A qualitative exploration of community pharmacists’ practices and beliefs of pretravel pharmacist consultations for prospective Hajj and Umrah pilgrims
Main Article Content
Keywords
Community pharmacist, Hajj, Umrah, mass gathering, travel medicine, qualitative, theoretical domains framework, Malaysia
Abstract
Background: The Hajj and Umrah pilgrimages to Mecca, Saudi Arabia, are renowned as two of the largest mass religious gatherings globally. These pilgrimages, due to the large congregations, present several risks to pilgrims, including the spread of communicable diseases and exposure to environmental hazards. Community pharmacists (CPs) offering pretravel pharmacist consultation (PTPC) can play a crucial role in safeguarding the well-being of prospective Hajj and Umrah pilgrims.
Objective: This study aims to explore CPs' practices and beliefs regarding PTPC for prospective Hajj and Umrah pilgrims.
Methods: A semi-structured interview study involving 24 CPs in Selangor and Kuala Lumpur, Malaysia, was conducted. The Theoretical Domains Framework (TDF) was employed in both the development of the interview guide and the data analysis. Face-to-face interviews were utilized to explore CPs’ practices and beliefs, encompassing an exploration of the barriers and facilitators in providing PTPC for prospective Hajj and Umrah pilgrims. The audio recording of the interviews were transcribed verbatim and subjected to qualitative content analysis.
Results: Seven distinct pharmacist activities were identified, with the provision of travel health education emerging as the primary activity reported by CPs. Beliefs regarding PTPC for prospective Hajj and Umrah pilgrims were categorized into fourteen domains of the TDF. The study reveals that CPs were motivated to offer PTPC for these pilgrims. However, they also faced knowledge gaps in Hajj and Umrah travel guidelines and health-related issues relevant to the pilgrimage. Additionally, they reported several barriers, including staff shortages, lack of time, limited confidence in providing PTPC related to regulations and disease management, and perceived lack of support from doctors.
Conclusion: Findings from this study indicate that enhancing the provision of PTPC for prospective Hajj and Umrah pilgrims can be achieved through avenues such as education, training, improved resources, interprofessional collaborative efforts, and supportive policies.
References
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org/10.1016/j.tmaid.2019.07.019.
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30. Dyson J, Cowdell F. How is the Theoretical Domains Framework applied in designing interventions to support healthcare
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org/10.1093/intqhc/mzab106.
31. Patton DE, Ryan C, Hughes CM. Enhancing community pharmacists’ provision of medication adherence support to older
adults: A mixed methods study using the Theoretical Domains Framework. Research in Social and Administrative Pharmacy.
2021;17(2):406-418. https://doi.org/10.1016/j.sapharm.2020.03.004.
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management of over-the-counter (OTC) consultations in community pharmacies. BMJ open. 2019;9(8):e029937. https://doi.
org/10.1136/bmjopen-2019-029937.
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women receiving opioid substitution treatment: A qualitative study using the TDF and COM-B. Exploratory Research in Clinical
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2014:365-380. 10.1007/978-94-017-9181-6_13.
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2648.2007.04569.x.
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library science. 2009:308-319.
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Perceptions and Barriers Towards It’s Performance: A Systematic Review. International Journal of Pharmacy and Pharmaceutical
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in providing vaccination services. Journal of Pharmaceutical Policy and Practice. 2022;15(1):81. 10.1186/s40545-022-00478-0.
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Regulations-Umrah-En.pdf.
49. Alabid AHMA, Ibrahim MIM, Hassali MA, Palaian S. Community Pharmacists’ Awareness toward Their Roles in Healthcare and
Interaction with General Practitioners: A Cross-Sectional Study. Journal of Pharmacy and Bioallied Sciences. 2021;13(2):220-
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50. Mutie M, Naunton M, Cooper G, Kyle G, Zwar N. Role of pharmacists in collaborative care of travellers with chronic conditions.
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Saudi Medical Journal. 2017;38(8):868-871. 10.15537/smj.2017.8.20124.
