|Year : 2017 | Volume
| Issue : 5 | Page : 222-227
Knowledge of community pharmacists regarding oral health care in Plateau State, Northern Nigeria
Olaniyi O Taiwo1, Raymond M Panas2
1 Regional Center for Oral Health Research and Training Initiatives for Africa, Jos, Plateau State, Nigeria
2 Department of Public Health, College of Health Sciences, Walden University, Minneapolis, Minnesota, USA
|Date of Web Publication||20-Oct-2017|
Olaniyi O Taiwo
Regional Center for Oral Health Research and Training Initiatives (RCORTI) for Africa, Jos, No. 3 CBN Road, PMB 2067, Jos, Plateau State
Source of Support: None, Conflict of Interest: None
Aims: The purpose of this study was to assess the knowledge of oral health of community pharmacists (CPs) in Plateau State, Northern Nigeria, serving as a template upon which they can be engaged as a medium to improve oral health care among the people. Materials and Methods: A quantitative cross-sectional study on CPs spanning the entire State. Results: CPs (113) were recruited as participants. A one-sample t-test showed good knowledge of oral health by the CPs: mean = 17.2, standard deviation (SD) = 2.44, t (112) = 5.14, P < 0.001. Independent sample t-test showed statistically significant differences in mean oral health knowledge of CPs who stock oral health-care products (mean = 17.3, SD = 2.4) than those who did not: (mean) = 13, (SD) = 1.41, t (111) = 2.50, P = 0.014. A multiple regression analysis also showed stocking oral health products as the only statistically significant predictor of knowledge score. Organizing workshops and seminars on oral health (63%) were the most common suggestion by the CPs on how knowledge of oral health can be improved among them. Conclusion: CPs may be effectively employed in oral health promotion because patients frequently contact them and regularly ask for their advice on both general and oral health-care. It would be beneficial to empower them through trainings and access to oral health information so as to help them take a more active and integrated role as part of a multidisciplinary health-care team attending to the oral health concerns of the people.
Keywords: Community pharmacists, knowledge, oral health
|How to cite this article:|
Taiwo OO, Panas RM. Knowledge of community pharmacists regarding oral health care in Plateau State, Northern Nigeria. J Int Oral Health 2017;9:222-7
|How to cite this URL:|
Taiwo OO, Panas RM. Knowledge of community pharmacists regarding oral health care in Plateau State, Northern Nigeria. J Int Oral Health [serial online] 2017 [cited 2022 Aug 10];9:222-7. Available from: https://www.jioh.org/text.asp?2017/9/5/222/216954
| Introduction|| |
Oral health is an integral component of general health and a major determinant of quality of life., The World Health Organization found a dentist to population ratio of 1:7500 effective for oral health delivery. However, in Nigeria, the ratio is approximately 1:58,824, reaching around 1:257,769 in Northern Nigeria, thus ranking the country as one of the poorest oral health-care providers globally.,, As a result, there are challenges with availability of and accessibility to oral health services, especially among poor and socially disadvantaged people causing predilection for the development of preventable dental pathologies.,,,
To address inequalities in oral health care, studies have proposed a paradigm shift from the traditional downstream biomedical approach (which predominantly focuses on cure of established disease conditions and addressing recognized harmful health behaviors) to the upstream model. The upstream intervention is preventive in nature, directed at circumstances that bring about harmful health behaviors and conditions. This model focuses on primary prevention and health promotion at the community level with such activities as educational media campaigns, legislative actions, healthy public polices, and community engagement. It is hoped that emphasis on community level would elicit the desired oral health outcomes on the disadvantaged populations.
Community pharmacists (CPs) in the past were merely druggists with very limited public health engagement. However, due to changing health environment and demands, their activities kept evolving. They now constitute an important member of the health-care team with crucial roles in health promotion and preventive services. This is because they are very accessible, often situated close to people's homes, and generally not operating on appointment-based schedules. More so, their advices are usually trusted, and visits to them do not constitute any direct charge on people.,, Invariably, they are suitably positioned to offer advice on oral health care, oral complications of medications, and susceptibility to a variety of oral problems.,,,
Despite being adequately positioned to offer advices on a host of oral health-care challenges, they seldom provide such. This was attributed to their less than optimum education and skills in oral health issues. Deficiencies in oral health-care knowledge of pharmacists had previously been noted. Poor knowledge of oral health care was reported among CPs in Riyadh, Saudi Arabia  and India. Apparently, studies from the UK also indicate that pharmacists there were not well trained in oral health-related topics. Despite these deficits, CPs have shown eagerness to increase their oral health knowledge., The same readiness was noticed in a South African study where 59.4% of the CPs responded positively to their willingness to partake in trainings on oral health.
