Pharmacist insights into antimicrobial stewardship: A social marketing approach.

BACKGROUND: Antimicrobial resistance is a worldwide public health problem. Antimicrobial stewardship programs (ASPs) optimize antimicrobial use within hospitals. The social marketing framework has been used in analyzing systems and devising best practices. OBJECTIVE: (s): To use the social marketing framework to explore pharmacist experiences and perceptions of structural, behavioral and interventional strategies that support ASPs. METHODS: A qualitative approach utilizing semi-structured individual interviews was utilized. A purposive sample of hospital pharmacists was invited to participate. An interview guide was constructed to describe participant experience and perceptions regarding ASPs in their institutions based on elements of social marketing: Behavioral goals; Customer Insight; Segmentation and Targeting; Competition; Exchange; and Marketing and Interventional mix. Interviews were recorded digitally and transcribed verbatim. Thematic analysis was conducted using deductive methods. A combination of case-based and code-based approaches allowed individual and holistic analyses respectively. Codes were collated into themes and subthemes. RESULTS: Saturation of themes occurred with 25 interviews from 17 hospitals. ASP metrics included: consumption of antibiotics using days of therapy and defined daily dose, rates of C. difficile and multidrug resistant organisms, resistance patterns, and provider adherence to the ASP. Active stewardship tools such as preauthorization, and prospective feedback/audit were preferred over passive tools such as order sets and automatic stop orders. A physician champion and a clinical pharmacist with infectious disease training were core elements in the multidisciplinary team. Despite certain areas being considered key for stewardship, participants emphasized a hospital-wide approach including outpatient departments; discharge stewardship emerged as a primary theme. Leadership supported ASPs with finances, rapid and novel diagnostics, Clinical Decision Support Systems, mobile technology, and continuous staff training. CONCLUSIONS: The social marketing framework has been used to explore pharmacist perceptions that inform successful qualities including metrics, restriction methods, personnel, benefits, barriers, training needs/modes, and promotional avenues that support ASPs in hospitals.

Validation and Psychometric Evaluation of Diabetes Literacy, Numeracy, and Knowledge Tools in the Arabic Context.

PURPOSE: The purpose of this study was to validate the Literacy Assessment for Diabetes (LAD), the Diabetes Numeracy Test (DNT), and the Simplified Diabetes Knowledge Test (DKT) in the Arabic language and context. METHODS: Three hundred eighty four, ≥18-year-old patients with type 1, type 2, or gestational diabetes mellitus were recruited from 3 endocrinology clinics in the United Arab Emirates. Exploratory factor analysis using principal component was performed. Achieved scores were compared using Pearson bivariate correlation. RESULTS: All 60 LAD items loaded on 1 factor accounting for 66.7% of the variance, with internal consistency α = .991. Average score = 68.7%. Nineteen out of 26 items were retained on the DNT and grouped into 4 factors, prescription reading and directions, proper dose coverage, nutrition, and insulin, with good internal consistency (α = .721). Average score = 73.2%. All 20 DKT items loaded on 3 factors accounting for 41.2% of the variance, causes and consequences of the high blood sugar level, prevention of the disease, and misconceptions about diabetes self-management, with good internal consistency (α = .799). Average score = 71.9%. A moderate and significant correlation between the DKT and DNT (r = .56, P < .001) was observed. CONCLUSIONS: Three tools to assess diabetes literacy, numeracy, and knowledge were psychometrically tested to establish their validity and reliability in the Arabic language and context. The tools could be used to assess patient skills and competence in navigating the health care system and managing their diabetes.

Student-created vignettes to enhance pharmacy student knowledge and skill in managing patients with neuropsychiatric disease

