The Viewpoint of Community Pharmacists about Their Professional Role in Dispensing Beauty Products: A Study from Western Region of Saudi Arabia

Background: Community pharmacists play a significant role in dispensing and counseling about medications and pharmaceuticals including beauty and cosmetic products. Aims and Objectives: The current study was conducted to assess the viewpoint of community pharmacists in the Western region of Saudi Arabia about their professional role in dispensing beauty products. Methods: A cross-sectional study was conducted between September and December 2019 using an online questionnaire. Expert professors from college of pharmacy, Taif University validated the questionnaire. Results: Five hundred seventy-seven community pharmacists completed the questionnaire. Most of the participants were male (99%) and aged 23 34 years old (71.1%). Slightly less than half (45.58%) of community pharmacists have 6 10 years of experience. Most pharmacists (96.9%) communicate directly with customers/ patients and most of them (85.3%) ask and counsel patients about their product. Pharmacists strongly agreed that pharmacists must keep in developing their communication skills with customers/patients. Conclusion: Most of the community pharmacists surveyed in this study reported a good perceived knowledge and attitudes and demonstrated an acceptable level of practices regarding beauty products. Saudi FDA is encouraged to adopt Good Pharmacy Practice standards and guidelines to improve current practice of community pharmacists concerning Beauty Products.


Introduction
Pharmacists play a complementary role to other health care professionals. They counsel patients about appropriate use of medications and serve them optimizing therapy [1]. A study conducted in the western region of Saudi Arabia revealed a high willingness among young residents to receiving medication therapy management services from community pharmacists [2].
A study among community pharmacists in Saudi Arabia indicated that effective clinical services inbound with knowledge, need, value and confidence of the pharmacists [3].
One of the common areas that require an effective contribution of community pharmacists and their direct involvement is the area of cosmetics and beauty products. It is, however, an ignored area regarding offering standardized quality service. A study in Riyadh assessed the information presented in print pharmaceutical advertisements and indicated that safety information related to side effects, precautions, and major interactions was inadequately reported in examined advertising materials [4]. Another study conducted in Riyadh, Saudi Arabia revealed presence of deficiencies in appropriate dispensing practices and medication counselling at community pharmacies [5]. A study performed at Qassim region, Saudi Arabia evaluated the medication counselling practice at community pharmacies and revealed that overall standard of medication counseling services provided to patients to improve usage of their medications, and consequently, their well-being was poor [6]. Rasheed et al. conducted a systematic review on 24 studies addressing community pharmacist's knowledge, attitude, roles and practices towards patient-centred care in Saudi Arabia [7]. Although such studies addressed various issues and topics across the broad array of practice none evaluated the role of community pharmacists in controlling beauty product sale. However, a recent study not covered by the previous review explored the pharmacists' knowledge and attitude towards cosmeceuticals in Saudi Arabia [8]. The study targeted registered pharmacists in different sectors in Saudi Arabia and its findings indicated a need for increasing the awareness of pharmacist in such area of practice. Another study from Iran indicted insufficiency of pharmacist information about some types of cosmetics [9].
To our knowledge, no reports are available evaluating current practices in community pharmacies regarding beauty products in the Western region, Saudi Arabia. This is what we attend to investigate in our study.

Study Objective
This study was conducted to assess the viewpoint of community pharmacists in the Western region of Saudi Arabia about their professional role in dispensing

Study Design
A cross-sectional study was conducted between September and December 2019 using an online questionnaire.

Population
The survey targeted community pharmacists all over Saudi Arabia and current analysis includes the pharmacists from Western region of the country. The

Inclusion Criteria
All Saudi and non-Saudi community pharmacists from the Western region of Saudi Arabia from both genders were included in this study.

