2023 Volume 143 Issue 10 Pages 871-879
Diabetes is a chronic disease requiring long-term management. Poorly controlled diabetes is associated with reduced quality of life and micro- and macro-vascular complications. Community pharmacists have a role in supporting people with diabetes to better address their condition and reduce their risk of diabetes-related illness. The purpose of this study was to examine and compare the attitudes, practices, and confidence of community pharmacists in Japan and Ireland on the care of people with diabetes. A cross-sectional survey of community pharmacists in Ireland (388 respondents) and Japan (144 respondents) was conducted to assess their attitudes, practices, confidence, and other characteristics linked to diabetes management. A Likert scale was utilized, with a range of strongly agree to strongly disagree. The study reported that Japanese pharmacists have lower levels of practice (p<0.004), confidence, trust by patients, job satisfaction, concern with patients, and knowledge (all p<0.001) regarding diabetes management than Irish pharmacists. Although there was no significant difference in the attitude of pharmacists in both countries, the results show almost similar attitudes toward diabetes management, indicating their willingness to support people with diabetes. These results demonstrated less confidence in diabetes management and less practice of diabetes management care among Japanese pharmacists than Irish pharmacists. The results can be used to identify pharmacist education needs and develop training programs in diabetes management for pharmacists in Japan and Ireland.
According to the World Health Organization (WHO), as of 2019, around 1.5 million deaths annually are directly attributed to diabetes and as of 2022, it is estimated that 537 million people are living with diabetes worldwide.1) There has been an increase in diabetes prevalence worldwide from 2011 to 2021, with incidence increasing from 6.5 to 9.8%.2) As of 2021, the prevalence of diabetes among adults in Japan is 6.6%,3) and in Ireland, it is 3%.4) Diabetes is a serious chronic condition that requires long-term treatment. Poorly controlled diabetes is associated with poor quality of life and morbidity associated with cardiovascular disease, neuropathy, nephropathy, and retinopathy. All health care professionals, including community pharmacists, have a role in aiding people with diabetes to effectively manage their condition and minimize their risk of severe diabetes-related illness.
Pharmacists, as healthcare providers, play an integral role in expanding access to healthcare. According to the WHO and the International Pharmaceutical Federation, pharmacy contributes to health enhancement. It assists people with health issues by providing convenient access with or without an appointment, promoting health, ensuring the effectiveness of medicines, and preventing medication-related harm.5) Numerous studies have indicated that people interact more with community pharmacists than their primary care physicians.6) Tsuyuki et al. report evidence that primary care pharmacists see patients between 1.5 and 10 times more often than primary care physicians.7)
It has been reported that pharmacists can effectively manage people with various chronic conditions, including smoking cessation, hypertension, diabetes, and high blood cholesterol.8) In addition, pharmacists can identify people at high risk of developing diabetes.9) Numerous international studies have demonstrated the role of community pharmacists in caring for people with diabetes in terms of managing glycaemic control,10) managing cardiovascular risk,11) and enhancing medication adherence.12) Studies conducted in the United States of America demonstrate a remarkable reduction in hemoglobin A1c (HbA1C) levels in people with diabetes treated at a pharmacist-based diabetes clinic and adhering to national standards for diabetes care.13,14)
Anderson et al.15) encouraged healthcare professionals to practice an empowerment approach for patient-centered collaborative diabetes care. Patient empowerment is defined as helping patients recognize and develop their innate capacity to be accountable for their own lives. The objective of patient education within the concept of empowerment is to assist patients in making decisions regarding their care and gaining clarity regarding their goals, values, and motivations.16) A few studies have examined the role of the empowerment approach in community pharmacy. However, in the United Kingdom, it has been reported that patient empowerment approaches are limited with Medicines Use Review (MUR) services.17)
Recently in Japan, the number of health facilities equipped with a Pharmaceutical Outpatient Clinic has increased.18) Pharmacists in Japan provide services to in-patient and home health care roles; however, their primary function remains to dispense medications. In Ireland, community pharmacies receive reimbursement for dispensing medicines for certain key clinical activities such as vaccine administration and supply of emergency hormonal contraception. However, services that are not renumerated in Ireland include medicines use reviews and health screening,19) and chronic disease management. The transition of the pharmacist’s role from dispensing medicines to utilizing their skills and knowledge as a medicines expert with a diversified role necessitates ongoing skill development. A study reported that by obtaining certified training as a diabetes educator, pharmacists could achieve a greater sense of job satisfaction.20) Adequately trained support staff can help alter patients’ expectations for on-demand services and encourage them to make diabetes management appointments with the pharmacist.20) Longer years of working experience can increase confidence levels,21) resulting in greater job satisfaction.
