Community pharmacists’ experiences and beliefs towards providing pharmacy services to deaf and hard of hearing patients: a mixed-method study in Riyadh, Saudi Arabia
Authors: Ibrahim A , Alarfaj S J , Alsantly A , Alfaran D , Alenezi M , Almutairi R 
Published: April 2022

Abstract

Introduction
Provision of pharmacy services to patients requires the pharmacist to well communicate with the patients. Research has shown that healthcare providers, including community pharmacists, face many challenges while providing services to deaf and hard-of-hearing patients (DHOH).

Aim
To investigate community pharmacists’ experiences and beliefs about providing pharmacy services to DHOH in Riyadh, Saudi Arabia.

Methods
This was a sequential explanatory mixed-method study involving a survey and semi-structured interviews. At first, a web-based, self-administered survey was disseminated to community pharmacists in Riyadh, Saudi Arabia during the period October to November 2020. The survey was disseminated through the official twitter account of Saudi Pharmaceutical Society. Two reminders were sent. It was made clear that the survey targeted community pharmacists working in Riyadh city. To calculate an appropriate sample size, according to Hair et al, the general rule to have a minimum sample size would be five observations per variable (5:1), and an acceptable sample size would be ten observations per variable (10:1). In this survey, there are 16 items, and hence the acceptable sample size was 160 participants. The semi-structured telephone-based interviews were conducted with a purposive sample of survey respondents to gather in-depth information on experiences, beliefs, and barriers about providing pharmacy services to DHOH. The interviews were conducted until saturation occurred. Survey data was analysed using Statistical Package for Social Sciences (SPSS version 24), and the semi-structured interviews were analysed by Framework analysis.

Results
A total of 175 community pharmacists completed the survey. The majority were: male (84.6%), aged between 25 to 35 years (74.9%). Of the respondents, 32.2% and 29.1% had experience in community pharmacy of 1-5 and 6-10 years, respectively. The number of DHOH patients the pharmacists met during the past 6 months were as follows: 68 (38.9%) pharmacists met 1-2 patients, 71 (40.6%) %) pharmacists met 3-4 patients, and 19 (11%) %) pharmacists met ≥ 5 patients. The provided services included: prescription medications (by 82.9%), counselling on prescription medications (by 56.6%), OTC medication dispensing (by 4.3%), and counselling on OTC medications (by 52.6%). Forty participants (22.8%) reported their awareness of the basics of Saudi sign language (SSL). Of the participants, 101 (57.7%) believed that they have handled communication barriers appropriately, while 61(35%) acknowledged unmanageable communication barriers. Among the main barriers identified were the lack of knowledge of the basics of SSL. (70.9%) and the inability to recognize disability (52.6%). The semi-structured interviews further explored pharmacists’ experiences and views on providing such a service. Of the main themes emerged were: (1) Experience; interviewees preferred written communication with DHOH patients regardless of their literacy level, while spontaneous hand gesturing was the least preferred method of communication, and they also acknowledged that their roles in providing services, to the DHOH, need to be improved (2) Beliefs; interviewees believed that awareness of the basics of SSL is important to ensure safe medication use. The barriers emerged from the interview were classified as pharmacist-related, system-related, and patient-related.

Conclusion
To our knowledge, this is the first study of its kind to be conducted in Saudi Arabia. The study highlighted that when providing pharmacy services to DHOH patients, community pharmacists encountered multiple barriers. These barriers need to be addressed for better support and provision of pharmacy services to DHOH. Further studies with large sample size, are warranted to better understand the situation.

References
(1) Hair J, Black W, Babin B, Anderson R. Multivariate data analysis. 7th ed. Harlow: Pearson Education Limited; 2014
(2) Scheier DB. Barriers to health care for people with hearing loss: a review of the literature. J N Y State Nurses Assoc. 2009 Mar 22;40(1):4-11.
(3) Ferguson MC, Shan L. Survey evaluation of pharmacy practice involving deaf patients. Journal of pharmacy practice. 2016 Oct;29(5):461-6.