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Al-Qerem W, Jarab A, Eberhardt J, Alasmari F, Alkaee SM, Alsabaa ZH. Development and Validation of the Jordanian Diabetic Health Literacy Questionnaire: Enhancing Diabetes Management in Arabic-Speaking Populations. Healthcare (Basel) 2024; 12:801. [PMID: 38610223 PMCID: PMC11011997 DOI: 10.3390/healthcare12070801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Amidst the global rise in type 2 diabetes mellitus (T2DM), effective management of the disease has become increasingly important. Health literacy, particularly in non-English speaking populations, plays a crucial role in this management. To address the lack of suitable tools for Arabic-speaking diabetic patients, this study developed and validated the Jordanian Diabetic Health Literacy Questionnaire (JDHLQ). (2) Methods: A sample of 400 diabetic patients from Jordan, with a balance in gender, age, and educational background, was recruited from an endocrinology outpatient clinic. The JDHLQ, consisting of informative and communicative sections, underwent rigorous validation. Utilizing principal component analysis and Rasch analysis, the JDHL's reliability and validity were evaluated. (3) Results: The results showed moderate proficiency in understanding and communicating diabetes-related information and confirmed the reliability and validity of the JDHLQ. (4) Conclusions: These findings emphasize the importance of culturally appropriate health literacy tools in enhancing patient understanding, engagement, and overall management of T2DM in Arabic-speaking communities.
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Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan;
| | - Anan Jarab
- College of Pharmacy, Al Ain University, Abu Dhabi 112612, United Arab Emirates;
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi 112612, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Judith Eberhardt
- Department of Psychology, School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK;
| | - Fawaz Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Safa M. Alkaee
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan;
| | - Zein H. Alsabaa
- Department of Pharmacy, Faculty of Pharmacy, Petra University, Amman 11196, Jordan;
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Mosleh R, U'wais A, Hamdan A, Ghanim M, Jarrar Y. Assessment of Alternative Medicine Use, Costs, and Predictors of Medication Adherence among Diabetes Mellitus Patients in Palestine. Endocr Metab Immune Disord Drug Targets 2024; 24:441-454. [PMID: 35616669 DOI: 10.2174/1871530322666220523114806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes Mellitus (DM) is considered the fourth leading cause of death in Palestine, with a prevalence of 9.1% in patients aged 20-79 years, and has increased to 20.6% in 2020. AIMS This study aims to estimate DM costs, compare DM total health care cost among patient characteristics and DM management (e.g. anti-diabetic medications and alternative medicine), as well as assess MA and its predictors including patient characteristics, DM management, alternative medicine use, and DM costs. METHODS A cross-sectional study was conducted for the past one year among 479 diabetic patients, selected by convenience sampling and snowball sampling methods via electronic post of an online questionnaire, including a web link to the questionnaire page in a Google Form via email or public social media pages and applications. Data on patients' socio-demographic and clinical characteristics, medication profile, use of medicinal plants as alternative medicine, costs, and Medication Adherence (MA) were collected. The Statistical Package for Social Sciences (SPSS v. 25) was used to perform a descriptive, Kolmogorov-Smirnov test, univariate analysis, Mann-Whitney or Kruskal- Wallis test, multiple linear regression, binary logistic regression, and multiple logistic regression analysis. A p-value < 0.05 was considered statistically significant. RESULTS More than half of the participants were male and living in villages (50.7%, 59.1%, respectively). Approximately 51.4% received Oral Hypoglycemic Drugs (OHDs) and only 16.1% received insulin. The participants receiving ≤3 medications daily acquired the highest percentage (55.7%), and less than half received medicinal plants as an alternative medicine for the management of DM. The estimated total DM health care cost per year incurred by patients and family members was Israeli Shekel 988,276 (US Dollar 307,590). More than half of the participants were considered adherent with the Eight-Item Morisky Medication Adherence Scale (MMAS-8) score ≥6. It is noteworthy that the use of alternative medicine was significantly associated with total health care cost and MA. Furthermore, DM duration was significantly associated with MA. These results are worth taking into consideration. CONCLUSION This study reflects the need for strengthening the patient-health care professionals' relationship, and to enhance the role of preventive education, and the importance of awareness about MA, DSCMBs, and the use of alternative medicine based on evidence-based strategies to improve MA, glycemic control, meanwhile reducing the costs incurred by patients and family members.
