Perception of Pharmacists about Scientific Publications in Saudi Arabia

Yousef Ahmed Alomi* , BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE, Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor and Data Analyst, Riyadh, Saudi Arabia. Sultan Mohammed Al-Jarallah Bsc. Pahrm, Msc Clin Pharm, Head, Ambulatory Care Pharmacy, Oncology and Hematology Clinical Pharmacist, Pharmaceutical Care Department, Security Forces Hospital, Riyadh, SAUDI ARABIA. Juman saad Mohammad Alsaab Erada psychiatric Hospital-Alkharj, Riyadh, SAUDI ARABIA. Razan Alshehri College of Pharmacy, Taif University, Tail, SAUDI ARABIA. Khawla Ibrahim Al-shahrani College of Pharmacy, Taif University, Tail, SAUDI ARABIA.


INTRODUCTION
After graduation, pharmacists, in general, will practice in either healthcare organizations or academia, community pharmacy, or the pharmaceutical industry. Each of these practice areas demands a certain level of research by the department of research and development (R&D). Thus, the hospital pharmacist can specialize in various styles. There are several types of specialties in pharmacy practice, including cardiology, critical care, drug information, nutrition support, infectious diseases, and pharmacy research specialties. 1,2 Usually, the pharmacist can choose from these aforementioned fields based on their interest and perception. The hospital or community pharmacist provides pharmaceutical care to the patients daily. 3 Each morning, the pharmacist receives the prescriptions and prepares them for delivery to the patients. The preparation might be done at an ambulatory care pharmacy with a ready package, by cart filling for the unit dose distribution system, or parenteral preparation under a sterile area. 4 After completing the preparation, the pharmacist dispenses the medications to ambulatory care or community patients with proper counseling. The unit dose delivery distributes the medicines if the drug is at an inpatient pharmacy. 4 The parenteral medication preparation requires preparation skills emphasizing infection control procedures and follow-up of the medication procurement. The aforementioned duties happen daily without rest until the end of the day. Sometimes, the hospital or the pharmacy provides educational lectures. The pharmacist might have had a high workload to make something new, such as research or scientific publications. Lack of time and support by the pharmacy administration will prevent them from scientific publications. 5 Moreover, disengagement from research and publication can develop a wrong perception about publications among pharmacists. The pharmacist needs to be encouraged for publication. Therefore, it was highly essential to explore the perception of pharmacists Alomi YA et.al. Perception of Pharmacists on Publications in Saudi Arabia about scientific publications in order to know the actual perception of pharmacists of scientific publications. They dedicated the reasons for perception and elements of stimulation. It is essential to have a positive perception of research publications in pharmacy practice. For example, if the pharmacist has a positive perception of research publications, then he/she will specialize in it and provide various outcomes. On the contrary, if the pharmacist has a negative perception, then he/she will encounter multiple barriers that prevent them from publishing their work. 5,6 Therefore, it is of utmost importance that we improve the perception of pharmacists about scientific publications so that they attempt to publish their work. So far, there are only a few studies that have discussed the perception of pharmacists about scientific publications. [5][6][7] Most of the previous studies have focused on pharmacist perception about research. [8][9][10][11][12] However, to the best of our knowledge, there are no studies have been conducted locally or in the Middle Eastern countries about the perception of pharmacists about scientific publications. Therefore, in this study, we aimed to assess the perception of pharmacists concerning research and publication in the Kingdom of Saudi Arabia.

