Assessment of Knowledge, Attitudes, Practices and Perceptions Regarding the Use of Sunscreen Among Pharmacists in Jordan

ABSTRACT

Background

Sunscreens are agents to protect the skin from the destructive effects of ultraviolet (UV) radiation. Pharmacists are expert healthcare providers who guide consumers regarding the usage of sunscreen. This study aims to evaluate pharmacists' knowledge, attitudes, practices and perceptions regarding sunscreen use in Jordan.

Method

A cross‐sectional study was conducted among pharmacists in Jordan using a self‐administered questionnaire created using Google Forms and distributed online social media platforms. The questionnaire contained five sections to assess demographics (9 items), knowledge (11 items), attitudes (8 items), practices (12 items) and perceptions (2 items). The data was analyzed using descriptive and inferential statistics.

Results

A total of 407 pharmacists working in different fields completed the survey, 79.6% were female and 20.4% male. 56.5% of participants were under 30 years old, while 56% of participants had less than 5 years’ experience. The results showed that knowledge, attitude and practice scores were significantly associated with age (p = 0.011 and p < 0.001, respectively). In addition, 53.8% of participants were familiar with the Fitzpatrick scale of skin type that categorizes the skin into six types, and 232 participants (57.0%) responded correctly regarding the classification of active ingredients in sunscreen agents. Participants with 5–10 years of experience were less likely (adjusted odds ratio (aOR): 0.59 (95%CI: 0.37–0.94); p‐value < 0.05) to have better knowledge of sunscreen compared to others (p < 0.05). Participants aged 30–39 years (aOR: 2.13 (95%CI: 1.34–3.38), p‐value < 0.01), those with postgraduate studies (aOR: 2.85 (95%CI: 1.41‐5.77), p‐value < 0.01), those with 11–15 years of experience (aOR: 2.37 (95%CI: 1.11–5.05), p‐value < 0.05), those who work in academia (aOR: 2.65 (95%CI: 1.15–6.10), p‐value < 0.05), those who were married (aOR: 1.83 (95%CI: 1.22–2.75), p‐value < 0.01), and those who graduated from a public university (aOR: 2.33 (95%CI: 1.55–3.51), p‐value < 0.001) were more likely to show positive attitude towards the use of sunscreen.

Conclusion

Jordanian pharmacists’ knowledge and practice of sunscreen use were generally adequate; however, specific gaps were identified in certain areas. This demonstrated that pharmacists need more specialized courses during their continuing professional development to address these gaps and improve their knowledge and abilities.

1. Introduction

Sunscreens are photoprotection agents formulated to protect the skin from the harmful effects of solar radiation, particularly ultraviolet (UV) radiation, either by absorbing or scattering solar rays [1]. UV radiation is subdivided into UVA, UVB and UVC. UVA radiation (315–400 nm) produces an excess of reactive oxygen species, which in turn indirectly damages DNA. While UVB radiation (280–320 nm) can directly damage DNA by forming pyrimidine dimers, which can trigger apoptosis or lead to DNA replication errors, resulting in mutations and potentially cancer. On the other hand, UVC radiation is blocked by the ozone layer in the atmosphere, preventing it from reaching the Earth's surface [2].

Sunscreen agents that absorb UV radiation and convert it into an insignificant amount of heat are classified as organic or chemical sunscreens, while sunscreen agents which reflect and scatter light are classified as inorganic or physical sunscreens [3]. The effectiveness of sunscreen in providing photoprotection is determined by sun protection factor (SPF), which measures a sunscreen's ability to protect from sunburn, primarily resulting from UVB and also by the protection grade of UVA (PA) values [4]. SPF was defined by the Food and Drug Administration (FDA) in 1978 as the ratio between the minimal erythemal dose (MED) of sunscreen‐protected skin, applied at a rate of 2 mg/cm², and the MED of unprotected skin [5].

Since the 1980s, international sun protection campaigns have played a crucial role in raising awareness of the risks of excessive sun exposure and the importance of sunscreen [6]. It was found that sunscreen agents play a crucial role in decreasing the prevalence of skin disorders in humans caused by UV rays, such as sunburn, skin aging, pigmentary symptoms and also play a role in the prevention of epithelial and non‐epithelial skin cancer [7].

Many types of sunscreen topical formulations are available in the pharmaceutical market, including gel, cream, lotion, foam and stick. Individual skin characteristics may influence sunscreen selection and recommendations. The Fitzpatrick skin type classification categorizes skin according to its response to UV exposure and may support individualized photoprotection recommendations according to skin sensitivity and sun exposure risk [8].

