Pharmaceutical Care Through Women’s Eyes: Insights from a Cross-Sectional Study in Jordan

Introduction

Healthcare services are now focused on enhancing patient satisfaction by providing high-quality care.¹ Pharmacists, whether they work in hospitals, health centers, or community pharmacies, are increasingly recognized as integral components of healthcare frameworks.^2–5 In recent decades, there has been significant evolution and growth in the pharmacy field, particularly a shift from medication dispensing and compounding toward more patient-focused pharmaceutical care services.^6–9 These include patient medication counseling, which is defined as providing patients with non-verbal or verbal information regarding medication, lifestyle changes, dietary considerations, proper storage, necessary precautions, potential side effects, and usage instructions.¹⁰ Indeed, comprehensive patient education and effective consultation are considered professional pharmaceutical interventions that pharmacists can offer.¹¹

Patient satisfaction is crucial in evaluating healthcare services, including pharmaceutical services,^12–16 since it reflects the clinical outcomes and effectiveness of treatment.^17,18 Hence, to optimize healthcare resources, it is essential to enhance and ensure the quality of pharmaceutical services by reviewing patient satisfaction.¹⁹ Furthermore, a prior study found an association between patients’ perception of pharmaceutical care and levels of satisfaction with this care.²⁰ The perception of healthcare is also affected by patients’ gender;²¹ the perception and expectations regarding pharmaceutical care services are higher among females than males.²²

Females play a central role in health-related decision-making for their families.²³ Previous research in Jordan demonstrated that females have considerable delay between the onset of their medical conditions and actual healthcare seeking.²⁴ Previous research in Jordan showed that female patients face multiple barriers that restrict their access to healthcare services such as the lack of confidence in the skills of the healthcare providers, availability of female healthcare professionals, and a perceived inadequate quality of services.²⁵ Therefore, studying satisfaction with pharmaceutical care services among females is necessary to understand their perceptions and expectations about these services, improve the services provided, and enhance the satisfaction of female patients. Nevertheless, no previous research has assessed satisfaction with pharmaceutical services among female patients in Jordan. Therefore, our study aims to evaluate the satisfaction of female patients with pharmaceutical services in Jordan.

Materials and Methods

Study Design and Setting

This is an online cross-sectional survey study that was conducted in Jordan between February 13^th and April 04^th 2025.

Study Population and Sampling Procedure

Participation in the investigation was restricted to females who satisfied the inclusion criteria. The study’s participants were females aged 18 years and older. This investigation employed the convenience sampling technique to invite eligible individuals to participate. Social media platforms (WhatsApp, Snapchat, and Facebook) were employed to solicit research participants.

Study Instrument

This study utilized the Arabic version of a previously developed questionnaire tool.²⁶ The original questionnaire was designed based on previous literature that assessed patient satisfaction with pharmaceutical care.^12,27–29

Our study instrument is comprised of two sections. The first section focused on participants’ demographic and socioeconomic characteristics utilizing multiple choice question (MCQ) format (age, marital status, education level, income, occupation, comorbidities, the frequency of visiting the pharmacy, type of pharmacy being visit, and type of drugs being used). The second section focused on patient satisfaction with pharmaceutical services. This section evaluated the pharmacist’s effectiveness in explaining potential side effects, medication usage, time allocated for patient interaction, identifying medication-related issues, gathering patient-specific details, resolving said issues, the waiting area ambiance, service swiftness, tracking outcomes, and medication availability. In addition, this section evaluated the convenience of pharmacy location, comfort of the waiting area, medication quantity adequacy, medication availability, pharmacy cleanliness, and packaging quality.

Instrument Validation

The validity of the original instrument was checked using pilot testing on a group of 30 patients. The outcome of the piloting phase was used to rephrase items, shortening the length of the instrument, and making some modifications. The internal consistency for the survey tool in the current study sample was examined and demonstrated excellent internal consistency with Cronbach’s alpha measure value of 0.974.