Backgound: Neuropsychiatric disease is common globally. It is vital train pharmacists to provide patient-centered care in neuropsychiatry. Objective: To evaluate the impact of student-created vignettes on their knowledge and abilities to assess and manage patients with neuropsychiatric diseases, and to evaluate their experience. Methods: Several learning/assessment methodologies within the Therapeutics III course were utilized, including a major assignment of student-created vignettes about neuropsychiatric diseases. A framework guided student in creating the vignettes; identifying conception, design, and administration. Created vignettes were evaluated based on a validated scoring guide. Mean scores in various assessments were compared using Spearman’s rank-order correlation. Students evaluated their experience on a 5-point Likert-type scale of 1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree. Results: Overall, students’ performance in the assignment was excellent, average score = 92%. A significant correlation existed between the vignette assignment and assessments covering neuropsychiatric disease. Most students agreed they were made aware of what needed to be done (95%), that the instructions about elements to include, designs, and delivery mechanisms were enough (93.4%, 86.7%, and 93.4%, respectively). Most students agreed that developing the vignette was stimulating, engaging and enjoyable (93.3% and 90%, 88.3% respectively). Students stated they felt confident in their scientific background knowledge (88.3%), in employing communication strategies with patients (85%) and their families (83.3%), and in their confidence in promoting and supporting patients with the diseases. (AU)

A Telehealth Module and Virtual Objective Structured Clinical Examination of Health Literacy in Pharmacy Education.

OBJECTIVE: To implement an online health literacy (HL) module and evaluate its impact through virtual Objective Structured Clinical Examination (OSCE) on students' abilities to manage patients with low HL. METHODS: Students virtually engaged in several learning activities related to HL, including practicing using HL assessment tools, designing an information booklet suitable for low HL patients, using readability formulas to lower text readability level to ≤ sixth grade, role-playing scenarios related to HL, and undergoing a virtual OSCE. Student performance on course assessments was tested using Spearman's rank-order. Students evaluated their OSCE experience in terms of case content, virtual assessment, and logistics; and effectiveness of the HL module and confidence related to HL. RESULTS: A total of 90 students completed the virtual OSCE; the mean score was 8.8 out of 10 (88%), which correlated with similar course assessments. The average score was 3.46 out of 3.7 for the "gathering information" domain (recognizing risk factors and behaviors, assessing HL and adherence, etc.), and 4.06 out of 4.9 for the "patient management" domain (counseling patients on taking medications, focusing on repeating key messages, offering adherence interventions, etc.). Students responded positively regarding case content and virtual assessment, but less favorably regarding logistics. Feedback on effectiveness of the HL module and confidence in managing patients with low HL was positive. CONCLUSION: An HL module delivered online was effective in improving student knowledge, abilities, and confidence related to HL. Students achieved high scores in all items in the virtual OSCE, and considered it a measure of communication and clinical skills that is comparable to traditional in-room assessments.

Development and Psychometric Evaluation of the Antibiotic Knowledge and Consumption Tool (AKCT).

Knowledge of antibiotics and awareness of microbial resistance are essential for appropriate antibiotic consumption. This study aimed to develop and validate a measure of antibiotic knowledge and consumption (AKCT) and to make it available in the Arabic language and context. The tool was developed and applied on individuals ≥ 18 years, with mastery of Arabic or English. Exploratory factor analysis using principal-component analysis tested the psychometric properties of the items. AKCT scores were compared with the Infectious Numeracy Test (INT) scores to establish convergent validity. Cronbach's α > 0.7 measured reliability. Three hundred-eighty-six participants completed the questionnaire, achieving a 95.3% response rate. Five components were retained after factor analysis: Side-effects and resistance, Access to antibiotics, Recovery after use, Antibiotics use indications, and Body response. Cronbach's α = 0.85. The mean ± SD of AKCT = 9.82 ± 3.85 (range = 7−20); lowest scores were related to "Side-effects and resistance" (2.32 ± 2.00, max = 7) and "Antibiotic use indications" (1.61 ± 1.29, max = 5). Scores on the AKCT and INT positively correlated. The AKCT is a valuable, valid, and reliable tool developed for measurement of antibiotic knowledge and consumption behaviors to identify specific areas needing improvements; hence, targeted interventions are devised.

