Abstract
Background
Pharmacological therapies are key component of effective smoking-cessation management; however, the extent to which community pharmacists are prepared to deliver these interventions remains unclear.
Objective
This study explored the knowledge, attitudes, and practical engagement of community pharmacists toward pharmacological interventions of smoking cessation, and to examine the influence of demographic factors on these outcomes.
Methods
A cross-sectional survey was conducted between January and August 2024 among licensed community pharmacists in Saudi Arabia. A structured questionnaire, distributed contained four sections: demographics, knowledge, attitudes, and practices.
Results
A total of 213 pharmacists participated (92% male, 80.8% non-Saudi), mostly aged 25–34 years and holding a bachelor’s degree (94.8%). Mean scores indicated moderate levels of knowledge (6.31 ± 2.7/10), attitude (13.07 ± 6.5/25), and practice (6.85 ± 2.1/12) toward smoking cessation. Although nearly one-third of pharmacists (30.5%) consistently referred patients to Ministry of Health cessation programs, routine assessment of smoking status was less common, with only 17.8% regularly asking patients whether they smoked. Reliability was good-to-excellent (α = 0.800–0.951). Knowledge correlated positively with practice (r = 0.203, p = 0.003) but negatively with attitude (r = − 0.244, p < 0.001). Higher knowledge was associated with younger age (p = 0.035). Practice scores were higher among pharmacists from the Northern (p = 0.001) and Eastern regions (p = 0.006), and among those with prior smoking-cessation training (p = 0.012).
Conclusion
Community pharmacists in Saudi Arabia demonstrated moderate levels of knowledge, attitudes, and practices related to pharmacological smoking-cessation interventions. Knowledge was positively associated with practice but negatively with attitudes. Practice levels varied significantly by region and were higher among pharmacists who had received prior training, highlighting the importance of targeted professional development and better integration of smoking cessation services into community pharmacy practice.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12913-025-13854-8.
Keywords: Community pharmacists, Smoking cessation, Nicotine addiction, Pharmacological interventions, Saudi arabia
Introduction
Smoking tobacco is one of the leading causes of morbidity and mortality worldwide [1]. Global estimates from WHO indicate that more than eight million individuals die each year due to smoking, including more than 1.3 million deaths linked to second-hand smoke exposure [2]. In addition, smoking is associated high risks of cardiovascular disease, cancer, and chronic respiratory diseases, and lower quality of life [3–8]. Smoking is major public health issue in many countries [9, 10]. In Saudi Arabia, smoking prevalence is a serious health concern [11] and tobacco use remains a significant public health concern, affecting approximately 20–25% of adults and 17.7% of adolescents aged 13–15 years, with consistently higher rates in men compared to women [12–14]. Also, the economic burden of smoking is significant, an earlier economic analysis estimated that smoking cost Saudi Arabia approximately US $20.5 billion between 2001 and 2010, with an estimated 280,000 premature deaths during the same period [15]. More recent reports from the Gulf region show that smoking and second-hand smoke together generated an economic burden of $34.5 billion in 2016, about 1.04% of the total GDP of Gulf countries, with Saudi Arabia contributing a significant share of these costs [16]. Recently, many health initiatives promote healthier lifestyles, smoking control initiatives have become prioritized [17]. In line with Vision 2030 goals to enhance public health, the Ministry of Health (MOH) established programs to control smoking include smoking cessation clinics, nationwide awareness campaigns, taxation policies, and restrictions on tobacco advertising [18]. However, these efforts face challenges, including high relapse rates, and limited integration of cessation support across different healthcare settings [19].
Pharmacists’ responsibilities include patient counseling, health education, and referral to specialized services [20, 21]. In Saudi Arabia, the community pharmacy sector includes around 20,900 pharmacists, and recent work has shown that community pharmacies provide up to 17 different clinical and support services, such as vaccination, minor ailment management, medication counselling, and smoking cessation [22]. For many patients, community pharmacists represent the primary point of access to healthcare advice, that facilitate them to address smoking cessation inquiries and provide evidence-based recommendation [21, 23, 24]. In fact, several studies have shown that pharmacist’s role in smoking cessation interventions and can significantly increase quit rates, improve patient adherence to pharmacotherapy, and reduce relapse [25–28].
