Community pharmacists’ knowledge of diabetes management during Ramadan in Egypt

Knowledge, attitude, and practice of insulin among diabetic patients and pharmacists in Egypt: "cross-sectional observational study"

BACKGROUND

Diabetes recently has been identified as a growing epidemic. Although insulin's vital role in both types of diabetes, it is considered one of the harmful medications if used incorrectly. In Egypt, effective usage of insulin remains a challenge due to insufficient knowledge of insulin and diabetes management, leading to errors in insulin therapy. As pharmacists are experts in pharmacological knowledge, they are uniquely situated to assess adherence to treatment regimens, the effect of drug therapy, or potential alterations in drug therapy to meet patient goals. To provide effective patient education and counseling, community pharmacists in Egypt should be efficiently knowledgeable about diabetes and insulin.

OBJECTIVE

To identify the knowledge, attitude, and practice of pharmacists and patients about insulin. To identify pharmacists' educational preparedness and confidence in counseling diabetic patients.

METHODS

A descriptive, cross-sectional study was conducted with two knowledge, attitude, and practice surveys. This study was carried out from September 2016 to February 2023. Face-to-face interviews were conducted with patients, and a paper-based questionnaire was administered to pharmacists. The two questionnaires were adapted from previous studies.

RESULTS

A total of 492 patients and 465 pharmacists participated in this study. The mean knowledge score of correct answers among patients and pharmacists was 10.67 ± 1.9 and 15 ± 3.6. Most of the patients and pharmacists had a positive attitude regarding insulin's role in improving health and to better control blood glucose. On the negative side, around half of the patients reported that they believe that regular use of insulin leads to addiction, while only 14.5% of the pharmacists believed that insulin could cause addiction. Self-confidence scores for pharmacists differed statistically with sex, years of experience, and pharmacist's direct exposure to diabetic patients.

CONCLUSIONS

This study uncovers considerable deficiencies in patients' and pharmacists' knowledge about insulin therapy. This study also strongly recommends higher education and a more structured pharmacist training schedule.

Healthcare professionals knowledge, attitude, practices, and perspectives providing care to Muslims in Western countries who fast during Ramadan: a scoping review

The practice of fasting during the month of Ramadan is an obligation for healthy Muslims and involves abstaining from food and drinks from dawn to dusk for 29-30 consecutive days annually. With changes in dietary and lifestyle patterns, healthcare professionals (HCPs) play a significant role in supporting Muslims health during Ramadan. In this scoping review, we employed a systematic approach to map existing literature on HCPs' knowledge, attitude, practices, and perspectives working with Muslims who fast during Ramadan in Western countries. Our aim was to identify research gaps and opportunities for improving healthcare services for Muslims during Ramadan. Literature searches were generated through multiple scientific literature databases, including Web of Science, Ovid MEDLINE, CINAHL, and Embase and reviewed following The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. From the eight sources included in this review, it was found that HCPs' knowledge of Ramadan fasting practices vary, with many lacking adequate knowledge. While HCPs recognize potential health complications, adjustments to medications for fasting patients, especially those with diabetes, are often neglected. Challenges in care included language barriers, limited cultural training, and resource awareness. Strategies identified to address barriers include reducing language barriers, providing resources in relevant languages, and enhancing cultural competence training. Further research is required on HCPs' knowledge providing care to Muslims during Ramadan, cultural competency training impact, and diverse healthcare interventions for fasting Muslims. Addressing these gaps may enhance culturally safe care and improve patient outcomes.