Sunscreen agents are classified as cosmetic products according to EU regulations, while they are over‐the‐counter drugs according to US regulations [9]. Consequently, pharmacists are key healthcare providers who play an essential role in medication and cosmetic management [10]. Health care specialists have a significant role in raising the level of awareness and encouraging the general population to protect themselves from skin cancer by following healthy behaviours [11]. A previous cross‐sectional study conducted in Spain, including 450 health care workers, found significant differences in the rate of sunscreen use amongst them [12].

A study conducted at a medical college in the United States showed that students have an important role in providing correct advice to patients to prevent skin cancer. As such, the presence of a detailed curriculum in medical education is essential [13]. Pharmacists can guide individuals in making informed decisions regarding usage the use of sunscreen agents. Despite the important role of pharmacists in sunscreen counselling, limited studies have evaluated their knowledge, attitudes and practices regarding sunscreen use, particularly in Jordan and the regional context.

The objective of this study is to evaluate pharmacists' knowledge, attitudes, practices and perceptions regarding sunscreen use in Jordan.

2. Method

2.1. Study Design and Setting

This is a cross‐sectional questionnaire‐based study among pharmacists in Jordan conducted from 21st January to eighth February 2025. The study was conducted using an online questionnaire developed using Google Forms. The researchers shared the form link on social media platforms to achieve wide reaching distribution.

Based on previous published studies evaluating knowledge, attitudes and practices related to sunscreen use and sun protection among healthcare staff, the questionnaire was developed and adapted to suit the primary objective of this study.

2.2. Pilot Phase

After developing the questionnaire, four experts in clinical pharmacy and two dermatologists reviewed the questionnaire to ensure content validity. Additionally, around 40 pharmacists were enrolled to evaluate the clarity and reliability of the questionnaire. The participating pharmacists confirmed the clarity of the questionnaire items. The KR‐20 coefficient for the knowledge scale was 0.681, which indicated acceptable internal consistency. The values for the knowledge items ranged from 0.60 to 0.70, which is within the commonly accepted range in pharmacy practice studies. Construct validity for the attitude scale was examined using the Kaiser–Meyer–Olkin (KMO) measure, which indicated an acceptable level for proceeding with factor analysis (0.619). Bartlett's test of sphericity was statistically significant, χ ² (21) = 216.264, p < 0.001, confirming that the correlation matrix was not an identity matrix and that sufficient relationships exist among the items.

2.3. Ethics and Consent

All individuals were informed that the study was voluntary through the description provided on the Google Form questionnaire, and consent was obtained from all participants. The questionnaire was developed based on insights from earlier studies on sunscreen agent use. The study received approval from the Deanship of Scientific Research and Graduate Studies at Jerash University. (Approval No. (7/2/2024/2025); December 23, 2024). To ensure anonymity, no personally identifiable information was collected during the data collection process.

2.4. Questionnaire

The questionnaire design included sections on knowledge of sunscreen agents, practices related to sunscreen use, attitudes and perceptions. The questionnaire was organized into five sections:

• Demographic Information: This section included questions about the participants' age, gender, degree, years of experience, current workplace, graduate university and grade point average.

• Knowledge: Comprised of 11 questions focused on assessing pharmacists' knowledge of sunscreen agents, including basic information about their effectiveness, ingredients and proper use. This included knowledge of the SPF mechanism, ingredient classification, types of sunscreen agents and the Fitzpatrick skin type scale. Each correct answer received a score of one. The maximum achievable knowledge score was 11, with a range of 0 to 11. Higher knowledge scores indicated a better knowledge level.

• Attitude: This section included eight items of yes/no and multiple‐choice question (MCQ) format that assessed participants' attitudes towards sunscreen. Each item was given a score of 1 for responses that indicated a positive attitude towards the use of sunscreen. The maximum achievable attitude score was 8, with a range of 0 to 8. Higher attitude scores reflected a more positive attitude towards sunscreen use.

• Practice: This section consisted of 12 questions that primarily examined pharmacists’ behaviours related to sunscreen use and their recommendations for patients.

• Perception: Included two questions designed to assess pharmacists' opinions and understanding of sunscreen.

Content validity was conducted by three experienced academics to ensure that all the questions are reliable and pertinent to pharmacists.

According to statistics from the Jordanian Pharmaceutical Association, there were a total of 34,325 registered pharmacists in 2024 [14]. Thus, the minimum required sample size determined using the SurveyMonkey method was 380 for a 95% confidence interval and 5% margin of error. A total of 407 complete responses were obtained and considered in this study.

