Assessing community pharmacists’ understanding, attitudes, self-confidence, and obstacles in patient-centered communication

Abstract

Background

Enhancing communication practices among pharmacy professionals is essential for patient-centered care.

Methods and Materials

A cross-sectional survey was conducted among a random sample of licensed pharmacists from June 2022 to January 2023. Out of 640 pharmacists, 577 participated in the study, yielding a response rate of 90.2%. Participants completed a questionnaire covering demographics and their knowledge, attitudes, self-efficacy, and perceived barriers regarding PCC. Multivariate logistic regression identified factors influencing PCC-related scores.

Results

The results indicated good knowledge, attitudes, and self-efficacy toward PCC. Higher PCC scores were associated with older age, postgraduate education, chain pharmacy employment, leadership roles, greater experience, and international or regional education. Key barriers included workload, staff shortages, time constraints, and an unsupportive work environment.

Conclusion

The findings, based on self-reported perceptions, suggest standard communication guidelines and awareness programs are warranted to facilitate PCC integration and enhance pharmacy professionals’ confidence and skills in patient-centered care.

PLAIN LANGUAGE SUMMARY

This study examines how well community pharmacists in the UAE understand and feel about Patient-Centered Communication (PCC), a practice that focuses on making patients’ needs central to healthcare interactions. PCC requires pharmacists to engage with patients, considering their preferences, history, and individual needs when providing care and guidance.

ARTICLE HIGHLIGHTS

• Enhancing communication practices among pharmacy professionals is essential for patient-centered care (PPC).

• The results indicated good knowledge and attitudes and self-efficacy toward PCC. Higher PCC scores were associated with older age, postgraduate education, chain pharmacy employment, leadership roles, greater experience, and international or regional education.

• Although the respondents showed good knowledge of PCC, their levels of confidence in applying some of the skills were low. For instance, they appeared to struggle with practices like building trustful relationships, identifying the emotions of the patient, and engaging the patient in care decision-making.

• Key barriers included workload, staff shortages, time constraints, and an unsupportive work environment

• There is a need for standard communication guidelines as well as programs aimed at raising pharmacy professionals’ awareness of the importance of PCC.

• There is a need to implement structural changes, e.g., lessening the workload and having more staff, as this will give pharmacists the necessary resources and time to integrate PCC into their practices

KEY FINDINGS

1. Pharmacists’ Knowledge and Attitudes: Most pharmacists demonstrated good knowledge and a positive attitude toward PCC. They generally understood the importance of effective communication and involving patients in decisions about their health.

2. Self-Confidence Challenges: Although pharmacists showed good understanding and attitudes, their self-confidence (self-efficacy) in applying PCC was lower. Many pharmacists felt uncertain about aspects like building a treatment plan with patients or addressing disagreements professionally.

3. Factors Linked to Better PCC Skills: Higher PCC knowledge, attitude, and self-efficacy scores were seen in pharmacists who were older, had postgraduate education, worked in chain pharmacies, held senior roles (e.g., chief pharmacist), and had more experience. Pharmacists educated at international or regional universities also tended to score higher.

4. Barriers to PCC: Major obstacles to effective PCC included high workloads, staffing shortages, lack of time, and an unsupportive work environment. These factors limited pharmacists’ ability to engage in patient-centered practices.

5. Conclusion: Pharmacists in the UAE understand PCC’s importance but often lack confidence in fully implementing it. To support PCC integration in community pharmacies, the study highlights the need for clear communication guidelines and training programs that build pharmacists’ confidence in using PCC.

Graphical Abstract

1. Introduction

Medication-related health issues are a growing worldwide concern, mainly due to adverse drug reactions, non-adherence to treatment regimes, and inappropriate prescribing and monitoring [1]. However, these issues are preventable and can be alleviated by pharmacy professionals implementing patient-centered communication (PCC) and taking on a leading role in promoting self-management among patients [2].

In PCC, the pharmacy professional focuses on the perspective of the patient by taking their history of illness into account, adopting a psychosocial stance, and including them in shared decision-making [3].

The definition of PCC indicates that the patient’s desires, preferences, and needs are respected and responded to, and that they are allowed to make their own decisions about their care in line with their unique circumstances [4]. As a dynamic and customized way to practice healthcare [5], PCC moves away from the conventional biomedical approach, focusing on the disease to ensure a holistic care practice that revolves around the patient [6]. The patient’s perspectives and preferences are thereby integrated into tailored healthcare planning that focuses on their health goals.

Effective dialogue with a patient concerning their health experiences, preferences and concerns is essential to promote medication adherence and identify problems with their medication, (e.g., inappropriate medication use or side effects) [7,8]. Notably, offering services that are tailored to the patient requires the pharmacy professional to develop an understanding of their unique needs and focus on individualizing the care [9,10].

To achieve PCC, the pharmacy professional must ensure the patient’s trust by building a good relationship with them [11,12]. For instance, as part of PCC, the pharmacist can conduct collaborative counseling, i.e., actively involve the patient by discussing their treatment with them [13,14]. This can not only contribute to a relationship based on trust but also ensure patient empowerment, enabling them to make informed care decisions. This approach has also been shown to promote medication adherence, as the regimen is tailored to the specific preferences and goals of the patient [15,16], thereby contributing to their overall well-being [13–15]. This study is based on two complementary theoretical frameworks: Bandura’s Social Cognitive Theory (SCT), which emphasizes the role of self-efficacy in behavior change, and the Calgary-Cambridge Guide to the Medical Interview, which outlines communication tasks central to patient-centered care. Together, these frameworks provide a structure for assessing pharmacists’ attitudes (affective domain), knowledge (cognitive domain), and self-efficacy (behavioral confidence) in relation to PCC. In this context, knowledge refers to possessing a working understanding of PCC principles and practices; attitudes capture professional beliefs and commitment to engage in PCC; and self-efficacy reflects the perceived ability to perform these communication behaviors in practice.