A pseudo-customer cross-sectional study to evaluate the community pharmacist’s management of migraine in pregnant women

Background: To the best of our knowledge few published studies have been conducted to evaluate customer’s care services in community pharmacies in the United Arab Emirates (UAE) using the pseudo-customer model. This further indicates that there is a paucity of information available about the current care services provided by the community pharmacists particularly for pregnant women with migraine. Objective: The main objective was to evaluate, the effectiveness of the pseudo-customer method on the care services (counseling, advice, and management) provided by the community pharmacists for migraine during pregnancy. Methods: This was a cross-sectional study conducted in community pharmacies with a cluster sampling of pharmacists. A sample of 200 community pharmacists was recruited from three emirates in the United Arab Emirates. Pregnant woman-related migraine management was assessed using the pseudo-customer model. The used script is not of a real patient but a fake/scripted used to describe the study. Results: No association was found between the gender and nationality of community pharmacists and the ability to be proactive (P =0.5, 0.568) and between the utilization of source of information and gender (P =0.31). The ability to prescribe by community pharmacists without probing or only after a probe was independent of job title (P =0.310); gender (P =0.44) and nationality (P =0.128). The community pharmacists who have offered written information have had significantly higher odds to dispense medication compared to those who have not (OR =45.547, 95% CI: 2.653 - 782.088, P =0.008). Furthermore, the pharmacists who have been reported to ask for precipitating factors of migraine had significantly higher odds to dispense medication compared to those who have not (OR =11.955, 95% CI: 1.083-131.948, P =0.043). The main outcome was the responses of the community pharmacists to the pseudocustomer visit (pregnant woman with migraine). (AU)

Antibiotic use numeracy: Developing the infectious numeracy test (INT).

BACKGROUND: Inadequate numeracy is a barrier to patients' understanding of their health. No measure of numeracy related to antibiotic use is available. OBJECTIVE: to develop and validate a measure of numeracy of antibiotic use, and to make this measure available in the Arabic language and context. METHODS: Best practices for developing, translating and validating scales were consulted to develop an anonymous survey administered on SurveyMonkey. Ten open-ended questions for which participants provided an answer assessed basic numeracy covering fractions, percentages, proportionality, measurement, and estimation, contextualized to real life situations. A panel of five experts, and 10 cognitive debriefings provided face and content validity for the tool. Individuals ≥18 years, who had mastery of Arabic or English were included. Exploratory factor analysis was performed to characterize the psychometric properties of the items, using principal-component analysis. Convergent validity was established by comparing numeracy scores with the antibiotic knowledge scale scores. Differences in numeracy scores according to sociodemographic variables were tested using multivariate analyses of variance. RESULTS: Two hundred fifty-four responses were obtained, giving a response rate of 63.5%. A two-factor structure which explained 44.2% of the variance evolved: "Mathematical knowledge and problem-solving skills" and "Numeracy-related practices and experience". An acceptable reliability of Cronbach's alpha coefficient = 0.713. Higher numeracy scores were significantly correlated with the scores of the antibiotic knowledge (r = 0.205, p < 0.01) and factor one within the tool: "side effects and resistance" (r = 0.162, p = 0.05). Participants with University/College education presented higher levels of numeracy-related practices and experience than those with high-school education. Likewise, participants with medical insurance presented with higher numeracy scores than those without. CONCLUSIONS: A valid and reliable measure of antibiotic numeracy in English and Arabic was created. The tool could identify patients with low numeracy who are candidates for targeted interventions and intensive education on appropriate antibiotic use.

A pseudo-customer cross-sectional study to evaluate the community pharmacist's management of migraine in pregnant women.

Background: To the best of our knowledge few published studies have been conducted to evaluate customer's care services in community pharmacies in the United Arab Emirates (UAE) using the pseudo-customer model. This further indicates that there is a paucity of information available about the current care services provided by the community pharmacists particularly for pregnant women with migraine. Objective: The main objective was to evaluate, the effectiveness of the pseudo-customer method on the care services (counseling, advice, and management) provided by the community pharmacists for migraine during pregnancy. Methods: This was a cross-sectional study conducted in community pharmacies with a cluster sampling of pharmacists. A sample of 200 community pharmacists was recruited from three emirates in the United Arab Emirates. Pregnant woman-related migraine management was assessed using the pseudo-customer model. The used script is not of a real patient but a fake/scripted used to describe the study. Results: No association was found between the gender and nationality of community pharmacists and the ability to be proactive (P =0.5, 0.568) and between the utilization of source of information and gender (P =0.31). The ability to prescribe by community pharmacists without probing or only after a probe was independent of job title (P =0.310); gender (P =0.44) and nationality (P =0.128). The community pharmacists who have offered written information have had significantly higher odds to dispense medication compared to those who have not (OR =45.547, 95% CI: 2.653 - 782.088, P =0.008). Furthermore, the pharmacists who have been reported to ask for precipitating factors of migraine had significantly higher odds to dispense medication compared to those who have not (OR =11.955, 95% CI: 1.083-131.948, P =0.043). The main outcome was the responses of the community pharmacists to the pseudo-customer visit (pregnant woman with migraine). Conclusions: The community pharmacist's care services (counseling, advice, and management) offered to the pseudo-customer visits was effective for dealing with migraine during pregnancy.