3. Statistical Analysis

The data was analyzed using descriptive and inferential statistics. Skewness and kurtosis statistics were used to examine the normality of the attitude and knowledge scores. The skewness measure for the attitude score was −0.426 (SE = 0.121), and the kurtosis measure was −0.231 (SE = 0.241), whereas the skewness measure for the knowledge score was −0.106 (SE = 0.121) and the kurtosis measure was −0.794 (SE = 0.241); demonstrating that the variables were normally distributed. Results are shown as a mean ± standard deviation (SD). Data was analyzed using Pearson's chi‐square, Pearson correlation coefficient, and independent t‐tests by Statistical Package for Social Sciences software version 26 for Windows. Multiple‐variable logistic regression was used to identify predictors of better sunscreen knowledge and positive attitude towards sunscreen use. The mean knowledge score (4.8 (SD: 2.0)) and attitude score (5.6 (SD: 1.3)) were used as the cut‐off points to define the dummy variable in the logistic regression models. The findings were reported as adjusted odds ratios (aOR) with 95% confidence interval. The level of statistical significance was set at p < 0.05 (two‐sided p‐values).

Before conducting logistic regression analysis for knowledge and attitude models, multicollinearity was evaluated using Tolerance and Variance Inflation Factor (VIF) values from linear regression collinearity diagnostics. Tolerance values ranged between 0.460 and 0.980. The VIF measures ranged from 1.021 to 2.176. The highest condition index across all dimensions was 6.253, indicating moderate multicollinearity. Therefore, model diagnostics confirmed the absence of significant multicollinearity.

4. Results

4.1. Demographic Data

The total number of pharmacists who completed the survey was 407, working in different fields. The study sample consisted of 79.6% female and 20.4% male pharmacists. 56.5% of participants were under 30 years old, and 77.1% held a bachelor's degree in pharmacy. 56% of participants had less than 5 years’ experience, and 59.7% of the participants worked in the middle Jordan region. Table 1 presents detailed demographic data for the pharmacists who participated in the survey.

TABLE 1.

Participants’ demographic data.

Factor	N (%)
Age
Less than 30 years	230 (56.5%)
30–39 years	126 (31.0%)
40–49 years	38 (9.3%)
50–59 years	12 (2.9%)
Above 60 years	1 (0.2%)
Gender
Female	324 (79.6%)
Male	83 (20.4%)
Degree
BSc. in Pharmacy	314 (77.1%)
BSc. in Doctor of Pharmacy (PharmD)	43 (10.6%)
Postgraduate (MSc. / Ph.D.)	50 (12.3%)
Years of experience
Less than 5 years	228 (56.0%)
5–10 years	105 (25.8%)
11–15 years	42 (10.3%)
More than 15 years	32 (7.9%)
Current workplace
Chain pharmacy	71 (17.4%)
Independent community pharmacy	114 (28.0%)
Hospital	47 (11.5%)
Medical representative	15 (3.7%)
The Ministry of Health	28 (6.9 %)
Academia	41 (10.1%)
others	91 (22.4%)
Working area
North Jordan (Irbid, Jerash, Ajlun, Mafraq)	130 (31.9%)
Middle Jordan (Amman, Balqa, Madaba, Zarqa)	243 (59.7%)
South Jordan (Aqaba, Karak, Ma'an, Tafilah)	34 (8.4%)
Status
Single	222 (54.5%)
Married	180 (44.2%)
Other	5 (1.2%)
Graduate University
Public university	182 (44.7%)
Private university	225 (55.3%)

4.2. Knowledge of SPF

Knowledge score (p = 0.011) was significantly associated with age, with the 60+ age group having the highest knowledge. Also, knowledge (p = 0.023) was significantly influenced by years of experience; pharmacists with less experience demonstrated superior knowledge. In addition, knowledge was influenced by current employment (p = 0.017), with Ministry of Health pharmacists ranking the lowest and independent community pharmacists the highest. Furthermore, knowledge (p = 0.043) was influenced by marital status, with single pharmacists having higher knowledge.

Out of 407 pharmacists, 70.5% were familiar with the concept of SPF, and 47.7% responded that SPF is a measure of the level of protection against UVB rays. 75.9% answered correctly that the SPF value indicates how long it would take for your skin to burn with sunscreen compared to without. 30.2% correctly identified that SPF level 30 provides 97% protection.

Table 2 summarizes the responses of pharmacists regarding questions related to knowledge of SPF.

TABLE 2.

Questionnaire results regarding knowledge of SPF.