The Questionnaire
The questionnaire was developed specifically for the purpose of the current study. It was used to elicit the community pharmacists' answers on different variables addressing the study objectives. It comprised four parts: demographic characteristics, knowledge, perceptions, and practice. Expert professors from college of pharmacy, Taif University validated the questionnaire for the face and contents. They have been asked to provide feedback on comprehensiveness of contents, consistency of measured items, overall length, redundancy of items and any required editing. The drafted questionnaire has been modified according to the reviewers' suggestions. They concluded that questions in the finalized version were clear-cut, easy to understand (for the potential respondents), and that the choice of answers accurately capture the opinions of the potential respondents.

Study Procedure
The sampling was convenient sampling technique. The questionnaire was designed to be administered online using Google forms. The survey link was distributed firstly to pharmacists' professional groups via social media like What-sApp and secondly through key persons in the large pharmaceutical groups in the country.

Sample Size
According to AlRuthia et al., the number of community pharmacists in Saudi Arabia is 8419 representing 34.5% of 24,395 licensed pharmacists working in different sectors [10]. By administrative provinces, there are 6100 and 1132

Ethical Consideration
Ethical approval was obtained from the research and ethics committee at Taif University (Reference number: 41-35-0028). Informed consent was obtained from all participants before commencing the study.

Data Analysis
Data was analyzed descriptively using SPSS software. Each section included qualitative and quantitative variables. Findings regarding qualitative variables were presented as frequencies and percentages, whereas that related to quantitative ones were presented as means (standard deviation).

Demographic Characteristics
Five hundred seventy-seven community pharmacists completed the questionnaires. Table 1

Knowledge
Most of respondents (80.07%) declared undertaking courses about cosmetic and personal care products (Table 2)

Perceptions
Most of respondents (93.1%) considered customers/patients counseling on cosmetics and personal care products as important (Table 3). Three perception-related statements were rated by respondents on 5 points Likert scale. The The later statement was rated low with a high variation among pharmacists in rating (i.e. standard deviation high).

Discussion
Being involved in patients counseling adds an important value to pharmacists and increases their job satisfaction. Suleiman conducted a study in Riyadh to evaluate job satisfaction among community pharmacists [11]. Among findings was that pharmacists who dispensed a higher number of prescriptions and those In a review about pharmacy practice in Saudi Arabia Al-jedai et al. judged patients counseling as a traditional role of community pharmacists in Saudi Arabia [12]. Almeman and Al-jedai considered cosmetics among four main sections in the community pharmacies in Saudi Arabia [13]. In the same context, most of the respondents in our study considered customers/patients counseling on cosmetics and personal care products as important. They were highly supportive of the statement "customers/patients are willing to listen to the counseling about their products" and the statement "pharmacists must keep in developing their communication skills with customers/patients". However, they were not supportive of the statement saying, "selling cosmetics and personal care products in other places than community pharmacies". Such findings indicate an excellent attitudes and views of pharmacists about their professional role as controllers of cosmetic and beauty products. In this regard, the study by Almeman reported significant variability among pharmacists in Saudi Arabia regarding the understanding and practice of whitening cosmeceuticals [8].
Most of pharmacists communicate with customers/patients directly via face-to-face, serve daily more than 100 customers/patients, and substantial proportion of them is asked for cosmetic or personal care products. Most of respondents ask the customers/patients if they have sensitivity from any components in the product and use both generic and brand names during dispensing process. Al Latif et al. reported findings of a study from the Eastern region of Saudi Arabia and mentioned that community pharmacist counseled their patients most of the times compared with sometimes for hospital pharmacists [14].
Such study reported lack of education and privacy along with impatient behavior of patients as common barriers hindering the provision of services in community pharmacy settings. On the other hand, our respondents rated the selling popularity of skin care products, hair care products, cosmetic products, and personal

Conclusion
In conclusion, most of the community pharmacists surveyed in this study reported a good perceived knowledge and attitudes and demonstrated an acceptable level of practices regarding beauty products. SFDA is encouraged to adopt good pharmacy practice standards and guidelines to improve current practice of community pharmacists concerning beauty products. Continuous educational programs are needed for community pharmacists to enhance their knowledge and practice regarding beauty products. Policy makers are encouraged to consider making cosmetic courses obligatory for community pharmacists as part of continuing professional development programs required for licensing renewal.