Evaluating Pharmacist Level of Involvement in disease Prevention Activities in Nigeria

David U Adje1, Azuka C Oparah2

1Department of Clinical   Pharmacy and Pharmacy Administration, Delta State University, Abraka, Nigeria

2Department of Clnical Pharmacy and Pharmacy Practice, University of Benin, Benin City, Nigeria

Received: 01-Apr-2017 , Accepted: 26-Aug-2017

Keywords: Disease prevention, Preventive health, Community pharmacy, Nigeria

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Abstract

Evidence exists in literature to support involvement of community pharmacists in a broad range of preventive health activities especially in developed countries. There is a need to explore extent of pharmacists’ involvement in resource limited countries. The objectives of this study were to describe community pharmacists’ involvement in disease prevention strategies and explore facilitators and barriers to involvement. A forty item pretested self- completion questionnaire with 0.944 reliability was administered to a convenient sample of 500 community pharmacists in 3 major cities in Nigeria. Self- reported involvement  in preventive health strategies was evaluated on a 5 point response scale ranging from 1 (Not involved at all ) to 5 (very much involved). Response rate was 90.6% (453/500). Mean scores on face to face delivery of preventive health service was consistently higher than leaflet or text message. Pharmacists were mostly involved in preventive health services in the area of hypertension mean (4.38±0.91) followed by Diabetes (4.35±0.86)  ST1 (4.27±0.84) and weight reduction (3.39±1.37). Areas of least involvement include osteoporosis (2.2±1.25), hyperlipidemia (2.9±1.43), travel health (2.33±1.33) and cancer risk assessment (1.67±0.96). Lack of adequate training was the most frequent reason for low level of involvement. Community pharmacists in Nigeria are involved to varying extent in a wide range of preventive health activities. Areas of low involvement in this study indicate a need for capacity building in order to increase level of community pharmacist involvement in preventive health activities.

1 Introduction

The cost of effectiveness of health systems based mostly on curative care is still a subject of debate.1-3 Some authorities have therefore advocated adoption of preventive health care as a tool for ensuring a healthier population and reducing skyrocketing health care cost.4-5

Community pharmacies have long been recognized as a very suitable site for delivering preventive health services.6-8 Apart from proximity to communities they serve; the pharmacist has been described as the most accessible of all health care providers.9-12 Most pharmacies have long and flexible opening hours, do not require previous appointment and a sizable number of people visit the pharmacy at least once a year and many consult pharmacists on a wide range of health issues. 13-14   These unique characteristics have the potential to provide a large population pool in community pharmacies that could be a target of preventive health services. Evidence exists in literature to support involvement of pharmacists in a broad range of  activities  including advice on preventive health,15-16 diet and healthy eating17-18, smoking cessation,19-20 sexual health services  including emergency hormonal contraceptives,21-22 cardiovascular risk reduction,23-25 cancer prevention,26 osteoporosis risk assessment and reduction,27-28  and other aspects of preventive health care. 29-30 Most of these studies however have been carried out in developed countries. There is little or no evidence base for a similar level of involvement in preventive health services in a resource limited area of the world like Nigeria. This study seeks to explore the level of involvement in preventive health care services among Nigerian pharmacists. The objectives of this study were to describe community pharmacists’ involvement in disease prevention strategies   and explore facilitators and barriers to involvement.

2 Materials and Methods

A total 40 preventive health services were identified from literature search. A questionnaire was developed based on preventive health strategies identified.  Section A dealt with demographic profile of superintendent pharmacist while section B, C, and D explored extent of   involvement in various preventive health activities by face to face, use of   leaflets and text messages respectively. Self- reported involvement of pharmacists was evaluated on a 5 point response scale ranging from 1 (Not involved at all to 5 (very much involved). Three modes of delivery of preventive health services were explored – face to face, use of leaflets and use of text messages. The last section explored reasons for low level of involvement in preventive health strategies.

2.1 Data collection/analysis

A cross sectional survey of 500 community pharmacists was carried out in three cities in South west and South Nigeria. Pharmacists were asked to indicate their perceived level of involvement on a 5 point Likert  type response scale as follows; Not involved at all=1; Not involved =2;  Involved =3; Very involved=4; and Very much involved=5.  Data was entered into SPSS version 20 package. Ratings were treated as interval data suited for quantitative analysis. Mean scores were computed for each variable on a scale of 1-5; with a midpoint=3. Percentage involvement was computed by summing up proportion of involved, very involved and very much involved responses. Possible association between demographic variables and responses were explored using chi-square tests.

2.2 Ethical approval

Ethical approval was obtained from the Delta State University Health Research Ethics Committee, Oghara, Delta state, Nigeria

3 Results

Response rate was 90.6% (453/500).  The questionnaire showed a high level of internal consistency as seen from a Chronbach’s alpha value of 0.944.

More than one third (39.5%) of the pharmacies had been in operation for 5 years or less and nearly three quarters of respondents (67.3%) had no additional qualifications. Demographic details of participating pharmacists are shown in table 1.