2. Bernama. Saudi Arabia records arrival of over 300,000 Malaysian Umrah pilgrims in just 8 months. New Straits Times. March
2. Accessed February 6, 2024. https://www.nst.com.my/news/nation/2023/03/885188/saudi-arabia-records-arrival-over-
300000-malaysian-umrah-pilgrims-just-8.
3. Tabung Haji. Hajj Quota. https://www.tabunghaji.gov.my/en/hajj/general-info/hajj-quota.
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default/files/Umrah_Statistics_2022_En_0.pdf.
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files/Hajj_Statistics_2022_En_0.pdf
6. World Health Organization. Managing health risks during mass gatherings. https://www.who.int/activities/managing-healthrisks-
during-mass-gatherings.
7. Hoang V-T, Gautret P, Memish ZA, Al-Tawfiq JA. Hajj and Umrah mass gatherings and COVID-19 infection. Current Tropical
Medicine Reports. 2020;7:133-140. https://doi.org/10.1007/s40475-020-00218-x.
8. Goni MD, Naing NN, Hasan H, et al. Uptake of Recommended Vaccines and Its Associated Factors Among Malaysian Pilgrims
During Hajj and Umrah 2018. Frontiers in Public Health. 2019;7268. 10.3389/fpubh.2019.00268.
9. Nik Zuraina NMN, Sarimah A, Suharni M, Hasan H, Suraiya S. High frequency of Haemophilus influenzae associated with
respiratory tract infections among Malaysian Hajj pilgrims. Journal of Infection and Public Health. 2018;11(6):878-883.
10.1016/j.jiph.2018.07.010.
10. BaDawood AO, Bossei AA, AlSabhani MF, AlAhmari SM, Shata MT, Hamam AF. The burden on EDs during Hajj due to pilgrim
noncompliance with treatment for chronic conditions. Saudi Journal of Emergency Medicine. 2020;1(2):103-109. 10.24911/
sjemed/72-1571844482.
11. Alqahtani AS, Althimiri NA, BinDhim NF. Saudi Hajj pilgrims’ preparation and uptake of health preventive measures during Hajj
2017. Journal of Infection and Public Health. 2019;12:772-776. 10.1016/j.jiph.2019.04.007.
12. Yezli S, Yassin Y, Mushi A, Balkhi B, Stergachis A, Khan A. Medication Handling and Storage among Pilgrims during the Hajj Mass
Gathering. Healthcare. 2021;9(626)10.3390/healthcare9060626.
13. Yezli S, Yassin Y, Mushi A, Balkhi B, Khan A. Insulin Knowledge, Handling, and Storage among Diabetic Pilgrims during the Hajj
Mass Gathering. J Diabetes Res. 2021;2021:5596914. 10.1155/2021/5596914.
14. Tan ZH, Zamli FNAM, Izal LHM, Joseph N, Mohamed NA, Nordin SA. Knowledge and attitude towards vaccine preventable
diseases and vaccination among prospective Malaysian Hajj pilgrims in Klang Valley, Malaysia. Malaysian Journal of Medicine
and Health Sciences. 2020;16(SP1):2-8.
15. Khan ID, Khan SA, Asima B, Hussaini SB, Zakiuddin M, Faisal FA. Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year
experience of Indian Hajj medical mission in mass-gathering medicine. Journal of Infection and Public Health. 2018/03/01/
2018;11(2):165-170. https://doi.org/10.1016/j.jiph.2017.06.004.
16. Khamis NK. Epidemiological pattern of diseases and risk behaviors of pilgrims attending mina hospitals, hajj 1427 h (2007 g).
The Journal of the Egyptian Public Health Association. 2008;
17. Abdul Kadir N, Wahab MSA, Mohd Suhaimi A, Othman N. Practices, barriers and facilitators to the delivery of pretravel health
services by community pharmacists: A scoping review using the theoretical domains framework. Research in Social and
Administrative Pharmacy. 2023;19(11):1412-1423. https://doi.org/10.1016/j.sapharm.2023.08.004.
18. Houle SKD. Pharmacy travel health services: Current perspectives and future prospects. Integr Pharm Res Pract. 2018;7:13-20.
https://doi.org/10.2147/iprp.s142982.
19. Aw B, Boraston S, Botten D, et al. Travel medicine: What’s involved? When to refer? Can Fam Physician. 2014;60:1091-1103.