Egyptian community pharmacies and self-care: Context, challenges and opportunities

Community pharmacists are ideally positioned to play a key role in promoting self-care behaviors through judicious use of self-care interventions. As highlighted by the International Pharmaceutical Federation, supporting effective self-care is a key strategy for pharmacists to contribute to the sustainability of healthcare systems. Despite recent positive developments in national health policies, Egypt does not have a clear self-care strategy and policy. It also has no national programs focusing on community pharmacists and self-care, important components that future health policy initiatives should tackle. This commentary explores self-care policies, strategies, and developments in the Egyptian community pharmacy practice context. It describes national research, roles, and challenges within the current model of community pharmacy practice and education concerning self-care. It addresses opportunities that Egyptian community pharmacy has to support self-care in light of the anticipated changes in the Egyptian healthcare system. Noting that success in the delivery of self-care interventions within community pharmacies is associated with key factors, recommendations are suggested for community pharmacy stakeholders to address such factors guided by the World Health Organization's implementation considerations for individuals' health needs and self-care-related health system challenges (agency, availability, quality, cost, information, accessibility, utilization, social support, acceptability, and efficiency).

Comprehensive Care for Patients with Diabetes in Ramadan: A Module for Pharmacy Students and Pharmacists

Introduction

Prior studies show that many patients with diabetes whose health maybe impacted by fasting, choose to fast during Ramadan. This study describes the implementation and evaluation of an online module targeting bachelor of pharmacy (BPharm) and doctor of pharmacy (PharmD) students that aims to improve participants' knowledge, communication, and self-efficacy concerning proper care for patients with diabetes in Ramadan.

Methods

An online module consisting of two phases targeting both BPharm and PharmD students was implemented over two semesters in fall 2020 and spring 2021. Participants were directed to fill pre-module and post-module assessments to evaluate the change in their knowledge and self-efficacy using two scales. Pre- and post-survey data for participants’ knowledge and self-efficacy were analyzed for significance using paired sample t-tests. Qualitative data analysis was performed to assess participants’ responses to the open-ended question concerning what they liked and disliked about the module.

Results

All BPharm and PharmD students taking the lesson responded to both the baseline survey and the follow-up one resulting in 92 responses (participation rate of 100%). The average score for participants in the pre-module self-efficacy section was 1.5 (SD = 1) and increased post-module to 3.5 (SD = 0.7), t (91) = 20.2, p < 0.001. Further, the average score for participants in the pre-module knowledge section was 14 (SD = 3), which similarly increased to 22 (SD = 3) post-module t (91) = 19.7, p < 0.001. Qualitative analysis provided insights on how participants perceived the module design, content, and its impact on practice. Participants described the module as an informative one that addresses a much-needed issue they haven’t been exposed to before. They emphasized how the module addresses the cultural needs of patients in their communities. They particularly appreciated seeing instructor videos depicting real-life scenarios and the focus on their communication skills, but some preferred learning about this topic through live sessions.

Conclusion

An online module positively impacted both self-efficacy and knowledge in relation to caring for patients with diabetes considering fasting in Ramadan. Future studies should explore how different versions of this module can be integrated into educational activities for pharmacy students, pharmacists in different settings, and for other health care professionals.

Construction and evaluation of an online module addressing counseling patients with diabetes observing religious fasting

INTRODUCTION

Little research has been conducted on training students of different health professions to deliver culturally appropriate care to patients observing religious fasting. This study aimed to formulate an online educational module on caring for patients with diabetes observing religious fasting and evaluate the module's impact.

METHODS

Third-year doctor of pharmacy students participated in an online module at the end of their core pharmacist-patient communication class. The module involved discussions and case scenarios addressing Muslim, Jewish, and Hindu patients with diabetes considering fasting. Students were provided with Ramadan Communication (RAMCOM), a tool designed to facilitate counseling of patients on religious fasting and were encouraged to use principles of motivational interviewing in addressing cases. A 13-item questionnaire was administered before and after the module. Answers provided on an open-ended item addressing students' experiences with the module were analyzed qualitatively using conventional content analysis.

RESULTS

Of 140 students taking the class, all students completed the module and 135 completed both questionnaires. The module elicited a statistically significant improvement in confidence across all 13 survey items. The computed aggregate score increased from 2.65 (0.56) to 3.66 (0.50) (P < .001), with 71% of students finding the module to be useful or extremely useful. Qualitative analysis provided insight into students' experiences, including how the module produced an improvement in student confidence as well as opportunities for module improvement.