Question	N (%)
How familiar are you with the term SPF?
Very familiar	1 (0.2%)
Somewhat familiar	103 (25.3%)
Familiar	268 (70.3%)
Not familiar at all	17 (4.2)
Which of the following statements about SPF is correct?
SPF measures the level of protection against UVA rays	181 (44.5%)
SPF measures the level of protection against UVB rays	194 (47.7%)
SPF measures the level of protection against UVC rays	12 (2.9%)
I don't know	20 (4.9%)
SPF indicates how long it would take for your skin to burn with sunscreen compared to without it
Yes	309 (75.9%)
No	98 (24.1%)
Which SPF level provides 97% protection?
SPF 15	36 (8.8%)
SPF 30	123 (30.2%)
SPF 50	220 (54.1%)
I don't know	28 (6.9%)
For patients who are concerned about skin irritation, do you generally recommend: (Select all that apply)
Mineral sunscreens (zinc oxide, titanium dioxide)	217 (53.3%)
Fragrance‐free, Alcohol‐free sunscreens	250 (61.4%)
Sunscreens with added skincare benefits (e.g., moisturizing agents)	202 (49.6%)
Sunscreen with SPF 90 or more	68 (16.7%)
I'm not sure	47 (11.5%)

4.3. Knowledge of Sunscreen Types and Fitzpatrick Skin Types

The results showed that pharmacists in Jordan recognize the difference between mineral (physical) sunscreen and chemical sunscreen. A significant majority (74.9%) responded that the sunscreen agent which works by scattering or reflecting UV radiation is mineral (physical) sunscreen, and a similar proportion (70.0%) recognized that the sunscreen agent that works by converting UV radiation into heat, then releasing it from the skin is chemical sunscreen. When the pharmacists were asked about the active ingredients for both physical and chemical sunscreen (multiple responses were allowed), 81 (20%) pharmacists answered correctly regarding physical sunscreens’ active ingredients: zinc oxide, titanium oxide and talc. While 151 (37.0%) pharmacists identified chemical sunscreens’ active ingredients correctly: octocrylene, ethylhexyl methoxycinnamate and avobenzone.

Out of 407 pharmacists, 219 (53.8%) were familiar with the Fitzpatrick scale of skin types that categorizes skin into six types. In this study, 33.9% responded correctly to the number of skin types.

Participants’ knowledge of sunscreen types and the Fitzpatrick scale was influenced by age, years of experience, current workplace and marital status (p < 0.05). Participants aged less than 30 years achieved higher knowledge scores. Those with less than five years’ experience, single and working in independent community pharmacies, showed similar knowledge levels.

Table 3 summarizes the responses of pharmacists to the questions related to knowledge of sunscreen active ingredients and the Fitzpatrick scale.

TABLE 3.

Questionnaire results regarding sunscreen knowledge of sunscreen types and the Fitzpatrick scale.

Question	N (%)
The sunscreen agent that works by scattering or reflecting UV radiation is
Mineral (Physical) sunscreen	305 (74.9%)
Chemical sunscreen	77 (18.9%)
I don't know	25 (6.1%)
The sunscreen agent that works by converting UV radiation into heat, then releasing the heat from the skin is
Mineral (Physical) sunscreen	285 (70.0%)
Chemical sunscreen	95 (23.3%)
I don't know	27 (6.6%)
Which of the following ingredients are found in physical sunscreens? (You may choose more than one answer.)
Zinc oxide	274 (67.3%)
Titanium dioxide	245 (60.2%)
Talc	78 (19.2%)
Octocrylene	29 (7.1%)
Ethylhexyl methoxycinnamate	34 (8.4%)
Avobenzone	31 (7.6%)
I don't know	60 (14.7%)
Which of the following ingredients are found in chemical sunscreens? (You may choose more than one answer.)
Zinc oxide	70 (17.2%)
Titanium dioxide	66 (16.2%)
Talc	50 (12.3%)
Octocrylene	180 (44.3%)
Ethylhexyl methoxycinnamate	171 (42%)
Avobenzone	176 (43.2%)
I don't know	76 (18.7%)
Are you familiar with the Fitzpatrick skin types classification?
Yes	219 (53.8%)
No	188 (46.2%)
How many skin types are categorized in the Fitzpatrick scale?
2	19 (4.7%)
4	89 (21.9%)
6	138 (33.9%)
10	13 (3.2%)
I don't know	148 (36.4%)
Do you know your skin type according to the Fitzpatrick scale?
Yes	185 (45.5%)
No	90 (22.1%)
I'm not sure	132 (32.4%)

4.4. Attitudes and Practices regarding Sunscreen Use

Figure 1 shows the pharmacists’ responses to questions related to sunscreen usage attitudes, while Table 4 summarizes the pharmacists’ responses regarding sunscreen usage practice.

FIGURE 1.

Questionnaire results regarding sunscreen usage attitude.

TABLE 4.

Questionnaire results regarding sunscreen usage practices.

