SSM: Qualitative Research in Health (Dec 2022)
Pharmacists under pressure to concede: Why pharmacists provide non-prescribed antibiotics in the Arab minority in Israel
Abstract
Background: Antibiotics overuse has become a global health threat because of increased antimicrobial resistance. Consumption of non-prescribed antibiotics contributes to this problem and has been found particularly among minority populations. One source for non-prescribed antibiotics are pharmacists. This study focuses on perspective of Arab pharmacists working in the Arab society in Israel--a minority reported to overconsume antibiotics--in order to learn why Arab pharmacists might accede to customers’ requests for non-prescribed antibiotics. Design: Face-to-face interviews were conducted with 60 Arab pharmacists working in private pharmacies in different regions in Israel. Qualitative data were analyzed thematically by focusing on the characteristics of pharmacist-customer relations, conceptions of social norms, and perceived expectations to provide non-prescribed antibiotics. Key results: The findings highlight how perceived normative expectations associated with a collectivist orientation predispose pharmacists to concede to customers' requests. The analysis identified two inter-related factors serving to pressure pharmacists to dispense non-prescribed antibiotics: personal customer-pharmacist relationship and cultural collectivist values. Pharmacists faced dilemmas between obligation to comply with customers' requests and going against professional ethos and described strategies to resist customers’ requests. Conclusions: This study illuminates the central role of sociocultural contexts and social norms in pharmacist-customer relations in a collectivist-oriented minority, resulting in pressuring pharmacists to go against regulations. The findings have implications to understanding reasons for dispensing prescription-only medications. Interventions to reduce antibiotics use could enlist the centrality of social ties and commitment in pharmacist-customer relationships to resist dispensing prescription-only medications without prescriptions and to strengthen pharmacists’ role in providing pro-health messages.