CONCLUSIONS

A brief online module significantly improved pharmacy students' confidence in working with patients from different cultures and religions considering religious fasting.

How do Polish pharmacy staff evaluate own qualifications, competences, relevance, motivation, effectiveness in health promotion?

Health promotion programmes are complex and need to engage all health care specialists, including pharmacists. Pharmacies are considered as a potentially ideal place for health promotion and education. To evaluate own qualifications, competences, relevance, motivation and effectiveness of Polish pharmacy staff with regard to health-related information provided to patients, which contributes to health promotion. 308 pharmacy staff from Lublin (Poland) were surveyed with a questionnaire prepared by the researchers and piloted previously. It consisted of 5 domains: qualifications, competences, relevance, motivation, and effectiveness of health promotion. Items in each domain were scored by respondents in 1 − 10 scale where 1 is ‘very low’ and 10 is ‘very high’. Pharmacy staff rated the relevance of health promotion the highest, while the lowest—own competences and effectiveness in health promotion. Female pharmacy staff assessed the relevance of health promotion significantly higher than males (7.1 vs. 6.1, p = 0.005). Higher self-assessments of qualifications, competences, relevance, motivation and effectiveness in health promotion were provided by: the youngest pharmacy staff, those with a short period of employment, and pharmacy staff working in pharmacies employing up to 3 persons. Qualification and competences in health promotion were assessed higher by pharmacy technicians and masters of pharmacy with post-graduate studies or professional specialization, or Ph.D. than by masters of pharmacy. Relevance and effectiveness in health promotion were evaluated higher by pharmacy staff in pharmacies serving more than 100 customers daily. There is a need to improve qualifications, competences, relevance, motivation and effectiveness in health promotion conducted by Polish pharmacy staff.

Communicating with Clinicians on Fasting during Ramadan: The Patients' Perspective

Caring for millions of Muslim patients who decide to fast during Ramadan can be challenging for clinicians. Using a theory-guided approach, this study explores Muslim patients' perspectives on factors influencing communication with clinicians in relation to fasting during Ramadan. Semi-structured interviews were conducted with a sample of patients in Egypt (9) and the USA (8). Participants were purposefully sampled to assure variance in age, gender, education, decision to fast and ethnicity. Data emerging from narratives were mapped to constructs within the Linguistic Model of Patient Participation in Care (LMOPPC). Using framework analysis, iterative sampling and analysis continued until saturation. Drawing on LMOPPC, participants' narratives were mapped and clustered into patient participation and quality of care; predisposing factors (perceptions about fasting and its significance including sense of spiritual benefit when fasting and sense of guilt when not fasting, prior experiences including prior conversations with clinicians on fasting and experience of fasting while sick, patients' personality and locus of control, belief in the legitimacy of participation, motivations and perception of need to communicate with clinicians about fasting, provider verbal and nonverbal responses, and provider-patient rapport); and enabling factors (knowledge about the topic and repertoire of communicative skills, presence of companions during appointment, and timing of appointments). The LMOPPC framework provided insight into patients' perspectives on barriers and facilitators for communication with clinicians about fasting during Ramadan. It is important for stakeholders to consider those issues when implementing interventions aiming to adopt a concordant approach in providing care for this group of patients.

Clinicians' Perspectives on Caring for Muslim Patients Considering Fasting During Ramadan

This study explores clinicians' perspectives on factors affecting care provided to Muslim patients who decide to fast during Ramadan. Semi-structured interviews were conducted with a purposeful sample of clinicians in Egypt (11) and the USA (10). Framework analysis was conducted through mapping data to constructs within social cognitive theory. Data were mapped into clinician's belief in ability to care for those patients, belief in group's ability to provide care, anticipated consequences of providing such care, knowledge, learning by observing other clinicians, cultural norms and perceived acceptability and prevalence of care provision, environmental barriers and opportunities, and communication approach.