Mean scores on face to face mode of delivery of preventive health services was consistently higher (3.19 ±1.16) than use of leaflet (2.11± 1.56) and text messages (1.61±1.04). Pharmacists were most involved in preventive health services in the areas of lifestyle advice (4.00±1.03), followed by sexual health (3.72±1.01) and nutritional advice/ food safety (3.63±1.18), Figure 1.

Specific areas of high involvement include high blood pressure (4.38±0.91), diabetes (4.35±0.86), STIs (4.27±0.84).  Self- reported involvement in the areas of   osteoporosis, asthma control, and vaccine administration were quite low with mean scores 2.2±1.25, 2.9 ±1.43, and 1.96±0.86 respectively. Specific details of pharmacist’s involvement in preventive health services are shown in table 2.

A Chi Square test was performed to evaluate association between demographic variables and total involvement in preventive health activity. Year of qualification, duration of pharmacy operation, and additional qualifications in public health were significantly associated with involvement in preventive health care activities. (X2=558.96, df 300, PË‚0.001; X2 =793.03, df 404, PË‚0.001; X2=131.55, df101,P=0.0022; and X2=938.45,df707.PË‚0.001) respectively.

Location of pharmacy and display of leaflet in pharmacy was not significantly associated with involvement (X2=208.60.df 360, P= 0.360, X2=124.56, df101, P=0.056 ), respectively.

Lack of adequate training was the reason given for non-involvement by more than half of the pharmacists 248 (54.7%) followed by lack of public acceptance 147 (32.5%). Other reasons included lack of legislative backing and lack of demand for services. Table 3 shows the reasons for none involvement of pharmacists in preventive health services.

4 Discussions

Community pharmacists have been involved in preventive health activities since the beginning of the century and preventive health roles for pharmacists are rapidly expanding.31-32 This is especially so in developed nations of the world.33 However, such an evidence base is still lacking in developing and resource limited countries.34-35 This study revealed that Nigerian community pharmacists are modestly involved in preventive health services. For instance in the area of advice about lifestyle modification, level of involvement ranged from 75% to 95.4%.

Despite a high level of self- reported involvement, only a handful of published articles in the area of pharmacists’ involvement in preventive health services have their setting in Nigeria.36-39 This might suggest a need for documentation of preventive health activities by community pharmacists.  Documentation is a critical step in demonstrating impact of interventions.40 and the more activities are documented, the quicker preventive health roles of pharmacists will be acceptable to the public and other health care professionals in Nigeria.  A cross sectional study evaluating ideal and actual involvement of pharmacists in public health activities showed that pharmacists in Quebec were most involved in screening for hypertension and diabetes and least involved in dental health.41 In the present  study, lifestyle advice was the area of involvement by most pharmacists, followed by sexual health and disease screening. 

Pharmacists’ involvement in oral health was also quite modest.  This profile of involvement differs from the findings of a review of literature focusing on developed countries which showed that pharmacists in the UK were mostly involved in smoking cessation, healthy eating, provision of emergency hormonal contraceptive, as well as drug abuse and addiction prevention.42  The differing profiles might be a reflection of the characteristics of pharmacy practice in the different settings.

The preference for face to face preventive health services is understandable given the fact that leaflet based approach involves extra cost and requires some training in order to acquire skills in developing patient education materials. The use of bulk text messages and the social media in delivering preventive health services offer a huge potential that community pharmacists in Nigeria are not exploiting at present. Telephone counseling, defined as any type of intervention aimed at delivering health counseling through the telephone or mobile phone given by a health care provider (doctor, nurse ,dietician, pharmacist or social worker’) has been shown to be effective in delivering interventions. 43 There is a need for pharmacists to tap into this mode of delivering preventive health messages in order to reach more people.

Lack of training was also the reason adduced for low level of involvement by majority of pharmacists in this study, followed by lack of public acceptance of preventive health roles, lack of space, finance and time. The importance of training has been a recurring theme in pharmacist related discourse.44 It is therefore very vital to focus training initiatives on areas of low involvement identified in this study. These areas include lipid management, immunization advocacy and administration, travel health, and use of printed materials and information technology in pharmacy practice. 

The  significant association between  length of existence of pharmacy, year of pharmacists’ qualification, additional qualifications in public health and the level of involvement in preventive health activities suggests  that the more matured and experienced a pharmacist is the greater the likelihood of involvement in preventive health activities.

5 Conclusions

Community pharmacists in Nigeria are involved in preventive health strategies to varying extent. Hypertension diabetes, weight reduction are areas of high level of involvement while activities in the area of immunization, oral and mental health, food safety, osteoporosis, dyslipidemia and cancer awareness and prevention were low. There is a need for training programs to develop preventive health capacity and improve involvement of community pharmacist in preventive health services.

6 Acknowledgements

The authors appreciate the support of the Nigerian government Tertiary Educational Trust Fund (TETFUND) in providing part funding for this work.

7 Conflict of interests

The authors report no conflicts of interest.

8 Author’s contributions

DUA and ACO were involved in conducting the research work, writing manuscript and draft the manuscript. Both authors read and approved the final manuscript.

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