While PCC is the responsibility of healthcare professionals from all fields, pharmacists are particularly well-placed due to their clinical knowledge combined with their expertise in medication counseling. In other words, they occupy an ideal position to ensure that patients receive optimal pharmaceutical care. Earlier studies have that by implementing PCC, pharmacists can improve patient outcomes, including increased adherence to the treatment regimen and a better pharmacist-patient relationship [17,18]. Patients further benefit through their greater involvement in the consultation process, for instance, when establishing treatment plans. Consequently, they tend to have greater motivation to perform self-management, especially when suffering from chronic illness [19,20].

It should be noted that skills beyond scientific knowledge and expertise are needed when implementing PCC in pharmacy care. Furthermore, several barriers to pharmacy professionals’ implementation of PCC exist, such as inadequate experience, staff shortages, a high workload, insufficient time per patient, and workplace constraints such as the absence of an organizational framework or legal regulations [21–23].

The literature has revealed the challenges of integrating PCC into healthcare consultations across various contexts. For example, the language barriers inherent in Malaysia—a multilingual society—complicate communication between patients and care providers, preventing effective PCC and adversely affecting patient engagement [24]. Meanwhile, studies have also demonstrated that patients may actually prefer to take a more passive role during consultation and may also possess inadequate health literacy, with both aspects diminishing the opportunities for shared decision-making [25,26]. Research on the communication enacted by pharmacy professionals has found numerous obstacles to patient-pharmacist communication, highlighting in particular the inadequacies in the ability to listen reflectively and elicit the perspective of the patient [17]. Such consultations tend to be technical and overlook the socioemotional elements that are integral to PCC [18,27–32]. While PCC is known to be important for improved patient outcomes, studies on how it is implemented practically in the context of community pharmacies, especially in the United Arab Emirates (UAE), remain limited. To promote the integration of PCC into community pharmacists’ daily practice, it is crucial to capture their current attitudes, knowledge, and self-efficacy in this regard. In light of this, the current study seeks to examine these factors among UAE community pharmacists and pinpoint which barriers are obstructing their implementation of PCC. However, most of the existing studies have not focused on the implementation of PCC in the UAE context. The barriers in the distinct context of community pharmacies in the UAE have unique cultural, systemic, and organizational factors that create thus far unexamined challenges. Our study shows how various factors, including the experience, education, and work setting of individual community pharmacists, influence the extent to which they implement PCC. Our study provides insight that can contribute to overcoming these obstacles by informing the design of region-specific interventions that can encourage community pharmacists to integrate PCC into their practice within the local healthcare context. By offering a finer understanding of these challenges, this study hereby helps to bridge the current gap in our knowledge regarding PCC in the UAE, which is a rapidly developing healthcare setting. In light of this, there is a need for a system outlining pharmacy professionals’ roles and responsibilities in this matter while ensuring that the correct infrastructure and processes are in place to facilitate the adoption of PCC.

2. Methods and materials

2.1. Study setting and design

Pharmacy professionals’ knowledge, attitude, and self-efficacy regarding PCC were evaluated using a cross-sectional research design. Pharmacies in the UAE were selected by random sampling, and five trained pharmacy students who were in their final study year visited these to conduct face-to-face interviews from June 2022 to January 2023. Based on prior experience demonstrating that in-depth training improves the interviewers’ skills as well as the error rate, the students received in-depth training before visiting the pharmacies to ensure that they understood how to use the questionnaire as well as the scientific terminology used in the study. The data was collected by five final-year pharmacy students who operated as trained research assistants under direct investigator supervision. Before fieldwork, they completed a structured training program covering research ethics, informed consent, standardized questionnaire administration, confidentiality, and participant communication. Their role was limited to survey administration, with study design, oversight, data management, and statistical analysis retained by the principal investigators.

2.2. Research instrument development

A structured questionnaire was constructed based on a review of the literature [8,17, 33,34], whereby certain modifications were made to bring the instrument in line with the UAE context; care was taken to ensure that no key research points were omitted.

The opinions of experts on pharmacy practice were elicited to ensure the suitability and relevance of the questionnaire for the research question. Moreover, to assess the instrument’s content relevance and appropriateness, five experts from the Faculty of Medicine and Clinical Pharmacy at Ajman University provided feedback. Some minor modifications were made to the instrument before the pilot phase in accordance with these experts’ recommendations.

Lawshe’s content validity was utilized to check the questionnaire’s content validity prior to pilot testing [34]. According to the method [34], items that have a content validity ratio (CVR) over 0.78 are considered acceptable, while those that do not are eliminated from the instrument [35,36]. The CVR values of all questionnaire items were above 0.78, demonstrating acceptable validity. The means of those items that had acceptable CVR values were then utilized in the content validity index (CVI) calculation for the final questionnaire. The produced CVI value of 0.88 indicated that the final instrument had acceptable validity overall [36].