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Affiliation(s)
- Rami Mosleh
- Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ala' U'wais
- Department of Pharmacology and Physiology, Basic Medical Unit/ Nursing College, Arab American University, Zababdeh, Jenin, Palestine
| | - Anas Hamdan
- Department of Allied and Applied Medical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mustafa Ghanim
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yazun Jarrar
- College of Pharmacy, AlZaytoonah University of Jordan, Amman, Jordan
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Islam MA, El-Dahiyat F, Nouri A, Alefan Q, Naqvi AA. Validation of the Arabic version of the general medication adherence scale in patients with type 2 diabetes mellitus in Jordan. Front Pharmacol 2023; 14:1194672. [PMID: 37799962 PMCID: PMC10547870 DOI: 10.3389/fphar.2023.1194672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Background: Medication adherence is a major challenge for patients with diabetes. Adherence rates are often low, and this can lead to poor glycaemic control and increased risk of complications. There are a number of tools available to measure medication adherence, but few have been validated in Arabic-speaking populations. Aim: This study aimed to validate the Arabic version of the General Medication Adherence Scale in patients with type 2 diabetes in Jordan. Methods: A cross-sectional study was conducted for 3 months among patients attending diabetes mellitus outpatient clinic in Irbid, Jordan. The validation procedure included confirmatory factor analysis (CFA) and equation modelling (SEM). Fit indices, namely, goodness of fit index (GFI), Tucker Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were observed. Corrected item-total correlation (ITC) was reported. Reliability was assessed using Cronbach's alpha (α) and α value based on item deletion was also carried out. Intraclass correlation coefficient (ICC) was reported. Data were analyzed using IBM SPSS v23 and IBM AMOS v25. Results: Data from 119 participants were gathered. The mean adherence score was 27.5 (±6) ranging from 6 to 33. More than half of the patients were adherent to their therapy (n = 79, 66.4%). The reliability of the scale (n = 11) was 0.907, and ICC ranged from 0.880-0.930: 95% CI. The following values were observed in CFA; χ2 = 62.158, df = 41, χ2/df = 1.516, GFI = 0.913, AGFI = 0.860, TLI = 0.960, CFI = 0.971 and RMSEA = 0.066. A total of 10 out of 11 items had corrected ITC >0.5. The α remained between 0.89-0.92 during item deletion. Conclusion: The results obtained in this study suggest that the scale is valid and reliable in measuring adherence to medications in the studied sample of patients with diabetes. This scale can be used by clinicians in Jordan to assess adherence and may further aide in evaluating interventions to improve adherence rates in persons with type 2 diabetes.
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Affiliation(s)
- Md. Ashraful Islam
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
| | - Ahmed Nouri
- Medical Faculty, Institute of Anatomy II, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Qais Alefan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Atta Abbas Naqvi
- Department of Pharmacy Practice, School of Pharmacy, University of Reading, Whiteknights Campus, Reading, United Kingdom
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Subih MM, Abu Saleh F, Malak MZ. Medication adherence among patients with cardiovascular diseases: a cross-sectional study. J Res Nurs 2023; 28:272-282. [PMID: 37534262 PMCID: PMC10392714 DOI: 10.1177/17449871231175737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Background Medication adherence has been recognised as one of the greatest areas to improve health outcomes and reduce health expenditure. Poor medication adherence has multifactorial causes that need to be understood. Aim To determine the levels of medication adherence and examine the factors associated with medication adherence among patients with cardiovascular diseases (CVDs) in Jordan. Methods A cross-sectional, descriptive correlational design was used to conduct this study. A convenience sample was used to recruit 250 patients with CVDs from outpatient clinics of Jordanian hospitals. Data were collected using the Multidimensional Scale of Perceived Social Support and Morisky Medication Adherence Scale, in addition to sociodemographic and clinical-related factors during the period from June to September 2019. Results It was found that the total mean score of medication adherence was 2.84 (standard deviation = 1.9), which reflected low adherence. A significant positive correlation was found between medication adherence and marital status and the number of diseases. However, smoking was negatively correlated with medication adherence. Smoking was the predictor of medication adherence. Conclusions Medication adherence among patients with CVDs needs to be improved. Thus, healthcare professionals should develop strategies and interventions based on identifying factors to enhance medication adherence among those patients.