Assessing Pharmacy Student Performance and Perceptions on Counseling Skills Through a Simulated Telehealth Encounter.

Objective. To describe the implementation of a teleconferencing-based patient counseling role play assessment in a newly developed pharmacy communications course, assess student performance on the role play and compare it with other assessments, and measure student perceptions of and satisfaction with the experience.Methods. Eighteen cases were developed, each belonging to one of three interactions in community pharmacy: filling a new prescription, completing a refill, or handling a request for a nonprescription (ie, over-the-counter [OTC]) medication. A rubric was designed to evaluate each type of interaction. Student scores in various course assessments were tested and scores on the three cases were compared. Students also evaluated their experience and satisfaction of the assessment and effectiveness of the course.Results. Seventy-nine students completed the assessment, achieving a mean score of 17.4/20 (87%). Student scores in the counseling role play were similar among case types and positively correlated with other traditional assessments in the course. Despite internet connectivity issues and heightened student anxiety, 71% of students agreed that the assessment did not affect the quality of their counseling, and 74% agreed that the experience was comparable to traditional assessments. The telehealth activity led to enhanced perceived student knowledge and confidence in interviewing and counseling patients.Conclusion. Students attained high scores that were consistent with other assessments in the course. Students reported that the assessment did not affect the quality of their counseling and felt the setting and context were still authentic. The experience required dedicated preparation and organization but was successful in demonstrating overall student satisfaction and positive perceptions.

Outcomes of a novel pharmacy screening intervention to address the burden of type 2 diabetes and cardiovascular disease in an Arabic-speaking country.

AIMS: Aim of this study is to evaluate the capacity of a pharmacist-delivered screening model for type 2 diabetes and cardiovascular disease (CVD) in identifying and referring individuals at risk. METHOD: A screening programme was implemented in 12 community pharmacies in three cities in the United Arab Emirates. Trained pharmacists screened adults (≥40 years) without a previous diagnosis of diabetes or CVD. Most participants were recruited during their visits to the pharmacies; pharmacy-based advertising and social media were also used. The screening included medical history, anthropometric measurements, point-of-care glycated haemoglobin (HbA1c ) levels, and a lipid panel. High-risk individuals (HbA1c  ≥ 5.7% [39 mmol/mol], a high diabetes risk score, or a 10-year CVD risk ≥7.5%) were given a referral letter and advised to visit their physician. Risk factors for elevated HbA1c were identified by logistic regression. RESULTS: Of the 568 screened participants, 332/568 (58%) were identified to be at risk: HbA1c levels were consistent with diabetes 67/560 (12%) or prediabetes 148/560 (26%), high diabetes risk score 243/566 (43%), CVD risk score > 7.5% 79/541 (15%). Obese people were more likely to have prediabetes or diabetes OR (95% CI): 3.2 (1.3, 7.5), as were those who spent more than 11 h/day sitting: 5.7 (1.8, 17.6). Of the 332 at-risk participants, 206 (62%) responded to a telephone follow-up at six weeks; one-third had discussed screening results with their physician. CONCLUSIONS: Community pharmacists detected and referred individuals at risk for diabetes or CVD, although participant follow-up with their physician could be improved. Pharmacy screening is feasible and will potentially improve outcomes.

Development and Validation of the New Asthma Numeracy Test.

