to plan training and educational programs based on the predictors identified in this study to improve CPs' positive attitudes toward vaccination services.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eWillingness of CPs to provide vaccination services\u003c/h2\u003e\u003cp\u003eIn our study, 87.93% of pharmacists were willing to offer vaccination services in community pharmacies in Uganda. Our study findings were aligned with the findings of the study conducted in Jordan (86.6%) [40]. The high willingness of the CPs is a foundation for the future health policy and practice changes in Uganda, aligned with the other regions where CPs expanded their role as vaccinators [16, 31, 38]. In low-income countries, Ethiopia has taken a step forward in implementing the \u0026ldquo;Pharmacy-Based Immunization Delivery Research-Based Pilot Project\u0026rdquo; by signing an MoU between the Ministry of Health and Population Services International and the FIP member organization, the Ethiopian Pharmaceutical Association [41].\u003c/p\u003e\u003cp\u003eCommunity pharmacists' good knowledge and positive attitudes were significantly correlated with their intention to provide vaccination services. Additionally, the location of the pharmacy and the CPs' experience were significantly associated with the CPs' willingness to offer vaccination services. These associations provide insights for developing educational interventions to address knowledge gaps and negative perceptions among community pharmacists, thereby increasing the acceptance rate. Evidence supports that the CPs who engaged in vaccination-related education programs expressed a high willingness to offer the vaccine-related activities [42]. The high willingness observed in our study suggests public health authorities and professional associations can utilize community pharmacists in vaccination services, especially in underserved and hard-to-reach areas. Furthermore, they are the most accessible and well-trusted healthcare professionals among the public. By considering these aspects, health authorities can utilize the CPs in vaccination campaigns to promote vaccination rates and coverage. However, before integration of this health fraternity in providing vaccination services, it is essential to address the perceived potential barriers towards vaccination practice in community pharmacy setups.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eBarriers to offering vaccination services at community pharmacies\u003c/h2\u003e\u003cp\u003eLack of authorization (95.17%) is the most common barrier to providing vaccination services at community pharmacies in Uganda. This finding was consistent with the results of various studies conducted in Ethiopia, Malaysia, and Jordan [13, 14, 40]. According to national guidance, pharmacists are not authorized to provide vaccination services in Uganda, which is allowed in many countries such as Argentina, Australia, Canada, Costa Rica, Denmark, Ireland, New Zealand, the Philippines, Portugal, South Africa, Switzerland, the UK, and the USA [43]. These countries recognized the potential benefits of pharmacists as community vaccinators.\u003c/p\u003e\u003cp\u003eLack of training (78.96%) is the second top perceived barrier for the CPs to provide vaccination services in the present study. A Polish study reported that pharmacists who completed training had a significant association with the willingness to offer vaccination services [12\u0026ndash;14, 40]. A Polish study reported that pharmacists who completed training had a significant association with the willingness to provide vaccination services [44]. The previous literature and current study findings underscore the importance of continuous educational and training programs to promote pharmacy-based vaccination services.\u003c/p\u003e\u003cp\u003eLack of adequate staffing and resources availability (76.90%) is the top third perceived barrier among CPs to offer vaccination services. In line with our study findings, previous studies have underscored that insufficient resources are a major barrier to offering vaccination services in community pharmacies [13, 14]. Additionally, in connection with previous findings, many CPs expressed that the lack of time was a barrier to introducing vaccination services in community pharmacy setups. Building on this, pharmacists were also expressed concerns about vaccine safety, lack of support from other HCPs, legal concerns with offering vaccine services, lack of reimbursement, complexity in the records management, and concerns about handling needles and performing procedures related to blood. Health authorities need to address all major barriers by providing continuous educational and training programs on the delivery of vaccination services at community settings, recognizing and authorizing CPs' services, and making investments in improving the resources and staff requirements at community pharmacies to integrate pharmacists in providing vaccination services. Structured, targeted, systematic training sessions focusing on the administration of vaccines, monitoring short-term and long-term adverse events upon vaccination, handling of blood and blood-related products, prevention of contamination, and good records management practice can address the existing barriers among CPs. Furthermore, HCPs' preparedness and cooperation are essential to incorporate CPs in vaccination services and implement services nationwide successfully.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eThe major strength of our study lies in the inclusion of a large sample size that increases the robustness and reliability of the study findings. This paper is the new evidence to the scientific community regarding community pharmacists' knowledge, attitude, and willingness (KAW) to provide vaccination services aimed at strengthening the vaccine delivery system in Uganda. Our study findings offer valuable insights to all stakeholders involved in the Uganda National Expanded Program on Immunization (UNEPI) for expanding vaccination services within community settings. Furthermore, our study provides guidance for researchers to design mixed-method studies to gain in-depth insights about CPs' perspectives and develop educational interventional studies to improve their KAW to offer vaccination services. The health authorities, researchers, policymakers, and other stakeholders of the vaccination program should view our findings in light of the following possible limitations. Firstly, a cross-sectional design used in our study can't establish time-relationship between predictor and dependent variable. Secondly, self-reported data collection method have high risk of social desirability bias, where participants provide responses based on their intentions rather than their actual beliefs or practices. Thirdly, the sampling method used in our study may cause sample bias because participants were invited through referrals, which can affect the generalizability of the findings. Further, this sampling procedure has the risk of community bias due to the influence of the initial participants. Lastly, the online mode of data collection may result in selection bias and affect the generalizability of the study findings. Building on this, the online data collection mode doesn't allow us to estimate the response rate of the CPs.