To evaluate the instrument’s face validity, pilot testing on 30 community pharmacists, whose data were not included in the final analysis, was performed from 11 June 2022 to 25 June 2022. Twenty-five of these respondents successfully completed the questionnaire. The reliability of the questionnaire was then estimated based on the results of the pilot study, and the size of the main research sample was also calculated. Finally, Cronbach’s α was used to check the instrument’s reliability; the Cronbach’s α of 0.75 demonstrated that its internal reliability was acceptable. Bandura’s Social Cognitive Theory and the Calgary-Cambridge guided the questionnaire design. Items assessing knowledge reflected factual comprehension of PCC principles and standards. The Calgary-Cambridge framework, with its emphasis on affective components, informed the attitude measures, which explored agreement with patient-centered values and preferences. Consistent with Bandura’s SCT, the self-efficacy items focused on pharmacists’ confidence in performing key communication undertakings such as obtaining information about patient concerns, engaging in shared decision-making, and managing emotionally challenging interactions.

2.3. Research instrument sections

The following four parts comprised the study questionnaire:

• Part 1—Seven questions eliciting the demographic information of the respondents, such as their gender, professional position (i.e., pharmacist in charge or chief pharmacist), years of professional experience, and the university from which they obtained their degree.

• Part 2—Seventeen questions on the knowledge of the respondents concerning PCC.

• Part 3—Ten questions examining the attitudes of the respondents toward PCC.

• Part 4—Twenty-four questions on the respondents’ perceived self-efficacy concerning PCC. (Questionnaire: S1).

2.4. Questionnaire scoring

Seventeen items focused on the respondents’ knowledge of PCC using categories (Yes/No/Don’t know). There was only one “correct” answer to each of these questions, and the remaining options were deemed “wrong” answers. Each correct answer scored one point, and the points for all items were summed to obtain each respondent’s knowledge score.

Ten items examined the respondents’ attitude toward PCC using a 5-point Likert scale (1=“Strongly Disagree” to 5=“Strongly Agree”). The scores from all 10 items were then added to receive the total attitude score per respondent, which ranged from 10 (least positive attitude) to 50 (most positive attitude).

Twenty-four items assessed the respondents’ self-efficacy regarding PCC using a 4-point Likert scale (1=“Very Unconfident”, 2=“Unconfident”, 3=“Confident”, 4=“Very confident”). These scores were all summed, giving a score for their total self-efficacy, ranging from 24 (lowest self-efficacy) to 96 (highest self-efficacy).

The respondents’ scores regarding knowledge, attitude, and self-efficacy were categorized as good knowledge, positive attitude, and good self-efficacy by calculating the median scores [37–40]:

• 17 was found to be the median knowledge score; hence, respondents scoring at least 17 were considered to have good knowledge of PCC.

• 34 was found to be the median attitude score; hence, respondents scoring at least 34 were considered to have a positive attitude toward PCC.

• 59 was found to be the median self-efficacy score; hence, respondents scoring at least 59 were considered to have good self-efficacy.

Median cutoffs were used to classify knowledge, attitude, and self-efficacy scores to improve interpretability and maintain comparability with prior KAP studies that applied the same approach. The categorization supported descriptive analyses and regression modeling rather than detailed scale-level inference.

2.5. Sample size calculation

The sample size for the primary research was calculated via the pilot study. The pilot questionnaire’s overall response rate was 83%. The respondents were presented with the question, “Is patient-centered communication essential for good pharmacist-patient communication?” Around half (50%) of the respondents answered affirmatively. This research employed a 5% alpha level, giving a 95% confidence interval (CI). As the precision (D) was 5%, the maximum 95% CI width was 10%. Based on this and the assumed non-response rate of 60%, 640 respondents were deemed to be a sufficient sample size. When selected sites did not respond, replacement community pharmacies were randomly drawn from the same regional stratum within the original sampling frame. This process continued until the target sample size was reached. Post-stratification weighting was unnecessary, as proportional regional representation was preserved by the sampling design.

2.6. Target population

The main research sample was chosen based on certain criteria. Respondents had to be community pharmacists with at least three months of professional experience at pharmacies that were independent or belonged to a chain registered with the Ministry of Health, the Health Authority Abu Dhabi (HAAD), or the Dubai Health Authority. The three-month timeframe was to ensure that participating pharmacists had sufficient exposure to daily pharmacy operations and patient interactions. This timeframe reflects the typical probationary period within the UAE’s pharmacy sector, during which pharmacists transition from supervised practice to independent professional responsibilities. Including only those beyond this initial period helped ensure that respondents could provide informed and relevant insights into the study’s focus on patient-centered communication.

Respondents were excluded if they were not registered with any of the above health authorities or had not yet reached three months of professional experience, i.e., had recently received their qualification or were still under probation.

2.7. Sampling technique

Random sampling was utilized to ensure the research was representative. A 2010 report found 2000 professionally active community pharmacies in the UAE [41]. For each region under study, we used the Yellow Pages and local business directories to obtain all relevant community pharmacies’ contact details, such as type and location.

To account for regional variation in pharmacy density across the UAE, the study used stratified random sampling. Community pharmacies were grouped according to region, i.e., Dubai, Abu Dhabi, and the Northern Emirates. They were subsequently randomly selected within each stratum in proportion to the total active pharmacies in that area. This approach ensured regional representativeness.

The relevant data of the community pharmacies, including name, type, location, email address, and phone number, were gathered and put into the sampling frame, which was constructed using an Excel spreadsheet. Each pharmacy was given a unique ID number, and then 640 community pharmacies were chosen using simple random sample selection. These were finally sorted according to their type and location.

2.8. Data collection

The selected UAE community pharmacies were visited by trained researchers from 28 June 2022 to 15 January 2023. After being told about the purpose of the research, the pharmacists at each pharmacy were asked for their email addresses. Then, the researchers conducted face-to-face interviews with the pharmacists using a structured questionnaire.