OBJECTIVES: This study aimed to examine the reliability and validity of a newly developed Asthma Numeracy Test (ANT) and to make it available in Arabic. METHODS: Patients with asthma who were ≥18 years were seen in 3 outpatient primary care or respiratory medicine clinics in the United Arab Emirates. They completed the ANT of 10 questions assessing participant arithmetic computation, meaning of percentages, estimation, and problem solving. Each question was worth 1 point, giving a total score of 10. The ANT was forward and back translated to Arabic and English, respectively, by independent legal translators and piloted on 15 participants. Convergent validity was tested by comparing the ANT with the Asthma Knowledge Test (AKT) scores, knowledge of inhaled medications, and practical inhaler technique using Pearson's correlation coefficients. RESULTS: The average ANT score achieved by 150 participants was 6.47 ± 2.09; 25% and 45% scored ≤4.0 and 6.0, respectively. Correlation between ANT and AKT and knowledge of inhaled medications were positive, r = .22 and r = .16, P < .05, respectively. No correlation with participants' practical inhaler technique was noted. ANT was positively associated with participant educational attainment and negatively with emergency room visits. CONCLUSIONS: A new short and easy-to-administer test of asthma numeracy has been developed and found to be valid and reliable. It may be used to assess numeracy levels of patients with asthma and consequently develop and evaluate targeted interventions designed to improve patient care outcomes. The test is available in English and Arabic.

Assessing the need for native language in pharmacy education and practice: a survey in the UAE.

OBJECTIVES: To evaluate pharmacists' opinions on the need for Arabic in pharmacy education and practice in the United Arab Emirates (UAE). METHODS: A questionnaire was developed to address the study objectives and hand delivered to a stratified sample of community pharmacists and a convenience sample of pharmacists in other areas of practice in the UAE. Pharmacists' responses were measured on a 5-point Likert-type scale (strongly disagree to strongly agree) towards teaching of the following topics in Arabic: management of chronic diseases and minor ailments, screening for diseases and counselling on smoking cessation, exercise, weight management, diet and nutrition and complementary/alternative medicine. Topics related to communication skills were also assessed. Descriptive statistics on participant responses were calculated and chi-square test of independence examined inter-relationships among pharmacist and pharmacy variables. KEY FINDINGS: A total of 351 pharmacists completed the questionnaire. Almost 50% of pharmacists considered Arabic in health sciences education a cultural and/or practice necessity. In pharmacy undergraduate curricula, preferred topics to be taught in Arabic included counselling on complementary/alternative medicine (67.4%), management of cold/flu (65.5%), counselling on weight management (64.2%), communication in special situations (63.2%), vocabulary (63.2%) and listening and empathic responding (62.6%). For continuing education, topics included management of cold/flu (69.8%) and skin conditions (69.2%), counselling on smoking cessation (68.9%), communicating with physicians and other professionals (54.8%), communication in special situations (54.7%) and vocabulary (50.9%). CONCLUSIONS: For all assessed topics and communication skills, more than half of the pharmacists agreed that they needed to be included in pharmacy education. A blended learning approach that combines integrated content for native language within an English curriculum could be explored.

A simulated patient study to evaluate community pharmacist assessment, management and advice giving to patients with asthma.

BACKGROUND: Research has shown that there is an increase in the global prevalence of asthma. Pharmacists are well positioned to screen and refer patients for better management of asthma. This study aimed to evaluate community pharmacists' ability to assess the 3 C's (Control, Compliance, Complications) and offer Management and Advice for patients with asthma in the UAE. METHODS: Three fifth year pharmacy students role played a mystery shopper visiting community pharmacies and requesting symptom relief from uncontrolled asthma. Incidence of cough syrup and reliever inhaler supply, physician referral rate, correction of inhaler technique, and counseling on the medications, adherence to the medications and adverse drug reactions were calculated. RESULTS: One hundred, ninety five pharmacies were visited, 27% of pharmacists asked about the need for cough syrup and 60% asked about the need for albuterol inhaler. Only 26% asked about other medications. Less than 20% assessed inhaler technique, only one pharmacist asked about regular use of preventer medications and if the patient was adhering to them and only 16% asked about side effects from medications. Most pharmacists (67%) supplied at least one of the medications, while 65% referred the patient to a physician. Only 21% gave information about correct inhaler technique, the majority (> 60%) being incomplete, only 16 pharmacists gave information about asthma and its triggers; the majority (63%) being incomplete. One third of the pharmacists counselled the patient on the medications with one giving complete information. CONCLUSIONS: The study highlighted suboptimal assessment of control, compliance to preventer medications and complications of asthma and the medications that treat it. It also highlighted suboptimal Management and Advice giving and counseling on medication use by pharmacists. Training pharmacists in all aspects of asthma handling is clearly indicated. Despite the high rate of correct patient referral to a physician noted in this study, there is risk to it, as patients might not actually go to see their physician and continue to depend on symptom relief for the management of their asthma. This study highlighted the importance of improving patient education and information seeking attitude.