Question	N (%)
Do you recommend using sunscreen to others? (relatives, friends or patients)
Yes	384 (94.3%)
No	23 (5.7%)
When do you recommend users apply chemical sunscreen?
15–30 min before sun exposure	332 (81.6%)
Immediately before going outside	52 (12.8%)
I don't pay attention to timing	23 (5.7%)
How often do you recommend users apply sunscreen throughout the day?
Once a day	73 (17.9%)
Every 2–4 h	294 (72.2%)
Only when they are outdoors on a sunny day	40 (9.8%)
What SPF do you usually recommend?
SPF 15	35 (8.6%)
SPF 30	115 (28.3%)
SPF 50	257 (63.1%)
What type of sunscreen do you recommend most?
Mineral (physical) sunscreen	196 (48.2%)
Chemical sunscreen	110 (27.0%)
No preferences	101 (24.8%)
How often do you explain the differences between sunscreen formulations? (e.g., mineral vs. chemical, lotion vs. spray)
Always	114 (28.0%)
Often	144 (35.4%)
Occasionally	63 (15.5%)
Rarely	51 (12.5%)
Never	35 (8.6%)
What factors influence your recommendation of sunscreen formulation? (Select all that apply)
Patient's skin type (e.g., oily, dry, sensitive)	364 (85.0%)
Patient's lifestyle or activity level (e.g., sports, beach, everyday use)	247 (60.7%)
Ease of application	202 (49.6%)
Skin concerns (e.g., acne, eczema)	241 (59.2%)
SPF level preference	204 (50.1%)
Cosmetic feel (e.g., non‐greasy, mattifying, fragrance‐free, tinted)	235 (57.7%)
Which sunscreen formulation do you commonly recommend for clients with oily or acne‐prone skin?
Spray	50 (12.3%)
Gel	225 (55.3%)
Stick	14 (3.4%)
Lotion	77 (18.9%)
Foam	14 (3.4%)
I'm not sure	27 (6.6%)
Which sunscreen formulation do you commonly recommend for clients with dry skin?
Spray	23 (5.7%)
Gel	26 (6.4%)
Stick	13 (3.2%)
Lotion	54 (13.3%)
Cream	271 (66.6%)
I'm not sure	20 (4.9)
Which sunscreen formulation do you commonly recommend for clients with sensitive skin?
Spray	81 (19.9%)
Gel	58 (14.3%)
Stick	17 (4.2%)
Lotion	105 (25.8%)
Cream	77 (18.9)
I'm not sure	69 (17.0%)
Do you advise parents to apply sunscreen to their children?
Yes	339 (83.3%)
No	68 (16.7%)
Do you provide patients with guidance on sunscreen application? (e.g., reapplication after swimming, amount to apply, etc.)
Yes	373 (91.6%)
No	34 (8.4%)
Would you be interested in additional training or resources to improve your ability to guide patients on sunscreen formulations?
Yes	378 (92.9%)
No	29 (7.1%)

Attitude and practice scores (p < 0.001) were significantly associated with age, with the 30–39 age group attaining the highest attitude scores. Attitude and practice were influenced by gender (p < 0.001), with women scoring higher than men. Also, both (p = 0.007) were significantly influenced by years of experience; pharmacists with 11–15 years had the highest attitude scores. Moreover, attitude and practice (p = 0.003) were influenced by marital status, with married participants displaying better attitudes and practices. Furthermore, the score was significantly higher (p < 0.001) among graduates of public colleges.

4.5. Predictors of Better Knowledge, Attitude and Practice Regarding Sunscreen Usage

Participants with 5–10 years of experience were less likely (aOR: 0.59 (95%CI: 0.37–0.94); p‐value < 0.05) to have better knowledge of sunscreen compared to others (p < 0.05). On the other side, participants who work in independent community pharmacy were more likely to be knowledgeable of sunscreen compared to others (aOR: 2.05 (95%CI: 1.12–3.75), p‐value < 0.05) (p < 0.05).

Participants aged 30–39 years (aOR: 0.43 (95%CI: 0.29–0.68), p‐value < 0.001), those who had a BSc in Doctor of Pharmacy (aOR: 0.49 (95%CI: 0.24–1.00), p‐value < 0.05), those with more than five to ten years of experience (aOR: 0.51 (95%CI: 0.31–0.84)) and eleven to fifteen years of experience (aOR: 0.37 (95%CI: 0.17–0.78), p‐value < 0.01), those who are married (aOR: 0.59 (95%CI: 0.39–0.89), p‐value 0.05) and those who graduated from public university (aOR: 0.51 (95%CI: 0.34–0.77), p‐value < 0.01) were less likely to be knowledgeable of sunscreen types and the Fitzpatrick scale compared to others.

Participants aged 30–39 years (aOR: 2.13 (95%CI: 1.34–3.38), p‐value <0.01), those with postgraduate studies (aOR: 2.85 (95%CI: 1.41–5.77), p‐value < 0.01), those with 11–15 years of experience (aOR: 2.37 (95%CI: 1.11–5.05), p‐value < 0.05), those who work in academia (aOR: 2.65 (95%CI: 1.15–6.10), p‐value < 0.05), those who are married (aOR: 1.83 (95%CI: 1.22–2.75), p‐value < 0.01), and those who graduated from public university (aOR: 2.33 (95%CI: 1.55–3.51), p‐value < 0.001) were more likely to show positive attitude towards the use of sunscreen (p < 0.05).