Therefore, this study examined pharmacists’ self-reported pharmacological knowledge and practices in delivering cessation services and identified demographic factors that predict variation in these areas. This study provides a comprehensive assessment of community pharmacists’ knowledge, attitudes, and practices (KAP) regarding pharmacological interventions for smoking cessation in Saudi Arabia.
Methods
Study design and duration
This is an online cross-sectional survey study. It was conducted over eight months period, from January to August 2024. The aim was to assess KAP of community pharmacists in Saudi Arabia regarding pharmacological interventions for smoking cessation.
Study population and sampling
The study targeted licensed community pharmacists actively practicing in Saudi Arabia during the study period. Community pharmacists were the focus of this study because they represent one of the most accessible healthcare providers in Saudi Arabia, offering immediate, walk-in access to medication counselling and health advice, which positions them to play an important role in delivering pharmacological smoking cessation aids. A total of 213 community pharmacists completed the survey. Participants were eligible for inclusion if they were licensed community pharmacists practicing in Saudi Arabia during the study period, were 18 years of age or older, held at least a Bachelor of Pharmacy degree, and were able to read and respond to an English-language questionnaire. Individuals were excluded if they were not working in a community pharmacy, were pharmacy technicians or assistant pharmacists, or submitted incomplete survey responses. Participants were recruited using a convenience sampling approach covering the five major geographical regions of Saudi Arabia (Northern, Southern, Central, Eastern, and Western). The questionnaire was designed based on previously validated studies on smoking cessation and adapted for the local context [24, 29, 30]. The full questionnaire is provided as a (Supplementary 1). The questionnaire comprised four sections. First, the demographics section collected information on gender, age, nationality, working region, highest pharmacy degree, country awarding the degree, years of experience, number of patients seen per day, smoking status, prior training in smoking cessation, and provision of smoking cessation services. Second, the knowledge section included ten items assessing pharmacists’ awareness of smoking cessation pharmacotherapies and techniques, such as nicotine replacement therapy, bupropion, and varenicline. Responses were recorded as “True”, “False”, or “Not sure”. Third, the Attitudes section consisted of five statements rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) that evaluated pharmacists’ attitude of their role and effectiveness in smoking cessation. Finally, the practices section contained six items measuring the frequency “Never”, “Sometimes”, or “Always” of smoking cessation activities, including asking patients about smoking, providing counseling, and referring patient’s cessation programs. A preliminary version of the questionnaire was tested with a small sample of pharmacists to check its clarity and relevance, and their suggestions were used to refine the final tool.
Data collection procedure
The survey was distributed via Google Forms through the Nahdi Medical Company, a nationwide pharmacy chain, enabling participation from pharmacists across Saudi Arabia. The survey link was distributed via Nahdi Medical Company’s internal email and digital communication system to reach community pharmacists nationwide. Participation was voluntary, and informed consent was obtained on the first page of the survey before proceeding to the questionnaire. No identifying information was collected to ensure confidentiality.
Data analysis
Analysis of the dataset was performed using SPSS Statistics version 27 (IBM Corp., Armonk, NY, USA). Demographic details and item responses were presented using descriptive statistics, frequencies, percentages, averages, and standard deviations. Independent t-tests and one-way ANOVA were performed to compare differences between groups, followed by the Least Significant Difference (LSD) post hoc test for multiple comparisons where relevant. Relationships among the knowledge, attitude, and practice domains were evaluated using Pearson’s correlation coefficient. A General Linear Model (GLM) was employed to identify demographic predictors of KAP scores. Practice scores were descriptively categorized using Bloom-style thresholds; however, all inferential analyses (comparisons and GLM models) were performed using the continuous practice score. A p-value of < 0.05 was considered statistically significant. Internal consistency reliability was examined using Cronbach’s alpha. The knowledge domain showed good reliability (α = 0.800), the Attitude domain excellent reliability (α = 0.951), and the practice domain acceptable reliability (α = 0.737).
Ethical approval
This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Biomedical Research Ethics Committee of Umm Al-Qura University (Approval No. HAPO-02-K-012-2022-11-1296). All participants provided informed consent electronically before completing the survey. Participation was voluntary, anonymity was ensured, and no identifying information was collected. Data were stored securely and used only for research purposes.