Prevalence and determinants of overweight/obesity among school-aged adolescents in the United Arab Emirates: a cross-sectional study of private and public schools.

OBJECTIVES: To estimate the prevalence and predictors of obesity among adolescents in the United Arab Emirates. DESIGN: Cross-sectional study. SETTING: Private and public secondary schools. PARTICIPANTS: Adolescents aged 13-19 years; 434 (46.6%) from private schools and 498 (53.4%) from public schools. MEASURES: Self-report questionnaires were used to assess adolescents' sociodemographic factors, fruit/vegetable (F/V) intake and physical activity. Participants' weight, height, waist circumference (WC), hip circumference and body fat percentage (%BF) were measured, and waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and body mass index (BMI) were calculated. Overweight/obesity was determined by BMI ≥85th percentile for age, abdominal obesity (AO) (WC, WHtR and WHR) and %BF. RESULTS: A total of 34.7% of participants were overweight/obese (BMI ≥85th percentile) and 378 (40.6%) had high %BF. AO was noted in 47.3%, 22.7% and 27.1% of participants, based on WC, WHR and WHtR, respectively. Significantly more participants from public schools were overweight/obese (37.8% vs 31.1%) and had greater AO (based on WC, WHR, WHtR) compared with those from private schools. Predictors of obesity based on BMI were: consuming less than five servings of F/V (adjusted OR (AOR) 2.41, 95% CI: 1.73 to 3.36), being physically inactive (AOR 2.09, CI: 1.36 to 3.22) and being men (AOR 3.35, 95% CI: 2.20 to 5.10). Predictors of AO were being men (WC: AOR 1.42, 95% CI: 1.01 to 2.00; WHtR: AOR 2.72, 95% CI: 1.81 to 4.08); studying at public school (WHR: AOR 1.67, 95% CI: 1.06 to 2.66); being Emirati (WHR: AOR 0.62, 95% CI: 0.43 to 0.90); consuming less than five servings of F/V (WC: AOR 1.71, 95% CI: 1.27 to 2.30; WHtR: AOR 1.46, 95% CI: 1.05 to 2.03), and being physically inactive (WC: AOR 1.63; 95% CI: 1.13 to 2.35). CONCLUSIONS: Focused interventions are needed to combat obesity while considering AO indicators and BMI to diagnose obesity in adolescents.

Pharmacists' experiences and views on providing screening services: An international comparison.

BACKGROUND: The PHARMASCREEN study, adapted from the Australian Cardiovascular Absolute Risk Screening study (CARS), tested the first community pharmacist-delivered screening model for diabetes and cardiovascular disease (CVD) in the UAE. Both PHARMASCREEN and CARS screening models successfully identified at-risk individuals despite differences in healthcare systems, infrastructure, and scope of practice. Comparing pharmacists' experiences of screening delivery in different health systems will help to understand key contextual factors that affect future implementation. OBJECTIVE: To explore and compare the views and experiences of pharmacists participating in the UAE PHARMACSCREEN trial, with those of community pharmacists who participated in the Australian CARS trial. METHODS: In-depth, face-to-face interviews were conducted with pharmacists who delivered the screening programs in Australia (n = 10) and UAE (n = 12) to explore their views and experiences. The interview guide was similar in both studies to ensure consistency and comparability of collected data. Interviews were transcribed verbatim and thematically analyzed. RESULTS: Two common themes emerged: pharmacists' experiences with the screening program, and barriers and facilitators to service delivery. Both groups held very positive views about the screening intervention, particularly referencing the professional satisfaction it generated and broad participant satisfaction with pharmacy-based screening. Despite country and health system differences, pharmacists reported many similar barriers (e.g., staffing levels, pharmacy coordination) and enablers (e.g., implementation support, adequate staffing, point-of-care tests, no cost to patient) to implementation. The context for screening delivery emerged as a key theme for UAE interviews only, where issues such as local population needs, regulatory factors, pharmacist roles and expectations, and training needs were quite prominent. CONCLUSIONS: Pharmacists' positive experiences with the screening programs is a testimony to the strong emerging evidence supporting pharmacists-delivered screening. Despite differences in health care systems, similar enablers and barriers were identified. The adaptation and successful implementation of international screening models requires a country-specific adaptation process.

