Article Figures & Data
Figures
- Figure 1
- Flowchart of study participant selection.
- Figure 1
- Results from both Chi-squared and Binomial tests showing difference from a pre-defined expected proportion of 50% for each primary outcome variable. Results from both tests are similar.
Tables
- Table 1
- Demographics and potential influencing factors gathered in the survey in 5 main categories.
Categories No. Variables Demographic information 1 Gender 2 Age group 3 Nationality 4 Residence 5 Marital status Professional background 6 Workplace 7 Workplace name 8 Years of work experience 9 Educational level Health and personal characteristics 10 Weight 11 Height 12 BMI* 13 BMI category** 14 Appearance 15 Parenting style 16 Quality of life Professional practices and confidence 17 Communication skills study 18 Confidence when communicating with children 19 Rewards for good communication 20 Work overload 21 Work shift impact 22 Attention loss Family and economic factors 23 Children 24 Economic status - Table 2
- The measured communication skills in the survey in 7 categories along with the overall pharmacists’ performance.
The measured skill Question measuring the outcome in the survey Good answers To whom pharmacists talk the most if a child accompanies their parents? If the child (the patient) accompanies their parent to the pharmacy to pick up drugs, to whom do you communicate most of the time? Child but not parent. What to do if a child did not accompany their parents? If the child did not accompany their parent to the pharmacy, what do you normally do? Ask the parent to have the child call the pharmacy, and not ignore the case and talk with the parent only. Evaluating ability to communicate effectively to different children age groups Self-evaluation Pharmacists’ self-evaluation of their understanding of how to communicate effectively with children in different age groups or different cognitive developmental levels. Do you know that children of different ages and different cognitive developmental levels understand different aspects of medications and illness? Yes, I know how to communicate with each different age or each different developmental level. Study evaluation Evaluating understanding “cause-effect” relationship in 3-6-year-old children. How would you communicate with a 3-6-year-old child on their medication? This drug will make you better. Take it regularly (at this age, there is no need to explain “why” the drug will make you better). Evaluating understanding the appropriate expression of dosage frequency to 3-6-year-old children. If you want to explain to a 3-6-year-old child on the dosage frequency, what will you say? Take the drug 3 times daily. Your mom will help you to know when to stop the drug (in this age group, avoid complex statements like “every 8 hours” and show that parents will help the child to know when to take and stop the drug as children in this age group cannot be totally independent). Evaluating understanding “cause-effect” relationship in 7-12-year-old children. How would you communicate with a 7-12-year-old child on their medication? This drug will make you better because it will fight bacteria in your body (children in this age group can understand “why” the drug will make them better). Evaluating understanding of suitable drug information provided to toddlers and pre-school children (3-5 years). With toddlers and pre-school children (3-5 years), what information do you believe they will understand and need to know on their medicine? Approximately >50% correct selections (≥4 out of 6 correct options: the drug is for which condition, how it can help the condition, how to take it, its side effects, the importance of complying, and the difference between medicines for children and medicines for adults?). Only 3 correct answers or stating that this information is not suitable for this age group reflects poor answers. Evaluating understanding of suitable drug information provided to school age children (6-12 years). With school-age children (6-12 years), what information do you believe they will understand and need to know on their medicine? Approximately >50% correct selections (≥4 out of 7 correct options: drug ingredients, how it works, how to know it is working, is it used for different illness, are there other drugs for the same illness, and are there different medicines for different illnesses?). Only 3 correct answers or stating “how drugs are made” or “drug-drug interactions” (suitable for older children only) reflect poor answers. Evaluating understanding of suitable drug information provided to adolescents (13-19 years). Do you explain the difference between brand and generic medicine to children or adolescents? Only for adolescents (this kind of information is only suitable for adolescents). Evaluating understanding of suitable drug information provided to 6-19-year-old children. You use device demonstrations (such as, show how to use inhalers) with which age group? 