2.9. Statistical analysis

We used SPSS Version 26 for the data analysis, summarizing the categorical variables as frequencies and percentages and using mean and standard deviation (SD) to describe the continuous, normally distributed quantitative variables. Unpaired student t-tests, one-way ANOVA, and non-parametric variants were performed where appropriate to identify any differences between the groups’ quantitative variables. Normality was assessed via a Shapiro-Wilk test (p > 0.05 demonstrating normally distributed continuous variables) or visually by examining a normal Q-Q plot. Multivariate logistic regression models were used to investigate the factors at play in the knowledge, attitude, and self-efficacy of the respondents. A p-value < 0.05 was assumed to demonstrate statistical significance.

2.10. Ethical considerations

This work was approved by Ajman University’s Institutional Ethical Review Committee (P-H-S-2022-2-13). All participants were told about the purpose of the research before the data collection commenced, and it was ensured that they understood that their full consent was required for completing and submitting the questionnaire. Written informed consent was obtained from all respondents. None of the participants’ identities were recorded, and steps were taken to ensure that their confidentiality was maintained.

3. Results

3.1. Demographic characteristics of the study subjects

Out of 640 pharmacists, 577 participated in the study, yielding a response rate of 90.2%. More than half of the participants were female, 318 (55.1%), and the majority of them held a bachelor’s degree, 508 (87.9%). Of the total, 415 (71.9%) had 1–5 years of experience, 146 (25.3%) had 6–10 years of experience, and 16 (2.8%) had more than 10 years of experience. Independent pharmacies constituted 227 (39.3%) of the study sample, and 350 (60.7%) were chain pharmacies. Among the total, 370 (64.1%) were pharmacists in charge, 109 (18.9%) were chief pharmacists, and 98 (17.0%) were assistant pharmacists. The university of graduation was as follows: 67 (11.6%) graduated from regional universities, 373 (64.6%) graduated from local universities, and 137 (23.7%) graduated from international universities (Table 1).

Table 1.

Number and percentages of the questions on demographics (n = 577).

Demographics	Response	Frequency	Percentage
Gender	Male	259	44.9%
	Female	318	55.1%
Educational level	Bachelor	507	87.9%
	Postgraduate	70	12.1%
Years of experience	1–5 Years	415	71.9%
	6–10 Years	146	25.3%
	> 10 Years	16	2.8%
Pharmacy type	Independent pharmacy	227	39.3%
	Chain pharmacy	350	60.7%
Pharmacist position	Pharmacist in charge	370	64.1%
	Chief pharmacist	109	18.9%
	Assistant pharmacist	98	17%
University of graduation	Regional	67	11.6%
	Local	373	64.6%
	International	137	23.7%

Abbreviations: Regional universities refer to institutions located within the Gulf Cooperation Council (GCC) countries. Local universities refer to institutions located specifically within the UAE.

3.2. Pharmacists’ knowledge, attitude, and self-efficacy about patient-centered communication

Average scores of 16.5 (95% CI: 16.3–16.7) for knowledge about PPC. In general, the overall level of knowledge among participants was good (Note: 17 was found to be the median knowledge score; hence, respondents scoring at least 17 were considered to have good knowledge of PCC). The results of each question related to knowledge about patient-centered communication were shown (Table S2). Pharmacists displayed a high level of knowledge on items such as using simple terms in PCC (98.3%) and promoting patient decision-making (96.7%). However, there were notable gaps in knowledge in several areas. For example, only 48.7% correctly identified that PCC involves going beyond just filling prescriptions, while just 55.1% recognized that pharmacists should consider the patient’s cultural and psychosocial context. Other lower-scoring items include identifying the patient’s perspective (66.7%) and non-judgmental engagement (64.5%).

The results of bivariate analysis showed that educational level (P = 0.007), type of pharmacy (P = 0.003), and position of the pharmacist in the pharmacy (P = 0.001) were statistically significantly associated with better knowledge about patient-centered communication. Accordingly, postgraduates, chain pharmacies, and chief pharmacists were more likely to score better in the knowledge about patient-centered communication (Table 2).

Table 2.

Comparing the knowledge and attitudes according to demographics.

	Knowledge scores (17 items)				Attitude scores (10 items)
Demographics	Mean	95% CI		P-value	Mean	95% CI		P-value
Gender
Male	16.31	15.95	16.68	0.116	30.89	30.13	31.65	0.059
Female	16.64	16.42	16.87		31.88	31.18	32.59
Education level
Bachelor	16.33	16.06	16.60	0.007*	30.59	30.05	31.12	<0.001*
Postgraduate	16.97	16.90	17.03		37.66	36.93	38.38
Pharmacy type
Independent pharmacy	16.11	15.65	16.55	0.003*	31.64	30.91	32.36	0.540
Chain pharmacy	16.74	16.57	16.92		31.31	30.60	32.02
Position in the pharmacy
Pharmacist in charge	16.69	16.51	16.87	0.001*	31.28	30.65	31.91	<0.001*
Chief pharmacist	17.0	14.11	19.41		34.53	33.25	35.80
Assistant pharmacist	15.86	15.24	16.49		29.23	28.14	30.31
Experiences
1–5 years	16.45	16.15	16.75	0.828	30.534	29.88	31.19	<0.001*
6–10 years	16.57	16.34	16.80		33.50	32.86	34.14
> 10 years	16.64	15.82	17.44		36.12	34.23	38.02
University of graduation
Regional	16.86	16.65	17.06	0.225	32.64	31.92	33.36	<0.001*
Local	16.36	16.01	16.72		30.01	29.34	30.69
International	16.53	16.27	16.77		36.94	36.12	37.764

Notes: *P-values < 0.05 considered statistically significant, P-values obtained from independent t-test and one-way ANOVA.