Results
Demographic characteristics
A total of 213 community pharmacists completed the survey. The demographic distribution is shown in Table 1. The majority of participants were male (92.0%, n = 195), while only 8.0% (n = 17) were female. The dominant age group was 25–34 years (59.6%, n = 127), followed by 35 to 44 years (33.3%, n = 71). Very few respondents were younger than 25 years (0.9%, n = 2) or older than 55 years (0.5%, n = 1). A large proportion were non-Saudi pharmacists (80.8%, n = 172), with Saudis representing only 19.2% (n = 41). Regarding education, most pharmacists held a bachelor’s degree (94.8%, n = 202), while only 2.8% (n = 6) and 2.3% (n = 5) had obtained a master’s or Ph.D., respectively. Non-Saudi institutions accounted for the majority of pharmacy degrees (77.5%). In terms of experience, 35.2% had worked for 6–10 years, 23.5% had less than 5 years, while 19.7% had more than 15 years in practice. Patient volume varied: 52.6% saw 50–100 patients daily, 35.2% saw more than 100, and 12.2% reported fewer than 50. Most pharmacists were non-smokers (83.1%), with 12.7% reporting current smoking. Importantly, 43.7% had attended prior training in smoking cessation, and 55.4% offered cessation services in their pharmacies.
Table 1.
Demographic characteristics of community pharmacists (N = 213)
| Demographics | Count | % | |
|---|---|---|---|
| Total | 213 | 100.0 | |
| Gender | Male | 195 | 92.0 |
| Female | 17 | 8.0 | |
| Missing | 1 | ||
| Age | 18–24 | 2 | 0.9 |
| 25–34 | 127 | 59.6 | |
| 35–44 | 71 | 33.3 | |
| 45–54 | 12 | 5.6 | |
| 55–64 | 1 | 0.5 | |
| Nationality | Saudi | 41 | 19.2 |
| Non-Saudi | 172 | 80.8 | |
| Working region | Northern region | 27 | 12.7 |
| Western region | 63 | 29.6 | |
| Central region | 52 | 24.4 | |
| Eastern region | 44 | 20.7 | |
| Southern region | 27 | 12.7 | |
| Highest pharmacy degree | Bacholar | 202 | 94.8 |
| Master | 6 | 2.8 | |
| PH.D | 5 | 2.3 | |
| Country awarding the highest degree | Saudi | 48 | 22.5 |
| Non-Saudi | 165 | 77.5 | |
| Years of experience in community pharmacy practice | 0–5 | 50 | 23.5 |
| 6–10 | 75 | 35.2 | |
| 11–15 | 46 | 21.6 | |
| More than 15 | 42 | 19.7 | |
| Number of patients seen per day | Less than 50 | 26 | 12.2 |
| 50–100 | 112 | 52.6 | |
| More than 100 | 75 | 35.2 | |
| Tobacco smoking status | Current smoker | 27 | 12.7 |
| Former smoker | 9 | 4.2 | |
| Non-smoker | 177 | 83.1 | |
| Have you attended specific training in smoking cessation prior this time? | Yes | 93 | 43.7 |
| No | 120 | 56.3 | |
| Do you offer a smoking cessation service in the pharmacy? | Yes | 118 | 55.4 |
| No | 95 | 44.6 | |
Knowledge of smoking cessation therapies
Pharmacists’ knowledge scores are summarized in Table 2. The mean score was 6.31 (SD = 2.7) out of 10. Strong knowledge was observed regarding the role of Nicorette gum as nicotine replacement therapy (85.4% correct) and its contraindication during pregnancy (71.8% correct). However, knowledge gaps were apparent: only 49.3% correctly identified the recommended 2 mg gum dosage for patients smoking ≤ 20 cigarettes/day, and less than half (40.8%) were aware that bupropion should not be initiated on the quit date but rather in advance.
Table 2.