The extent of pharmacy education concerning oral health issues has not been formally assessed in Nigeria neither is oral health education incorporated into the study curriculum of pharmacy in Nigerian Universities. Thus, this study assessed the knowledge of oral health of CPs in Plateau State, Northern Nigeria, serving as a template on how they can be used as a medium to improve oral health care among the people.
| Materials and Methods|| |
Quantitative cross-sectional study design was used for this study. This study took place among CPs in Plateau State, one of the states in the North Central geopolitical zone of Nigeria. All practicing CPs in the state served as the study sample. As pharmacies are commercial outfits, they are usually located along major streets. All the major streets in the 17 Local Government Areas of Plateau State were navigated to find the community pharmacies from where the CPs were identified. For the purpose of this study, a CP was defined as the health-care provider most accessible to the public. They supply medicine based on prescription, counsel patients, and participate in health promotion activities. They also maintain links with other health-care professionals. He/she must be a practicing pharmacist, not an intern or a student pharmacist, should be in constant contact with community members, practicing in settings such as independently owned pharmacies, those attached to shopping malls, retail stores, and pharmacy chains. Other inclusion criteria included a minimum of 6 months practice as a CP and consent to participate in the study. Those CPs not fulfilling the above conditions were excluded from the study.
CPs were traced (by navigating all the major roads/streets in the state) and contacted at their pharmacies. A working list comprising the number of registered pharmacies in the state (compiled by the Director of Pharmaceutical Services, Ministry of Health, Plateau state) served as the starting point for locating the CPs in their practices. There were 104 community pharmacies on the list. There was a brief introduction of the purpose of the study where an informed consent form about the study was given. Willingness to partake in the study was based on signing the consent form after addressing any question that arose from the participants. A total number of CPs approached, and the number of those who agreed to participate in the study were noted.
Data collection was done using a structured paper-based, self-administered questionnaire. Every filled questionnaire was checked for adequacy and completeness, and any question about the exercise was addressed to dispel any misconceptions. A completed questionnaire was adequate if most of the relevant questions were filled (as there were some contingency questions that required skipping). A modified survey instrument developed by Mann et al. was used for data collection. The survey instrument was readministered to six randomly selected CPs after a week of filling the first one to assess the internal reliability of the instrument. Reliability was determined using Cohen's Kappa. Data collection took 6 weeks.
After data collection and cleaning (verification of retrieved questionnaires), it was entered into the computer and analyzed with Statistical Package for the Social Sciences (SPSS, version 23 software SPSS Inc, Chicago, IL, USA). Knowledge of oral health care was measured by the use of a 24-item questionnaire answered on a True or False basis. A knowledge score was computed for each CP based on the number of correct answers given to questions asked on knowledge of oral health care. Correct responses were scored one (1) while incorrect ones were scored zero (0). The maximum possible score was 24. The possible scores were graded as follows: a score of 8 and below was poor knowledge, 9–16 average knowledge, whereas 17–24 was taken as good knowledge. A one sample t-test was done to assess the knowledge of CPs on oral health, and a multiple regression analysis was conducted to evaluate the relationship between the following demographic characteristics: age, gender, location of practice, duration of practice, highest education level, prior dental visit, number of years' postgraduation, registration of pharmacy, prior dental education, stocking of oral health-care products, and knowledge of oral health.
To ensure that participants in the study were adequately protected, the study proposal was submitted to and approved by the Walden University Institutional Review Board (approval number: 10-21-16-0497336) and the Plateau State Specialist Hospital Health Research Ethics Committee – Ref. No: PSSH/ADM/ETH.CO/2016/020. The study was conducted in full accordance with the World Medical Association Declaration of Helsinki.
