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THE PROVISION OF PHARMACEUTICAL CARE IN OMAN: PRACTICE AND PERCEIVED FACILITATORS AND BARRIERS TO IMPLEMENTATION by Awatif Al Abdullatif A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Pharmaceutical Sciences University of Toronto © Copyright by Awatif Al Abdullatif (2014) ABSTRACT The Provision of Pharmaceutical Care in Oman: Practice and Perceived Facilitators and Barriers to Implementation Awatif Al Abdullatif Doctor of Philosophy Department of Pharmaceutical Sciences University of Toronto 2014 Objectives: The study purpose was to determine the extent of the implementation of pharmaceutical care (PC) in Oman and factors affecting its implementation. Methods: A cross-sectional mail survey of all practicing pharmacists in Oman based on the Theory of Planned Behavior (TPB) was conducted. The survey instrument was informed by a focus group study to identify behavioral, normative, and control beliefs amongst pharmacists in three practice settings: inpatient, outpatient, and community pharmacy. Results: The survey useable response rate was 61.2%. Participants provided PC activities between ‘sometimes’ and ‘most of the time’; however, provision of advanced PC activities was limited. Provision of PC did not significantly differ across inpatient, outpatient, and community settings. Clinical knowledge, communication skills, pharmacist time, and adequate staffing were common facilitators across practice settings; worry about responsibility and culturally-based gender issues regarding patient care were common barriers. While having a private counseling area, and access to patient records and to drug information databases were facilitators identified in the public sector, their absence was a barrier in community pharmacies. Reimbursement was the main barrier in the private sector. Country of origin was significantly related to pharmacists’ ii beliefs about providing PC; specifically, Omani pharmacists had significantly different behavioral, normative, and control beliefs than their South Asian counterparts. All constructs of the TPB (attitude, subjective norm, and perceived behavioral control) were significant predictors of intention to provide PC, but the added construct—past behavior recency was not. The overall variance explained in intention was 43%. Of the two predictors of behavior in the TPB model, only perceived behavioral control was significant; intention was not. The explained variance in PC behavior was 13.0%. Conclusions: This is the first study to examine the implementation of PC in Oman. The findings of this study will inform the development of strategies for advancing PC practice, a mandate of Ministry of Health and the pharmacy profession in Oman. The TPB was useful for explaining pharmacists’ intention to provide PC; however, a longitudinal study is recommended to test its predictive validity for PC behavior. iii ACKNOWLEDGEMENTS I would like to express my gratitude to all of those who have helped me accomplish my studies and this insurmountable venture. Firstly, I would like to thank Dr. Linda MacKeigan, for it was under her guidance and wisdom, without which this thesis would not have been possible. She continued to stand by me and offer continuous feedback to ensure the quality of work delivered is of a high calibre. I also extend my utmost thanks to the members of the Advisory Committee; Dr. Joan Marshman and Dr. Rhonda Cockerill. Their addition of perspective and sage advice enabled me to further improve the quality of my work. Similarly, I would like to thank H.E. Minister of Manpower Mohamed Al Bakri, and former Minister of Manpower H.E. Juma Ali, for making all of this possible in the first place by granting me this scholarship. Additional thanks goes to the Site Advisory Committee in Oman that consisted of Mrs. Sawsan Ahmed Jaffer, Dr. Ibrahim Al Zakwani, Mrs. Jehan Alfanna, Mr. Qasim Al Riyami, Dr. Bryan Gunn, Mr. Osama Babiker, and Mr. Bakool Mehta. Their support in providing me with the information and data necessary was pivotal to my research. I am also very thankful to the funding agencies that helped me finance my expenses and allowed me to carry out the necessary set ups to conduct my research; namely, the Ministry of Manpower, Oman, Muscat pharmacy for sponsoring the survey study, and Oman Pharmaceutical Products (OPP) for sponsoring the focus group study. Along with every venture, there come several points in time where we require additional moral support and motivation to continue soldiering on. For those moments, I take this opportunity to iv
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