Knowledge of community pharmacists regarding smoking cessation therapies (N = 213)
| Knowledge n = 213 | False | Not sure | True |
|---|---|---|---|
| Nicorette Gum is a nicotine replacement therapy (NRT) that is used to relieve withdrawal symptoms and reduce the cravings for nicotine | 7(3.3) | 24(11.3) | 182(85.4) |
| Nicorette Gum is contraindicated during pregnancy and breastfeeding | 22(10.3) | 38(17.8) | 153(71.8) |
| Patients smoking 20 cigarettes or fewer are required to use 2 mg gum to relieve withdrawal symptoms | 29(13.6) | 79(37.1) | 105(49.3) |
| Nicorette Chewing Technique is to chew slowly until the taste becomes strong and to rest between gum and cheek, then Chew again when the taste has faded | 13(6.1) | 79(37.1) | 121(56.8) |
| Bupropion is an antidepressant medicine that may increase suicidal thoughts or actions in some within the first few months of treatment. | 26(12.2) | 69(32.4) | 118(55.4) |
| Bupropion (Wellbutrin or Contrave) should be initiated on the first day the patient plans to quit smoking. | 40(18.8) | 86(40.4) | 87(40.8) |
| Varenicline (CHAMPIX) is more effective than bupropion (Wellbutrin or Contrave) in helping patients quit smoking. | 14(6.6) | 47(22.1) | 152(71.4) |
| The health risk of nicotine replacement therapies are lower compared to smoking | 16(7.5) | 41(19.2) | 156(73.2) |
| Varenicline (CHAMPIX) can help to relieve the craving and withdrawal symptoms associated with stopping smoking. | 18(8.5) | 40(18.8) | 155(72.8) |
| Varenicline (CHAMPIX) can also reduce the enjoyment of cigarettes during treatment. | 10(4.7) | 41(19.2) | 162(76.1) |
Awareness of varenicline was relatively high, with 71.4% acknowledging it as more effective than bupropion, 72.8% recognizing its role in reducing withdrawal symptoms, and 76.1% understanding its ability to reduce cigarette enjoyment. These results suggest that while pharmacists were familiar with smoking cessation medications, gaps remained in the specifics of dosage and treatment initiation.
Attitudes and practices toward smoking cessation
Pharmacists’ attitudes are shown in Table 3. The mean attitude score was 13.07 (SD = 6.5) out of a possible 25, indicating a generally moderate attitude toward smoking cessation counseling. Among individual items, the statement “Providing smoking cessation advice is appreciated by the patient” had the highest mean (2.74 ± 1.4), suggesting some recognition of the value of counseling. However, items reflecting self-efficacy, such as “It would be possible for me to promote smoking cessation effectively” (mean = 2.61 ± 1.4) and “Smoking cessation services can be offered effectively by me” (mean = 2.64 ± 1.4), were relatively low.
Table 3.
Attitudes of community pharmacists toward smoking cessation (N = 213)
| Attitude | N | Min | Max | Mean | SD |
|---|---|---|---|---|---|
| My responsibility is to provide advice on quitting smoking. | 213 | 1 | 5 | 2.46 | 1.5 |
| It would be possible for me to promote smoking cessation effectively. | 213 | 1 | 5 | 2.61 | 1.4 |
| Providing smoking cessation advice is appreciated by the patient. | 213 | 1 | 5 | 2.74 | 1.4 |
| Smoking cessation services can be offered effectively by me. | 213 | 1 | 5 | 2.64 | 1.4 |
| Most patients can quit smoking if they are committed to doing so. | 213 | 1 | 5 | 2.62 | 1.4 |
Pharmacists’ reported practices varied considerably shown in Table 4. The mean practice score was 6.85 (SD = 2.1) out of 12. While 30.5% of pharmacists reported always referring patients to Ministry of Health cessation programs, and 24.9% always provided non-drug counseling, routine inquiries about smoking status were less common, with only 17.8% consistently asking patients if they smoked. Similarly, drug-related counseling was always practiced by 23.9% of respondents.
Table 4.