Table 5 presents the aORs and 95% confidence intervals for factors associated with knowledge of sunscreen use, sunscreen types and the Fitzpatrick scale, as well as attitudes towards sunscreen use.

TABLE 5.

Predictors of better knowledge of sunscreen use, types and the Fitzpatrick scale and sunscreen use attitudes and practices.

Variable	Adjusted odds ratio of better knowledge (95% confidence interval)	Adjusted odds ratio of knowledge of sunscreen types and Fitzpatrick scale (95% confidence interval)	Adjusted odds ratio of positive attitude and practice (95% confidence interval)
Age
Less than 30 years (Reference category)	1.00	1.00	1.00
30–39 years	0.72 (0.47–1.11)	0.43 (0.29–0.68) ***	2.13 (1.34–3.38) **
40–49 years	0.83 (0.41–1.64)	0.60 (0.29–1.23)	1.36 (0.67–2.73)
50–59 years	0.37 (0.11–1.27)	0.58 (0.17–1.96)	0.44 (0.13–1.51)
60 years and older	—	—	—
Gender
Female (Reference category)	1.00	1.00	1.00
Male	0.68 (0.42–1.10)	0.93 (0.56–1.52)	0.31 (0.19–0.52) ***
Degree
BSc in pharmacy (Reference category)	1.00	1.00	1.00
BSc in Doctor of Pharmacy	1.11 (0.59–2.11)	0.49 (0.24–1.00) *	1.23 (0.64–2.36)
Postgraduate studies	1.03 (0.57–1.88)	0.73 (0.39–1.37)	2.85 (1.41–5.77) **
Years Of experience
Less than 5 years (Reference category)	1.00	1.00	1.00
5–10 years	0.59 (0.37–0.94) *	0.51 (0.31–0.84) **	1.11 (0.69–1.78)
11–15 years	0.97 (0.50–1.89)	0.37 (0.17–0.78) **	2.37 (1.11–5.05) *
More than 15 years	0.64 (0.31–1.35)	0.61 (0.28–1.33)	0.51 (0.24–1.08)
Current workplace
Chain pharmacy (Reference category)	1.00	1.00	1.00
Independent Community pharmacy	2.05 (1.12–3.75) *	1.69 (0.92–3.09)	1.44 (0.79–2.61)
Hospital	1.01 (0.48–2.12)	0.76 (0.35–1.66)	1.01 (0.49–2.12)
Medical representative	1.01 (0.33–3.08)	0.25 (0.05–1.20)	0.85 (0.28–2.60)
Pharmacist at Ministry of Health	0.55 (0.22–1.37)	0.44 (0.16–1.24)	1.75 (0.71–4.31)
Academia	1.33 (0.62–2.88)	0.94 (0.42–2.08)	2.65 (1.15–6.10) *
Others	1.54 (0.82–2.87)	1.02 (0.54–1.93)	1.56 (0.83–2.92)
Working area
North Jordan (Irbid, Jerash, Ajlun, Mafraq) (Reference category)	1.00	1.00	1.00
Middle Jordan (Amman, Zarqa, Balka’, Madaba)	1.18 (0.77–1.80)	0.92 (0.59–1.42)	1.12 (0.73–1.73)
South Jordan (Karak, Tafilah, Maan, Aqaba)	0.84 (0.39–1.78)	0.70 (0.31–1.55)	0.73 (0.34–1.56)
Marital status
Single (Reference category)	1.00	1.00	1.00
Married	0.81 (0.55–1.20)	0.59 (0.39–0.89) *	1.83 (1.22–2.75) **
Others	0.19 (0.02–1.76)	0.31 (0.03–2.82)	1.37 (0.23–8.36)
Graduate University
Private university (Reference category)	1.00	1.00	1.00
Public university	0.98 (0.66–1.45)	0.51 (0.34–0.77) **	2.33 (1.55–3.51) ***

^* p < 0.05;

^** p < 0.01;

^*** p < 0.001.

5. Discussion

To the best of our knowledge, this is the first study to assess knowledge, attitude, practices and perceptions regarding the use of sunscreen among pharmacists in Jordan. Previous studies have evaluated knowledge and practices regarding sunscreen use among university students [15] and dermatology patients at University Hospital [16]. The present study extends this body of evidence by specifically targeting pharmacists, a group with a critical role in advising patients and promoting public health.

