Community pharmacists’ strategies and barriers in supporting medication adherence in Saudi Arabia: a cross-sectional study

A cross-sectional survey of licensed community pharmacists across all five regions of Saudi Arabia found that respondents reported using several practical strategies to identify medication non-adherence and support medication use, while also reporting barriers involving consultation privacy, time, clinical information, training and patient health literacy. Among 345 eligible and complete responses analyzed, encouraging patients to monitor their own medication use was the most frequently reported support strategy, followed by using labels in the patient’s preferred language and simplifying medication regimens. The study, conducted between September and November 2025, characterizes self-reported practice rather than the effectiveness of these strategies or any resulting improvement in patient adherence or clinical outcomes.

The most commonly reported approaches for identifying possible non-adherence were a combined item covering medication electronic monitoring systems, known as MEMS, or pill counts, which 50.8% of respondents said they used at least 75% of the time. Assessing patients’ response to medication was reported by 50.1%, exploring barriers to adherence by 47.5% and reviewing prescription-refill records by 47.2%. The use of a standardized adherence tool, such as the Morisky scale, was reported by 41.7% at least 75% of the time.

Because electronic monitoring and pill counts appeared in one questionnaire item, the survey could not determine their individual frequencies, how either method was performed or how pharmacists interpreted the results. The 50.8% figure therefore should not be interpreted as evidence of widespread use of dedicated electronic adherence-monitoring systems. Both composite scores ranged from 1 to 5, with higher values indicating greater self-reported frequency.

Among the support activities performed at least 75% of the time, patient-friendly labeling was reported by 58.8%, regimen simplification by 57.7%, linking medication use to daily activities by 55.9% and large-font labels by 55.4%. Recommending a medication review was reported by 50.7%, providing dose-administration aids by 45.8%, sending SMS refill reminders by 44.6% and communicating with physicians about adherence by 40.6%. These figures describe reported frequency, not intervention effectiveness, and the survey did not observe consultations or measure whether patients followed the advice they received.

Several activities reported by pharmacists were indirect rather than direct measures of medication-taking behavior. Lung-function testing was performed at least 75% of the time by 35.7% of respondents. Such testing can provide information about disease control or treatment response and may prompt discussion of medication use or inhaler technique, but it does not independently establish whether a patient has taken medicines as prescribed.

Blood-pressure monitoring, blood-glucose monitoring and cholesterol monitoring were also reported as activities performed at least 75% of the time by 48.7%, 50.1% and 45.5%, respectively. The questionnaire did not establish how pharmacists used these clinical measurements to evaluate adherence, illustrating the distinction between monitoring signs or treatment response and determining medication-taking behavior. Pharmacists’ stated attitudes toward adherence support were generally favorable, although responses also reflected uncertainty about professional boundaries.

Among the 345 participants, 65.5% agreed that adherence education was part of the pharmacist’s professional role, 63.2% agreed that pharmacists should promote medication adherence and 62.9% agreed that all pharmacists should identify non-adherence. More than half believed that physicians supported pharmacists’ involvement, at 55.1%, and 55.1% believed patients viewed pharmacists as supporting adherence. Yet 49.6% also agreed that adherence services were primarily the physician’s responsibility.

The survey did not determine whether these attitudes were reflected in consistent service delivery. Its self-administered design also permitted social-desirability and recall bias, meaning responses may overstate the frequency or consistency of positive practices. The most frequently endorsed perceived barriers were a lack of private consultation space, reported by 49.6%, lack of time by 45.8% and limited clinical information by 44.1%.

Insufficient training in adherence services was cited by 41.2%. Difficulty discussing adherence with physicians and poor patient health literacy were each reported by 40.6%, while patient resistance to counseling was reported by 36.5% and language barriers by 35.7%. These were self-reported obstacles rather than experimentally measured effects on service delivery.