Average scores of 31.4 (95% CI: 30.9–31.9) for attitude about PPC. In general, the overall level of the attitude among participants was positive (Note: 34 was found to be the median attitude score; hence, only respondents scoring at least 34 were considered to have a positive attitude toward PCC.). The results of each question related to attitude about patient-centered communication were shown (Table S3). The highest positive attitude was observed in the belief that PCC between pharmacists and patients is essential (60.1% agree and 38.1% strongly agree). However, several items reflect more neutral or negative attitudes. For instance, a substantial percentage of pharmacists somewhat disagree that all pharmacies in the UAE practice PCC (19.6%), and nearly 44.4% somewhat disagree that understanding a patient’s cultural and social background is crucial for engaging in PCC. Moreover, a significant portion (43.7%) also somewhat disagrees that pharmacists should show interest in the patient’s overall well-being.

We observed a statistically significant relationship between attitudes about patient-centered communication and educational level (P < 0.001), position in the pharmacy (P < 0.001), years of experience (P < 0.001), and university of graduation (P < 0.001). This means that postgraduates, chief pharmacists, pharmacists with more years of experience, and those who graduated from regional and international universities are more likely to score better in the attitude about patient-centered communication (Table 2).

Average scores of 61 (95% CI: 59.8–62.2) for self-efficacy about PPC. In general, the overall level of self-efficacy among participants was good. (Note: 59 was found to be the median self-efficacy score; hence, only respondents scoring at least 59 were considered to have good self-efficacy.). The results of each question related to self-efficacy about patient-centered communication were shown (Table S4). Most pharmacists reported feeling confident in their ability to engage empathetically with patients, with 77.8% displaying confidence in using a caring manner (item 6). Similarly, 61.2% expressed confidence in ensuring that all decisions made by the patient are understood (item 13). However, particular areas showed lower self-efficacy. For instance, only 0.2% felt very confident in agreeing on a treatment plan with the patient (item 11), and only 0.3% felt very confident in clarifying the patient’s condition (item 17). Additionally, there was a notable lack of confidence in handling professional disagreements (48.4% confident, 27% very unconfident for item 22) and being unaffected by personal biases (54.1% confident, 27% very unconfident for item 23).

We verified a statistically significant association between the self-efficacy score and educational level (P < 0.001), pharmacy type (P = 0.38), position in the pharmacy (P < 0.001), years of experience (P < 0.001), and university of graduation (P < 0.001) (Table 3).

Table 3.

Comparing the self-efficacy about patient-centered communication according to demographics.

	Self-Efficacy scores (24 items)
Demographics	Mean	95% CI		P-value
Gender
Male	60.22	58.80	61.64	0.194
Female	61.50	60.18	62.83
Education level
Bachelor	59.64	58.62	60.66	<0.001*
Postgraduate	70.29	68.46	72.11
Pharmacy type
Independent pharmacy	59.66	58.08	61.24	0.038*
Chain pharmacy	61.75	60.53	62.97
Position in the pharmacy
Pharmacist in charge	61.28	60.09	62.39	<0.001*
Chief pharmacist	64.72	62.87	66.58
Assistant pharmacist	56.43	53.74	59.12
Experiences
1–5 years	59.30	58.18	60.43	<0.001*
6–10 years	64.40	62.73	66.08
> 10 years	71.44	62.58	80.29
University of graduation
Regional	64.51	62.58	66.44	<0.001*
Local	57.40	56.34	58.47
International	73.22	71.02	75.43

3.3. Identifying the factors influencing the patient-centered communication among community pharmacists

Better knowledge, attitudes, and self-efficacy in Patient-Centered Communication (PCC) were observed among older pharmacists, postgraduates, those working in chain pharmacies, and those in leadership roles (chief pharmacists or pharmacists in charge). Additionally, pharmacists with more years of experience and those who graduated from international or regional universities showed stronger scores across all three areas. These findings suggest that higher education, experience, and working in structured environments like chain pharmacies positively influence pharmacists’ competence and confidence in implementing PCC practices. The following are the odds ratios and 95% confidence intervals to provide insights into the strength and precision of associations.

Better knowledge scores were observed in older participants (OR 1.46; 95% CI 1.29–1.65), postgraduates (OR 6.07; 95% CI 3.26–8.56), chain pharmacies (OR 1.72; 95% CI 1.08–2.75), chief pharmacists (OR 4.21; 95% CI 2.02–8.77), pharmacists in charge (OR 2.62; 95% CI 1.55–4.72), pharmacists with 6–10 years of experience (OR 1.44; 95% CI 1.19–1.61), pharmacist with > 10 years’ experience (OR 1.63; 95% CI 1.34–1.83), pharmacists graduated from international universities (OR 1.66; 95% CI 1.23–1.77), and pharmacists graduated from regional universities (OR 1.44; 95% CI 1.18–1.25) (Table 4).

Table 4.

Regression analysis for the factors affecting knowledge and attitude on patient-centered.