The studies mentioned above8–14) outlined the advanced role of pharmacists in diabetes care in several developed countries. However, in Ireland and Japan, such advanced pharmacy practice is not yet developed within the primary healthcare team. Regardless of the differences in the structure and approach of their pharmacy education and healthcare systems, Japan and Ireland share a commitment to providing high-quality healthcare to their citizens. Therefore, this study aimed to assess and compare community pharmacists’ attitudes, practices, and confidence regarding diabetes management in Japan and Ireland. Additionally, the study examined self-assessment of factors such as patient trust, overall job satisfaction, general concern for patients, and self-development among community pharmacists in both countries.
Ethical approval for the study was granted by the Health Research Ethics Board at Kyoto University, Japan, and by the Clinical Research Ethics Committee of the Cork Teaching Hospitals in Ireland. All the participants received a clear explanation of the study’s purposes and procedures, and all participants included in the study gave informed consent.
Study DesignA cross-sectional survey was conducted during the period between 2018–2019 by pharmacist researchers at Kyoto University, Japan, and University College Cork, Ireland.
SettingData were collected through a self-reported questionnaire. The questionnaire was developed based on surveys used in past studies of pharmacists and people with diabetes22–24) and a consultation between the researchers (HO, MB) and a panel comprised of pharmacist researchers with diabetes expertise at the University of Alberta and survey specialists at the Kyoto University School of Public Health.
The contents of the questionnaire were the same in both countries. In total, the survey tool consisted of eight sections. Section (A) asked respondents about their attitude to managing diabetes; section (B) asked about diabetes management practice; and section (C) assessed pharmacists’ confidence in managing people with diabetes in a community pharmacy. Each section (A), (B), and (C) consisted of six statements. Section (B) contained a question about the empowerment approach and a definition of empowerment was provided to participants. The following five sections concerned trust by patients, job satisfaction, concern with patients, and pharmacist self-development. All but one of the statements were answered on a five-point Likert scale, anchored by strongly disagree and strongly agree. Demographic questions, including duration of pharmacist practice, were also asked.
Participants were community pharmacists from Japan and Ireland. In Japan, participants were pharmacists in the city of Takatsuki who were members of the Takatsuki Pharmacists Association (N=240). In Ireland, all community pharmacists (N=3606) registered with the Pharmaceutical Society of Ireland were invited by email to participate in the study.
In Japan, the survey was in Japanese, and data were obtained through visiting community pharmacists in their workplace settings in October 2019. The pharmacists who agreed to participate could answer the questionnaire at the time or could complete it later. Pharmacists who chose the second option were revisited one week later to collect the completed questionnaires.
In Ireland, the survey was in English and was hosted on the Survey Monkey (www.surveymonkey.com) platform. Irish community pharmacists received an email inviting them to participate in the study and with a link to the survey in July 2018 and received a reminder email one month later. Based on the availability of research staff, the survey was conducted at different times in both countries.