Assessing Patient Knowledge of Asthma Using a Newly Validated Tool.

OBJECTIVES: To develop and validate a measure of asthma knowledge and to translate and culturally adapt the measure into the Arabic language and context. METHODS: Medically diagnosed individuals 18 years and older were recruited in primary care and specialty asthma clinics in the United Arab Emirates. The National Asthma Education and Prevention Program recommendations for education on asthma were used as a framework to develop the Asthma Knowledge Test (AKT). A measurement scale of "Yes," "No," and "I don't know" was selected. Descriptive statistics were calculated for participant demographics and other healthcare information. Cronbach α ≥ 0.7 was used to measure reliability. Principal component analysis was used to determine the distinct areas of asthma knowledge covered by the AKT. Differences in asthma knowledge depending on sex, age, marital status, and education were tested using multivariate analyses of variance. RESULTS: Cronbach α = .70. Four components were retained and included: asthma as a common disease, triggers and control issues, inhalers, and beliefs and myths. The average AKT score = 13.95 ± 2.77 (range = 5.0-18.0). There was a significant effect of participant level of education on the AKT scores. CONCLUSIONS: The availability of the AKT in Arabic is a valuable addition to the limited available tools related to asthma. As a simple and short tool, it could be used in clinical practice and research to identify specific areas of patient asthma knowledge needing improvements; hence, targeted interventions are sought.

A qualitative study to explore the role of pharmacists in healthy weight management in adults in Pakistan: current scenario and future perspectives.

BACKGROUND: Pharmacists possess significant potential for providing health services to the public when it comes to issues of weight management. However, this practice has not been observed in most parts of the world including low- and middle-income countries (LMICs) such as Pakistan. The aim of this study was to explore the potential role of pharmacists in providing healthy weight management (HWM) services to adults in Pakistan, and the barriers associated with the implementation of this type of role. METHODS: This descriptive qualitative study was set in seven hospitals (public and private) and three chain pharmacies in Lahore, Punjab - a province of Pakistan. Data was collected from in-depth individual interviews with pharmacists (n = 19) and medical doctors (n = 15). Purposive sampling techniques were applied to recruit both types of study participants. Telephone contact was made by the trained data collectors with the pharmacists to set the date and time of the interview after explaining to them the purpose of the study and obtaining their willingness and verbal recorded consent to participate. Registered medical doctors were recruited through snowball sampling techniques. The sample size was determined by applying the point at which thematic saturation occurred. All interviews were audio-recorded and transcribed verbatim. The data were analyzed to draw conclusions using inductive thematic content analysis. RESULTS: Through inductive qualitative analysis eight themes emerged; potential role for community pharmacists, collaborative approaches, barriers, ideal pharmacist-based weight management program, professional requirements and need for training, potential for implementation, current scenario in pharmacies and level of trust of pharmacists. The first six themes were common to both pharmacists and medical professionals. The unique theme for doctors was the 'level of trust of pharmacists', and for the pharmacists was the 'current scenario in pharmacies'. CONCLUSION: The majority of participants in our study had strong convictions that Pakistani pharmacists have the potential for provide effective HWM services to their communities. Of concern, none of the participating pharmacies were offering any sort of weight management program and none of the medical professionals interviewed were aware of HWM programs taking place. Medical doctors were of the opinion that pharmacists alone cannot run these programs. Doctor participants were firm that after being adequately trained, pharmacists should only carry out non-pharmacological interventions. To implement a HWM pharmacy model in Pakistan, it is necessary to overcome barriers outlined in this study.

The impact of a self-management educational program coordinated through WhatsApp on diabetes control.

BACKGROUND: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction. OBJECTIVE: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes. METHODS: During an 'intervention phase' spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received 'usual care' provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p<0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p<0.05. Participants' satisfaction with the intervention was also assessed. RESULTS: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p=0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p=0.064), 3 months (r=-0.123, p=0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention 'beneficial' and suggested it be used long term. CONCLUSIONS: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients' health literacy or numeracy.