	Good knowledge ≥ 17				Positive attitude ≥ 34
Demographics	Or	95% CI		P-value	Or	95% CI		P-value
Gender (Ref. Male)
Female	1.48	0.95	2.31	0.085	0.95	0.88	1.04	0.29
Education level (Ref. Bachelor)
Postgraduate	6.07	3.26	8.56	<0.001*	2.80	2.36	3.33	<0.001*
Pharmacy type (Ref. Independent Pharmacy)
Chain Pharmacy	1.72	1.08	2.75	0.024*	1.08	1.010	1.16	0.019*
Position in the Pharmacy (Ref. Assistant pharmacist)
Chief pharmacist	4.21	2.02	8.77	<0.001*	1.62	1.44	1.82	0.001*
Pharmacist in charge	2.62	1.55	4.72	0.001*	1.85	0.77	4.94	0.651
Experiences (Ref. 1–5 Years)
6–10 Years	1.44	1.19	1.61	0.001*	1.51	1.12	2.03	0.001*
> 10 years	1.63	1.34	1.83	<0.001*	2.039	1.471	2.83	0.007*
University of graduation (Ref. Local)
International	1.66	1.23	1.77	0.001*	4.68	3.94	5.57	<0.001*
Regional	1.44	1.18	1.75	0.013*	1.05	0.961	1.140	0.298
Age	1.46	1.29	1.65	0.003*	1.15	1.14	1.17	<0.001*

Notes: *P-values < 0.05 considered statistically significant.

Good knowledge and Positive scores were generated by finding the median score.

A Better attitude score was observed in older participants (OR 1.15; 95% CI 1.14–1.17), postgraduates (OR 2.80; 95% CI 2.36–3.33), chain pharmacies (OR 1.08; 95% CI 1.01–1.16), chief pharmacists (OR 1.62; 95% CI 1.44–1.82), pharmacists with 6–10 years of experience (OR 1.15; 95% CI 1.12–2.03), pharmacists with > 10 years’ experience (OR 2.04; 95% CI 1.47–2.83) and pharmacists graduated from international universities (OR 4.68; 95% CI 3.94–5.57) (Table 4).

Better self-efficacy scores were observed in older participants (OR 1.05; 95% CI 1.04–1.06), postgraduates (OR 1.35; 95% CI 1.27–1.44), chain pharmacies (OR 1.06; 95% CI 1.02–1.11), chief pharmacists (OR 1.24; 95% CI 1.17–1.31), pharmacists with 6–10 years of experience (OR 1.52; 95% CI 1.16–1.91), pharmacists with > 10 years’ experience (OR 2.34; 95% CI 1.87–6.15) and pharmacists graduated from international universities (OR 1.87; 95% CI 1.54–2.02) (Table 5).

Table 5.

Regression analysis for the factors affecting self-efficacy on patient-centered.

	Good self-efficacy ≥ 59
Demographics	Or	95% CI		P-value
Gender (Ref. Male)
Female	1.010	0.97	1.05	0.57
Education level (Ref. Bachelor)
Postgraduate	1.35	1.27	1.44	<0.001*
Pharmacy type (Ref. Independent Pharmacy)
Chain pharmacy	1.06	1.02	1.11	0.006*
Position in the pharmacy (Ref. Assistant pharmacist)
Chief pharmacist	1.24	1.17	1.31	<0.001*
Pharmacist in charge	1.910	0.86	2.96	0.164
Experiences (Ref. 1–5 years)
6–10 Years	1.52	1.16	1.91	0.001*
> 10 years	2.34	1.87	6.15	0.002*
University of graduation (Ref. Local)
International	1.87	1.54	2.02	0.0014*
Regional	1.01	0.98	1.22	0.871
Age	1.05	1.04	1.06	<0.001*

3.4. Obstacles and barriers to the practice of patient-centered communication among community pharmacies

The most common reported obstacles to patient-centered communication among community pharmacies were workload and/or shortage of pharmacy staff (81.5%) and a discouraging working environment (75.7%), followed by time constraints (68%) and patients unwilling to participate (53%) (Table S5).

4. Discussion

Despite the benefits to patient outcomes gained when pharmacists integrate a PCC approach into their practice, especially when counseling on medication management. There is scarce research examining the operationalization of this approach in pharmacies. In particular, there has been a lack of focus on the factors and barriers affecting the practical implementation of PCC. As far as we know, our work is the first to explore community pharmacists’ perspectives on integrating PCC, including the obstacles they encounter. To this end, this work evaluates the knowledge, attitude, and self-efficacy regarding PCC among community pharmacists in the UAE.

Overall, we found that the respondents showed good knowledge and attitudes toward PCC, which is consistent with prior findings on pharmacy professionals’ perceptions and knowledge of PCC [42]. For instance, a previous study revealed that 95.1% of pharmacy professionals displayed correct knowledge of the need for pharmacy professionals to clearly inform patients when counseling on treatment plans [42].

We found a significant concern in that the respondents demonstrated a low level of efficacy in identifying the thoughts and feelings of patients, advising and supporting patients during decision-making, and continuing their relationship with a patient who expresses anger. This finding implies that the respondents are to some extent unaware of the PCC approach [42], which is in line with the results of prior work on self-efficacy and barriers among pharmacy professionals regarding PCC [42]. Overall, we may consider this to imply a general unawareness of the importance of PCC among pharmacy professionals. However, it is necessary to emphasize that pharmacy professionals have an essential role to play. By taking the patient’s thoughts and feelings into account and encouraging them to take part in the treatment decision-making, these professionals can contribute significantly toward improved patient outcomes.

The findings align with Bandura’s Social Cognitive Theory, which frames self-efficacy as a product of mastery experiences, observational learning, verbal persuasion, and outcome expectancies. Pharmacists expressed broadly positive views of patient-centered communication (PCC), yet reported lower confidence in demanding behaviors such as shared decision-making, explaining patients’ conditions, and handling emotionally charged encounters. These gaps reflect limited opportunities to repeatedly use skills in routine community pharmacy settings, where work demands and time pressure constrain practice.

