---
title: "Community pharmacists’ roles and barriers in health promotion and disease prevention in Jordan: CO"
id: "plos-one-8-factors-influencing-community-pharmacists-provision-of-health-promotion-and"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-8-factors-influencing-community-pharmacists-provision-of-health-promotion-and"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355315"
published_at: "2026-08-05T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Community pharmacists’ roles and barriers in health promotion and disease prevention in Jordan: CO
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-8-factors-influencing-community-pharmacists-provision-of-health-promotion-and
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355315)
- **Published At:** 2026-08-05T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This qualitative study explored how community pharmacists (CPs) in Amman, Jordan, experience and perceive provision of **health promotion and disease prevention (HPDP)** services. - Between January and April 2025, semi-structured face-to-face interviews were conducted with 15 CPs using purposive and snowball sampling; interviews were audio-recorded and transcribed verbatim. - Inductive thematic analysis following Braun and Clarke’s six-step approach was used; transcripts were coded independently by two researchers and analyzed in NVivo QSR 14. - Four main themes were identified: (1) Diverse and evolving roles of CPs in HPDP; (2) Barriers to providing HPDP services, including workload, limited patient engagement, lack of appreciation from owners, and absence of financial incentives; (3) Professional requirements and capacity building, including continuing professional development, undergraduate training, and physician collaboration; and (4) Impact of providing HPDP services on patients, pharmacists, and the healthcare system. - Themes were deductively mapped to the **COM-B** framework, showing that pharmacists’ engagement is influenced by capability-, opportunity-, and motivation-related factors. - The study concluded that CPs in Jordan are active in HPDP but face structural, educational, and motivational barriers; recommendations include targeted training, infrastructure development, improved pharmacist–physician collaboration, and public awareness to support integration of pharmacists into public health strategies. - Data saturation was reported when no new themes emerged. The study was funded by Al-Zaytoonah University of Jordan and is published in PLOS ONE (August 5, 2026).
## Clinical Analysis & Structured Key Points
Factors influencing community pharmacists’ provision of health promotion and disease prevention services in Jordan: Qualitative thematic analysis and deductive mapping to the COM-B model | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract Background Non-communicable diseases represent a major cause of morbidity and mortality in Jordan and place increasing demands on primary healthcare services. Community pharmacists (CPs) play an important role in providing health promotion and disease prevention (HPDP) services. However, limited evidence exists regarding factors influencing their involvement in these activities. Objective The study aimed to explore CPs’ perceptions and experiences regarding the provision of HPDP services in Jordan and to identify factors influencing service delivery, including facilitators and barriers. Methods Between January and April 2025, face-to-face semi-structured interviews were conducted with CPs in Amman, Jordan, recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed in NVivo® QSR 14 using inductive thematic analysis following Braun and Clarke’s six-step approach. Transcripts were independently coded by two researchers. The identified themes were subsequently deductively mapped to the Capability, Opportunity, Motivation-Behavior (COM-B) framework. Data collection and analysis were conducted concurrently, and data saturation was achieved when no new themes emerged. Results Fifteen CPs participated. Four themes were identified: (1) Diverse and evolving roles of CPs in HPDP; (2) Barriers to providing HPDP services, including workload, limited patient engagement, lack of appreciation from pharmacy owners, and the absence of financial incentives; (3) Professional requirements and capacity building, including continuing professional development, undergraduate training, and physician collaboration; and (4) Impact of providing HPDP services on patients, pharmacists, and the healthcare system. Deductive mapping indicated that pharmacists’ engagement in HPDP services was influenced by capability-, opportunity-, and motivation-related factors. Conclusions CPs in Jordan play an active role in HPDP services; however, their contribution is hindered by structural, educational, and motivational barriers. Addressing these barriers through targeted training, infrastructure development, enhanced pharmacist-physician collaboration, and public awareness initiatives is essential to strengthen pharmacist-led HPDP services and support their integration into broader public health strategies in Jordan. Citation: Hasan Ibrahim A, Ibrahim I, Alwidyan T, Tayyem M (2026) Factors influencing community pharmacists’ provision of health promotion and disease prevention services in Jordan: Qualitative thematic analysis and deductive mapping to the COM-B model. PLoS One 21(8): e0355315. https://doi.org/10.1371/journal.pone.0355315 