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Affiliation(s)
- Maha M Subih
- Assistant Professor, Adult Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Fadwa Abu Saleh
- Registered Nurse and Echo Technician, Royal Medical Services, Amman, Jordan
| | - Malakeh Z Malak
- Associate Professor, Community Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
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Abbas Q, Latif S, Ayaz Habib H, Shahzad S, Sarwar U, Shahzadi M, Ramzan Z, Washdev W. Cognitive behavior therapy for diabetes distress, depression, health anxiety, quality of life and treatment adherence among patients with type-II diabetes mellitus: a randomized control trial. BMC Psychiatry 2023; 23:86. [PMID: 36737757 PMCID: PMC9896442 DOI: 10.1186/s12888-023-04546-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Diabetes distress typically causes depressive symptoms; common comorbidity of diabetes unpleasantly affects patients' medical and psychological functions. Psychotherapeutic interventions are effective treatments to treat depressive symptoms and to improve the quality of life in many chronic diseases including diabetes. The present study investigated the efficacy of cognitive behavior therapy (CBT) to treat depressive symptoms in patients with type 2 diabetes mellitus (T2DM) using experimental and waitlist control conditions. MATERIALS AND METHODS A total of 130 diagnosed patients with T2DM were taken from outdoor patients services of different hospitals in Faisalabad. Ninety patients met the eligibility criteria and were randomly assigned to experimental (n = 45) and waitlist control (n = 45) conditions. All the patients completed clinical interviews and assessment measures at pre-and post-assessment stages (16 weeks intervals). Medical consultants at the respective hospitals diagnosed the patients on the base of their medical reports and then referred those patients to us. Then we used different scales to assess primary and secondary outcomes: Diabetes Distress Scale (DDS) and Patient Health Questionnaire (PHQ) to assess primary outcomes, and a Short Health Anxiety Inventory (SHAI), a Revised Version of the Diabetes Quality of Life Questionnaire (DQLQ), and a General Medication Adherence Scale (GMAS) were used to investigate secondary outcomes. Repeated measure ANOVA was used to analyze the results. RESULTS The findings indicated that patients who received CBT got a significant reduction in their diabetes distress F(1,60) = 222.710, P < 0.001, η2 = .788), depressive symptoms F(1,60) = 94.436, P < 0.001, η2 = .611), health anxiety F(1,60) = 201.915, P < .0.001, η2 = 771), and a significant improvement in their quality of life F(1,60) = 83.352, P < 0.001, η2 = .581), treatment adherence F(1,60) = 67.579, P < 0.001, η2 = .566) and physical activity schedule F(1,60) = 164.245, P < .0.001, η2 = .736 as compared to the patients in waitlist control condition. CONCLUSION It is concluded that cognitive behavior therapy is an effective and promising intervention for depressive symptoms, diabetes distress, and health anxiety which also helps the person to promote quality of life, treatment adherence and physical activity.
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Affiliation(s)
- Qasir Abbas
- Department of Applied Psychology, Government College University Faisalabad, Old Campus, Faisalabad, Pakistan.
| | - Sana Latif
- grid.411786.d0000 0004 0637 891XDepartment of Applied Psychology, Government College University Faisalabad, Old Campus, Faisalabad, Pakistan
| | - Hina Ayaz Habib
- grid.266518.e0000 0001 0219 3705Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
| | - Salman Shahzad
- grid.266518.e0000 0001 0219 3705Institute of Clinical Psychology, University of Karachi, Karachi, Pakistan
| | - Uzma Sarwar
- grid.513947.d0000 0005 0262 5685Department of Psychology, Government College Women University Sialkot, Sialkot, Pakistan
| | - Mafia Shahzadi
- grid.411786.d0000 0004 0637 891XDepartment of Applied Psychology, Government College University Faisalabad, Main Campus, Faisalabad, Pakistan
| | - Zoobia Ramzan
- grid.412080.f0000 0000 9363 9292Institute of Behavioral Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Washdev Washdev
- grid.412080.f0000 0000 9363 9292Institute of Behavioral Sciences, Dow University of Health Sciences, Karachi, Pakistan
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Alanazi M, Alatawi AM. Adherence to Diabetes Mellitus Treatment Regimen Among Patients With Diabetes in the Tabuk Region of Saudi Arabia. Cureus 2022; 14:e30688. [DOI: 10.7759/cureus.30688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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Al-Qerem W, Al Bawab AQ, Abusara O, Alkhatib N, Horne R. Validation of the Arabic version of medication adherence report scale questionnaire and beliefs about medication -specific questionnaire: A factor analysis study. PLoS One 2022; 17:e0266606. [PMID: 35413086 PMCID: PMC9004743 DOI: 10.1371/journal.pone.0266606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Medication Adherence Report Scale questionnaire (MARS-5) and the Beliefs about Medication Questionnaire-specific (BMQ-specific) are well known tools to assess adherence to medication and beliefs of chronic patients. However, validated Arabic versions of such questionnaires are lacking. We aim to validate the Arabic versions of BMQ-specific and MARS-5. In this study, a cross-sectional study was performed between November 2019 and March 2020. Participants were reached from secondary and tertiary care clinics in Jordan. Exploratory factor analysis (EFA) and Confirmatory Factor analysis (CFA) were conducted to validate the employed questionnaires on the tested sample. The internal consistency of the questionnaires was assessed by calculating Cronbach’s alpha, and Cronbach’s alpha if item is deleted. A total of 485 patients who met the inclusion criteria were recruited. The mean age of the participants was 57.14 years (22–82 years); and 39% of the participants were older than 65 years. The most common chronic diseases reported by participants were hypertension and diabetes mellitus, 35.7 and 32.2% respectively. EFA suggested two-factor model for BMQ-specific and one-factor model for MARS-5 which was confirmed by CFA analyses. The resulted Cronbach’s alphas of the questionnaires ranged from 0.89–0.93. Both analyses showed that the Arabic versions of both MARS-5 and BMQ-specific are valid and can be used for the suggested study population. Further validation-based research may enhance the transcultural adaptation of such questionnaires.