METHODS
This is a six-month cross-sectional study conducted to assess the perception of pharmacists about scientific publications in Saudi Arabia. We used a self-reported electronic survey questionnaire to obtain responses and distributed it to pharmacists, including interns to consultants and specialists in Saudi Arabia. All non-pharmacists, students, and incomplete surveys were excluded from the study. The survey collected demographic information of the responding pharmacists, their perception of scientific publications, and barriers that prevent them from participating in pharmacy scientific publications. We also collected their suggestions for stimulating their interest in publishing their work. We used a 5-point Likert response scale system with close-ended questions to obtain responses. According to the previous literature with unlimited population size, the sample was calculated for this cross-sectional study with the following parameters: the confidence level of 95%, a z score of 1.96, the margin of error of 5%, the population percentage of 50%, and drop-out rate of 10%. Consequently, the sample size was calculated as 418 with a power of study of 80%. [13][14][15] The response rate required for this sample size was at least 60-70%. 15,16 The survey was distributed through social media such as Telegram, WhatsApp, and via face-to-face contact. In addition, a reminder message was sent once every 1-2 weeks. Expert reviewers and pilot testing validated the survey. The reliability tests such as McDonald's ω, Cronbach's αs, Gutmann's λ2, and Gutmann's λ6 were conducted. The data were collected through the Survey Monkey system and analyzed with Microsoft Excel (version 16), Statistical Package of Social Sciences (SPSS), and Jeffery's Amazing Statistics Program (JASP) software. We performed descriptive and frequency analysis, the goodness of fit analysis, correlation analysis, and inferential analysis on the factors that affect the perception of pharmacists about scientific publications. The STROBE (Strengthening the reporting of observational studies in epidemiology statement: guidelines for reporting observational studies) guided fore reporting of this study. [17][18][19]

RESULTS
A total number of 543 pharmacists responded to this questionnaire. Of them, more than one-quarter belonged to the central region (155 (28.55%)) and eastern region (133 (24.49%)), with a statistically significant difference between the provinces (p=0.000). Most of the responders were from private primary care centers (110 (20.26%)) and Ministry of Health (MOH) hospitals (97 (17.86%)), with statistically significant differences between working sites (p=0.000). There were 321 (59.12%) female and 222 (40.88%) male responders. Based on nationality, there were 351 (64.64%) Saudi nationals and 192 (35.36%) non-Saudi nationals, with statistically significant differences between them (p=0.000). Most of the responders were in the age group of 30-44 years (209 (38.49%)) and 18-29 years (166 (30.57%)), with statistically significant difference between all age groups (p=0.000). Most of the pharmacists were community pharmacists (107 (19.74%)) and pharmacy supervisors (57 (10.52%)), with statistically significant differences between all levels of qualifications (p=0.000). Most of the responders held Diploma in Pharmacy (202 (37.20%)), Bachelor in pharmacy (199 (36.65%)), and Master of Science in Clinical Pharmacy degree (140 (25.78%)). Most of the pharmacists had a work experience of 6-10 