Editor: Miquel Vall-llosera Camps, PLOS ONE, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND Received: March 5, 2026; Accepted: July 20, 2026; Published: August 5, 2026 Copyright: © 2026 Hasan Ibrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the manuscript and its Supporting Information files. Funding: This research was funded by Al-Zaytoonah University of Jordan, grant number 51/17/2022–2023. The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or in the decision to submit the paper. Competing interests: The authors have declared that no competing interests exist. Introduction Non-communicable diseases, such as diabetes, hypertension, and cardiovascular disease, are leading causes of morbidity and mortality worldwide [ 1 ]. Addressing this growing burden requires effective health promotion and disease prevention (HPDP) strategies. Health promotion has been defined by the World Health Organization (WHO) as enabling people to live healthier lives by increasing their control over their health through improved health literacy and multisectoral actions to produce healthy environments and behaviors [ 2 ]. Accordingly, disease prevention involves population-level and individual-level interventions aimed at reducing the incidence, progression, and complications of chronic diseases and other health conditions [ 2 ]. HPDP services are fundamental components of public health efforts to improve population wellbeing. These services involve several interventions, such as screening programs, health education initiatives, and lifestyle counseling [ 3 ]. Available evidence indicates that HPDP services contribute to increased productivity, reduced disease burden, and lower healthcare costs across diverse populations [ 4 – 7 ]. While HPDP services are widely recognized as valuable, their integration into routine healthcare practice remains challenging. Barriers include limited time, lack of adequate training, poor integration of information technology systems, and limited professional experience among healthcare providers (HCPs) [ 8 , 9 ]. Worldwide, community pharmacists (CPs) are increasingly recognized as highly accessible HCPs, particularly in low- and middle-income countries [ 10 – 12 ]. As the scope of pharmacy practice continues to expand, CPs are anticipated to deliver preventive services in addition to their traditional dispensing responsibilities [ 12 – 14 ]. This shift is largely driven by the growing prevalence of chronic disease [ 15 ], an aging population [ 15 ], increasing pressure on healthcare systems [ 15 ], and greater public awareness of health risks such as obesity [ 16 ] and tobacco smoking [ 17 ]. Consequently, CPs are increasingly expected to contribute to public health initiatives through the delivery of HPDP services [ 10 ]. However, the extent to which pharmacists engage in these activities may be influenced by individual, organizational, and system-level factors [ 18 ]. Several studies have shown that pharmacist-led interventions are effective across several important areas such as smoking cessation [ 14 ], diabetes care [ 19 ], hypertension management [ 19 ], dyslipidemia management [ 19 ], immunization uptake [ 20 ], contraception counseling [ 21 ], and osteoporosis prevention [ 22 ]. Moreover, during the COVID-19 pandemic, CPs played a vital role by providing point-of-care testing, telepharmacy services, and mass vaccination programs, highlighting their contribution to enhancing healthcare reach and system resilience [ 23 ]. In Jordan, CPs have taken on a more active role in public health initiatives, particularly through telepharmacy services and COVID-19 vaccination programs [ 24 ]. However, recent studies identified substantial training and infrastructure needs among CPs [ 24 – 26 ]. Additionally, qualitative research examining the role of Jordanian CPs in mental health support has identified communication difficulties and the need for better training in sensitive, high-stigma healthcare areas [ 27 ]. These findings point to continuing structural and professional challenges that may hinder efforts to expand CPs’ public health role. Research investigating the role of CPs in providing HPDP services in Jordan remains limited. Few studies have explored CPs’ experiences of delivering HPDP services in routine practice, their perceived roles, and the contextual factors influencing service delivery within community pharmacy settings [ 28 – 30 ]. Furthermore, most existing studies have employed quantitative approaches, providing limited insight into pharmacists’ experiences and the context in which HPDP services are delivered in everyday practice [ 28 – 30 ]. Existing quantitative evidence suggests that HPDP services are not fully integrated into routine practice in Jordan due to systemic constraints [ 28 – 30 ]. This gap limits the ability to fully utilize CPs’ potential in advancing public health. Understanding the factors that influence CPs’ engagement in HPDP services requires a theoretically informed perspective on the professional behaviors involved in service delivery [ 31 ]. The Capability, Opportunity, Motivation-Behavior (COM-B) framework proposes that behavior is influenced by an individual’s capability, opportunity, and motivation [ 31 ]. As the provision of HPDP services represents a professional behavior shaped by individual, organizational, and system-level factors, the COM-B framework provides a useful theoretical lens for interpreting factors that may