Knowledge, attitude and practice of Sudanese pharmacist with regard to management of diabetes during Ramadan: A cross-sectional survey

BACKGROUND

Fasting during Ramadan for some individuals with diabetes may lead to complications. Pharmacists may assist in dose adjustment and compliance with medication during Ramadan. Therefore, the aim of this study was to assess the knowledge, attitude and practice of Sudanese community pharmacists in the management of diabetes during Ramadan.

METHOD

A cross-sectional study from April to June 2017, included 330 pharmacies in Khartoum state. The sampling technique was done by two methods using stratified and systematic methods for seven localities of Khartoum State. The community pharmacists were assessed in their knowledge about Medication regimen adjustment (MRA), diabetes risk stratification and the condition in which the fasting diabetic patient have to stop their fast.

RESULTS

The total response rate was 311(94.2%), and the females were 203(65.3%). Pharmacists mean age was 27.6 (SD = 5.9), ranged between 21-62 years. Importantly, more than 75% of the Pharmacists have sufficient knowledge of both identifying high-risk individuals and whether they need to break their fasting. The practice questions answered correctly by more than 80% of pharmacists in relation to monitor blood glucose level, undergo meal planning to avoid hypoglycemia and dehydration during prolong fasting hours and to undergo meal choices to avoid postprandial hyperglycemia. Importantly, 56.9% community pharmacists advised individuals with diabetes about physical activity. The barriers that hindering the proper counseling was attributed to the Lack of knowledge (71.4%). MRA was reported as highly important by (56.6%) and extremely important by (39.2%). The confidence of knowledge about MRA was reported by 52.1%.

CONCLUSION

This study showed that pharmacists had sufficient knowledge, positive attitude and good practice about diabetes management during Ramadan.

Perspectives and experiences of patients with type 2 diabetes observing the Ramadan fast

INTRODUCTION

Diabetes is a common chronic disease among Australians. Culturally and linguistically diverse groups are observed to have higher prevalence rates of diabetes. Continuing management needs adherence to medication and diet regimens. Religious practices such as fasting can affect diabetes management and medication use. Pharmacists as medication specialists have a significant role in helping people observing religious practices such as the Ramadan fast, which involves month-long absolute abstinence from food during daylight hours, to maintain good control over their condition.

OBJECTIVE

This study investigated the perspective of patients with type 2 diabetes (T2D) who undertake the fast of Ramadan, to understand their experiences, health-related needs and service preferences regarding diabetes management.

METHODS

A qualitative, exploratory design was used in this study. Data collection comprised the conduct of semi-structured interviews with a purposive convenient sample of patients in areas of ethnic diversity in Sydney, using a standardised interview guide. Interview data were transcribed verbatim and thematically analysed.

RESULTS

Twenty-five semi-structured interviews (68% males) among a heterogeneous sample of fasting T2D patients were conducted. Themes emerging from analysis of transcripts included issues relating to sociocultural pressure for T2D patients to fast; lack of awareness about the role of pharmacists and, most importantly, the need to train pharmacists in cultural sensitivity and clinical implications thereof.

CONCLUSIONS

Community awareness about the role of the pharmacists in assisting medication use and adjustment during fasting periods should be enhanced. Furthermore, community pharmacists need to be trained about the unique religious and sociocultural issues of patients with diabetes opting to observe spiritual rituals such as the Ramadan fast. Clinical education in this area should up-skill pharmacists to inculcate self-management behaviours in fasting T2D patients.