The impact of a self-management educational program coordinated through WhatsApp on diabetes control

BACKGROUND: Social media can effectively mediate digital health interventions and thus, overcome barriers associated with face-to-face interaction. OBJECTIVE: To assess the impact of patient-centered diabetes education program administered through WhatsApp on glycosylated hemoglobin (HbA1c) values, assess the correlation, if any, between health literacy and numeracy on intervention outcomes. METHODS: During an 'intervention phase' spread over six months, target diabetic patients (N=109) received structured education through WhatsApp as per the American Association of Diabetes Educators Self-Care Behaviors recommendations. The control group with an equal number of participants received 'usual care' provided by health professionals void of the social media intervention. Changes in HbA1c levels were recorded thrice (at baseline, 3 and 6 months) for the test group and twice (baseline and 6 months) for the control group. Change in HbA1c values were compared and statistical significance was defined at p < 0.05. Baseline health literacy and diabetes numeracy were assessed for both groups (N=218) using the Literacy Assessment for Diabetes (LAD), and the Diabetes Numeracy Test (DNT), respectively, and values were correlated with HbA1c change p < 0.05. Participants' satisfaction with the intervention was also assessed. RESULTS: The average age of respondents was 41.98 (SD 15.05) years, with a diabetes history of 10.2 (SD 8.5) years. At baseline, the average HbA1c in the control and test groups were 8.4 (SD 1.06) and 8.5 (SD 1.29), respectively. After six months, a significant drop in HbA1c value was noticed in intervention group (7.7; SD 1.35; p= 0.001); with no significance in the control group (8.4; SD 1.32; p = 0.032, paired t-test). Moreover, the reduction in HbA1c was more in the test group (0.7%) than the control group (0.1%) with a difference of 0.6% which is considered clinically significant. There was no significant correlation between LAD score and HbA1c at baseline (r=-0.203, p = 0.064), 3 months (r=-0.123, p = 0.266) and 6 months (r=-0.106, p= 0.337) Pearson correlation. A similar result was observed with DNT, where DNT score and HbA1c at baseline, 3 months and 6 months showed no correlation (r=0.112, 0.959 and 0.886; respectively) with HbA1c levels. Eighty percent of the respondents found the social media intervention 'beneficial' and suggested it be used long term. CONCLUSIONS: Diabetes education via WhatsApp showed promising outcomes regardless of the level of patients' health literacy or numeracy

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Critical Role of Pharmacists in Caring for Alzheimer's Disease Patients.

BACKGROUND: The global prevalence of Alzheimer's disease (AD) and its treatment costs are projected to increase significantly, placing increasing pressure on health systems to create new models of care. Community pharmacists are well-positioned to provide medication management for people with AD. In Arabic-speaking countries, little is known about pharmacists' knowledge and practices in caring for people with AD. OBJECTIVE: To evaluate community pharmacists' knowledge of AD and its management, counseling skills, and dispensing patterns when caring for people with AD and their caregivers in the United Arab Emirates (UAE). METHODS: A large-scale cross-sectional survey of community pharmacists was conducted in three cities in the UAE using stratified random sampling. The questionnaire comprised of validated tools to measure knowledge and open-ended questions. A logistic regression model was conducted to predict counseling comprehensiveness. RESULTS: A total of 325 community pharmacists completed the questionnaire. The mean knowledge scores about AD and its pharmacotherapy were 57.0% and 67.6%, respectively. Major shortcomings in pharmacists' practices were identified; history-taking, adherence assessment, and counseling were provided by 2.2%, 9.3%, and 17.3%, respectively. A minority provided comprehensive counselling; the multivariate analysis yielded new insights into pharmacist characteristics associated with such counseling. CONCLUSION: Pharmacists did not provide structured patient-centered care for people with AD. Community pharmacists did not provide adequate counseling, did not assess adherence-related issues appropriately, and had deficient knowledge. To develop patient-centered pharmacy-based services for Arabic-speaking communities, a multifaceted approach is required that goes beyond improving pharmacy workforce knowledge and communication skills to address broader sociocultural, legislative, and financial factors.