influence pharmacists’ engagement in these activities [ 31 ]. Therefore, this study sought to explore CPs’ perceptions and experiences regarding the provision of HPDP services in Jordan and to identify factors influencing service delivery, including barriers and facilitators. Gaining a deeper understanding of these aspects is crucial for guiding policy decisions, enhancing pharmacy education, and promoting the effective integration of CPs into Jordan’s broader public health system. Methods Study design A qualitative study employing semi-structured interviews was conducted to explore CPs’ perspectives on providing HPDP services in Jordan. The study was exploratory in nature and aimed to gain an in-depth understanding of CPs’ experiences and perceptions regarding the provision of HPDP services. This study adopted an applied qualitative descriptive approach to generate a practice-oriented account of CPs’ experiences and perceptions regarding HPDP service provision. It was conceptually informed by the COM-B framework. Thematic analysis was conducted inductively, and the COM-B framework was subsequently used to provide a theoretical interpretation of the identified themes through deductive mapping. This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (see S1 File ) [ 32 ]. Participants and setting Eligible participants were CPs registered with the Jordan Pharmacists Association, who had at least one year of experience working in a community pharmacy setting in Amman, Jordan, and expressed willingness to participate. The interviews were conducted face-to-face at the community pharmacies. Sampling and recruitment Purposive and snowball sampling were used to recruit participants between 1 January 2025 and 30 April 2025 to ensure diversity in experiences and perspectives regarding HPDP service provision. Purposive sampling was used as the primary recruitment strategy to capture variation in participants’ demographic and professional characteristics, while snowball sampling facilitated access to additional eligible participants. Pharmacists were identified through the official Jordan Pharmacists Association Directory [ 33 ] and contacted using publicly available telephone numbers. Potential participants were provided with an information sheet outlining the study objectives, procedures, and voluntary nature of participation. Written informed consent was obtained from all participants prior to data collection. During the interviews, participating CPs were asked to nominate and suggest the name of a potential CP participant. Data collection Semi-structured interviews were conducted by a trained female interviewer, Ibtihal Ibrahim (II). The interviewer (II) holds a Master’s degree in Clinical Pharmacy, is a qualified PharmD, and was a lecturer at Al-Zaytoonah University of Jordan at the time of the study. No participants were known to the interviewer prior to the study commencement. Furthermore, the interviewer did not practice in community pharmacy. Additionally, participants were aware that the researcher (II) worked as a lecturer at Al-Zaytoonah University of Jordan and were given an overview of the project. The researcher (II) also had an interest in the research topic of assessing CPs’ perceptions regarding the provision of HPDP services in Jordan. To minimize the potential influence of researcher assumptions on data collection and interpretation, reflexivity was maintained throughout the study. The interviewer recorded field notes and documented reflections and observations following interviews to capture contextual information relevant to data interpretation. Regular discussions were held within the research team to critically examine emerging interpretations and potential sources of bias. An interview topic guide with prompts ( Table 1 ) was developed based on a review of relevant literature and expert input. The topic guide was pilot-tested with two CPs who were not included in the final analysis, and refined accordingly. During the interviews, probing questions were used to clarify participants’ responses, explore emerging issues in greater depth, and encourage participants to elaborate on their experiences and perspectives regarding HPDP services. Download: PNG larger image TIFF original image Table 1. Interview topic guide and prompts. https://doi.org/10.1371/journal.pone.0355315.t001 Each interview was audio-recorded with participants’ permission. Interviews were conducted in Arabic and transcribed verbatim. Transcripts were subsequently translated into English and checked for accuracy by AHI and II, who are fluent in both Arabic and English. To ensure translation accuracy and preserve the meaning of participants’ responses, the translated transcripts were reviewed against the original Arabic transcripts. Any discrepancies or ambiguities were discussed and resolved through consensus. Transcripts were not returned to participants for comment or correction, and formal member checking was not undertaken. However, credibility was supported through reflexive and collaborative analytical procedures. In addition, no repeat interviews were conducted. Data management and analysis All data were anonymized during transcription to ensure participant confidentiality. Each participant was given an anonymous code (e.g., CP1, CP2). Thematic analysis was conducted following Braun and Clarke’s six-step approach [ 34 ], which includes familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the final