Statistical MethodsThe survey data collected was analyzed quantitatively using the statistical analysis software SPSS Version 23 (IBM, Seattle). Demographics as the number of working years of the pharmacists are demonstrated as percentages. The Kolmogorov–Smirnov test was used to check the normality assumption. A 5-point Likert scale using the options “strongly disagree,” “disagree,” “not sure,” “agree,” and “strongly agree” was used for the item responses. A score was allocated to each Likert scale response, with strongly agree=5, agree=4, neutral=3, disagree=2 and strongly disagree=1. The mean score (±standard deviation: S.D.) of each questionnaire statement was then calculated. The percentage of participants answering “agree” or “strongly agree” to each statement was calculated. The mean of each item in section (A) attitude to diabetes management was calculated. Then the total mean for that section was calculated. The mean of all other survey sections was calculated in the same way. Results were expressed as mean and S.D. Comparisons were made between survey item responses from Ireland and Japan. Due to the unbalanced sample sizes between Japan and Ireland, Welch’s t-test was used to assess the statistical significance of the differences between the two settings. Differences were considered significant when the p-value <0.05. Simple linear regression was used to assess the relationship between (i) attitude, (ii) practice, (iii) confidence in diabetes management, (iv) trust by patients, (v) overall job satisfaction, (vi) concern with patients in general, knowledge, and (vii) self-development and the independent variable number of working years. This analysis was conducted for pharmacists in both countries. Data on the number of working years of pharmacists was available for both the countries. Therefore, simple linear regression was used to evaluate the relationship between the number of working years and different variables. Spearman’s correlation coefficient was used to assess the association between practice in diabetes management and (i) attitude; and (ii) confidence in diabetes management among the pharmacists of Japan and Ireland.
The sample was composed of 144 Japanese pharmacists and 388 Irish pharmacists. The response rate was 60% in Japan and 10.8% in Ireland. In Japan, 59% and Ireland 75% of respondents had 11 years or more of pharmacy experience (Table 1).
| Work experience (years) | Japan | Ireland |
|---|---|---|
| n=144 | n=388 | |
| n (%) | n (%) | |
| –4 | 29 (21) | 19 (5) |
| 5–10 | 29 (21) | 76 (20) |
| 11–20 | 55 (39) | 127 (33) |
| 21– | 28 (20) | 164 (42) |
The proportions of pharmacists who responded “Agree” and “Strongly agree” to questionnaire items in Japan and Ireland are displayed in Tables 2, 3. “Agree” and “Strongly agree” will be merged and referred to as “agreed” when describing future outcomes.
| Japan | Ireland | |
|---|---|---|
| n=144 | n=388 | |
| A) Diabetes management: Attitude | n (%) | n (%) |
| CP* should assess patient medication adherence | 133 (93) | 357 (93) |
| CP should know about oral diabetes drugs like dose, side effects etc. | 141 (98) | 374 (97) |
| CP should know preparation of insulin | 139 (97) | 283 (73) |
| CP should instruct patients on diet and nutrition | 101 (71) | 270 (70) |
| CP should provide exercise guidance to diabetics | 87 (61) | 221 (57) |
| CP should care for diabetic patients using the empowerment approach | 106 (74) | 265 (69) |
| B) Diabetes management: Practice | ||
| I assess patient’s medication adherence | 103 (72) | 326 (85) |
| I counsel diabetic patients on oral diabetes drugs | 108 (75) | 337 (87) |
| I discuss insulin treatment with my diabetic patients & educate about it | 62 (44) | 169 (44) |
| I offer nutritional advice to my diabetic patients | 67 (47) | 186 (48) |
| I emphasize importance of exercise to my patients | 56 (39) | 196 (51) |
| I use the empowerment approach with my patients | 36 (25) | 185 (48) |
| C) Diabetes management: Confidence: I am confident | ||
| My ability to assess patient’s medication adherence | 59 (41) | 317 (82) |
| My ability to explain oral diabetes medications | 73 (51) | 344 (89) |
| My ability in discussing insulin treatment | 43 (30) | 221 (57) |
| My ability in giving nutritional advice | 46 (32) | 224 (58) |
| My ability in advising about exercise | 37 (26) | 218 (57) |
| My ability to use the empowerment approach | 35 (25) | 185 (48) |
*CP: Community pharmacists.