According to our study, participants’ knowledge scores were statistically significant (p = 0.011), which reflects a high awareness of sunscreens among pharmacists. This aligns with the study assessing pharmacists’ knowledge of sunscreen and skin cancer [17]. Such consistency with international findings suggests that baseline awareness among pharmacists is generally adequate across different healthcare systems; however, variations in depth and accuracy of knowledge remain evident.

Our study showed that pharmacists are familiar with the term SPF (70.3%), with a larger proportion (25.3%) reporting being somewhat familiar. Furthermore, 75.9% of participants correctly identified that SPF reflects how long it takes for skin to burn with sunscreen compared to without it. Similarly, a large majority (83%) of community pharmacists in Jeddah, Saudi Arabia, identified that SPF stands for SPF [18]. However, most of the pharmacists in Mashad have inadequate knowledge of sunscreens and moisturizers and their formulations [19]. This contrast highlights regional variability, where pharmacists in Jordan and Saudi Arabia demonstrate relatively higher conceptual understanding compared to findings from Iran, possibly reflecting differences in education systems or professional training exposure. Moreover, our study's results highlighted that a significant group of pharmacists (44.5%) believe that SPF measures the level of protection against UVA rays, while only slightly more (47.7%) answered that SPF measures the level of protection against UVB rays. Far more community pharmacists (72%) in Jeddah, Saudi Arabia answered that SPF measures the level of protection against UVB rays, while 19.0% answered that SPF measures the level of protection against UVB, UVA and UVC [18]. This discrepancy indicates a knowledge gap in distinguishing between UV radiation types, which is essential for appropriate product recommendation, and suggests that pharmacists in Jordan need to increase their knowledge and awareness of the differences between sun rays and how sunscreen works. This can be implemented by giving more lectures on cosmetics at universities and providing specialized courses in this field.

Furthermore, our study found that a little over half of pharmacists (54.1%) reported that SPF level 50 provides 97% protection. All pharmacists in the United Arab Emirates answered that the optimal SPF is 15–20 [20]. Compared to pharmacists in Jeddah, the results showed that broad‐spectrum sunscreens with SPF less than 15 are not used to prevent sunburn only [18]. These inconsistencies indicate a lack of knowledge about sunscreen and that more focus should be given to this subject by giving lectures related to cosmetic matters and sunscreens based on international dermatological recommendations.

To the best of our knowledge, no prior studies have directly evaluated pharmacists’ familiarity with the Fitzpatrick scale and our study is the first to highlight pharmacists’ knowledge of sunscreen types and the ingredients of each type of sunscreen agent (chemical or physical sunscreens), as well as the Fitzpatrick scale of skin types. Knowledge scores were significant (p = 0.011), and a majority (63.0%) of pharmacists responded that they either always or often explain the differences between sunscreen formulations to their clients. Additionally, 85.0% recommend the sunscreen dosage form according to the skin's type, 60.7% according to lifestyle or activity level (e.g., sports, beach, everyday use), 59.2% according to skin concerns (e.g., acne, eczema) and 57.7% according to cosmetic feel (e.g., non‐greasy, mattifying, fragrance‐free, tinted). These findings indicate a relatively advanced level of patient‐centered practice.

A previous study illustrated that healthcare providers’ understanding of individual skin phototypes plays a vital role in tailoring sunscreen recommendations and prevention strategies [21]. Moreover, it is important to understand how sunscreen agents provide UV protection and how the six different skin types of the Fitzpatrick scale react once exposed to sunlight [22]. Our findings are consistent with these international perspectives, reinforcing the importance of integrating dermatological principles into pharmacy practice.

Regarding advising on appropriate sunscreen dosage according to the skin type, 55.3% and 66.6% of pharmacists responded correctly that gel form and cream form are recommended for clients of oily skin and dry skin, respectively. However, only 25.8% and 19.9% of pharmacists recommend lotion and spray form, respectively, for sensitive skin. These results show that pharmacists should be educated more about the correct dosage form to be prescribed according to skin type, either throughout university education or by further training courses conducted by companies producing sunscreen agents as part of pharmacists’ continuous professional development. A further 83.3% of pharmacists advise parents to apply sunscreen to their children.

The study results showed that 86.0% of pharmacists apply sunscreens themselves and 94.3% recommend sunscreen use to others. A large majority (81.6%) of pharmacists recommend users apply chemical sunscreens 15–30 min before sun exposure, and to continue applying every 2–4 h (72.2%). These results align with Kurban, et al., who studied awareness of cosmeceuticals, including sunscreen agents, among pharmacists in Saudi Arabia. They found that 90.0% of pharmacists believe that sunscreens should be applied 15–20 min before sunlight exposure, and 92.0% think that sunscreens should be reapplied every 2 h [18]. This alignment with regional data reflects consistency in practical recommendations, suggesting that behavioural practices among pharmacists are more standardized than their theoretical knowledge.

