Study design

This was a quantitative – cross-sectional descriptive study targeting the community pharmacy visitors. Participants were included in the study if they aged 18 years old or more, live in Hail region, and able to understand and provide written informed consent. Any participants below 18 years of the age and living in other part of the country than Hail region, and not willing to participate in the study were excluded. This study was approved by the Research and Ethics Committee at the University of Ha’il, Saudi Arabia with approval number: H-2024–296

Study duration and location

The data was gathered in the community pharmacies from the visitors in the Hail region for a duration of three months, i.e., from 14 June 2024–29 September 2024.

Study setting, sample size and sampling procedure

The study's minimum required sample size was 384, calculated using 95% confidence level, a 5% margin of error, and an assumed response distribution of 50%. The 50% value was used solely as a statistical assumption for sample size estimation and does not represent the actual participant response rate in the study.

A total of 20 community pharmacies were included in this study. These pharmacies were purposively selected from different geographical districts across Hail city (e.g., Al-Aziziyah, Al-Wusayta, Al-Muhammadiyah, etc.) to ensure a diverse representation of pharmacy visitors. Regarding the distribution of subjects, we recruited a total of 200 participants, with a target of 10 patients per pharmacy (20 pharmacies × 10 patients = 200). This balanced approach allowed us to obtain a consistent and representative sample across all included sites.

In order to reduce selection bias and guarantee a diverse demographic mix, interviewers approached the pharmacy visitor leaving the premises during peak working hours. Researchers used a face-to-face survey methodology, where interviewers went directly to pharmacy visitors to explain the study and obtain their prompt consent, to reduce high non-response and dropout rates. However, despite these aggressive measures to increase engagement and guarantee eligibility through on-site assessments, the final sample only included 200 participants, short of the original goal of 384.

Data collectors were given standardized training to guarantee impartial and consistent questionnaire administration to reduce any bias. In order to minimize social desirability bias and promote truthful answers, interviews were held in a quiet location and participants were guaranteed anonymity. To guarantee language clarity and reduce response errors, the survey was also pre-tested and validated.

Study tool

Patient satisfaction with pharmacists’ services was measured by a validated scale consisting of 17 items, developed by Hasan et al [10]. The responses of items were recorded, combined, and weighted to generate four scales of relationship, information, availability, and accessibility, having reliabilities, as measured by Cronbach's alpha, was of 0.92, 0.90, 0.74, and 0.87, respectively. The relationship scale consists of six items, while information scale with four items, availability scale with two items, and the accessibility scale with five items. All items in the survey were a 5-point Likert scale response (Poor = 1, Fair = 2, Good = 3, Very good = 4, Excellent = 5). The instrument also contained some questions related to sociodemographic characteristics of the participant, and health status.

Data collection

Our study employed a face-to-face survey instrument designed to capture data on all three key variables of interest. The survey was administered in community pharmacies across the Hail region. Interviewers approached potential participants in the pharmacies. To ensure eligibility, interviewers utilized a brief screening questionnaire aligned with the study's inclusion and exclusion criteria. Interviewers provided a clear and concise explanation of the study's purpose and procedures. Participants provided written informed consent ensuring their voluntary participation and understanding of their rights. Upon obtaining informed consent, interviewers proceeded with the survey questions. All responses were recorded for further analysis.

Data analysis

Means and standard deviations were used for continuous variables, while frequencies and percentages were used for categorical variables. The data was analyzed using the most up-to-date version of SPSS, version 29.0 to assess patient satisfaction towards pharmacists’ services in community pharmacies.

Demographic profile and patient characteristics

Most participants were young adults, with a predominant proportion being married (60.5%) and showing a closely balanced distribution between high school (51.5%) and college-level education (48.5%). Males slightly outnumbered females among pharmacy visitors (56.5%), which is consistent with previous research showing gender differences in healthcare utilization. A significant portion of respondents (84%) reported not having health insurance, potentially affecting their dependence on community pharmacies for medication access and advice. Uninsured individuals may be more inclined to visit a pharmacy because they often depend on pharmacies for a variety of health-related needs, including over-the-counter medicines, basic health guidance, and medical supplies, instead of going to a healthcare provider. Pharmacies are easily accessible and convenient, making them a practical option for those without insurance, as they usually do not require appointments and can be more cost-effective [11,12]. Moreover, uninsured people might visit pharmacies more often to address minor health concerns or buy medications they cannot afford through other medical channels. Contradictly, a study by Alotaibi et al in Saudi Arabia found that participants who had health insurance were also more likely to visit a pharmacy [13]. This might be due to the reason that health insurance plans include coverage for community pharmacy visits, making it easier and more affordable for insured individuals to utilize pharmacy services regularly and conveniently [14]. Internationally, in structured referral systems like the UK’s National Health Service (NHS) or heavily insured European frameworks, pharmacy visits are tightly coupled with formal physician prescriptions [15,16]. Our results, however, point to a unique regional model in which community pharmacists serve as crucial safety point for primary care. The majority did not have chronic health conditions (87.5%), indicating that pharmacy visits were primarily for minor or acute health issues, aligning with the high frequency of consultations for common ailments.