| Japan | Ireland | |
|---|---|---|
| n=144 | n=388 | |
| Trust by patients | ||
| I feel that my pharmacy has a trusted reputation in the local area I am trusted as a pharmacist by patients | 71 (50) | 376 (97) |
| I am trusted as a pharmacist by patients | 53 (37) | 379 (98) |
| Job satisfaction | ||
| I sometimes get questions from patients about their medicines and prescriptions | 63 (44) | 383 (99) |
| Patients often consult me about their medical or health concerns | 61 (43) | 363 (94) |
| Patients sometimes consult with me about their diet and exercise habits | 54 (38) | 238 (62) |
| Patients often express their gratitude after a consultation | 87 (61) | 348 (90) |
| I try to provide good printed information for patients | 48 (34) | 268 (70) |
| The staff at my pharmacy cooperate with each other for benefit of patients | 110 (77) | 346 (90) |
| In the pharmacy, we have some autonomy regarding the quality of our work | 90 (63) | 298 (77) |
| Concern with patients | ||
| I try to understand each patient’s individual personality | 96 (67) | 350 (91) |
| I try to ask patients about their blood tests and other test results | 83 (58) | 241 (63) |
| I try to reduce patient concerns about their medication by providing a medication consultation | 108 (75) | 374 (97) |
| Knowledge | ||
| I can give explanations within a set time limit, depending on the patient’s comprehension level | 68 (48) | 338 (88) |
| I can educate the patient on their health condition with confidence | 41 (29) | 329 (85) |
| I can explain the patient’s course of treatment and prognosis | 52 (37) | 256 (66) |
| I can explain the doctor’s treatment plan to the patient | 50 (35) | 193 (50) |
| Self-development | ||
| I feel I am developing my communication skills through my work as a community pharmacist | 89 (62) | 343 (89) |
| I feel I am developing my clinical knowledge through my work as a community pharmacist | 80 (56) | 303 (79) |
| Overall, I feel a sense of achievement at the end of my work day | 87 (61) | 260 (68) |
| I feel fulfillment in my work | 92 (64) | 252 (65) |
*CP: Community pharmacists. **A&SA: Agree & Strongly agree.
Regarding diabetes management (Table 2), results show the disparity between pharmacists’ attitudes, practice, and confidence in key activities relating to the care of people with diabetes. This disparity was more significant among Japanese pharmacists than among Irish pharmacists. For example, among Japanese pharmacists, 93% agreed that they should assess patient medication adherence, 72% practiced this, but only 41% were confident in their ability to do so. In contrast, among Irish pharmacists (i), 93% agreed that they should assess patient medication adherence, 85% practiced it, and 82% were confident about it.
Differences in attitude, practice, and confidence were most remarkable concerning insulin preparation, diet, and exercise advice. Among Japanese pharmacists, 97% agreed that they should know the preparation of insulin, 44% put it into practice, and 30% were confident about it; 71% agreed that they should instruct patients on diet and nutrition, 47% practiced it, and 32% were confident to do it, and 61% agreed that they should provide exercise guidance to diabetics, 39% brought into practice while 26% were confident about it. Similar responses were seen in the Irish pharmacist cohort, where 73% agreed that they should know the preparation of insulin, 44% practiced it, and 57% were confident about it; 70% agreed that they should instruct patients on diet and nutrition, 48% practiced it, but 58% felt confident to do it; and 57% agreed that they should provide exercise guidance to diabetics, 51% brought into practice and 57% were confident about it.
While more Japanese pharmacists (74%) than Irish pharmacists (69%) agreed with the empowerment approach, just 25% of Japanese pharmacists practiced it, and 25% felt confident regarding it. This contrasts with 48% of Irish pharmacists who practiced it and 48% who felt confident regarding the empowerment approach.