Smoking cessation practices reported by community pharmacists (N = 213)
| Practice | Never | Sometimes | Always |
|---|---|---|---|
| I ask all patients whether they smoke or not | 16(7.5) | 159(74.6) | 38(17.8) |
| I inquire if the patient has considered quitting smoking before | 14(6.6) | 160(75.1) | 39(18.3) |
| I determine whether patients are willing to quit smoking | 24(11.3) | 151(70.9) | 38(17.8) |
| I assist patients in quitting by referring them to a MOH smoking cessation programs | 20(9.4) | 128(60.1) | 65(30.5) |
| I assist patients in quitting by providing non-drug counseling | 15(7.0) | 145(68.1) | 53(24.9) |
| I assist patients in quitting by providing drug counseling | 14(6.6) | 148(69.5) | 51(23.9) |
Correlation between KAP
The summary of KAP scores is provided in Table 5. Pharmacists scored moderately across all domains: knowledge (mean = 6.31 ± 2.7), attitude (mean = 13.07 ± 6.5), and practice (mean = 6.85 ± 2.1). Reliability analysis demonstrated that the instruments used in the study were robust: Cronbach’s alpha values were 0.800 for knowledge, 0.951 for attitude, and 0.737 for practice, indicating good-to-excellent internal consistency (Table 6).
Table 5.
Summary scores for KAP (N = 213)
| Scores | N | Min | Max | Mean | SD |
|---|---|---|---|---|---|
| Knowledge | 213 | 0.00 | 10.00 | 6.31 | 2.7 |
| Attitude | 213 | 5.00 | 25.00 | 13.07 | 6.5 |
| Practice | 213 | 0.00 | 12.00 | 6.85 | 2.1 |
Table 6.
Reliability statistics of KAP domains
| Reliability Statistics | Cronbach’s Alpha | N of Items |
|---|---|---|
| Knowledge | 0.800 | 10 |
| Attitude | 0.951 | 5 |
| Practice | 0.737 | 6 |
Pearson’s correlation analysis shown in Table 7 showed interesting patterns. Knowledge was significantly and positively correlated with practice (r = 0.203, p = 0.003), indicating that higher knowledge translated into better application of cessation services. However, a significant negative correlation was found between knowledge and attitude (r = − 0.244, p < 0.001), suggesting that pharmacists with higher knowledge scores did not necessarily hold more favorable attitudes toward smoking cessation. Similarly, attitude and practice were negatively correlated (r = − 0.195, p = 0.004), implying that positive attitudes did not consistently translate into proactive practices.
Table 7.
Correlations between KAP scores
| Correlations | Attitude | Practice | |
|---|---|---|---|
| Knowledge | r | -0.244** | 0.203** |
| p-value | < 0.001 | 0.003 | |
| N | 213 | 213 | |
| Attitude | r | -0.195** | |
| p-value | 0.004 | ||
| N | 213 | ||
**. Correlation is significant at the 0.01 level (2-tailed)
Demographic predictors of KAP
Associations between demographic characteristics and KAP domains are summarized in Table 8. Knowledge scores varied significantly by age (p = 0.035), with the highest scores observed among pharmacists aged 18–24 years (mean = 9.0 ± 0.0). Non-Saudi pharmacists also had significantly higher knowledge scores compared to Saudis (6.61 ± 2.6 vs. 5.05 ± 2.8, p < 0.001). Practice scores varied significantly across regions (p = 0.012), with the highest scores among pharmacists in the Northern (7.74 ± 2.7) and Eastern regions (7.20 ± 1.9). Training was another important predictor: pharmacists who had attended smoking cessation training had significantly higher practice scores compared to those without training (7.26 ± 2.1 vs. 6.53 ± 2.1, p = 0.012). No demographic factors significantly predicted attitudes.
Table 8.