| Results|| |
A total of 207 community pharmacies were identified. Of this number (207), 12 community pharmacies were no longer in operation (they remained shut after a minimum of three random visits) and 26 were without a resident CP. They were either manned by a Pharmacy Technician or a pharmacy counter assistant (14), nurses (2), or had CPs who visited occasionally (10). Thus, 169 community pharmacies with resident CPs were available for participation. Of the 169 CPs identified, 32 were not around during visits to the pharmacies: many had traveled for different reasons (26), 4 were sick and stayed home, and 2 were on maternity leave. Out of the remaining 137 CPs, 11 did not fulfill the inclusion criteria for practice and 13 CPs declined participation. This left a total of 113 CPs as participants. The CPs ages ranged from 23 to 70 years. Average age was 41.28 ± 11.62 years with more male CPs in the population (62.8%). Of the 28 CPs with postgraduate qualifications, the number of years' postgraduation (from basic degree) ranged from 1 to 40 years with a mean of 13.29 ± 11.86. Duration of practice ranged from 0.5 to 36 years and mean of 9.26 ± 9.28. [Table 1] summarizes other demographic details of the CPs. About half (51.8%) of the CPs claimed they received some form of dental education. Scheduled lectures during undergraduate training in the university (17.7%) and attendance at dedicated seminars, trainings, and conferences on oral health (14.2%) were the most common time for when such education was acquired.
|Table 1: Demographic characteristics of study population - community pharmacists (n=113)|
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The survey instrument was readministered to six randomly selected CPs after a week of filling the first administered one to assess the internal reliability of the instrument. Reliability determined by Cohen's κ showed substantial agreement between the first and second responses with κ = 0.646, 95% CI (0.181 and 0.927), P < 0.0001 [Table 2].
Knowledge score for the CPs showed a range of 11–21 and a mean score of 17.18 ± 2.44. None of the CPs fell into the group of poor knowledge of oral health. Forty-four CPs (38.9%) had average knowledge of oral health (score 9–16) whereas 61.1% had good knowledge of oral health (score >16). Taking 16 (out of 24) as the minimum pass score for knowledge of oral health by CPs, a one-sample t-test reported good knowledge of oral health by the CPs: mean = 17.2, standard deviation (SD) = 2.44, t (112) = 5.14, P < 0.001. Independent sample t-tests showed that there were no statistically significant differences in the mean oral health knowledge of CPs by the following categorical variables: gender, prior dental education, prior dental visits, provision of oral health services, and membership with the Association of Community Pharmacists of Nigeria. However, those CPs who stock oral health-care products had statistically significant higher knowledge scores (mean = 17.3, SD = 2.4) than did those who did not stock oral health-care products mean = 13, SD = 1.41, t (111) = 2.50, P = 0.014. There also were no statistically significant differences in the mean oral health knowledge of CPs by their highest educational attainment.
A multiple regression analysis was conducted to evaluate the relationship between some demographic characteristics and knowledge of oral health. This was done using forced entry method for the independent variables. The relationships between the predictors and knowledge of oral health were not statistically significant, with R2 = 0.12 and adjusted R2 = 0.005, F (10, 78) = 1.041, and P = 0.418. [Table 3] summarizes the weights of the B coefficients for the predictor variables. All of the predictors were not significantly related to knowledge of oral health apart from stocking of oral health-care products. Although prior dental education (β = −0.081, sri2 = 0.052), gender (β = −0.121, sri2 = 0.012), and duration of practice (β = 0.001, sri2 = 0.012) are better predictors of knowledge of oral health than stocking of oral health products (β = −0.246, sri2 = 0.006), they were not statistically significant (P > 0.05).
|Table 3: Relationship between demographic characteristics of community pharmacists and knowledge of oral health|
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Most of the CPs (86.7%) said they knew where to access more information on oral health if needed. [Table 4] summarizes that the most preferred media of communication for any new information on oral health are organizing seminars, conferences, and workshops on oral health (76.11%), oral health products and medication leaflets (74.34%), and through the dentist or other oral health-care professionals (72.57%). The suggestions by the CPs on how they think knowledge of oral health can be improved among them includes organizing workshops and seminars on oral health (63%), collaboration with oral health-care workers (6.2%), continuing education program on oral health (4.4%), and incorporating oral health into the Pharmaceutical Council of Nigeria (PCN) community pharmacy practice standard (1.8%).
|Table 4: Preferred communication medium for disseminating new information on oral health|
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| Discussion|| |
CPs are an indispensable member of the health-care team having important roles in addressing oral health-care challenges. Their consultative role is important for those disadvantaged people who ordinarily do not have access to the dentist. All the CPs surveyed in this study exhibited an above average knowledge of oral health (i.e., knowledge score of >70%). However, similar studies from other parts of the world such as in Riyadh, Saudi Arabia, India, and the UK reported CPs poor knowledge of oral health.,,, Disparities with this study finding may be due to varying demographics of the study populations and lack of uniformity of the measuring instrument.