Higher PCC scores among pharmacists in leadership roles, those with longer professional experience, and those with postgraduate or international education suggest a different trajectory. These groups benefit from sustained exposure to role models, formal training, and more precise feedback on the value of PCC. Repeated reinforcement strengthens both confidence and commitment to patient-centered approaches.

The Calgary–Cambridge framework provides a clear structure for capturing PCC in the survey. Items on greeting, agenda setting, and eliciting concerns map to initiating the session; empathy, trust, and non-judgmental engagement reflect relationship building; explaining options and involving patients align with explanation and planning; and summarizing and checking understanding correspond to closing the session.

Within this structure, knowledge items evaluated conceptual understanding, attitude items captured endorsement of patient-centered values, and self-efficacy items measured perceived ability to perform specific communication tasks. The mismatch between strong knowledge and weaker self-efficacy signals a practical problem rather than a conceptual one. Addressing it requires targeted training interventions and organizational support that prioritize advanced PCC behaviors, with a particular emphasis on socioemotional communication and shared decision-making.

Less than half (48.7%) of the participants gave an incorrect response to the question on the meaning of the concept of PCC by stating that it refers solely to filling prescriptions and offering guidelines on how to use the medication. A large number of previous studies have made similar findings regarding pharmacy professionals’ lack of knowledge of PCC [17,43], demonstrating that such an attitude also relates to a reduced quality of care [44,45]. It has also been established that certain strict behaviors displayed by pharmacy professionals are contrary to the core aspects of PCC, which aims to strengthen the relationship between the patient and the care provider to elicit engagement from the patient [42,46]. For instance, previous research has suggested that such behaviors may be due to the conventional health education model used to train pharmacists, which has an overly paternalistic tendency and a focus on technical knowledge [47].

This study makes some other concerning findings regarding pharmacy professionals’ attitudes toward PCC. First, 44.4% of the respondents disagreed with the item “In PCC, the pharmacist should express an interest in the patient’s knowledge about their condition and treatment”. In addition, 64.8% stated that the treatment decision-making process should not be shared with the patients. This may imply that the respondents consider it not important for patients to agree on their treatment, and thus, they consider the incorporation of their knowledge into the decision-making process as unnecessary.

Nonetheless, it must be reiterated that patients have unique needs and backgrounds and thus can be expected to have informed knowledge about their own health. In line with this, pharmacy professionals should seek to provide transparency by engaging in behaviors such as listening to patients, respecting their feelings and thoughts, and engaging in reflection on their own attitudes and behaviors [17]. A number of patient-centered strategies, such as conducting motivational interviewing (MI) with patients, can be implemented to help patients make informed choices, support their emotional needs, and promote positive behaviors, such as increased treatment adherence [48]. Thus, training for pharmacy professionals should focus on enhancing their communication skills, such as motivational interviewing [49,50].

Overall, this research has found that several factors influence the knowledge of, attitude toward, and self-efficacy in PCC among UAE community pharmacists. These factors may facilitate or hinder their integration of PCC into practice. Specifically, respondents who were older, had more experience, were postgraduates, worked in chain pharmacies, and had received their degrees from international universities scored higher in terms of their PCC knowledge, attitude, and self-efficacy. Due to their generally more positive experience with PCC and the training they received, this finding should come as no surprise. This is also consistent with research in the South Korean context, which shows that pharmacy students’ attitudes and skills regarding PCC are enhanced by relevant training, which also increases their confidence in their ability to provide counseling for patients [51].

Another interesting finding of this study is that chief pharmacists scored higher on PCC knowledge, attitude, and self-efficacy. This could be attributed to the fact that the UAE healthcare market is highly competitive, especially for chain pharmacies, meaning that patient satisfaction and customer loyalty are critical to remain competitive. While some chain pharmacies in other regions may be perceived as less focused on patient interaction due to profit-driven motives, many in the UAE base their business model on patient engagement and offering a high-quality service. As a result, they frequently use standardized practices to make sure that the level of care quality remains consistently high regardless of location; this approach often involves structured counseling protocols. Moreover, unlike independent pharmacies in the UAE, chain pharmacies often have access to substantial resources, giving them the ability to train staff and give them the time and tools needed to implement PCC. Due to this focus on high-quality service and a better patient experience, pharmacists employed in UAE chain pharmacies may demonstrate a higher level of attitudes, knowledge, and self-efficacy toward this care approach, as was seen here.

The barriers to PCC inherent in the research study fell into two categories. Structural constraints included workload, staffing, time pressure, and organizational conditions, while behavioral barriers centered on patient reluctance and pharmacists’ confidence in shared decision-making. These findings point to the need for system-level reform alongside focused individual training.

The results also indicate that staff shortages and increased workloads produce an environment that is not conducive to PCC. Other barriers to PCC reported here include time constraints and an unwillingness among patients to take part in decision-making. This is similar to prior findings from research conducted in the Australian [21] and Polish contexts [52].

The PCC patterns observed among UAE community pharmacists must be interpreted within the local sociocultural and healthcare context. Professional–patient interactions in the UAE have traditionally followed hierarchical norms, with pharmacists positioned as authoritative experts and patients often expecting directive guidance rather than collaborative decision-making. This context helps explain lower confidence in shared decision-making and eliciting patient perspectives, despite strong endorsement of patient-centered values.

Population diversity adds further complexity. Wide variation in language, cultural norms, and health literacy shapes communication encounters and constrains participatory dialogue. In settings where shared decision-making is embedded in training and patient expectations, PCC is enacted differently than in routine UAE community pharmacy practice.