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Affiliation(s)
- Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Abdel Qader Al Bawab
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
- * E-mail:
| | - Osama Abusara
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Nimer Alkhatib
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
- Al-Zaytoonah Health Technology and Innovation Office, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Robert Horne
- Centre for Behavioral Medicine, UCL School of Pharmacy, University College London, London, United Kingdom
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Jarrar Y, Lee SJ. Demand for Pharmacogenomics and Personalized Medicine in the United Arab Emirates. J Pers Med 2022; 12:jpm12010104. [PMID: 35055419 PMCID: PMC8779682 DOI: 10.3390/jpm12010104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 12/10/2022] Open
Affiliation(s)
- Yazun Jarrar
- Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan;
| | - Su-Jun Lee
- Department of Pharmacology and Pharmacogenomics Research Center, College of Medicine, Inje University, Busan 50834, Korea
- Correspondence:
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Al Bawab AQ, Al-Qerem W, Abusara O, Alkhatib N, Mansour M, Horne R. What Are the Factors Associated with Nonadherence to Medications in Patients with Chronic Diseases? Healthcare (Basel) 2021; 9:1237. [PMID: 34575011 PMCID: PMC8469667 DOI: 10.3390/healthcare9091237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/29/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Adherence to medications is very crucial for an optimized clinical outcome in the management of chronic diseases. Beliefs about medications and other factors can significantly affect adherence to chronic medications. The objective of the present research was to identify the associated factors of adherence to medication in Jordanian patients with chronic diseases utilizing a stepwise binary logistical regression model. Methods: A cross-sectional study was carried out between November 2018 and March 2020. The participants were reached from secondary and tertiary care setting clinics in Jordan. The recruited patients were asked to report their attitudes of adherence to medications and beliefs about medications via filling out the MARS-5 and BMQ-specific tools. Sociodemographic data were also collected from the recruited patients and included in the regression model. A stepwise binary logistical regression model was applied to identify the associated factors of adherence to chronic medications in the tested sample. Results: A total of 485 patients who met the inclusion criteria were recruited. The mean age of the participants was 57.14 (age ranged from 22 to 82 years). Around 39% of the participants were older than 65 years. Most of the patients were either hypertensive or diabetic (35.7% and 32.2%, respectively). The logistic regression model indicated that necessity beliefs are strongly associated with adherence (OR 4.22), while concerns beliefs, dosage frequency and having medical insurance were negatively associated with adherence (OR 0.73, 0.74 and 0.26, respectively), with a p-value ≤ 0.05. Conclusions: Both the MARS-5 and BMQ-specific questionnaires were applied successfully on the tested sample. Better attention should be paid to the logistic regression model variables that were associated with adherence in order to guarantee optimal treatment outcomes in the treatment of chronic diseases.
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Affiliation(s)
- Abdel Qader Al Bawab
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Walid Al-Qerem
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Osama Abusara
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Nimer Alkhatib
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Maha Mansour
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan; (W.A.-Q.); (O.A.); (N.A.); (M.M.)
| | - Robert Horne
- Centre for Behavioral Medicine, UCL School of Pharmacy, University College London, London WC1H 9JP, UK;
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