6-19-year-old children. Ways to initiate conversation with children How do you generally start the conversation? When talking to a child in the pharmacy, how would you approach the conversation? Use icebreakers (namely, talk about his or her favourite games before talking about drugs). How do you start with a seemingly shy child? If the child is shy or embarrassed, what do you normally do? Use icebreakers (namely, talk about his or her favourite games before talking about drugs). Evaluating to what extent drug-drug and drug-food interactions are explained to adolescents How often do you tell an adolescent (13-19 years) on the potential of their drug to interact with other drugs or food? Always, often, or at least sometimes. Never or rarely reflect poor answers Respecting privacy Asking parents for a few minutes alone with a child How often do you ask parents to give you a few minutes alone with their child to ensure privacy and a quiet area to counsel? Always, often, or at least sometimes. Never or rarely reflect poor answers. Not telling parents on sensitive products bought by an adolescent If adolescents ask you not to tell their parents what they say or buy, what do you usually do? Obey their request or try to help them communicate with their parents, but not try to tell their parents. Methods to get a child’s attention If the child or parent appear uninterested or distracted, what do you normally do? Ask the child for feedback or use visual aids (namely, iPad). Overall pharmacist performance Approximately >50% good answers (≥9 out of 16 questions).
Approximately ≤50% good answers (≤8 out of 16 questions) reflect poor performers. - Table 3
- Poor, moderate, and good communication skills with children among pharmacists in Saudi Arabia along with the Chi-squared test p-values.
Measured skills Good answers Poor answers P-values Performance level according to our criteria To whom pharmacists talk the most if the child accompanies a parent 15 (8.8) 155 (91.2) 7.79×10-26 Poor What to do if the child did not accompany their parent 52 (30.6) 118 (69.4) 9.36×10-7 Poor Evaluating ability to communicate effectively to different children age groups Self-evaluation Pharmacists’ self-evaluation of their understanding of how to communicate effectively with children in different age groups and or different cognitive developmental levels. 150 (88.2) 20 (11.8) 9.90×10-24 Good Actual evaluation Understanding “cause-effect” relationship in 3-6-year-old children. 77 (45.3) 93 (54.7) 0.2429083 Moderate Understanding the appropriate expression of dosage frequency to 3-6-year-old children. 84 (49.4) 86 (50.6) 0.8153346 Moderate Understanding “cause-effect” relationship in 7-12-year-old children. 109 (64.1) 61 (35.9) 2.53×10-4 Good Understanding suitable drug information provided to toddlers and pre-school children (3-5 years). 10 (5.9) 160 (94.1) 1.25×10-30 Poor Understanding suitable drug information provided to school age children (6-12 years). 11 (6.5) 159 (93.5) 7.33×10-30 Poor Understanding suitable drug information provided to adolescents (13-19 years). 48 (28.2) 122 (71.8) 1.32×10-8 Poor Understanding suitable drug information provided to 6-19-year-old children 95 (55.9) 75 (44.1) 0.1391008 Moderate Overall actual performance across different age groups 62 (36.5) 108 (63.5) 4.2×10-4 Poor Ways of initiating conversation with children How do you generally start the conversation? 81 (47.6) 89 (52.3) 0.5857884 Moderate How do you start with a seemingly shy child? 78 (45.9) 92 (54.1) 0.3115148 Moderate Overall performance regarding conversation initiation ~80 (46.8) ~91 (53.2) 0.4002 Moderate Evaluating to what extent drug-drug and drug-food interactions are explained to adolescents 150 (88.2) 20 (11.8) 2.02×10-24 Good Respecting privacy Asking parents for a few minutes alone with the child 89 (52.3) 81 (47.6) 0.4835221 Moderate Not telling parents regarding sensitive products bought by an adolescent 80 (47.0) 90 (52.9) 0.5857884 Moderate Overall performance regarding respecting privacy ~85 (50.0) ~86 (50.0) 0.939 Moderate Methods to get the child’s attention 106 (62.3) 64 (37.6) 8.15×10-4 Good Overall pharmacists’ performance across all communication scenarios 41 (24.1) 129 (75.9) 8.48×10-10 Poor Values are presented as numbers and percentages (%).
