0% READ
FULL TEXT
INTRODUCTION
Pregnancy is a physiologically dynamic state in which maternal pharmacokinetics, placental drug transfer and fetal vulnerability intersect to make medication use uniquely complex. Although drug therapy in pregnancy can seldom be avoided entirely-many women contend with conditions such as nausea, diabetes, asthma or hypertension that require treatment-every exposure must be weighed against the potential for fetal harm (George et al., 2011). Most medicines reach the market without robust clinical-trial evidence on gestational risk, which places a heavy interpretive burden on the health professionals who prescribe and dispense them (Schwarz et al., 2009).
The scale of maternal morbidity sharpens the relevance of this issue. The World Health Organization has estimated that a large share of maternal deaths are preventable through appropriate care during pregnancy and labour, and that hundreds of millions of women live with pregnancy-related morbidity worldwide (Hafez, 1998; Veneman, 2008). Within this care pathway, safe medication use is a modifiable determinant of outcome, and the professionals who govern access to medicines carry a corresponding responsibility.
Among health professionals, community pharmacists occupy a distinctive position: they are the most accessible, often the first and sometimes the only point of contact for women seeking remedies for common ailments (Leung et al., 2018). Globally, pharmacists are regarded as medication experts, equipped to counsel pregnant women on the risks of prescription and non-prescription drugs, herbal preparations and substances of abuse (Zaki et al., 2014). Where community pharmacy services are stretched by population pressures and a high proportion of minimally qualified dispensers, the quality of medication advice in pregnancy may be compromised (Jagarlamudi et al., 2018).
Evidence on the specific competencies of community pharmacists in safe medication use during pregnancy remains limited, and interventional evidence demonstrating that these competencies can be improved is scarcer still (Devkota et al., 2017). Against this background, the present study was undertaken with three objectives: to assess the baseline Knowledge, Attitude and Practice (KAP) of community pharmacists regarding medication safety during pregnancy; to deliver a structured educational intervention; and to evaluate the change in KAP following that intervention.
MATERIALS AND METHODS
Study design and setting
A single-group, pre-post educational interventional study was conducted over a six-month period among community pharmacists practising in the urban area of Bagalkote. The phased timeline encompassed area mapping, tool development, a pilot phase, baseline data collection, the educational intervention, post-intervention data collection, and analysis.
Study population and sampling
The study population comprised registered community pharmacists holding at least a Diploma in Pharmacy. Pharmacists willing to participate were included; those unwilling to participate or not engaged in community practice were excluded. The sample size was derived using OpenEpi version 2, taking the proportion of subjects with optimal knowledge of safe practice in pregnancy as 45.9% (Narayana et al., 2019), an absolute precision of 12% and a 95% confidence level, yielding a required sample of 70 participants.
Data collection instrument
A pre-designed, pre-tested, structured, self-administered questionnaire was used. It comprised four sections: demographic details (age, gender, qualification, experience) and three KAP domains of six items each. Knowledge items addressed the potential harm of over-the-counter, topical and herbal preparations and the role of iron, folic acid and calcium supplementation, together with awareness of teratogenicity. Attitude items captured confidence, caution and risk perception in dispensing. Practice items addressed counselling behaviour, the use of drug-information resources and the habit of updating one's knowledge. Each completed interview required approximately 20-25 min.
Scoring
Each domain contained six items scored 2 for a correct response and 1 for an incorrect response, giving a domain range of 6-12. For knowledge, scores of 10-12 denoted good knowledge and 6-9 poor knowledge; for attitude, 10-12 denoted a positive attitude and 6-9 a negative attitude; for practice, 10-12 denoted safe practice and 6-9 unsafe practice.
Intervention
Following baseline assessment, a structured multimodal educational intervention was delivered comprising a PowerPoint presentation, a supporting video and a printed leaflet addressing safe medication use during pregnancy. KAP was reassessed using the same instrument two months after the intervention, an interval chosen to allow inference about retained learning rather than the immediate recall of intervention content.
