The Practice of Scientific Publications by Pharmacists 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
Over the past few years, various biomedical, medical, and pharmaceutical journals have been released in the market in Saudi Arabia. East journal had a policy of submitting a manuscript to the journal. However, the earliest guidelines for writing manuscripts for the biomedical journals were started in the 1980s by the International Committee of Medical Journal Editors (ICMJE) and are regularly updated. 1,2 Moreover, further guidelines were released about writing each type of research article for publication, such as clinical trials, observational studies, pharmacoeconomics, and quality improvement studies. As a result, the number of published research articles emphasizing medical or pharmaceutical research has increased over the past few years. 3 As a result, Saudi Arabia has emerged as the first country in the Arabian subcontinent to top in research publications. 4,5 The Healthcare sciences publications were considered the top second or third among all types of sciences specialties. Pharmacology and pharmaceutics were the top third research category for publications, representing almost 10% of the publications in medical research. 6 Despite previous data about research in Saudi Arabia, we still need in-depth analysis about pharmacists' practice of scientific publications. 7 For instance, the participation of pharmacists with regard to the type of the study design such as randomized clinical studies, observational studies, or systematic reviews. Moreover, research tools usages during research publications, which kinds of publication sections the pharmacist involved, and authorship arrangement of corresponding author or coauthor.
Pharmacists and other healthcare professionals should practice writing manuscripts based on the journal guidelines. 8 The magnitude of the practice in writing the journal articles emphasizes the number of publications they have made annually and the type of journals they have submitted their papers for publications. Moreover, the pharmacists involved authorship ranking and the publication specialty. That includes pharmacy practice, pharmacogenomics, pharmacokinetics, and pharmacoeconomics. Exploring these areas will help pharmacists in strategic planning in Alomi YA et.al. Practice of Scientific Publications in Saudi Arabia a pharmacy career. Moreover, it allows the educators to update their strategies to improve the practice of publications in the pharmacy field. A previous study was conducted to analyze scientific research conducted by pharmacists and their practice of writing scientific articles for publication. 9 However, to the best of our knowledge, only a single study has discussed the approach of publication of scientific research articles by pharmacists. 10 Therefore, in this study, we aimed to assess the practice of publishing scientific articles by pharmacists in the Kingdom of Saudi Arabia.

METHODS
It was a 6-month cross-sectional study conducted to assess the practice of publishing research articles by pharmacists in Saudi Arabia. We used a self-reported electronic survey questionnaire and distributed it to pharmacists from interns to consultants and specialists in Saudi Arabia. Responses obtained from non-pharmacists and students and incomplete surveys were excluded from the analysis. The survey collected demographic information of the pharmacists and information about the frequently published article/journal types often used the selected elements during scientific publications and social media platforms where they intend to distribute their published articles. Moreover, the number of publications annually, author's position in the scientific publications, type of pharmaceutical sciences interested in writing or publishing. Besides, the methods of the pharmacy scientific publications and costs of publication. We used 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 a confidence level of 95%, z score of 1.96, a margin of error of 5%, a population percentage of 50%. In addition, the drop-out rate of 10%. Consequently, the sample size was calculated as 418 with a power of study of 80%. [11][12][13] The response rate required for the estimated sample size was at least 60-70%. 13,14 The survey was distributed through social media such as WhatsApp and Telegram and via face-toface contact. A reminder message was sent once every 1-2 weeks. Expert reviewers and pilot testing validated the survey data. Moreover, various reliability tests such as McDonald's ω, Cronbach's α, Gutmann's λ2, and Gutmann's λ6 were tested. The data were collected through the Survey Monkey system, and data were analyzed with Microsoft Excel (version 16), the 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. The STROBE (Strengthening the reporting of observational studies in epidemiology statement: Guidelines for reporting observational studies) guided the reporting of the results of this study. [15][16][17]

RESULTS