- Table 4
- Explanatory variables with nominal significant associations with overall pharmacist performance when communicating with children.
Variables Estimate Std. error z value Pr(>|z|) Cities (Intercept) 1.12214 0.30771 3.647 0.000266 Jeddah -0.97904 (OR=2.66) 0.48813 -2.006 4.49×10-2* Other cities† >0.05 Age (years) (Intercept) 1.10E+00 2.27e-01 4.851 0.0000012 30-39 2.06E-02 3.66e-01 0.056 0.9551 40-49 -1.61E+00 (OR=5) 7.65e-01 -2.105 3.53×10-2* 50-59 -3.72E-15 1.18e+00 0 1 Obesity (Intercept) 1.3257 0.2729 4.859 1.18e-06 Obesity class I -0.6325 0.5696 -1.11 0.2668 Obesity class II 14.2404 1029.1215 0.014 0.989 Obesity class III -1.6134 (OR=5) 0.811 -1.989 4.67×10-2* Overweight -0.4319 0.3908 -1.105 0.2692 Underweight 0.6202 1.1033 0.562 0.574 Physical appearance (Intercept) 1.5686 0.3476 4.513 6.4e-06 Excellent -0.8183 (OR=2.26) 0.4051 -2.02 4.34×10-2* Fair -0.1023 0.7288 -0.14 0.8884 Poor -16.1347 882.7434 -0.018 0.9854 Parenting (Intercept) 0.7673 0.1938 3.96 7.51e−05 They frequently say “don’t do that, this could be harmful for you. We will do it for you”. 1.0519 (OR=2.86) 0.4809 2.187 2.87 × 10-2* They just don’t care most of the time.
They let you do whatever you want.0.619 0.674 0.919 0.3583 Studied communication skills for children? (Intercept) 0.1823 0.4282 0.426 0.6702 Yes, but I did not study a topic on communications’ skills for children. 0.7732 0.5026 1.539 0.1239 I took a communication skills course not specifically directed to pharmacists. 1.1029 (OR=3) 0.5306 2.079 3.77×10-2* No 1.2993 (OR=3.6) 0.6548 1.984 4.72×10-2* Confidence (Intercept) 0.5188 0.2526 2.054 0.0400 Fairly confident 0.8922 (OR=2.44) 0.4338 2.057 3.97×10-2* Not confident at all 15.0473 1029.1215 0.015 0.9883 Slightly confident 0.1744 0.5273 0.331 0.7409 Somewhat confident 1.2158 (OR=3.37) 0.5098 2.385 1.71×10-2* Working time (Intercept) 0.5819 0.2864 2.032 0.0422 I feel better at night. -0.1119 0.638 -0.175 0.8607 I feel better in the afternoon. 0.3054 0.5327 0.573 0.5664 I feel better in the morning. 0.8889 (OR=2.43) 0.3929 2.262 2.37×10-2* Other 16 explanatory variables** NA NA NA NA >0.05 Reference levels for the 8 explanatory variables are: I) Makkah, II) 20-29, III) normal, IV) good, V) you can do it, we will support you, VI) studied CSs with children, VII) completely confident, and VIII) not affected by working time.
↵† Abha, Al-Ahsaa, Al-Bahah, Al Kharj, Aldawadmi, Alkhober, Riyadh, Bahrah, Buraydah, Dammam, Dhahran, Hail, Fifa, Jazan, Madina, Khamis Mushait, Mubarraz, Najran, Neom, Rafha, Qassim, Qatif, Sakaka, Tabuk, Taif, Tayma.
↵* The reference level for the outcome variable: “Good” overall performance.