Ethical approval
The study was approved by the Institutional Ethics Committee of Hanagal Shri Kumareshwar College of Pharmacy, Bagalkote (Ref. No. HSKCOP/IEC/23/6, dated 21 March 2023). Written informed consent was obtained from every participant after the nature and purpose of the study were explained, and confidentiality was assured throughout.
Statistical analysis
Data were compiled in Microsoft Excel. Categorical variables were summarised as frequencies and percentages. Pre-and post-intervention mean domain scores were compared using the paired t-test, with p<0.05 considered statistically significant.
RESULTS
Of the 70 community pharmacists enrolled, the majority were male (91.4%), aged 20-29 years (41.4%), held a Diploma in Pharmacy (57.1%) and had 0-10 years of professional experience (58.6%). The full demographic profile is presented in Table 1.
Marked shifts were observed across all three domains after the educational intervention. Good knowledge increased from 50.0% to 97.1%, positive attitude from 75.7% to 98.6%, and safe practice from 28.6% to 97.1%. The pre-and post-intervention category distributions are shown in Table 2.
At the item level, the proportion of participants giving the correct response rose for every knowledge, attitude and practice item assessed. The most pronounced gains were recorded for awareness that over-the-counter medicines may be harmful (60.0% to 97.1%), recognition of teratogenicity and its effects (21.4% to 75.7%), and the practice of consulting a drug-information resource before dispensing to a pregnant woman (17.1% to 85.7%). The item-wise responses are summarised in Table 3. The mean domain scores improved significantly after the intervention. Knowledge rose from 8.57±0.99 to 10.65±0.92, attitude from 9.01±0.86 to 10.11±0.79, and practice from 7.81±1.07 to 10.14±0.95. The paired t-test confirmed that all three changes were highly statistically significant (p<0.001), as shown in Table 4.
DISCUSSION
This interventional study set out to measure, and then to improve, the competencies of community pharmacists in medication safety during pregnancy. The baseline picture was sobering: only half of the participants demonstrated good knowledge, fewer than three in ten followed safe dispensing practices, and awareness of teratogenicity was strikingly low. These deficits are concerning given that community pharmacists are frequently the first professionals a pregnant woman consults about a minor ailment.
The demographic profile helps to contextualise these findings. Most participants held only a diploma qualification and had limited professional experience, a pattern that mirrors earlier observations from community-pharmacy settings and that has been linked to weaker medication-safety competencies (Jagarlamudi et al., 2018). The predominance of male, early-career, diploma-qualified dispensers suggests that any strategy to raise the standard of pregnancy-related counselling must reach precisely this group.
The central finding is that a brief, structured educational intervention produced large and statistically significant gains across all three domains. Good knowledge nearly doubled, positive attitude approached universality, and safe practice rose more than threefold. The magnitude of these shifts is consistent with prior work showing that targeted counselling and education can meaningfully improve medication-related KAP among pharmacy personnel and pregnant women alike (Devkota et al., 2017). The parallel improvement in attitude and practice alongside knowledge supports the view that knowledge deficits sit upstream of the cautious-but-uninformed behaviour observed at baseline.
Certain items proved more resistant to change than others. Awareness of the potential harm of herbal preparations, and the habit of routinely consulting drug-information resources, improved but remained imperfect after a single intervention-an indication that some behaviours require reinforcement rather than a one-off exposure. This observation argues for continuing, rather than episodic, professional education.
The study has several limitations that merit consideration. The single-group pre-post design, undertaken without a concurrent control arm, limits the extent to which the observed gains can be attributed to the educational intervention alone rather than to other influences operating over the same period. Repeated exposure to an identical questionnaire may have produced a testing effect, in which familiarity with the items rather than genuine learning inflated post-intervention scores; recall of intervention content at the time of reassessment may similarly have shaped responses independent of any real change in underlying competence; and secular influences over the two-month follow-up, such as incidental professional exposure or discussion among peers, cannot be excluded as contributors to the improvement. Reassessment was carried out two months after the intervention, which permits some inference about short-term retention but leaves the durability of these gains beyond that window untested; a longer follow-up would be needed to establish whether the improvements are sustained. The sample was drawn from a single urban area, which may limit the generalisability of these findings to pharmacists practising in rural or other urban settings. Finally, the practice domain relied on self-report rather than direct observation of dispensing encounters: gains in reported practice may reflect a genuine shift in intended behaviour, a tendency toward socially desirable responding once the correct answers had just been taught, or both, and may not fully correspond to how pharmacists actually counsel or dispense in real consultations with pregnant women. Direct observation or standardised-patient methodology would be needed to confirm that the reported changes translate into observed practice. Notwithstanding these constraints, the consistency and statistical strength of the improvements across all three domains lend confidence to the central conclusion.