Demographic predictors of KAP scores (N = 213)
| Demographics | Total | Knowledge | Attitude | Practice | |
|---|---|---|---|---|---|
| Gender | Male | 195 | 6.25 ± 2.7 | 13.14 ± 6.5 | 6.84 ± 2.1 |
| Female | 17 | 7.41 ± 2.2 | 11.47 ± 6.0 | 6.94 ± 2.0 | |
| p-value | 0.082 | 0.306 | 0.851 | ||
| Age | 18–24 | 2 | 9.00 ± 0.0 | 12.00 ± 2.8 | 6.50 ± 0.7 |
| 25–34 | 127 | 6.08 ± 2.7 | 12.96 ± 6.3 | 6.91 ± 2.4 | |
| 35–44 | 71 | 6.83 ± 2.4 | 13.61 ± 7.0 | 6.77 ± 1.5 | |
| 45–54 | 12 | 5.67 ± 3.3 | 10.67 ± 5.7 | 6.83 ± 2.1 | |
| 55–64 | 1 | 1.00 ± 0.0 | 19.00 ± 0.0 | 5.00 ± 0.0 | |
| p-value | 0.035 b, d | 0.552 | 0.905 | ||
| Nationality | Saudi | 41 | 5.05 ± 2.8 | 13.78 ± 6.1 | 6.98 ± 2.1 |
| Non-Saudi | 172 | 6.61 ± 2.6 | 12.90 ± 6.6 | 6.82 ± 2.1 | |
| p-value | < 0.001 a | 0.434 | 0.669 | ||
| Working region | Northern region | 27 | 6.74 ± 2.6 | 11.70 ± 6.3 | 7.74 ± 2.7A |
| Western region | 63 | 6.29 ± 2.7 | 12.40 ± 5.9 | 6.73 ± 1.9BC | |
| Central region | 52 | 6.31 ± 2.7 | 13.06 ± 5.8 | 6.75 ± 1.8BC | |
| Eastern region | 44 | 6.34 ± 2.9 | 13.82 ± 7.9 | 7.20 ± 1.9AB | |
| Southern region | 27 | 5.89 ± 2.4 | 14.78 ± 6.7 | 5.85 ± 2.3C | |
| p-value | 0.851 | 0.365 | 0.012 b, c | ||
| Highest pharmacy degree | Bacholar | 202 | 6.34 ± 2.7 | 13.09 ± 6.5 | 6.82 ± 2.1 |
| Master | 6 | 7.00 ± 3.0 | 13.17 ± 5.2 | 6.33 ± 2.0 | |
| PH.D | 5 | 4.20 ± 2.9 | 11.80 ± 6.9 | 8.80 ± 2.6 | |
| p-value | 0.172 | 0.908 | 0.092 | ||
| Country awarding the highest degree | Saudi | 48 | 5.06 ± 2.8 | 13.85 ± 6.2 | 7.13 ± 2.1 |
| Non-Saudi | 165 | 6.67 ± 2.5 | 12.84 ± 6.6 | 6.77 ± 2.1 | |
| p-value | < 0.001 a | 0.340 | 0.302 | ||
| Years of experience in community pharmacy practice | 0–5 | 50 | 5.94 ± 2.8 | 12.16 ± 6.1 | 6.96 ± 2.2 |
| 6–10 | 75 | 5.96 ± 2.9 | 13.97 ± 6.1 | 7.01 ± 2.3 | |
| 11–15 | 46 | 7.02 ± 1.9 | 12.57 ± 7.3 | 6.72 ± 2.1 | |
| More than 15 | 42 | 6.60 ± 2.7 | 13.07 ± 6.7 | 6.57 ± 1.6 | |
| p-value | 0.113 | 0.440 | 0.680 | ||
| Number of patients seen per day | Less than 50 | 26 | 5.58 ± 2.9 | 11.73 ± 6.7 | 7.19 ± 3.0 |
| 50–100 | 112 | 6.34 ± 2.6 | 13.14 ± 6.3 | 6.62 ± 1.9 | |
| More than 100 | 75 | 6.52 ± 2.7 | 13.41 ± 6.8 | 7.08 ± 2.0 | |
| p-value | 0.299 | 0.516 | 0.224 | ||
| Tobacco smoking status | Current smoker | 27 | 5.48 ± 2.9 | 12.19 ± 6.2 | 7.33 ± 2.8 |
| Former smoker | 9 | 5.44 ± 2.1 | 15.11 ± 6.8 | 7.67 ± 2.0 | |
| Non-smoker | 177 | 6.48 ± 2.6 | 13.10 ± 6.5 | 6.73 ± 2.0 | |
| p-value | 0.120 | 0.500 | 0.188 | ||
| Have you attended specific training in smoking cessation prior this time? | Yes | 93 | 6.59 ± 2.5 | 11.98 ± 6.1 | 7.26 ± 2.1 |
| No | 120 | 6.09 ± 2.8 | 13.91 ± 6.7 | 6.53 ± 2.1 | |
| p-value | 0.178 | 0.031 a | 0.012 a | ||
| Do you offer a smoking cessation service in the pharmacy? | Yes | 118 | 6.61 ± 2.5 | 12.42 ± 6.5 | 7.06 ± 2.0 |
| No | 95 | 5.94 ± 2.9 | 13.86 ± 6.4 | 6.59 ± 2.1 | |
| p-value | 0.068 | 0.108 | 0.104 | ||
a-significant using Independent t-test at < 0.05 level
b-significant using One-Way ANOVA Test at < 0.05 level
c-Post-Hoc Test = LSD
d-Post hoc tests are not performed because at least one group has fewer than two cases
*Capital letters represent the Post-Hoc multiple pairing summary indicator. When two measures share the same letter, they are statistically similar
General linear model analyses
The General Linear Model further examined predictors of knowledge and practice. As shown in Table 9, pharmacists aged 18–24 years had significantly higher knowledge scores (B = 9.210, p = 0.006), while other age categories showed no significant effect. Nationality and country awarding the degree were not significant predictors. For practice, results presented in Table 10 showed that pharmacists working in the Northern (B = 1.790, p = 0.001) and Eastern regions (B = 1.376, p = 0.006) had significantly higher practice scores compared to other regions. Additionally, attending prior smoking cessation training significantly predicted higher practice scores (B = 0.669, p = 0.019).