Sample Size

The minimum required sample size was 383 females, with a confidence interval of 95%, a standard deviation of 0.5, and a margin of error of 5%.

Ethical Considerations

The scientific research ethics committee granted ethical approval for this study (SREC/25/02/127).

Data Analysis

Demographic variables such as age group, marital status and income were presented using frequency and percentages. Continuous variables, including the total scale and the four subscales, were summarized using mean and standard deviation (SD). The Kolmogorov–Smirnov test was used to assess the normality of the continuous variables. The total score was calculated as summation of the four subscales. To compare groups such as type of drugs, independent t test was utilized. For comparisons across more than two demographic groups, one-way ANOVA was performed, followed by Tukey post hoc test for pairwise comparisons. Furthermore, multivariable logistic regression analysis was used to identify significant predictors of satisfaction level. Before conducting the regression, the total score was dichotomized based on the median value of 103. All statistical analysis were performed using SPSS version 31, with significance level set at p < 0.05.

Results

A total of 637 females participated in this study. The majority of female participants were aged 18–23 years (n = 435, 68.3%), followed by those aged 24–30 years (n = 158, 24.8%). Most were single (n = 501, 78.6%) and held a bachelor’s degree (n = 404, 63.4%). A large portion reported a monthly income of less than 500 (n = 327, 51.3%). Regarding employment, 227 (43.5%) were not working and 247 (38.8%) were students. Most respondents had no comorbidities (n = 576, 90.4%) and used medication on as needed basis (n = 579, 90.9%), Table 1.

Table 1 Demographic Characteristics of Participants

Overall, patients’ satisfaction with pharmaceutical services was positive. For instance, 237 participants (37.2%) rated the courtesy and respect shown by pharmacy staff as excellent, while 221 (34.7%) gave excellent ratings for pharmacist’s instructions on medication use. Moreover, 224 (38.3%) rated the pharmacy’s professional appearance as excellent, and 230 (36.1%) expressed excellent satisfaction with pharmacy services overall. However, some areas showed room for improvement, only 94 (14.8%) rated the pharmacists’ frequency of checking on medication effectiveness as excellent, and 129 (20.3%) rated the pharmacists’ interest in their health as excellent, Table 2.

Table 2 Patient’s’ Perception of Pharmaceutical Service Quality at Primary Healthcare Centers

Patients with a monthly income between 1000 and 1500 reported higher overall satisfaction (111.81 ± 24.58) compared to those earning less than 500 (99.80 ± 27.89) (p = 0.003). Those visiting community pharmacies also had higher satisfaction scores (104.74 ± 24.48) than patients visiting government centers pharmacies (93.98 ± 30.21) (p = 0.002). Furthermore, patients using PRN medications reported greater satisfaction in other parameters (11.23 ± 1.14) compared to those on chronic medications (10.71 ± 1.86) (p = 0.002). Additional differences were seen across occupational groups, particular in other parameters (10.00 ± 2.55) than those in other employment fields. More details are provided in Table 3.

Table 3 Sociodemographic and Clinical Determinants of Patient Satisfaction with Pharmacy Services

Patients with monthly income of 1000–1500 were more than twice as likely to report higher satisfaction compared to those earning less than 500 (OR = 2.23, 95% CI: 1.25–3.99, p = 0.006). Additionally, visiting government center pharmacies (OR = 0.44, 95% CI: 0.24–0.82, p = 0.009) or government hospitals (OR = 0.42, 95% CI: 0.21–0.84; p = 0.014) was associated with significantly lower odds of satisfaction compared to those visiting community pharmacy, Table 4.