Regarding the items under job satisfaction (Table 3), fewer than 44% of Japanese pharmacists (44%) agreed that they get questions from patients about their medicines and prescriptions, in contrast to Irish pharmacists (99%). 63% of Japanese and 77% of Irish pharmacists agreed that they have some autonomy regarding the quality of our work.
Regarding the concern with patients (Table 3); (i) 67% of Japanese and 91% of Irish pharmacists agreed that they try to understand each patient’s personality, and (ii) 58% of Japanese and 63% of Irish pharmacists agreed that they try to ask patients about their blood tests and other test results, (iii) 75% Japanese and 97% Irish pharmacists agreed that try to reduce patient concerns about their medication by providing a medication consultation.
Concerning knowledge (Table 3); 48% of Japanese pharmacists agreed that they could give explanations within a set time limit, depending on the patient’s comprehension level, compared to 88% of Irish pharmacists and relatively fewer Japanese pharmacists (29%) as compared to Irish pharmacists (85%) agreed that they could educate the patient on their health condition with confidence.
Pertaining the self-development items (Table 3); (i) 62% of Japanese pharmacists agreed that they developed communication skills through their work, while 89% of Irish pharmacists felt the same, and more than 60% of Japanese and Irish pharmacists felt a sense of achievement and fulfillment in their work.
The mean scores for each section of the questionnaire are outlined in Table 4. The result showed no significant difference in the mean attitude towards diabetes management between Japanese and Irish pharmacists. However, Japanese pharmacists reported being less confident in managing people with diabetes than their Irish counterparts (mean score 3.1±0.7 vs. 3.7±0.7, p<0.001). In addition, mean scores for practice in diabetes management were also significantly lower among Japanese than Irish pharmacists (3.4±0.7 vs. 3.6±0.7, p=0.004). Other variables, including self-assessed patient trust, overall job satisfaction, knowledge, concern for patients (all p’s<0.05), and self-development (p=0.005), were significantly higher in Irish pharmacists than in Japanese pharmacists (Table 4).
| Japan | Ireland | p-Value** | |
|---|---|---|---|
| mean (S.D.*) | mean (S.D.) | ||
| Diabetes management | |||
| Attitude | 4.3 (0.5) | 4.0 (0.6) | 1.000 |
| Practice | 3.4 (0.7) | 3.6 (0.7) | 0.004 |
| Confidence | 3.1 (0.7) | 3.7 (0.7) | <0.001 |
| Trust by patients | 3.4 (0.7) | 4.5 (0.5) | <0.001 |
| Job satisfaction | 3.5 (0.6) | 4.1 (0.5) | <0.001 |
| Concern with patients in general | 3.6 (0.8) | 4.1 (0.6) | <0.001 |
| Knowledge | 3.2 (0.7) | 3.8 (0.6) | <0.001 |
| Self-development | 3.7 (0.7) | 3.9 (0.8) | 0.005 |
*S.D.: Standard deviation. **p-Value: Welch’s test.
The relationship between the number of working years and various dependent variables was examined (Table 5). In Ireland, pharmacist confidence in diabetes management increased with an increase in working years, but other variables were not affected by pharmacist experience. Conversely, Japanese pharmacists showed higher job satisfaction levels, increased trust by patients, and more significant concern for patients in general with a higher number of working years.