20. Kc B, Alrasheedy AA, Leggat PA, et al. Types and outcomes of pharmacist-managed travel health services: A systematic review.
Travel Med Infect Dis. 2023;51:102494. https://doi.org/10.1016/j.tmaid.2022.102494.
21. Kc B, Khan TM, Xuan WY, Alrasheedy AA, Ibrahim MIM, Leggat PA. Travel health-related activities and services provided by
community pharmacies in Selangor, Malaysia: A cross-sectional analysis. Travel Med Infect Dis. 2020;33:101463. https://doi.
org/10.1016/j.tmaid.2019.07.019.
22. Kc B, Alrasheedy AA, Leggat PA, et al. Pharmacies in the Airport Ecosystem and How They Serve Travelers’ Health and Medicines Need: Findings and Implications for the Future. Integr Pharm Res Pract. 2022;11:9-19. 10.2147/iprp.S345621.
23. Taha NA, See YL. Provision of travel medicine advice through community pharmacies: assessment of knowledge, attitudes and
practices of pharmacists in Malaysia. Int J Pharm Pract. 2016;24:326-332. https://doi.org/10.1111/ijpp.12256.
24. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews
and focus groups. International Journal for Quality in Health Care. 2007;19(6):349-357. 10.1093/intqhc/mzm042.
25. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence
based practice: A consensus approach. Qual Saf Health Care. 2005;14:26-33. https://doi.org/10.1136/qshc.2004.011155.
26. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research
findings into practice: a consolidated framework for advancing implementation science. Implement Sci. Aug 7 2009;4:50.
10.1186/1748-5908-4-50.
27. May CR, Albers B, Bracher M, et al. Translational framework for implementation evaluation and research: a normalisation
process theory coding manual for qualitative research and instrument development. Implementation Science. 2022;17(1):19.
10.1186/s13012-022-01191-x.
28. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation
research. Implement Sci. 2012;7:37. https://doi.org/10.1186/1748-5908-7-37.
29. Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate
implementation problems. Implement Sci. 2017;12:77. https://doi.org/10.1186/s13012-017-0605-9.
30. Dyson J, Cowdell F. How is the Theoretical Domains Framework applied in designing interventions to support healthcare
practitioner behaviour change? A systematic review. International Journal for Quality in Health Care. 2021;33(3). https://doi.
org/10.1093/intqhc/mzab106.
31. Patton DE, Ryan C, Hughes CM. Enhancing community pharmacists’ provision of medication adherence support to older
adults: A mixed methods study using the Theoretical Domains Framework. Research in Social and Administrative Pharmacy.
2021;17(2):406-418. https://doi.org/10.1016/j.sapharm.2020.03.004.
32. Cassie H, Duncan EM, Gibb EA, et al. Qualitative study exploring the key determinants of information gathering to inform the
management of over-the-counter (OTC) consultations in community pharmacies. BMJ open. 2019;9(8):e029937. https://doi.
org/10.1136/bmjopen-2019-029937.
33. Alhusein N, Scott J, Neale J, Chater A, Family H. Community pharmacists’ views on providing a reproductive health service to
women receiving opioid substitution treatment: A qualitative study using the TDF and COM-B. Exploratory Research in Clinical
and Social Pharmacy. 2021;4:100071. https://doi.org/10.1016/j.rcsop.2021.100071.
34. Tew MM, Hatah E, Arif F, Wahid MAA, Makmor‐Bakry M, Maulad KNA. Geospatial analysis of distribution of community
pharmacies and other health care facilities providing minor ailments services in Malaysia. Journal of Pharmaceutical Policy
and Practice. 2021;14(1). https://doi.org/10.1186/s40545-021-00308-9.
35. Saudi Press Agency. Makkah Route Initiative Continues to Serve Pilgrims of Malaysia. Accessed 14 May 2024. https://spa.gov.
sa/en/77e552d07ag.