Table 4 Multivariable Logistic Regression of Factors Associated with Pharmacy Service Satisfaction

Discussion

Our study found that overall patient satisfaction with pharmaceutical services was positive. For example, 37.2% of participants rated the courtesy and respect shown by pharmacy staff as excellent. Likewise, 34.7% of participants gave excellent ratings for the pharmacist’s instructions on using their medications. Additionally, 38.3% of patients rated the pharmacy’s professional appearance as excellent, and 36.1% expressed excellent satisfaction with the pharmacy’s overall services. Similarly, the overall satisfaction with the pharmacy services in Pakistan was 39.6%.³⁰ However, the overall satisfaction with the pharmacy services in our study was lower than that of the bulk of prior studies, as the overall satisfaction with the pharmacy services was 46.2% in Eastern Ethiopia,³¹ 49% in Nigeria,³² 52.6% in Ethiopia,³³ 62.5% in Saudi Arabia,³⁴ 64.8% in Nablus,³⁵ 72.5% in Jordan,³⁶ and 74.6% in South Korea.³⁷ Additionally, earlier investigations found that participants from Romania,³⁸ Nablus,³⁵ Jordan,³⁹ and India⁴⁰ reported higher satisfaction with the courtesy and respect shown by pharmacy staff, the pharmacist’s instructions on using their medications, and/or the pharmacy’s professional appearance than our participants did. A previous systematic review that involved 59 studies in the Middle East region identified multiple factors that affect Middle Eastern women’s utilization of healthcare services such as their sociodemographic characteristics, education, sources of their health information, risk factors, personal factors, service access and quality levels, and organizational factors.⁴¹ Other research in the Middle East reported that cultural and religious factors strongly influence females’ perception and utilization of healthcare services.^42,43 This underscored the need for culturally sensitive healthcare services.⁴¹ Previous research in Saudi Arabia found that female patients delay their emergency medical care due to gender preferences and religious rules concerned with cross-gender interactions.⁴⁴ Indeed, positive pharmacists’ attitude, excellent consultation, and clear explanation of pharmaceutical services and products are associated positively with patients’ satisfaction.^29,45–48 Thus, training Jordanian pharmacists on updated roles of pharmacists and medication information may aid in improving their professionalism and consultation skills, thereby increasing satisfaction with pharmacy services. These may also enhance patients’ health outcomes and medication regimen adherence, as patients with high levels of satisfaction are anticipated to have elevated levels of medication regimen adherence and more favorable health outcomes.⁴⁹

Other areas in the current investigation also showed room for improvement; only 14.8% rated the pharmacists’ frequency of checking medication effectiveness as excellent, and 20.3% rated the pharmacists’ interest in their health as excellent. Consistent with these, in Nablus, patients rated the effort of pharmacists to check medication effectiveness and pharmacists’ interest in their health as moderate.³⁵ Besides, approximately 50% of participants in a prior study from Jordan indicated that during their treatment with medications, they required follow-up with their pharmacist.⁵⁰ Now, the pharmaceutical care vision encompasses a wide range of responsibilities for pharmacists, extending beyond the management of patient medications to include providing patients with the most cost-effective, safe, and effective medications, checking medication effectiveness, and offering comprehensive patient consultations.⁶ Thus, pharmacists must spend more consultation time to ensure they deliver comprehensive information to patients.⁵¹ Research documented that both non-verbal and verbal communication-related consultations enhanced the level of patient satisfaction.⁵² However, satisfaction with pharmacist communication is low among many participants, such as in Qatar.⁵³ The literature underscores that the deficiency of professional pharmacists and privacy concerns are among other barriers to consultation.⁵⁴ Consequently, training pharmacists on pharmaceutical services and checking their consultations and communications is recommended.³⁵ Furthermore, pharmacists must follow up with patients during their treatment.⁵⁵