| Japan | Ireland | |||||||
|---|---|---|---|---|---|---|---|---|
| Mean (S.D.) | F | R2 | p-Value | Mean (S.D.) | F | R2 | p-Value | |
| Attitude in DM | 4.3 (0.5) | 1.91 | 0.116 | 0.17 | 4.0 (0.6) | 0.94 | 0.002 | 0.334 |
| Practice in DM | 3.4 (0.7) | 1.88 | 0.013 | 0.173 | 3.6 (0.7) | 1.69 | 0.004 | 0.194 |
| Confidence in DM | 3.1 (0.7) | 2.77 | 0.02 | 0.098 | 3.7 (0.7) | 5.54 | 0.014 | 0.019 |
| Trust by patients | 3.4 (0.7) | 6.94 | 0.049 | >0.001 | 4.5 (0.5) | 0.23 | 0.001 | 0.629 |
| Job satisfaction | 3.5 (0.6) | 12.23 | 0.074 | 0.001 | 4.1 (0.5) | 0.21 | 0.001 | 0.646 |
| Concern with patients | 3.6 (0.6) | 10.26 | 0.070 | 0.002 | 4.1 (0.6) | 0.83 | 0.002 | 0.362 |
| Knowledge | 3.2 (0.7) | 8.78 | 0.059 | 0.004 | 3.8 (0.6) | 1.20 | 0.003 | 0.273 |
| Self-development | 3.7 (0.7) | 0.06 | 0 | 0.801 | 3.9 (0.8) | 2.65 | 0.007 | 0.104 |
DM: Diabetes management, S.D.: standard deviation.
Among Irish pharmacists, a positive and moderate correlation was found between practice in diabetes management and attitude to diabetes management (r=0.559) and a positive and strong correlation between practice in diabetes management and confidence in diabetes management (r=0.741). Among Japanese pharmacists’ moderate positive correlations were found between practice in diabetes management and attitude to diabetes management (r=0.456); and practice in diabetes management and confidence in diabetes management (r=0.663).
This study reported the attitude, practice, confidence, and various self-assessment factors among Japanese and Irish community pharmacists regarding diabetes management. The study revealed no difference in the attitude score related to diabetes management among the pharmacists of both countries but higher practice and confidence levels among Irish pharmacists. The study also showed that the self-assessment factors like trust by patients, overall job satisfaction, concern with patients in general, and self-development are significantly higher among Irish pharmacists than Japanese pharmacists. A positive correlation was found between practice and attitude in diabetes management and between practice and confidence in diabetes management among pharmacists in Japan and Ireland.
The findings from this study indicate that pharmacists in both countries value the provision of diabetes care despite different pharmacy structures in each setting. Pharmacists in both countries had positive attitudes toward diabetes care. However, in both settings, pharmacists reported lower scores for statements about counseling people with diabetes on insulin therapy and making lifestyle interventions. As chronic disease care focuses increasingly on primary care models, pharmacist interventions in self-management support will become ever more in demand. In the present study, just 44% of pharmacists in Japan and Ireland reported that they discuss insulin treatment and educate people with diabetes about insulin (Table 2). However, the RxING study10) conducted in Alberta, Canada, demonstrated that community pharmacists could initiate and manage insulin therapy for people with type 2 diabetes, significantly reducing HbA1c and fasting blood glucose levels. Therefore, once pharmacists are equipped with the skills to manage and deliver counseling on insulin therapy, they can provide effective advanced care to people with diabetes.
Furthermore, in our study, over 70% of pharmacists in Japan and Ireland believed that pharmacists should advise people with diabetes about diet and nutrition, and almost 60% believed they should advise on exercise. However, just 32% of Japanese and 58% of Irish pharmacists were confident in giving nutritional advice, and similar rates were reported for confidence in giving exercise advice. In a study by Douglas et al.,6) 87% of pharmacists surveyed in Northern Ireland believed that patients would value nutritional advice from a pharmacist, but 74% of respondents were not confident in providing dietary advice to a person with diabetes. This would suggest a disconnect among pharmacists about their role in providing lifestyle advice in diabetes care. Pharmacists want to support their patients in managing diet and exercise but may lack the knowledge, skills, or confidence to do so. Our study results showed a comparatively stronger correlation between practice in diabetes management and confidence in diabetes management among Irish pharmacists than among Japanese pharmacists.