Table 9.
General linear model parameter estimates for knowledge scores
| Dependent Variable: Knowledge | |||||
|---|---|---|---|---|---|
| Parameter | B | S.E. | 95% C.I | p-value | |
| Lower Bound | Upper Bound | ||||
| Intercept | 1.578 | 2.742 | -3.829 | 6.984 | 0.566 |
| Age = 18–24 | 9.210 | 3.311 | 2.682 | 15.738 | 0.006a |
| Age = 25–34 | 5.027 | 2.748 | -0.391 | 10.444 | 0.069 |
| Age = 35–44 | 5.320 | 2.749 | -0.100 | 10.740 | 0.054 |
| Age = 45–54 | 4.234 | 2.768 | -1.224 | 9.691 | 0.128 |
| Nationality = Saudi | -1.210 | 1.036 | -3.253 | 0.832 | 0.244 |
| Country awarding the highest degree = Saudi | -0.578 | 0.962 | -2.475 | 1.319 | 0.549 |
a-significant using General Linear Model at < 0.05 level
Table 10.
General linear model parameter estimates for practice scores
| Dependent Variable: Practice | |||||
|---|---|---|---|---|---|
| Parameter | B | S.E. | 95% C.I | p-value | |
| Lower Bound | Upper Bound | ||||
| Intercept | 5.554 | 0.410 | 4.746 | 6.362 | < 0.001a |
| Working region = Northern region | 1.790 | 0.553 | 0.699 | 2.881 | 0.001a |
| Working region = Western region | 0.921 | 0.467 | 0.001 | 1.841 | 0.050 |
| Working region = Central region | 0.900 | 0.481 | -0.049 | 1.848 | 0.063 |
| Working region = Eastern region | 1.376 | 0.496 | 0.399 | 2.354 | 0.006a |
| Have you attended specific training in smoking cessation prior this time?=Yes | 0.669 | 0.282 | 0.112 | 1.226 | 0.019a |
a-significant using General Linear Model at < 0.05 level
Discussion
This study provides important insights into the KAP of community pharmacists in Saudi Arabia regarding pharmacological smoking-cessation interventions. The findings showed moderate levels of knowledge and practice, with relatively low confidence in attitudes. This indicates that the role of pharmacists in smoking cessation need to be reinforce and expand in supporting smoking cessation efforts. These results are consistent with previous reports from Saudi Arabia and other countries in the region, where pharmacists have shown potential as accessible health professionals but face limitations in training, awareness, and organized involvement into cessation programs [24, 27, 31].