years (140 (34.15%)) and 3-5 years (124 (30.24%)), with a statistically significant difference between all levels of work experience (p=0.000). More than two-thirds of the responders were board-certified pharmaceutical specialists (367 (68.21%)). Most of them were Board Certified Critical Care (220 (40.89%)) and Board-Certified Nuclear Pharmacist (218 (40.52%)), followed by Board Certified Ambulatory Care (192 (35.69%)) and Board-Certified Nutrition Support 187 (34.76%) pharmacists. Most of the practice areas were in the department of narcotics (61 (11.25%)), clinical pharmacy (59 (10.89%)), and repacking (57 (10.52%)), with statistically significant difference between all sites (p=0.000). There was a medium positive correlation between age (years) and years of experience in pharmacy career based on Kendall's tau_b (0.414) and Spearman's rho (0.485) correlation coefficients, with a statistically significant difference between them (p<0.001). There was a medium positive correlation between the worksite and current position based on Kendall's tau_b (0.457) and Spearman's rho (0.610) correlation coefficients, with a statistically significant difference between them (p<0.001) (Tables 1 and 2). The average score of perception of pharmacists about scientific publications was (3.74). The element "the pharmacist understands the pharmacy publication and pharmacy publications terminology" obtained a score of 3.33. The pharmacists believe that pharmacy publications are essential for the pharmacist (3.97). They are interested in working on a pharmacy publications project. In contrast, the lowest score was obtained for the element "the pharmacy publications vital for my recognition and self-satisfaction" (3.40). The score for the element "the pharmacist can evaluate the pharmacy publications findings regarding their application to pharmacy practice" was 3.58, and for the element "pharmacists believe that the pharmacy publications enhance the quality of patient care" was 3.59, with a statistically significant difference between the responses (p<0.05). All aspects of perception of pharmacists about scientific publications were statistically significant between responses (p<0.05) ( Table 3). The average score for the element "barriers that prevent pharmacists from participating in pharmacy scientific publication" was 3.76. The score for the element "the pharmacist believes the daily activities prevent me from doing pharmacy publication Lack of interest and motivation" was (3.88. The score for the element "pharmacist considers those pharmacy publications essential for the pharmacist" was 3.85. In contrast, low scores were obtained for the elements "difficulty in obtaining ethical approval" (3.64) and "lack of supervision/ mentorship" (3.68), with statistically significant difference between the responses (p<0.05). All responses about aspects of perception of pharmacists about scientific publications were statistically significant (p<0.05) ( Table 4). The average score for the element "suggestions to stimulate interest in pharmacy publications" was (3.40). The highest score (3.68) was obtained for the element "the pharmacist believes that teaching undergraduate about pharmacy publication to students should be an integral part of the practice. The score for the element "creating awareness about practice-based pharmacy publications and benefits to practice" was (3.58). In contrast, the score for the element "have pharmacy publications-experienced pharmacist's mentor" was