Fasting, Diabetes, and Optimizing Health Outcomes for Ramadan Observers: A Literature Review

INTRODUCTION

Globally, and in Australia, diabetes has become a common chronic health condition. Diabetes is also quite prevalent in culturally and linguistically diverse pockets of the Australian population, including Muslims. There are over 90 million Muslims with diabetes worldwide. Diabetes management and medication use can be affected by religious practices such as fasting during Ramadan. During Ramadan, Muslims refrain from oral or intravenous substances from sunrise to sunset. This may lead to many potential health or medication-related risks for patients with diabetes who observe this religious practice. This literature review aimed to explore (1) health care-related interventions and (2) intentions, perspectives, or needs of health care professionals (HCPs) to provide clinical services to patients with diabetes while fasting during Ramadan with a view to improve health outcomes for those patients.

METHODS

Using a scoping review approach, a comprehensive search was conducted. Databases searched systematically included PubMed, Medline, Embase, and International Pharmaceutical Abstracts. Studies published in English that described interventions or intentions to provide interventions regarding diabetes and Ramadan fasting were included.

RESULTS

Fourteen published articles that met the inclusion criteria were retrieved and content analyzed. Of those, nine intervention studies regarded diabetes management education. Five studies described professional service intention, four of which were related to the role of pharmacists in diabetes management in Qatar, Australia, and Egypt, and one French study examined the general practitioners' (GPs) experiences in diabetes management for Ramadan observers. The intervention studies had promising outcomes for diabetes management during Ramadan. Effect sizes for improvement in HbA1c post intervention ranged widely from -1.14 to 1.7. Pharmacists appeared to be willing to participate in programs to help fasting patients with diabetes achieve a safe therapeutic outcome. Service intention studies highlighted pharmacists' and GPs' need for training prior to providing services from a clinical as well as cultural competence perspective.

CONCLUSION

Interventions research in this area requires robustly designed and structured interventions that can be tested in different contexts. This literature review revealed many gaps regarding diabetes management in Ramadan. Health professionals are willing to provide services for fasting diabetes patients, but need upskilling.

Pharmacists' knowledge and interest in developing counseling skills relating to oral contraceptives

BACKGROUND

Possessing correct therapeutic information on oral contraceptives is an important prerequisite for the provision of sound advice to women who are using these products.

OBJECTIVES

This study examines Egyptian pharmacists' knowledge of pharmacotherapeutic aspects of oral contraceptives as well as interest in developing skills in providing counseling on oral contraceptive pills.

SETTING

Community pharmacies throughout Alexandria, Egypt.

METHODS

A cross-sectional survey was self-administered by a random sample of community pharmacists in Alexandria, Egypt. Five multiple choice questions likely to arise when counseling women on oral contraceptives were constructed. Questions covered compatibility with breastfeeding, precautions, health risks and managing missed pills of oral contraceptives. Using ordered logistic regression, a model was estimated to predict pharmacists' interest in developing skills in providing counseling on oral contraceptives.

MAIN OUTCOME MEASURE

Pharmacists' aggregate scores for knowledge questions and pharmacists' interest in developing skills in providing counseling on oral contraceptive pills.

RESULTS

Of the 181 approached pharmacists, 92 % participated. Twenty one pharmacists (13 %) did not know the correct answer to any question, 122 (73 %) answered one-two correctly, 23 (14 %) answered three-four correctly. No pharmacist answered all five questions correctly. For pharmacists' interest in developing skills in providing counseling on oral contraceptives, the percentage values for answers were: not interested at all (10.2 %), slightly interested (27.0 %), somewhat interested (23.4 %), interested (30.0 %) and extremely interested (9.6 %). Pharmacists' interest in developing skills in providing counseling on oral contraceptives was significantly associated with the number of women who requested advice from the pharmacists on oral contraceptives (OR 1.54, CI 1.24-1.91). In terms of the learning method of preference, percentage values for answers were: attending a workshop (4 %), online course (18 %), publications distributed to pharmacy (44 %), other methods (1 %) and more than one method (23 %). Ten percent were not interested in developing their skills on oral contraceptives.

CONCLUSION

This study identifies considerable gaps among community pharmacists' knowledge of oral contraceptives. It also shows variation in willingness and choice of learning strategies among pharmacists to develop their skills in providing counseling on oral contraceptives.