report. Transcripts were imported into NVivo® QSR 14 to facilitate systematic coding and data organization. Two researchers (AHI and TA) independently coded the transcripts and compared their coding decisions. Initial codes were generated inductively from the data and grouped into broader themes through iterative comparison and refinement. The developing themes were continuously reviewed against both the coded extracts and the complete dataset to ensure coherence, consistency, and clear distinction between themes. Any discrepancies in coding or interpretation were discussed within the research team until consensus was reached. Themes were further refined through ongoing discussions among the research team to ensure accurate interpretation and representation of the data. In this study, data saturation was the main determinant of the sample size. Data collection and analysis were conducted concurrently, with newly generated codes continuously compared with existing codes throughout the analytical process. Saturation was considered achieved when no new themes, concepts, or meaningful insights emerged from subsequent interviews. Following the point at which no new information was identified, a final interview was conducted to confirm saturation. Reflexivity was maintained through documentation of researchers’ assumptions and analytic decisions throughout the study. Emerging interpretations were regularly discussed within the research team to critically examine potential biases and ensure that themes remained grounded in the data. Following completion of the inductive thematic analysis, a secondary deductive analysis was undertaken to provide a theoretical interpretation of the findings. Two researchers reviewed the finalized themes (AHI and TA) and mapped them to the COM-B framework using the original COM-B definitions. Differences in mapping were discussed until consensus was reached. Ethical considerations The study received ethical approval from the Institutional Review Board at Al-Zaytoonah University of Jordan (IRB #15/12/2024–2025). The research was conducted in accordance with the principles of the Declaration of Helsinki. Participation was voluntary and written informed consent was obtained prior to all interviews. Data confidentiality and participant anonymity were strictly maintained and all identifying information was removed from transcripts. Results In this study, 15 CPs were interviewed, with an average interview duration of 40 minutes. Data saturation was reached after 14 interviews. One additional interview was conducted to confirm that no new themes or meaningful insights emerged, after which no further recruitment was undertaken. The majority were female (n = 10, 66.7%), with a mean age of 27.5 (±6.1) years, and had less than 5 years of experience in community pharmacy practice (n = 11, 73.3%). Participants worked an average of 8 hours per day (SD ± 2.2). Two-thirds (n = 10, 66.7%) were the only pharmacist on duty per shift and most worked in single independent pharmacies (n = 12, 80.0%). Six CPs were unable to take part in the study due to time constraints and workload pressures. The demographic characteristics of participants are presented in Table 2 . Download: PNG larger image TIFF original image Table 2. Demographic characteristics of the participants (N = 15). https://doi.org/10.1371/journal.pone.0355315.t002 Main themes from thematic analysis Thematic analysis revealed four main themes that emerged from interview data: diverse and evolving roles of CPs in HPDP, barriers to providing HPDP services, professional requirements and capacity building, and impact of providing HPDP services. Theme 1: Diverse and evolving roles of CPs in HPDP This theme describes the range of HPDP activities undertaken by CPs and their evolving role in promoting health and preventing disease within community pharmacy practice. CPs described diverse and evolving roles in HPDP and consistently linked these services to improved public health outcomes. Although they agreed that health promotion could lead to disease prevention, none provided a definition fully aligned with that of the WHO. Instead, their explanations reflected a general understanding of reducing disease risk rather than a comprehensive public health perspective: “Improving the health of the patient to reduce the risk of developing certain diseases…Health promotion leads to disease prevention; the two terms are not identical” (CP3) In practice, CPs reported engaging in a wide range of HPDP-related activities. The most common activities included recording vital signs, providing ongoing patient education, monitoring medication adherence, and offering lifestyle advice, such as exercise, a healthy diet, weight management, and smoking cessation, particularly for patients at risk of or newly diagnosed with chronic conditions: “We monitor patients with diabetes and hypertension by regularly recording blood glucose and blood pressure readings to assess their adherence to prescribed medications and determine if medication adjustments are needed.” (CP1) “We offer nicotine gum to smokers and instruct them on its correct use.” (CP4) “When patients are newly diagnosed with diabetes, hypertension, or dyslipidemia, I make sure to teach them about non-pharmacological therapies that aid in disease control, such as healthy food and exercise.” (CP5) Patient education also extended to addressing mis
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