Answered question 543
Skipped question 0  (3.15) and for "provide administrative/organizational support and lead the project" was (3.23), with statistically significant difference between responses (p<0.05) All aspects of pharmacist perceptions of scientific publications were statistically significant (p<0.05) ( , with a statistically significant difference between various sections (p=0.000). Five levels of work experience affected the perception of publication. The lowest score (1.7708) was obtained for those with work experience of 6-10 years, with a statistically significant difference between all levels (p=0.000). Fifteen levels of the position held affected the perception of pharmacists, with the lowest score (1.1775) obtained for the position of pharmacy technician and director of primary care center (1.2368), with a statistically significant difference between all levels (p=0.000). The relationship between the perception of scientific publications and factors affecting it such as location, worksite, age (years), gender, nationality, practice area, position held, and years of experience in a pharmacy career. The multiple regression analysis considered perception as the dependent variable and factors affecting it as an expletory variable. There was a medium relationship (R=0.483 with p=0.000) between the perception of scientific publications and factors involving it. Six out of eight were non-significant differences (p>0.05). However, multiple regression analysis confirmed that two factors (i.e., nationality and gender) explained 36.3% and 16.7% respectively of the negative relationship to the variation in perception, with a statistically significant difference (p=0.000 and 0.001, respectively) Bootstrap model also confirmed. Furthermore, the relationship was verified by the nonexistence of multicollinearity with the current position factor with variance inflation factor (VIF) of 1.536 and 1.222, respectively less than three or five as an acceptable number of VIF. [20][21][22] (Table 6).
A single factor (gender) did not affect the pharmacist's perception of barriers preventing scientific publications with a non-statistically significant difference (p>0.05). Five locations affected the perception of obstacles preventing scientific publications from the practice. The Eastern region showed the lowest scores (2.1638) with a statistically significant difference (p=0.007). Nationality also affected the scores. Non-Saudi pharmacists showed the lowest score (2.0820), with a   Skipped 0  Five levels of years of experience affected the knowledge of types of scientific publications, with the lowest score (2.1767) obtained for 6-10 years of work experience, with statistically significant difference between them (p=0.000). Fifteen levels of the position held affected the knowledge of types of scientific publications, with the lowest score (1.7113) obtained for the community pharmacy with statistically significant difference (p=0.000). The relationship between the perception of pharmacists about barriers preventing pharmacists from participating in scientific publications and factors affecting it were analyzed. The multiple regression analysis was performed by considering the perception of obstacles that prevent pharmacists from participating in scientific publications as the dependent variable and factors affecting it as the expletory variable. There was a medium relationship (R=0.420 with p=0.000) between the dependent and the expletory variables. Four out of eight factors showed non-significant differences (p>0.05). However, three factors such as location, nationality, and practice area explained 11.8%, 29.1%, and 2.1% negative relationship. In contrast, the factor's current position explained 16.4% of the positive relationship to the variation in pharmacist perception of barriers. There was a statistically significant difference between the four variables (p=0.015, 0.000, 0.000, and 0.015, respectively). The non-existence of multicollinearity verified the relationship with the current position factor with variance inflation factor (VIF) of 1.134, 1.536, 1.381, and 1.681, respectively, which was less than three or five as an acceptable number of VIF. [20][21][22] (Table 7). Five locations affected the perception of pharmacists about stimulating interest in scientific publications. The western region showed the lowest scores (2.2970) with a statistically significant difference (p=0.000). Nationality also affected the scores, with non-Saudi having the highest score (2.8464), with a statistically significant difference (p=0.000). Gender affected the perception of pharmacists about stimulating interest in scientific publications, with the highest score obtained for females (2.6822) followed by males (2.4949), with a statistically significant difference between gender (p=0.000). Six different age groups affected the perception of stimulation of scientific publications.  The lowest score (1.2500) was obtained for those in the age group of 65-74 years, with a statistically significant difference between all age groups (p=0.000). Fourteen worksites affected the perception of stimulation of scientific publications, with the lowest score (2.0741) obtained for the university, with a statistically significant difference between all worksites (p=0.000). Twelve practice areas affected the perception of stimulation of scientific publications, with the lowest score (1.7537) obtained for the pharmaceutical companies and pharmacy research practice areas (2.1800), with statistically significant differences between all practice areas (p=0.000). Five levels of years of experience affected the perception of stimulation of scientific publications, with the lowest score (2.0800) obtained for those who had less than three years of experience, with a statistically significant difference for all levels of expertise (p=0.000). Fifteen levels of positions held affected the perception of stimulation of scientific publications, with the lowest score obtained for the position of representative of pharmaceutical companies (1.9056) and staff pharmacist (2.0615), with a statistically significant difference between all positions (p=0.000). Next, we analyzed the relationship between the perception of suggestions about stimulating interest in scientific publications and factors affecting it. Multiple regression analysis was performed to investigate the relationship between the dependent variable and factors affecting it. The study revealed a medium relationship (R=0.420 with p=0.000) between the perception of scientific publications and factors. Six out of eight factors were found to be nonsignificant (p>0.05). However, multiple regression analysis confirmed that one factor (location) explained a 15.3% negative relationship. Besides, two factors (nationality and years of experience) explained 33.6% and 16.9% positive relationship to the variation, with a statistically significant difference (p=0.001, 0.000, and 0.001) respectively, which the Bootstrap model confirmed. In addition, the relationship was verified by the non-existence of multicollinearity with the current position held with VIF= 1.134, 1.536, and 1.397, respectively, less than three or five 20-22 (Table 8).