↵** For all other explanatory variables, review Table 1.
Explanatory variables n (%) (1) Where are you working ? In a hospital pharmacy 95 (55.9) In a community pharmacy 45 (26.5) In medical wards as a clinical pharmacist 30 (17.6) Total 170 (100) (2) What is the name of your workplace Al-Nahdi 22 (12.9) Al-Dawa Pharmacy 7 (4.1) King Abdulaziz Medical City, national gurad 7 (4.1) Prince Sultan Military Medical City 7 (4.1) King salman specialist hospital· 6 (3.5) Alhabib Medical Group 5 (2.9) King Saud University Medical City 4 (2.3) Maternaty and Childern Hospital 4 (2.3) MOH 4 (2.3) Almoosa health group 3 (1.8) Faisal pharmacy 3 (1.8) Hera General Hospital 3 (1.8) King Abdulaziz Hospital 3 (1.8) King Fahad hospital 3 (1.8) King Faisal Hospital - Makkah 3 (1.8) King Faisal specialist hospital and research center Jeddah 3 (1.8) MCH 3 (1.8) Alhada military hospital 2 (1.2) Fifa General Hospital 2 (1.2) KAAUH 2 (1.2) KAMC 2 (1.2) Lamon pharmacy 2 (1.2) Military hospital 2 (1.2) Prince muteb hospital· 2 (1.2) Prince Saud bin Jalawy Hospital 2 (1.2) Qatif central hospital· 2 (1.2) United pharmacy· 2 (1.2) Abha international private hospital· 1 (0.6) Adam medical group 1 (0.6) Adam pharmacy 1 (0.6) AKMICH 1 (0.6) Al Hada Armed Forces Hospital 1 (0.6) Al Salama Hospital 1 (0.6) Alaffary medical clinic 1 (0.6) Albadr Developed Medical Group 1 (0.6) Almana hospital 1 (0.6) Almoujtma 1 (0.6) Alsaady pharmacy 1 (0.6) Alzafer hospital 1 (0.6) Amwaj Ageeli 1 (0.6) Andalusia 1 (0.6) Aomori 1 (0.6) Aseel med pharmacy· 1 (0.6) Aseer Central Hospital· 1 (0.6) Dammam medical complex 1 (0.6) Davita 1 (0.6) Dawadmi general hospital· 1 (0.6) DMC 1 (0.6) Dr Sulaiman Al Habib· 1 (0.6) Dr. Erfan & Bagedo General Hospital 1 (0.6) Dr.soliman fakeeh hospital 1 (0.6) Eastern Health cluster· 1 (0.6) EHC 1 (0.6) Explanatory variables n (%) (2) What is the name of your workplace Extended care· 1 (0.6) General directorate of health affairs in Tabuk 1 (0.6) Ghaya pharmacy 1 (0.6) Hammadi Pharmacy 1 (0.6) Health & beautify pharmacy· 1 (0.6) I Brand pharmacy· 1 (0.6) Ibrand 1 (0.6) HMG 1 (0.6) Kaah 1 (0.6) KASH-Taif 1 (0.6) KFMC 1 (0.6) King Abdullah medical cmoplex-Jeddah 1 (0.6) King faisal medical complex 1 (0.6) King khaled university hospital 1 (0.6) King Khalid hospital-Tabuk 1 (0.6) Lama lab pharmacy· 1 (0.6) MCH/Makkah cluster· 1 (0.6) MMC 1 (0.6) National care hospital 1 (0.6) Neom hospital 1 (0.6) Noon medical center 1 (0.6) Prince Sultan Cardiac Center 1 (0.6) Private sector 1 (0.6) Qilwah general hospital· 1 (0.6) Sami Ghanem pharmacy 1 (0.6) Saudi German Hospital· 1 (0.6) Security Forces Hospital 1 (0.6) SFH 1 (0.6) SFHM 1 (0.6) SGH 1 (0.6) Tayma General Hospital 1 (0.6) The Specialist Hospital· 1 (0.6) University of tabuk 1 (0.6) Whites Pharmacy 1 (0.6 Total 170 (100) (3) Where do you live? Makkah 57 (33.5) Riyadh 35 (20.6) Jeddah 23 (13.5) Abha 4 (2.3) Al-Ahsaa 4 (2.3) Dammam 4 (2.3) Eastern province 4 (2.3) Tabuk 4 (2.3) Taif 4 (2.3) Al-Bahah 3 (1.8) Madina 3 (1.8) Al Kharj 2 (1.2) Hail 2 (1.2) Fifa 2 (1.2) Khamis Mushait 2 (1.2) Najran 2 (1.2) Rafha 2 (1.2) Qassim 2 (1.2) Aldawadmi city 1 (0.6) Alkhober 1 (0.6) Bahrah 1 (0.6) Buraydah 1 (0.6) Dhahran 1 (0.6) Jazan 1 (0.6) Explanatory variables n (%) (3) Where do you live? Mubarraz 1 (0.6) Neom 