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study concludes that the majority of CPs are willing to offer vaccination services at community pharmacies. This could help to improve nationwide vaccination rates and coverage, and enhance public access to vaccination services for the community. However, only about half of the respondents had adequate knowledge, and two-thirds had positive attitudes towards providing vaccination services. It is essential to provide targeted educational interventions that address barriers to vaccination and predictors of KAW among CPs to improve vaccination services at the community level. The health authorities, policymakers, and professional associations may consider including community pharmacists as vaccinators in the national immunization program to enhance vaccination services in Uganda.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eAuthors Contribution\u003c/h2\u003e\u003cp\u003eE.F.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. R.L.: conceptualization and design; interpretation of findings; critical revision of the manuscript. B.R.B.: data acquisition; interpretation of findings; critical revision of the manuscript. M.J.S.M.: data acquisition; interpretation of findings; critical revision of the manuscript. V.E.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. S.P.N.B.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. T.M.Y.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. N.G.: data acquisition; interpretation of findings; critical revision of the manuscript.\u003c/p\u003e\u003c/div\u003e\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable. No individual-level data are presented in this manuscript\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNIL\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.F.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. R.L.: conceptualization and design; interpretation of findings; critical revision of the manuscript. B.R.B.: data acquisition; interpretation of findings; critical revision of the manuscript. M.J.S.M.: data acquisition; interpretation of findings; critical revision of the manuscript. V.E.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. S.P.N.B.: conceptualization and design; data acquisition; interpretation of findings; critical revision of the manuscript. T.M.Y.: conceptualization and design; data acquisition; data analysis; interpretation of findings; primary draft of manuscript and critical revision of the manuscript. N.G.: data acquisition; interpretation of findings; critical revision of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank all community pharmacists for spending their valuable time in providing data to strengthen the vaccination policies in Uganda\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author, Narayana Goruntla, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCarter A, Msemburi W, Sim SY, A.M. Gaythorpe K, Lindstrand A, Hutubessy RCW. 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Readiness and Willingness to Provide Immunization Services after Pilot Vaccination Training: A Survey among Community Pharmacists Trained and Not Trained in Immunization during the COVID-19 Pandemic in Poland. International Journal of Environmental Research and Public Health. 2021;18. https://doi.org/10.3390/ijerph18020599.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Community pharmacists, vaccination services, immunization, awareness, perception, acceptance ","lastPublishedDoi":"10.21203/rs.3.rs-7923040/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7923040/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCommunity Pharmacists (CPs) play a significant role in improving vaccination rates and coverage by offering vaccination services in various countries. However, little is known about CP\u0026rsquo;s willingness to offer vaccination services in Uganda. The study aimed to assess the knowledge, attitudes, and willingness (KAW) of the CPs to offer vaccination services in community pharmacy settings in Uganda\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA nation-wide, web-based, cross-sectional survey was conducted using a snowball sampling technique to obtain responses from community pharmacists across Uganda. A pre-designed data collection form was used to obtain information regarding demographics, knowledge about vaccination, attitude, willingness, and barriers to providing vaccination services among community pharmacists. A binary and multiple logistic regression analysis was employed to identify predictors of KAW towards vaccination services.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 290 community pharmacists participated in the study. Overall, 46.55% of pharmacists demonstrated good knowledge, 65.17% positive attitude, and 87.93% were willing to provide vaccination services. Barriers like lack of authorization (95.17%), lack of training (78.96%), lack of staffing/resources (76.90%), time constraints (74.14%), and vaccine-associated safety concerns (64.83%) were expressed by the CPs to offer vaccination services. Good knowledge and positive or neutral attitudes were significantly associated with willingness to offer vaccination services.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe majority of the community pharmacists are willing to provide vaccination services, which could improve national vaccination coverage and public access. However, only half had adequate knowledge, and two-thirds showed positive attitudes. Targeted educational interventions and inclusion of community pharmacists in Uganda\u0026rsquo;s national immunization program are recommended to strengthen vaccination services.\u003c/p\u003e","manuscriptTitle":"Knowledge, Attitudes, and Willingness of community pharmacists to provide vaccination services: A web-based cross-sectional survey in Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-07 17:26:52","doi":"10.21203/rs.3.rs-7923040/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-17T08:24:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T03:20:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157652527105564707700937923936465379362","date":"2026-01-21T05:34:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-16T13:19:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267420726787091126343964099036147794439","date":"2025-10-29T07:56:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-29T06:20:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T06:09:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-27T19:34:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-25T12:06:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-10-25T12:02:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0bf0db0d-5c8a-421e-8ba7-5329567d42f4","owner":[],"postedDate":"November 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:06:18+00:00","versionOfRecord":{"articleIdentity":"rs-7923040","link":"https://doi.org/10.1186/s12913-026-14440-2","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-03-30 15:59:02","publishedOnDateReadable":"March 30th, 2026"},"versionCreatedAt":"2025-11-07 17:26:52","video":"","vorDoi":"10.1186/s12913-026-14440-2","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14440-2","workflowStages":[]},"version":"v1","identity":"rs-7923040","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7923040","identity":"rs-7923040","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}