A total of 543 pharmacists responded to the questionnaire. Of them, more than one-quarter were from the central region (155 (28.55%)), followed by the eastern region (133 (24.49%)), with a statistically significant difference between all provinces (p=0.000). Of the total responders, 110 (20.26%) were from private primary healthcare centers, and 97 (17.86%) were from Ministry of Health (MOH) hospitals, with a statistically significant difference between worksites (p=0.000). Moreover, females responded more than males (321 (59.12%) versus 222 (40.88%), respectively). Based on the nationality, Saudi nationals responded more than the non-Saudi nationals (351 (64.64%) versus 192 (35.36%), respectively), with a statistically significant difference between them (p=0.000). Most of the responders were in the age group of 30-44 years (209 (38.49%)), followed by those in the age group of 18-29 years (166 (30.57%)), with a statistically significant difference between all age groups (p=0.000). Most of the pharmacists were community pharmacists (107 (19.74%)), followed by pharmacy supervisors (57 (10.52%)), with a statistically significant difference between all levels of qualification (p=0.000). Most of the responders held Diploma in Pharmacy (202 (37.20%)), followed by Bachelor in Pharmacy (199 (36.65%)), and a Master in Science in Clinical Pharmacy (140 (25.78%)). Most of the pharmacists had a work experience of 6-10 years (140 (34.15%)), followed by 3-5 years (124 (30.24%)), with a statistically significant difference between years of experience (p=0.000). More than two-thirds of the responders were boardcertified pharmaceutical specialists (367 (68.21%)), followed by boardcertified critical care specialists (220 (40.89%)), board-certified nuclear pharmacists (218 (40.52%)), board-certified ambulatory care specialists (192 (35.69%)), and board-certified nutrition support specialists (187 (34.76%)). Most of the pharmacists practiced in the area of narcotics (61 (11.25%)), clinical pharmacy (59 (10.89%)), and repacking (57 (10.52%)), with statistically significant difference between all sites of pharmacy practice (p=0.000). There was a medium positive correlation between age (years) and years of experience based on Kendall's tau_b (0.414) and Spearman's rho (0.485) values, with statistically significant difference (p<0.001). There was a medium positive correlation between the worksite and current position held based on Kendall's tau_b (0.457) and Spearman's rho (0.610) values, with statistically significant difference (p<0.001) (Tables 1 and 2). The majority of the responders published an article on their life (346 (63.84%)). Most of the pharmacists (213 (39.23%)) published at least 1-3 and >10 research papers (120 (22/10%)) annually. Most of the responders were the second author (231 (42.94%)) and the first author (210 (39.03%)). Furthermore, most of the pharmacists published research articles about social and behavioral aspects of life (280 (51.66%)), pharmaceutics (271 (50.00%)), and pharmacoeconomics (271 (50.00%)). The majority of the responders published articles such as systematic reviews (313 (58.29%)) and cohort (230 (42.83%)), and they rarely participated in randomized controlled clinical trials (68 (12.66%)) and animal pre-clinical studies (83 (15.46%)). Most of the pharmacists participated in the processes of scientific publication, such as writing a literature review in the Introduction section of the article (309 (57.76%)) and analyzing the data. In addition, they summarized the Results section (305 (57.01%)). On the other hand, they rarely participated in the Correspondence and Communication sub-section (111 (20.75%)), in the interpretation of the results and writing the Discussion section (134 (25.05%)), and in searching and writing References section (139 (25.98%)). The cost of publication to the authors was 0-499 USD and 2500-2999 USD for most responders (136 (25.42%) and 93 (17.38%), respectively) (Tables 3 and 4). The average score of frequently published types of the article was 3.99, with high scores obtained for the "article published in an international scientific journal" (4.26) and in "local scientific journal (4.22). Next, the lowest scores were obtained for writing a complete Book (3.73) and chapter in the book (3.81), with a statistically significant difference between responses (p=0.000) ( Table 5). The average score for the practice of unique elements during scientific publications was 3.81, with high scores obtained for the element "was any of your colleagues was the reviewer" (4.10) and "spelling and grammar checked through special software" (3.95). Furthermore, the lowest scores were obtained for the "journal impact factor" (3.74) and "reliability of the survey" (3.75), with statistically significant differences between responses. Moreover, all elements showed statistically significant differences between responses (p<0.001) ( Table 6). Finally, the average score for the type of social media platforms used by the pharmacists to distribute your research article was 3.33, with high scores obtained for WhatsApp (3.