Of about 583 pharmacists interviewed in a fairly recent UK study, 91.5% had a high level of knowledge (>70%) for common oral conditions. This is similar to what was obtained in this study though the high proportion (in the UK study) may be due to the survey question which asked the CPs to self-assess their level of confidence on some oral health conditions. A previous Nigerian study which utilized similar constructs for measuring knowledge of oral health with this study also reported high proportion where 60.4% and 34.3% of the respondents had average and good knowledge score of oral health, respectively. The respondents were primary health-care (PHC) workers and may not be comparable to CPs as CPs have higher educational requirements than PHC workers.
About half (51.3%) of the respondents claimed that they received some form of dental education in the past. Most of which were scheduled lectures during undergraduate training (17.7%) and attendance at dedicated oral health seminars, trainings, and conferences (14.2%). Oral health education had not been officially incorporated into the study curriculum of pharmacy in Nigerian Universities. Similarly, about 30% of CPs from South Africa did not partake in any form of education on oral health during their undergraduate training. Together with South Africa, other southern and eastern African countries like Zambia, Malawi, Botswana, Sudan, Tanzania, Zimbabwe, and Uganda do not have oral health education as part of undergraduate training for pharmacy.,,,
All the examined demographic factors had no statistically significant association with knowledge of oral health apart from stocking oral health products which had a statistically significant predictive relationship with knowledge of oral health. Such that for every CP who does not stock oral health products, there is a corresponding 246 unit reduction in the knowledge score of oral health controlling for the other covariates. Many oral health products come with educational leaflets and posters for advertorials that could have served as a source of information about one or more conditions, for which the product was developed. However, a study in Riyadh province, Saudi Arabia showed that male non-Saudi pharmacists working in chain pharmacies, having 11–15 years of experience with a master's degree qualification showed significantly higher mean knowledge and practices scores as compared to their counterparts.
Although many of the CPs (86.7%) in this study said they knew where to access more information on oral health if needed, it seems such resources were not utilized going by the huge requests for more training on oral health conditions. It had been reported that pharmacists who were not well trained in oral health-related topics showed eagerness to increase their oral health knowledge.,, This was noticed where 59.4% of the CPs in South Africa responded positively to their willingness to partake in trainings on oral health. The most preferred medium of communication for any new information on oral health in this study was through seminars, conferences, and workshops on oral health (76.11%). This aligns with their recommendations on how to improve the knowledge of oral health. Seminars and conferences may be preferred as they could be scheduled many times within a year and repeated yearly compared to incorporation into undergraduate studies whose impact tends to wane with increasing years' postgraduation. Others were through oral health products and medication leaflets (74.34%) and through the dentist or other oral health-care professionals (72.57%).
Eighty-one CPs (71.7%) in this study cited publications in pharmaceutical journals as a preferred medium for disseminating oral health information. Increased awareness of oral health-related issues has been found to be a result of production of educational packages and publication of oral health articles in pharmaceutical journals., It was also suggested that producing leaflets and materials related to oral health care could further improve knowledge on oral health care. The use of such materials has not been documented as effective in increasing knowledge of oral health of CPs though other approaches including distance learning packages and postgraduate courses have been employed as initiatives for oral health education of pharmacists. CPs, who receive training on oral health-related issues, would be more equipped to give counsel on oral health diseases, methods of prevention, and possible management.,, Poor knowledge of oral health care is a major hindrance to CPs integrating oral health promotional activities in their practices.,
Close to 90% of the CPs surveyed in this study were licensed. Thus, this study reflects primarily the views of those who are licensed. This means that the views of the unlicensed CPs who are predominantly women graduates within the past 10 years having no postgraduate qualifications may not be accurately reflected in this study. This may constitute a limitation with generalizability. Apart from that, not all the views of the CPs in the state were captured as some declined, a sizeable amount was not available, and others were excluded from the study. Views from these other CPs could have had some significant influences on the study findings. Notwithstanding, the study was holistic covering the entire state and the different cadres of CPs. Being conducted in the natural settings of the CPs, consequently, increases the external validity of findings.
| Conclusion|| |
CPs may be effectively employed in oral health promotion because patients frequently contact them and regularly ask for their advice on both general and oral health care. As a result of their established role in promoting and improving the health within the community, CPs in Plateau state, Northern Nigeria, may be underutilized for such purposes. It would be beneficial to empower them through trainings and access to oral health information so as to engage them as conduit pipes to improve oral health awareness of the people. It may also be possible to incorporate oral health within the PCNs community pharmacy practice standard to help them take a more active and integrated role as part of a multidisciplinary health-care team attending to the oral health concerns of the people. Future research may be needed to evaluate the effectiveness or correctness of oral health advices given to the public by the CPs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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