1 (0.6) Qatif 1 (0.6) Sakaka 1 (0.6) Tayma 1 (0.6) Total 170 (100) (4) Nationality Saudi 150 (88.2) Egyptian 13 (7.6) Jordanian 2 (1.2) Syrian 2 (1.2) Palestinian 1 (0.6) Sudanese 1 (0.6) Yemen 1 (0.6) Total 170 (100) (5) Gender Male 96 (56.5) Female 74 (43.5) Total 170 (100) (6) Age group 20 - 29 94 (55.3) 30 - 39 65 (38.2) 40 - 49 8 (4.7) 50 - 59 3 (1.8) Total 170 (100) (7) Body mass index category Normal 78 (46.7) Overweight 58 (34.7) Obesity class I 15 (9.0) Obesity class III 7 (4.2) Underweight 7 (4.2) Obesity class II 2 (1.2) Total 167 (100) (8) How do you rate your general appearance ? Excellent 100 (58.8) Good 54 (31.8) Fair 15 (8.8) Poor 1 (0.6) Total 170 (100) (9) Marital status Single 95 (55.9) Married 72 (42.3) Divorced 2 (1.2) Widowed 1 (0.6) Total 170 (100) (10) How you was raised by your parents? They frequently say “ don’t do that, we will do it for you” 41 (24.1) They frequently say “You can do it, we will support you” 151 (67.6) Thay just don’t take care most of the time, let you do whatever you want 14 (8.2) (11) Economic status Moderate monthly income (7000-14,000 SAR). 82 (48.2) High monthly income (15,000-19,000 SAR). 57 (33.5) Very high monthly income (20,000 SAR or more). 22 (12.9) Poor monthly income (6000 SAR or less). 9 (5.3) (12) How do you evaluate your quality of life? Happy and satisfied in general 87 (51.2) Very happy and satisfied most of the time 41 (24.1) Moderate happiness and satisfaction 35 (20.6) Explanatory variables n (%) (12) How do you evaluate your quality of life? I have been through chronic stress, and I have been treated or I think I need to be treated for some potential psychological illnesses. 7 (4.1) Poor happiness and satisfaction. 0 (0.0) Total 170 (100) (13) Educational level ? Bachelor’s degree 129 (75.9) Master’s degree or PGY1 33 (19.4) PhD degree or PGY2 8 (4.7) Total 170 (100) (14) Years of work expereicne 2-4 years 49 (28.8) 5-10 years 48 (28.2) 0-1 years 42 (24.7) More than 10 years 31 (18.2) Total 170 (100) (15) Did you study communication skills in pharmacy practice? Yes, but I did not study a topic on communication skills with children 67 (39.4) Yes, but I studied general communication skills which is not directed to pharamcists 57 (33.5) No 25 (14.7) Yes, and I studied communication skills with children 21 (12.3) (16) Are you confedinet when talking with children? Compeletely confiednet 62 (36.5) Fairly confiednet 48 (28.2) Not confiednet 2 (1.2) Slightly confiednet 20 (11.8) Somewhat confiednet 38 (22.3) Total 170 (100) (17) Do you get rewards from your managesrs on good communication? No 107 (62.9) Yes 63 (37.1) Total 170 (100) (18) Often overloaded ? No time for communication? Sometimes 96 (56.5) Yes, most of the time 38 (22.3) Not at all 36 (21.2) Total 170 (100) (19) Does working in the night or day affect your ability to wrok? Yes, I feel better in the morning 87 (51.2) Not at all 48 (28.2) Yes, I feel better in the afternoon 22 (12.9) Yes, I feel better at night 13 (7.6) Total 170 (100) (20) Do you lose attention as working hours pass? No 79 (46.5) Yes 91 (53.5) Total 170 (100) (21) Do you have children ? No 101 (59.4) Yes 69 (40.6) Total 170 (100) - Appendix 2B
- Characteristics of study participants and potential influencing factors (continuous variables).