Answered question 543
Skipped question 0     Skipped 0  Factors affecting the practice of publishing scientific research by pharmacists Several factors affected the practice of scientific research publications. We adjusted the significant values by using independent samples Kruskal-Wallis test and the Bonferroni correction for multiple tests. The following factors were tested for their effect on pharmacists' practice of scientific publications: location, worksite, gender, age, practice area, current position, and work experience. However, a single factor (i.e., nationality) did not affect the practice of publication, with a non-statistically significant difference (p>0.05). Five locations affected the practice of publication. The Eastern region showed the lowest scores (3.4436), with a statistically significant difference between regions (p=0.000). Non-Saudi nationals showed the lowest score (3.2188), with a statistically significant difference between nationalities (p=0.000). Females scored less than males (3.9254 versus4.2707), with a statistically significant difference between them (p=0.008). Six different age groups affected the practice of publication. Pharmacists in the age group of 65-74 years obtained the lowest score for scientific publications (2.000), followed by those in the age group of >75 years (2.000), with statistically significant difference between all age groups (p=0.000). Fourteen working sites affected the practice of scientific publications, with the lowest score (2.6318) obtained for private primary healthcare centers, with a statistically significant difference between all worksites (p=0.000). Twelve practice areas affected the practice of scientific publication, with the lowest score (2.6502) obtained for the emergency pharmacy and narcotics section (2.6762), with a statistically significant difference between all practice areas (p=0.000). Five levels of work experiences affected the practice of scientific publications by pharmacists. The lowest score (3.5099) 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 positions held affected the practice of scientific publications made by pharmacists, with the lowest score (2.2696) obtained for those working as a pharmacy technician, followed by director of primary healthcare center (2.4727) and community pharmacy (2.5783), with statistically significant difference between them (p=0.000). Next, multiple regression analysis revealed a weak relationship (R=0.272) with p=0.000) between types of publications and factors affecting them. Five out of eight factors showed non-significant differences (p>0.05). However, three factors showed significant differences. Of the three factors, nationality and years of experience explained 25.4% and 13.5% of the negative relationship, whereas practice area explained 11.9% of the positive relationship to the variation (p=0.000, 0.011, and 0.025, respectively). The bootstrap model confirmed these results. The non-existence of multi-collinearity verified the relationship with the current position factor with Variance Inflation Factor (VIF) of 1.536, 1.397, and 1.381, respectively, which is less than 3 or 5 [18][19][20] (Table 8).   6190), with statistically significant difference between them (p=0.000). Five levels of work experience affected the use of selected publication tools by pharmacists. The lowest score (2.1647) was obtained for those with 3-5 years of experience, with a statistically significant difference between all levels (p=0.000). Fifteen positions held by pharmacists affected the use of selected publication tools, with the lowest score (1.2710) obtained for those who worked at a community pharmacy, with a statistically significant difference between all positions (p=0.000). The relationship between the pharmacist practice using particular items during scientific publications and factors affecting it were analyzed via multiple regression analysis. The results showed a weak relationship (R=0.266) with p=0.000) between certain items for scientific publications and factors affecting them. Six out of eight factors showed non-significant differences (p>0.05). However, locations explained 16.4% of the positive relationship, whereas the current position held explained 20.4% of the negative relationship to the variation, with a statistically significant difference between them (p=0.001 and 0.001, respectively). The bootstrap model confirmed this result. Furthermore, the relationship was verified by the non-existence of multi-collinearity with the current position held with a VIF of 1.134 and 1.681, respectively, which is less than 3 or 5 18-20 (Table 9). Next, we analyzed the factors that affected the pharmacists regarding the distribution of their published articles. Using the independent samples Kruskal-Wallis test and the Bonferroni correction for multiple tests, we adjusted the significant values. Various factors affected the pharmacists' distribution of their scientific publications, including location, worksite, gender, age, practice area, current position held, and years of experience. A single factor (i.e., gender) did not affect the distribution methods with a non-statistically significant difference (p>0.05). However, five different locations affected the practice of distribution methods of scientific  Non-Saudi nationals obtained a lower score (5.1689) than that of Saudi nationals, with a statistically significant difference between nationalities (p=0.003). Six age groups affect the distribution methods of scientific publications with the lowest scores obtained for those in the age group of 65-74 years (2.1667), with a statistically significant difference between them (p=0.000). In terms of the worksite, 14 private primary healthcare centers (4.2157) obtained the lowest scores, followed by the non-MOH governmental hospitals (4.2481), with statistically significant differences between all worksites (p=0.000). In terms of practice areas, 12 practice areas affected the distribution methods of scientific publications, with the lowest score obtained for emergency pharmacy (4.1562), followed by repacking (4.3711) and clinical pharmacy units (4.4838), with a statistically significant difference between them (p=0.000). Five levels of work experience affected the distribution methods of scientific publications by pharmacists, with the lowest score (4.8070) obtained for those with a work experience of 11-15 years, with a statistically significant difference between all levels (p=0.000). In terms of the position held, 15 positions affected the distribution methods of scientific publications by pharmacists, with the deputy director of pharmacy (4.0946) showing the lowest scores, followed by the community pharmacy (4.2931). There were statistically significant differences between them (p=0.000). A multiple regression analysis revealed the relationship between the practice of a type of social media platforms used to distribute their publications and factors affecting it. In this analysis, the variety of social media platforms used to distribute articles was the dependent variable, and factors affecting it were considered the expletory variable. According to the results, there was a weak relationship (R=0.307 with p=0.000) between the particular items of scientific publications and the factors affecting them. Four out of eight factors showed non-significant differences (p>0.05). However, four factors (i.e., location, nationality, gender, and years of experience) explained 11.5% of the positive relationship, 17% of the positive relationship, 18.6% of the negative relationship, and 20.2% of the negative relationship with a statistically significant difference (p=0.023, 0.004, 0.000, and 0.000, respectively) through multiple regression model and confirmed by Bootstrap model. The non-existence of multi-collinearity verified the relationship with the current position factor with VIF values of 1.134, 1.536, 1.222, and 1.397, respectively, which is less than 3 or 5 [18][19][20] (Table 10).