In our study, the vast majority (94.6%) responded that sunscreens are effective in sunburn prevention, and a further 72.2% of pharmacists believe that sunscreens are effective in preventing skin damage. This result aligns with a Malaysian study that showed that pharmacists are aware that sunscreen is effective in preventing sunburn and skin aging [23]. The additional advantages of sunscreen usage include prevention of sunburn, aging, pigmentary disorders and skin cancer [24]. This agreement across international studies supports the global consensus regarding the clinical benefits of sunscreen use, reinforcing pharmacists’ reliability as promoters of preventive care.

Intriguingly, 43.5% of pharmacists think that sunscreens can lead to vitamin D deficiency. It was reported that sunscreens could affect vitamin D photoproduction if applied at the tested concentration. 1/SPF of UV radiation is transmitted into skin if sunscreen is applied at a concentration of 2 mg/cm² (the tested level of protection), while users commonly apply 0.5 mg/cm², which is unlikely to cause vitamin D deficiency. Additionally, applying sunscreen extends the time people spend outdoors, increasing exposure to UV radiation [25].

Most pharmacists (89.7%) considered sunscreen safe to use during pregnancy, aligning with Lim et al.’s review of sunscreen usage during pregnancy that identified diminishing pigmentation changes from UV exposure during pregnancy [26]. A large number of participants (79.1%) believed that sunscreens are safe for babies older than 6 months. This aligns with the US FDA's recommendation that sunscreens should not be applied to babies less than 6 months old [27]. These findings demonstrate good alignment with international safety guidelines, reflecting appropriate risk awareness among pharmacists.

Most pharmacists (91.6%) stated that they provide patients with guidance on sunscreen reapplication after swimming and the amount to apply. Moreover, 92.9% of pharmacists are interested in additional training or resources to improve their ability to guide patients on sunscreen formulations. This highlights an opportunity for intervention, as willingness to learn is a key driver for improving professional competency and bridging identified knowledge gaps.

According to our study, participants who work in independent community pharmacies were more likely to be knowledgeable about sunscreen compared to others (p<0.05). This is in line with a study [28], which showed that pharmacists had better knowledge of sunscreen than physicians even though statistical significance was not reached (p = 0.008).

Gender was also a factor that influenced attitudes towards sunscreen; female participants in our study scored higher than males (p<0.001), reflecting their greater use of sunscreen. This result aligns with another study conducted in southern Sweden, which showed that females used sunscreen more than men. Also, as age increased, the level of protection also increased (p<0.001) [29]. This pattern reflects broader behavioural trends in health awareness and preventive practices across populations.

Interestingly, participants aged 30–39 years, pharmacists holding a Doctor of Pharmacy degree, those with more than five years of experience, those who were married and those who graduated from a public university were less likely to be knowledgeable about skin and sunscreen types compared to others (p<0.05). A prior study also illustrated that the socio‐demographic factors correlating with sunscreen use are gender (females more than males), higher status, higher levels of education, skin type IV and married individuals [30]. These results highlighted the influence of demographic and professional characteristics on knowledge, attitude and practice and further indicated the need for further health education programs.

Importantly, Fabbro's research showed that the curricula of the American College of Clinical Pharmacy and the American Society of Consultant Pharmacists included negligible coursework on dermatology‐related diseases and treatment. This suggests that pharmacists may not receive sufficient training in advising patients with dermatological conditions [31]. This lack of specialized education at universities can explain the limited knowledge of skin types and sunscreen formulations among pharmacists. Therefore, incorporating structured dermatology‐focused content into pharmacy education could help address these gaps and improve pharmacists’ competence in sun protection counselling.

The use of online survey could have introduced selection bias particularly an over presentation of younger pharmacists, this could have affected the generalizability of the study finding. Therefore, our study finding should be interpreted carefully.

6. Conclusion

This study concluded that a significant percentage of pharmacists are informed about sunscreen agents, but their knowledge about sunscreen was lower than their attitudes and practices. This indicates that pharmacists may benefit from more specialized courses as part of their continuing professional development to improve their knowledge and practice. Alongside this, pharmacy students may also benefit from courses that provide comprehensive information about sunscreen agents within their curricula. These findings highlight the importance of integrating dermatology‐related content into pharmacy education and developing targeted continuing education programs and practical guidelines to support pharmacists in effective sun protection counselling.

Funding

This research was supported by Princess Nourah bint Abdulrahman University Researchers Supporting Project number (PNURSP2026R483), Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

Ethics Statement

The study received approval from the Deanship of Scientific Research and Graduate Studies at Jerash University, with the ethical approval number (7/2/2024/2025).

Conflicts of Interest

The authors have declared that no competing interests exist.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.