In this study, patients with a monthly income of 1000–1500 were more than twice as likely to report higher satisfaction compared to those earning less than 500 (OR = 2.23, 95% CI: 1.25–3.99, p = 0.006). Although several prior studies are consistent with this finding, other studies find no significant association, no association, or even a negative association between income and satisfaction with pharmaceutical services. For instance, in Ethiopia, the level of expectation towards pharmaceutical services was higher among individuals with higher incomes.^56,57 Moreover, Ethiopian patients were dissatisfied with pharmacy services due to high medication prices and other socioeconomic factors.⁵⁸ Similarly, satisfaction with pharmacy services was higher among US patients with higher socioeconomic status.⁵⁹ On the contrary, another earlier investigation from Romania did not find an association between patients’ income and satisfaction with services provided by community pharmacies.⁶⁰ Even a significant negative association was reported between income and satisfaction with primary healthcare services in Saudi Arabia.⁶¹ These results suggest an inconsistent and intricate association between income and satisfaction with pharmaceutical services. Besides, this association may be influenced by other factors that are documented to impact patients’ satisfaction, such as differences in healthcare settings, region, and service delivery.⁶² In line with this, although the level of financial satisfaction was higher with postal pharmacy services than with community pharmacy services in South Africa, the level of satisfaction with community pharmacy services was higher due to less medication wastage and better counseling.⁶³ Hence, it is essential to implement strategies that ensure all patients receive equitable and adequate pharmaceutical services.

This study showed that visiting government center pharmacies (aOR = 0.44, 95% CI: 0.24–0.82, p = 0.009) or government hospitals (aOR = 0.42, 95% CI: 0.21–0.84; p = 0.014) was associated with significantly lower odds of satisfaction compared to those visiting community pharmacies. Consistent with this, levels of patient satisfaction with community pharmacy services in Spain⁶⁴ and Pakistan⁶⁵ were higher than those with hospital pharmacy services. These findings also align with observations from Saudi Arabia and South Africa, which indicate that participants have higher satisfaction levels with community pharmacy services compared to primary healthcare center pharmacies in Saudi Arabia⁶⁶ and postal pharmacies in South Africa.⁶³ These significantly higher satisfactions with community pharmacy services reflect better counseling and an increased interest in patients’ health, as well as lower waiting times.^63,64,66 The low satisfaction with hospital pharmacy services may also be a result of poor interaction with patients due to the hospital pharmacists’ workload.⁶⁵ The literature also highlights that patients’ expectations and satisfaction are affected by the location of the pharmacy, waiting zone, knowledge and availability of pharmacists, and prior experience.^34,67 Therefore, educational and counseling interventions for pharmacists at government pharmacies are necessary to enhance their knowledge and skills, thereby enabling them to interact effectively with patients, reduce patient waiting times, improve their experience, and increase their satisfaction levels.

Decision makers in the healthcare sector are advised to decrease workload on the pharmacists, which might cause medication errors.⁶⁸ Besides, increasing the number of pharmacists at the dispensing window, can enhance patient throughput time. Furthermore, continuous training and knowledge assessment are recommended on regular basis to maintain up to date knowledge and skills.

This research is not free from limitations. The online cross-sectional survey research utilizing convenience sampling technique through social media platforms has limited generalizability and ability to examine causality across the study variables. Survey-based research utilizing self-reported measures is prone to reporting bias and social desirability bias. Therefore, the study findings should be interpreted carefully. Future research should target the implementation of longitudinal study design utilizing probability sampling techniques. Furthermore, female patients’ satisfaction could be further examined utilizing other objective healthcare measures such as improved medication adherence rate, improved medication awareness, adverse drug monitoring, and frequency of follow-up contacts.

Conclusion

This study indicates that female patients in Jordan generally have a positive overall satisfaction with pharmaceutical services. However, many areas showed room for improvement. Moreover, patients with a high monthly income and those visiting community pharmacies report higher satisfaction. Thus, training Jordanian pharmacists on updated medication information, pharmaceutical services, consultations, communications, and follow-up with patients during their treatment is required to increase satisfaction with pharmacy services and patients’ health. Furthermore, it is crucial to develop strategies that ensure all patients receive equitable and satisfactory pharmaceutical services.