DISCUSSION
The pharmacist practice of scientific publications reflected their background knowledge. 8 All pharmacists publish a number of articles annually. 3,21 The pharmacists showed a positive attitude toward authorship during publications, and each pharmacist had a specific role during academic writing and publications. Exploring this information will lead to a unique plan for pharmacists in their practice of scientific  publications. Therefore, this study examined the elements of practice through a self-administered electronic survey. It is a validated and high-reliability survey. The questionnaire was distributed locally to pharmacists of different age groups, nationalities, gender, occupational status, and worksites. The responders were selected through a convenient sampling system with a calculated number of subjects based on international guidelines. More than 500 individuals responded to the questionnaire; of them, 60 had published an article at least once in their lifetime, which is a good number. One-third of the responders published at least 1-3 articles annually, which agrees with the results of previous studies. 21 Of those responders, more than one-third were third or second, and the first position during publications, reflecting their role in the publications or being responsible or original research. Almost half of the responders published an article about social science, pharmaceutics, or pharmacoeconomics, which can be done quite fast compared to other types of articles. In addition, the types mentioned above of articles are easy to type the document for publication. During pharmacy school, those topics are easy to research study and not tricky for publications.
Most of the responders participated in writing a systemic review, cohort, and observational studies, which is not expensive for publication. However, they had to undergo the process of data collection, analysis, writing, and presenting the data in academic writing. Many of the responders had to work in order to obtain the skills mentioned earlier.
On the contrary, the responders rarely published randomized clinical trials or animal studies because they were costly compared to observational studies. More than half of the responders participated in writing a literature review or analyzed the data for publication, which is not so difficult for the young researchers and students. However, most pharmacists felt that the challenging part of a publication is the corresponding author section, interpretation of the results, and writing the discussion part. Very few pharmacists wrote citations, which requires more experience and writing skills. The average score of pharmacists practicing the type of publications was good, which shows that they published articles in international or local journals. Most pharmacists wish to publish an article in an international journal as they are more popular than a local journal and wish to participate in international conferences, which agrees with the results of a previous study. 22 In this study, most pharmacists did not participate in writing book chapters and book publication-related work, which is less than what was reported by a previous study. 23 This result might be because book publication requires more time to work on. Moreover, it is not easy to publish with various regulations. Therefore, most pharmacists referred to and cited journal articles than books or book chapters. In addition, the majority of the pharmacists rarely read and referred to books or book chapters. In this study, the average score for practicing some unique items during scientific publications was acceptable, emphasizing their colleague as the reviewer in the journal or spelling and grammar checking through a particular software program. Usually, most research asks their colleagues or friends to review the research to correct any mistakes for good publications. Moreover, many software programs are used for checking spelling and grammar issues, especially for Arabicspeaking authors. Furthermore, most of the responders did not take the journal impact factor or reliability survey test seriously. The impact factor of journals was found to have some defects and inappropriate tool measurements. [24][25][26][27][28] Therefore, the results of reliability tests need to be confirmed by a biostatistician. In addition, pharmacists who have good education and training in biostatistics can do those tests.

Limitations
Although this study had several advantages, such as good sample size and a high-reliability score, it had limitations. First, the responders were from different locations, age levels, gender, practice site, and years of experience. Therefore, we recommend that future research should be conducted with equal or the same demographic information.

CONCLUSION
The practice of publishing scientific research was found to be acceptable in the Kingdom of Saudi Arabia. However, some factors negatively affected the practice, such as the old age of pharmacists, the high level of work experience, and higher position. However, some factors did not affect the practice of publishing articles, such as geographic location, gender, and practice area. Therefore, key performance indicators of scientific publications are suggested to improve the outcome of publication in scientific research in Saudi Arabia.