Stat measure Body mass index Height (cm) Weight (kg) Mean 27.4 165.93 71.59 Standard deviation 21.63 13.42 18.51 Minimum 17.78 74 39 Q1 22.23 160 59 Median 24.61 168 70 Q3 27.22 174 80 Maximum 271.87 187 174 - Appendix 2C
- Percentages of “good” and “poor” answers to various communication skills questions along with the percentages of “good” and “poor” performers of pharmacists (categorical variables).
Outcome variables n (%) (1) Talking mostly to children or parents about medicine Good 15 (8.8) Poor 155 (91.2) Total 170 (100) (2) Understanding different cognitive levels Good 150 (88.2) Poor 20 (11.8) Total 170 (100) (3) Communicate to 3-6 years old children about medicine (evaluating understanding cause-effect relationship) Good 77 (45.3) Poor 93 (54.7) Total 170 (100) (4) Communicate to 3-6 years old children about dosage frequency Good 84 (49.4) Poor 86 (50.6) Total 170 (100) (5) Communicate to 7-12 years old children about medicine (evaluating understanding cause-effect relationship) Good 109 (64.1) Poor 61 (35.9) Total 170 (100) (6) Initiating conversations with a child Good 81 (47.6) Poor 89 (52.3) Total 170 (100) (7) Information for children 3-5 years old Good 10 (5.9) Poor 160 (94.1) Total 170 (100) (8) Information for children 6-12 years old Good 11 (6.5) Poor 159 (93.5) Total 170 (100) (9) Adolescent drug-drug reactions and adverse effects Good 150 (88.2) Poor 20 (11.8) Total 170 (100) (10) Respecting adolescent’s privacy Good 80 (47.0) Poor 90 (52.9) Total 170 (100) (11) Explaining difference between brand and generic names Good 48 (28.2) Poor 122 (71.8) Total 170 (100) - Appendix 2C
- Percentages of “good” and “poor” answers to various communication skills questions along with the percentages of “good” and “poor” performers of pharmacists (categorical variables, continuation).
Outcome variables n (%) (12) Device demonstration at different ages Good 95 (55.9) Poor 75 (44.1) Total 170 (100) (13) Wha to do if child not in the pharmacy Good 52 (30.6) Poor 118 (69.4) Total 170 (100) (14) Solutions to capture a child’s attention Good 106 (62.3) Poor 64 (37.6) Total 170 (100) (15) Asking for a few minutes alone for privacy Good 89 (52.3) Poor 81 (47.6) Total 170 (100) (16) Initiating conversations with a shy child Good 78 (45.9) Poor 92 (54.1) Total 170 (100) (17) Overall performance per pharmacist Good 41 (24.1) Poor 129 (75.9) Total 170 (100)
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