36. Tabung Haji. Pelaksanaan Tahun Ketiga Makkah Route Untuk Keselesaan Jemaah Malaysia Lambang Kepercayaan Kerajaan
Arab Saudi. 22 June 2022. Accessed 14 May 2024. https://www.tabunghaji.gov.my/en/press-release/wed-06222022-1200/
pelaksanaan-tahun-ketiga-makkah-route-untuk-keselesaan-jemaah.
37. Jared W. Batik Air and Lion Air Group to make KLIA central umrah travel hub. Malay Mail. Accessed 14 May 2024. https://www.
malaymail.com/news/life/2024/01/15/batik-air-and-lion-air-group-to-make-klia-central-umrah-travel-hub/112512.
38. Castillo-Montoya M. Preparing for Interview Research: The Interview Protocol Refinement Framework. The Qualitative Report.
2016;21(5):811-831. 10.46743/2160-3715/2016.2337.
39. Mayring P. Qualitative Content Analysis: Theoretical Background and Procedures. Advances in Mathematics Education.
2014:365-380. 10.1007/978-94-017-9181-6_13.
40. Elo S, Kyngäs H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62(1):107-115. 10.1111/j.1365-
2648.2007.04569.x.
41. Zhang Y, Wildemuth B. Thematic content analysis. Applications of social research methods to questions in information and
library science. 2009:308-319.
42. Miles MB, Huberman AM. Qualitative data analysis: An expanded sourcebook. Sage; 1994.
43. Nordin N, Hassali MAA, Sarriff A. Actual or Potential Extended Services Performed by Malaysian Community Pharmacists,
Perceptions and Barriers Towards It’s Performance: A Systematic Review. International Journal of Pharmacy and Pharmaceutical
Sciences. 2017;9(10):13-20. 10.22159/ijpps.2017v9i10.20694.
44. Ang WC, Fadzil MS, Ishak FN, Adenan NN, Nik Mohamed MH. Readiness and willingness of Malaysian community pharmacists
in providing vaccination services. Journal of Pharmaceutical Policy and Practice. 2022;15(1):81. 10.1186/s40545-022-00478-0.
45. Centers for Disease C, Prevention. Saudi Arabia: Hajj/Umrah Pilgrimage - Chapter 10. 2021.
46. Tabung Haji. Hajj Management. https://www.tabunghaji.gov.my/index.php/en/hajj/services/hajj-management.
47. Ministry of Health Saudi Arabia. Health Requirements and Recommendations for Travelers to Saudi Arabia for Hajj – 1445H
(2024). Accessed January 4th, 2024, https://www.moh.gov.sa/en/HealthAwareness/Pilgrims_Health/Documents/Health-
Regulations-En.pdf.
48. Ministry of Health Saudi Arabia. Health requirements and recommendations for travelers to Saudi Arabia for Umrah - 1444H (2023). Accessed November 18th, 2023, https://www.moh.gov.sa/en/HealthAwareness/Pilgrims_Health/Documents/Health-
Regulations-Umrah-En.pdf.
49. Alabid AHMA, Ibrahim MIM, Hassali MA, Palaian S. Community Pharmacists’ Awareness toward Their Roles in Healthcare and
Interaction with General Practitioners: A Cross-Sectional Study. Journal of Pharmacy and Bioallied Sciences. 2021;13(2):220-
229. 10.4103/jpbs.JPBS_680_20.
50. Mutie M, Naunton M, Cooper G, Kyle G, Zwar N. Role of pharmacists in collaborative care of travellers with chronic conditions.
Travel Med Infect Dis. 2014;12:286-287. https://doi.org/10.1016/j.tmaid.2014.03.001.
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A qualitative exploration of community pharmacists’ practices and beliefs of pretravel pharmacist consultations for prospective Hajj and Umrah pilgrims. Pharm Pract (Granada) [Internet]. 2025 May 22 [cited 2025 Jul. 16];23(2):1-21. Available from: https://pharmacypractice.org/index.php/pp/article/view/3188
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How to Cite
1.
A qualitative exploration of community pharmacists’ practices and beliefs of pretravel pharmacist consultations for prospective Hajj and Umrah pilgrims. Pharm Pract (Granada) [Internet]. 2025 May 22 [cited 2025 Jul. 16];23(2):1-21. Available from: https://pharmacypractice.org/index.php/pp/article/view/3188