Pharmacists showed a mean knowledge score of 6.31/10, indicating gaps in areas such as dosage recommendations. These findings are similar to previous studies in Saudi Arabia and internationally, which have shown that while pharmacists are aware of common cessation medications and aids, their understanding of pharmacological details often remains limited [32–34]. Pharmacists are generally aware of nicotine replacement therapies; however, their depth of knowledge regarding pharmacological details and appropriate dosing remains insufficient [35–37]. In addition, pharmacist should improve their knowledge regarding emerging use of new electronic nicotine delivery systems, which require an updated understanding of both their risks and potential role in smoking cessation strategies [38–40]. The attitude score showed moderate confidence, with pharmacists recognizing their potential role but expressing uncertainty about their effectiveness in smoking cessation. Previous studies have reported similar results among pharmacists [41, 42]. The correlations observed between knowledge and attitude in the current study suggest that awareness of cessation complications may reduce confidence, highlighting the need for supportive environments training and practice for pharmacists. Thus, there is a strong need for pharmacy education and development programs to support pharmacists’ knowledge and readiness to participate in smoking cessation to help patients quit smoking.
Pharmacists have an important role in smoking cessation through patient counseling [43]. More important, community pharmacists are one of the most accessible healthcare practitioners, and their frequent contact with patients position them to initiate conversations about smoking, assess patients who want to quit, and provide personalized guidance [44]. In fact, systematic reviews showed that community pharmacists’ involvement in smoking cessation interventions can lead to higher quit rates and reduces smoking related diseases [45–47]. They can participate in disease interventions and face-to-face counseling to encourage smoking cessation [48]. This is not limited to smoking cessation, in fact, pharmacists’ counseling has been shown to improve outcomes of other chronic conditions such as diabetes [49], hypertension [50], dyslipidemia [51], and asthma [52], where patient education, medication compliance, and lifestyle counseling have significantly reduced complications and enhance patients quality of life [52, 53].
The prevalence of smoking and nicotine addiction remains a global and national health issue affecting healthcare professionals and community pharmacists [54–56]. Nicotine dependence is characterized as a chronic and relapsing condition that cause addictive behavior to nicotine, that involve the brain’s dopaminergic reward pathways, reinforcement and withdrawal upon cessation [57, 58]. This neurobiological effect of nicotine addiction highlights those unassisted quit attempts are often unsuccessful, which lead to high relapse rates, especially in absence of medical supervision [59–61]. In Saudi Arabia, smoking prevalence is high, according to National data which suggest that approximately 20–25% of adults are current smokers, with a clear gender difference showing significantly higher rates among men than women [62]. These data indicate that smoking in Saudi Arabia remains a rapidly increasing behavior in both adolescence and adults; therefore, increasing the risk of dependence and associated health complications. Taken together, the high prevalence of smoking and nicotine addiction in Saudi Arabia highlights the importance of community pharmacist interventions. The accessibility of community pharmacists makes them a crucial point of contact for early identification of smokers, initiation smoking cessation, and providing evidence-based pharmacological and behavioral support.
This study collected data from community pharmacists from multiple regions in Saudi Arabia using a structured questionnaire, with participants recruited through the largest community pharmacy chain. Different statistical methods were used; however, the study has limitations. The final sample size (n = 213) was lower than the target estimate, which may have reduced precision and limited the detection of small effects. The sample was predominantly male and younger, reflecting current workforce trends but reducing generalizability to female and older pharmacists. The survey was administered only in English, potentially excluding pharmacists more comfortable with Arabic. Some demographic subgroups contained very few participants, limiting the reliability of subgroup comparisons. Additionally, the absence of patient outcome data prevents evaluation of whether reported knowledge and practices translated into improved cessation outcomes.
Conclusion
This study highlights that while community pharmacists in Saudi Arabia are moderately knowledgeable and engaged in smoking cessation, substantial barriers remain in translating awareness into confident practice. Training programs, regional initiatives, and systematic integration of cessation services into pharmacy practice are crucial steps toward maximizing pharmacists’ contribution to national smoking cessation strategies.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The author thanks the participating pharmacists and Nahdi Medical Company for facilitating survey distribution.
Author contributions
F.S.A. conceived and designed the study, collected and analyzed the data, interpreted the results, and drafted the manuscript.
Funding
This research received no external funding.
Data availability
The datasets generated and/or analyzed during the current study are included in the supplementary table.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Biomedical Research Ethics Committee of Umm Al-Qura University (Approval No. HAPO-02-K-012-2022-11-1296). All participants provided informed consent electronically before completing the survey.
Consent for publication
Not applicable.
Competing interests
The author declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and/or analyzed during the current study are included in the supplementary table.