DISCUSSION
The perception and attitude of pharmacists reflected their participation in the research and publication process. 23,24 Knowledge is the background of perception; 25 therefore, exploring the perception of pharmacists is critical to setting up a plan for improving and changing attitudes and perceptions of scientific publications. The survey questionnaire was validated based on a high-reliability test and a convenient sample. The majority of the responders were from the local region and had different ages, gender, nationality, occupational status, and membership of healthcare boards. The average score of perception of pharmacists Alomi YA et.al. Perception of Pharmacists on Publications in Saudi Arabia policies and procedures of research publications should be changed, which agrees with a previous study. 26 In that case, the pharmacist might be depressed to do the scientific research and publications. Therefore, pharmacists believe that research publications are not necessarily there for career improvement and promotion. The pharmacists are not considered some barriers like ethical approval or lack of support of a mentor. However, the ethical committee can facilitate the acceptance of research, and educators or mentors can supervise the research and support the pharmacists willing to publish. They provide full cooperation for publication. The average scores of stimulation elements were fair, emphasizing the undergraduate and postgraduate education and training of scientific publications.

Factors affecting the perception of pharmacists about scientific publications
Various factors might affect the perception of scientific publications. Based on the geographic location of the pharmacist, the central region showed a high perception of scientific publications because it contained several Healthcare institutions and research Center done various scientific publications annually. Moreover, the university published multiple articles in various scientific journals. Saudi pharmacists had a higher perception than non-Saudi pharmacists because they about scientific publications was found to be satisfactory. This result emphasizes the fact there is a positive attitude among pharmacists about understanding the basic terminology of publications. They also believe that pharmacy publications are essential for them, which is similar to the results of a previous study. 25 However, some aspects of perceptions did not reach an optimal level. For instance, pharmacists believe that pharmacy publications should not necessarily be done for the sake of self-recognition or satisfaction. Participation in scientific publications is a factor or tool for promotions in the pharmacy practice. It is challenging to consider the employment proportion by a long and complicated procedure of scientific publication. Moreover, a pharmacist is not fully skilled in evaluating publicationrelated activities. Furthermore, the pharmacist did not fully agree that publications improved patient's quality of life. That has explored insufficient experiences in research practice, particularly the pharmacist did not participate in any clinical trials at their healthcare organizations. The findings of this study showed that the average perception of barriers that prevent the implementation of scientific publication was satisfactory. The pharmacists believe that the most significant barriers were busy schedules and lack of interest and motivation, similar to a previous study 5 and differed from another. 6   have appropriate education and training, which might help promote pharmacy careers. Male responders had more perceptions of scientific publications than female responders because they were more interested in research and publications. Older pharmacists with less experience had a low perception of scientific publication, which is related to reducing the perception by the time with getting old, with continues busy workload. Besides, the pharmacist publication was not recognized by the pharmacy administration or the absence of support from the healthcare administration. The Ministry of Health (MOH) hospital showed an inadequate perception of scientific publications related to the lack of financial or administrative support and weak research and development activities. The pharmacy practice area or higher position held negatively affected the perception of scientific publications, which maybe because of the busy schedule of administration activities. Various factors might affect the perception of barriers preventing scientific publications. For instance, based on the pharmacists' geographic location, the eastern region showed the lowest perception because most of the obstacles did not exist or were removed. Non-Saudi pharmacists had a low perception of barriers than that of Saudi pharmacists. They participated in the publication related activities without barriers or were not interested in the scientific publications. Old pharmacists with high experience and higher jobs affected the perception of scientific publications, which is related to a busy schedule or not being interested in doing research and publication. The practice area affected the perception development of non-interested pharmacists because they were busy and did not find support from higher administration. Various factors affected the perception of the stimulation elements for scientific publications. For instance, based on the geographic location, western region showed the lowest perception, which is related to the well-developed system of scientific publications and the pharmacist had appropriate participation. Non-Saudi professionals had a higher perception because of the administration and financial support from the healthcare organizations. Old pharmacists with more experience had the lowest perception of inadequate interest in scientific publications and busy life. Females needed more support and stimulation than that of males because there were many problems in the scientific publications. The worksite is another factor that affected the stimulation of scientific publication, as universities have everything related to the publications and provide adequate support for publications. The pharmaceutical companies and community pharmacies had the lowest score of stimulation elements, which might be because of the busy schedule and less interest in scientific publication. The pharmacist might get depressed from current situation because unavailable system or policy and procedures of research and scientific publications.

Limitation
This study had an acceptable sample size with good validation and a highreliability survey. However, the study showed various drawbacks, such as multiple demographic data including location, worksite, nationality, gender, years of experience, and current position. Therefore, additional study is suggested in the future to overcome the limitation.

CONCLUSION
The perception of pharmacists about scientific publications was positive. However, the perception of barriers preventing scientific publications stimulation elements of scientific publications was fair. In addition, various factors affected the perception of scientific publications, such as higher age, more experience, and higher positions, which negatively affected the results. However, other factors such as location, gender, and nationality varied. Therefore, clinical and administrative support for scientific publications and implementation programs will improve pharmacy scientific publications' perception in Saudi Arabia.