Principal-component analysis of the 13 barrier items separated them into role, stakeholder and patient-related barriers, which explained 54.26% of the variance, and practice-resource and communication barriers, which explained another 8.26%. The complete scale had a Cronbach’s alpha of 0.939, indicating strong internal consistency among the survey responses. Adjusted multiple linear regression identified two workplace characteristics associated with the support-strategy composite score.

Pharmacists working at least 40 hours per week had a lower score than those working fewer than 40 hours, with an unstandardized coefficient of −0.30 and a 95% confidence interval of −0.56 to −0.04. Employment in a chain pharmacy was associated with a higher score than employment in an independent pharmacy, with a coefficient of 0.56 and a 95% confidence interval of 0.16 to 0.96. The model was statistically significant, F(27,317) = 2.079, p = 0.002, and explained 15.0% of the variance in support scores, with an adjusted R-squared of 0.078.

No examined predictor was significantly associated with the identification-strategy score at p < 0.05, even though that model was significant overall and explained 13.9% of the variance, with an adjusted R-squared of 0.066. These results are statistical associations in a cross-sectional survey, not evidence that long hours cause lower engagement or that chain-pharmacy employment produces better support. Education level, previous adherence-support training and interest in further training were not significantly associated with either composite score.

That finding does not demonstrate that training has no effect on adherence services, because the cross-sectional design did not test an intervention and previous training was measured only as a participant characteristic. At the same time, 41.2% of respondents perceived insufficient training as a barrier, and 70.4% expressed interest in receiving further training. The survey also did not assess pharmacists’ access to licensed or validated versions of standardized adherence tools, so it could not determine why use of instruments such as the Morisky scale was reported less often than several broader approaches.

Similarly, it did not examine whether the organizational procedures, staffing structures or standardized resources that might distinguish workplaces produced the observed chain-pharmacy association. The sample and recruitment process limit how broadly the results can be generalized. Of 681 pharmacists invited through four community pharmacy chains, 382 responded, producing an initial response rate of 56.1%.

After 37 incomplete or ineligible questionnaires were excluded, the analytical sample represented 50.6% of those invited and 91.3% of the calculated minimum sample of 378. Most participants were men, at 91.6%; held a bachelor’s degree in pharmacy, at 81.7%; worked at least 40 hours per week, at 83.5%; and worked in urban locations, at 68.4%. Chain-pharmacy employees accounted for 93.6% of the sample.

Although licensed pharmacists from all five regions participated, the Western Region contributed 47.0%, compared with 3.2% from the Northern Region. Overall, the survey provides a detailed snapshot of what Saudi community pharmacists said they did to identify medication non-adherence and support medication use. The results show a broad repertoire of reported practices, from refill-record review and direct questioning to self-monitoring, regimen simplification, language-appropriate labels and medication reviews.

They also document perceived organizational, informational, interpersonal and patient-related barriers, while showing that workplace characteristics accounted for some variation in reported support activity. However, the study did not measure patient adherence, clinical outcomes, consultation quality or actual service implementation, and its cross-sectional design cannot establish causal relationships. Questions about the separate use of electronic monitoring and pill counts, the connection between reported strategies and patient-level results, and the organizational factors behind workplace associations therefore remain unanswered by these data.

Subject of Research: Self-reported medication-adherence strategies and perceived barriers among licensed community pharmacists in Saudi Arabia

Article Title: Community pharmacists’ strategies and barriers in supporting medication adherence in Saudi Arabia: a cross-sectional study

Article References: Alzahrani, F., Alnezary, F. S., Saleem, Z., & Almutairi, M. S. (2026). Community pharmacists’ strategies and barriers in supporting medication adherence in Saudi Arabia: a cross-sectional study. Frontiers in Medicine, 13, Article 1962692. https://doi.org/10.3389/fmed.2026.1962692

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1962692

Keywords: medication adherence, community pharmacists, Saudi Arabia, cross-sectional survey, pharmacy practice, health literacy, patient counseling, consultation privacy, clinical information, chain pharmacies, Community, pharmacists