In light of the above, it is recommended that health authorities take steps to overcome the staff shortages to alleviate the workload in community pharmacies, thereby ensuring a positive working environment that can offer the space for pharmacy professionals to implement the PCC approach. Furthermore, pharmacy professionals should be given training on the use of PCC as this will go some way toward overcoming the abovementioned obstacles, representing a relatively straightforward way to improve patient outcomes.

To promote the integration of the PCC approach, there is a need for standard communication guidelines as well as programs aimed at raising pharmacy professionals’ awareness of the importance of PCC. Meanwhile, the authorities should also consider interventions aimed at empowering patients to become involved in the decision-making regarding their treatment. In this context, decision aids can be developed to help patients express their emotional needs, pose relevant questions to their pharmacists, and participate in decisions about their care.

Sustained integration of patient-centered communication (PCC) within undergraduate pharmacy education requires deliberate curricular design. Web-based learning modules have strengthened communication skills, including English-language competence essential for patient interaction [53]. Practice-based student learning modules using role-play, facilitation, and structured debriefing have improved communication, professionalism, and ethical practice [54,55].

Simulation-based communication and counseling programs, particularly those involving simulated patients, have produced gains in communication competence and empathy [56]. Motivational interviewing courses have strengthened patient-centered counseling strategies and increased students’ confidence in applying them in practice [57]. Case-based learning enhances critical thinking, problem-solving, academic performance, and communication skills [58–60].

Embedding social determinants of health into patient cases supports holistic clinical reasoning by linking social context to care decisions [61]. Longitudinal progressive disclosure cases, which mirror real patient care trajectories, improve confidence in patient care skills and strengthen the transfer of theory to practice [62].

This study has a few limitations. To begin with, our cross-sectional survey design prevented us from drawing significant conclusions on the potential relationships between the factors. Longitudinal research would offer more valuable in-depth findings in this regard. Moreover, there may have been bias in the responses due to the observational nature of this study; specifically, the responses are likely to have been influenced by the respondents’ memories and concerns about social desirability. Another limitation of this study is that the demographic characteristics of the sample may not perfectly match the overall population of pharmacists in the UAE. While random sampling was employed to minimize bias and ensure diversity, there may be slight variations in factors such as gender, years of experience, and educational background. These differences could potentially affect the generalizability of the findings to the broader population of pharmacists in the UAE. Future studies could aim to achieve a more representative sample to confirm these results across a larger population. The questionnaire showed acceptable content validity and internal consistency, but construct validity was not formally tested through exploratory or confirmatory factor analysis after pilot testing. The instrument was theory driven and adapted from established tools, so validation relied on expert review and reliability assessment. This choice limits the strength of the psychometric evidence. Future work should apply factor analytic methods to verify the factor structure and reinforce the instrument’s robustness.

Dichotomizing continuous scores at the median compresses meaningful variation within the data. The analysis did not include sensitivity checks using continuous outcomes. Modeling PCC domains as continuous variables in future studies would preserve scale information and allow clearer assessment of gradient effects.

The study also depended on self-reported measures, which introduces the risk of social desirability bias and inflated estimates of knowledge, attitudes, or self-efficacy related to patient-centered communication. Although the response rate was high, non-response bias cannot be ruled out. Pharmacists who declined participation may differ systematically from respondents, particularly with respect to workload, motivation, or engagement with patient-centered practice.

Finally, some perspectives may not have been taken into consideration due to the closed-ended questions used in the survey. Our findings have revealed specific gaps in pharmacists’ self-efficacy regarding PCC, suggesting that improvement efforts should focus on this area. To be specific, although the respondents showed good knowledge of PCC, their levels of confidence in applying some of the skills were low. For instance, they appeared to struggle with practices like building trustful relationships, identifying the emotions of the patient, and engaging the patient in care decision-making. Thus, a priority should be establishing training programs that specifically target these practices. Furthermore, there is a need to implement structural changes, e.g., lessening the workload and having more staff, as this will give pharmacists the necessary resources and time to integrate PCC into their practices. By targeting such efforts at community pharmacies, it will become possible to close the gap between pharmacists’ attitudes and knowledge regarding PCC and their practical application of it.

5. Conclusion

While the self-reported responses indicate a reasonably good understanding of PCC among participating pharmacists, gaps in self-efficacy and practical application remain evident. In particular, predictors of good self-efficacy were respondents’ age, work setting, level of training, years of experience, and the university from which they received their degree. Barriers to the implementation of PCC primarily encompassed workload, staff shortages, time constraints, and an unfavorable work environment. Finally, pharmacy professionals should engage in respectful and supportive communication, as this lays the foundation for effective PCC, whereby both they and their patients should engage in positive behaviors and two-way communication to enhance patient engagement.

Funding Statement

This paper was not funded.

Authors contributions

Ammar Abdulrahman Jairoun: Conceptualization, methodology, data collection, data analysis, drafting and revising the manuscript. Sabaa Saleh Al-Hemyari: Data collection, drafting of initial manuscript, reviewing, and editing. Faris El-Dahiyat: Data analysis, interpretation of results, manuscript review, and critical revisions. Moyad Shahwan: Data collection, reviewing, and editing of manuscript. Sa’ed H. Zyoud: Statistical analysis, interpretation of findings, and manuscript review. Eman Abu-Gharbieh: Supervision, project administration, critical revision, and final approval of the manuscript. Fahad S. Alshehri: Manuscript review, resources, and guidance in data interpretation. Alanood S. Algarni: Data collection support and manuscript editing. Nasser M. Alorfi: Manuscript editing, reviewing, and supervision.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.