Medication use and chronic conditions

Among those with chronic illnesses, diabetes and hypertension were most common, reflecting non-communicable diseases in the region to be prevalent. The fact that more than two-thirds (67.5%) of patients obtained medications without prescriptions suggests that pharmacy services are easily accessible and may promote self-medication or immediate over-the-counter drug purchases. Studies have pointed towards prevalence of self-medication in the region [17–19]

Patient satisfaction with pharmacy services

Overall, perceptions about pharmacy services were largely positive, with most respondents expressing satisfaction with the explanations given about medications, advice on managing common illnesses, and the professionalism of pharmacy staffs. Specifically, over 60% rated staff explanations, management advice, and staff expertise as excellent or very good. The findings of a study conducted in Jordan go in line with our study’s findings [20]. Another study conducted by Al-Arifi [8] found higher level (91.5%) of respondents’ satisfaction with the services provided by pharmacists. These findings indicate that community pharmacists are viewed as capable and reliable sources of medication-related information. A community pharmacy is a vital part of the healthcare delivery system, and they offer a wide range of services such as counseling, disease prevention and medication management. The level of satisfaction that patients have with the services of a community pharmacy is a vital indicator of the quality of their healthcare [9,21]. Nevertheless, some areas showed dissatisfaction such as the availability of private consultation spaces was notably rated poorly, with 57% of participants considering this aspect inadequate. Privacy is essential for effective counseling, especially when discussing sensitive health issues and the lack of private areas might hinder thorough and confidential discussions. Furthermore, more privacy is necessary for effective patient counseling in culturally particular contexts like Saudi Arabia. The findings of a study by Alrasheed et al also align with the findings of this study [22] Another study from Australia also highlights the challenges with private consultation space in community pharmacies [23] Although the physical layout of community pharmacies is a global privacy challenge, Saudi Arabia's cultural factor is sensibly linked with this. For normal counseling, a semi-private counter could be adequate in Western models; but, Saudi Arabia's distinct cultural values on gender privacy and family confidentiality require fully segregated, private spaces for patient engagement. Our poor privacy satisfaction scores (M = 2.07) clearly show that the physical infrastructure in outlying areas like Hail has fallen behind as the regulatory mandate turns toward increasing the clinical role of pharmacists, creating a bottleneck for efficient, private patient care. Additionally, about one-half of the participants expressed dissatisfaction with medication prices, possibly due to concerns over affordability or transparency. High medication prices pose a barrier to effective healthcare delivery, potentially leading to poorer health outcomes and increased societal costs. A global study on medicine prices, availability and affordability in 54 low- and middle-income countries also highlighted that high price of medicines will lead to poor health outcomes [24]. A scoping review in Saudi Arabia also highlighted the issue of price of medicine [24].

Implications and suggestions

The high satisfaction levels with most pharmacy services demonstrate that pharmacists are effectively performing their pharmacy services in the region. However, the identified shortcomings—particularly regarding privacy and medication costs—warrant attention. Improving privacy by creating dedicated consultation areas could enable more comprehensive and confidential counseling, and ultimately enhancing patient trust. Addressing concerns related to medication pricing, perhaps through increased transparency or cost-control strategies, could further improve patient experiences.

Considering the heavy reliance on pharmacies for medication without prescriptions and the lack of insurance coverage for most patients, pharmacists could expand their role in patient education and health promotion. This would include emphasizing the safe use of medications and raising awareness about available health insurance options. Furthermore, policymakers could enforce private consultation areas through updated license criteria and introduce pricing transparency measures to address economic concerns among the uninsured in order to better align pharmacy services with public needs. Formalizing ‘Minor Ailment Schemes’ would also take use of the pharmacist's primary care function, and geriatric-specific treatments could address the reduced availability and satisfaction that older patients have expressed. A more patient-centered, fair healthcare delivery system throughout the Hail region would be ensured by these specific infrastructure and economic changes.