Variable | Category | n (%) |
|---|---|---|
Age (years) | 20-29 | 29 (41.4) |
30-39 | 21 (30.0) | |
40-49 | 16 (22.9) | |
50-59 | 2 (2.9) | |
≥60 | 2 (2.9) | |
Gender | Male | 64 (91.4) |
Female | 6 (8.6) | |
Qualification | D.Pharm | 40 (57.1) |
B.Pharm | 29 (41.4) | |
M.Pharm | 1 (1.4) | |
Experience (years) | 0-10 | 41 (58.6) |
11-20 | 16 (22.9) | |
21-30 | 9 (12.9) | |
≥31 | 4 (5.7) |
Domain | Category | Pre-intervention n (%) | Post-intervention n (%) |
|---|---|---|---|
Knowledge | Good | 35 (50.0) | 68 (97.1) |
Poor | 35 (50.0) | 2 (2.9) | |
Attitude | Positive | 53 (75.7) | 69 (98.6) |
Negative | 17 (24.3) | 1 (1.4) | |
Practice | Safe | 20 (28.6) | 68 (97.1) |
Unsafe | 50 (71.4) | 2 (2.9) |
Item | Pre n (%) | Post n (%) |
|---|---|---|
Knowledge: OTC medicines may be harmful in pregnancy | 42 (60.0) | 68 (97.1) |
Knowledge: Topically applied medicines may be harmful | 16 (22.9) | 39 (55.7) |
Knowledge: Herbal medicine contents may be harmful | 21 (30.0) | 40 (57.1) |
Knowledge: Daily iron and folic acid is necessary | 49 (70.0) | 63 (90.0) |
Knowledge: Daily calcium supplementation is necessary | 37 (52.9) | 63 (90.0) |
Knowledge: Awareness of teratogens and their effects | 15 (21.4) | 53 (75.7) |
Attitude: Confident in dispensing drugs in pregnancy | 49 (70.0) | 56 (80.0) |
Attitude: All OTC drugs are not safe in pregnant women | 34 (48.6) | 58 (82.9) |
Attitude: Extra caution required while dispensing | 52 (74.3) | 61 (87.1) |
Practice: Consults a drug-information resource before dispensing | 12 (17.1) | 60 (85.7) |
Practice: Regularly updates medication-safety knowledge | 11 (15.7) | 44 (62.9) |
OTC: Over-the-Counter.
Domain | Pre (Mean±SD) | Post (Mean±SD) | Mean change | t value | p value |
|---|---|---|---|---|---|
Knowledge | 8.57±0.99 | 10.65±0.92 | 2.08 | 12.40 | <0.001 |
Attitude | 9.01±0.86 | 10.11±0.79 | 1.10 | 7.93 | <0.001 |
Practice | 7.81±1.07 | 10.14±0.95 | 2.33 | 13.60 | <0.001 |
SD: Standard Deviation; df=69; paired t-test, p<0.05 considered significant.
The practical implication is clear. Community pharmacists are willing and able to improve, but they need structured opportunities to do so. Embedding mandatory continuing pharmacy education-focused on the specific lacunae identified here-into routine professional development would be a proportionate and effective response.
CONCLUSION
Community pharmacists in this study began with substantial deficits in their knowledge, attitude and practice regarding medication safety during pregnancy, with poor knowledge translating into cautious yet uninformed dispensing behaviour. A short, structured, multimodal educational intervention produced statistically significant improvements across all three domains. These findings make a strong case for the routine incorporation of continuing pharmacy education, targeted at identified knowledge gaps, to strengthen the quality of medication counselling that pregnant women receive at the community level.