Community pharmacists see people with the chronic disease more often than other healthcare professionals, in some cases at least monthly, giving frequent opportunities for pharmacists to make lifestyle interventions among those with chronic diseases such as diabetes. The COMPASS19) study conducted among Japanese pharmacists to support people with hypertension showed an improved confidence level after pharmacists were provided with training to provide lifestyle support and guidance based on empowering language and a coaching style of communication. The study’s findings demonstrated that training and the ability to practice providing lifestyle support services in an everyday setting improved pharmacists’ attitude and confidence in their ability to provide them, even when their time and environment remain unchanged. To ensure that pharmacists can deliver effective lifestyle interventions for diabetes and other chronic illnesses, it is essential that they receive training in communication skills and self-management support for chronic disease at undergraduate and postgraduate levels.
There is a strong association between knowledge of pharmacists and trust by patients.22) For example, Irish pharmacists in our study showed higher knowledge in educating patients regarding patients’ health conditions and doctors’ treatment plans and providing pertinent information in a limited amount of time. As a result, patients had a high level of trust in them, compared to pharmacists in Japan, who lacked knowledge and thus garnered less trust from patients. This finding is supported by a survey conducted in Ireland25) that found that among people with type 2 diabetes who were attending a community pharmacy, 99% were satisfied with their visit to the pharmacist, and 95% would recommend to others to see the pharmacist.
It has been reported26) that compassion, adequate time spent with patients, active listening, and assistance in advising and resolving patients’ problems all contribute to developing a trustworthy and respectful relationship between patient and pharmacist. Our study revealed that concern with patients among Irish pharmacists was more significant than among Japanese pharmacists as Irish pharmacists tried to understand patients’ personalities and reduced patient apprehension about their medication. However, Japanese pharmacists with more working years showed more significant concern for patients. Person-centered care, the ability to interact effectively, maintain, develop, and apply professional knowledge and skills, and the capacity to behave professionally can all contribute to increased trust.26)
In a previous Japanese study22) on yarigai, which translates as “being worthwhile,” participating pharmacists had higher overall job satisfaction, less concern for patients, and similar self-development skills as the participants in the present study. In contrast to our findings, a study conducted in Malaysia found no significant association between the number of years worked and job satisfaction.21) In the present study, a number of years of work experience influenced Irish community pharmacists’ confidence in managing diabetes. It is unsurprising that with longer professional experience, pharmacists achieve greater confidence. However, it is also essential that early career pharmacists have developed the knowledge and skills to manage people with chronic diseases before they enter the workforce as independent practitioners.
On the other hand, Japanese pharmacists’ assessment of their knowledge, concern with patients, trust by patients, and job satisfaction was influenced by years of experience. The self-reported confidence of Japanese pharmacists can be related to the tendency of Japanese people to be self-critical by nature, which may influence their response to self-perception questions. Paulhus27) incorporated two distinct factors into his study of socially desirable responses (SDR); self-deceptive enhancement (SDE) and impression management (IM). A cross-cultural study on Japanese and American pharmacy students showed lower SDE and higher IM among Japanese pharmacy students.28) However, no such data is available for Irish pharmacists. Self-deceptive enhancement is part of SDR and refers to an unconsciously entirely positive presentation of oneself, in other words, positively biased self-perception. Such characteristic traits may explain some of the differences between Japanese and Irish pharmacists reported in this study, particularly concerning confidence in diabetes management and self-assessed knowledge and trust by patients.
Future research can uncover best practices in pharmacy teaching and learning methodology in other countries by comparing various healthcare and pharmacy education systems and how these approaches can be applied in Japanese and Irish settings. Our study examined two geographically and culturally dissimilar nations to demonstrate the benefits of comparing countries that, if meticulously considered, could enhance healthcare policies, address global health issues, and advance scientific understanding.
LimitationsAn acknowledged limitation of this study is the unbalanced sample sizes among the participating pharmacists in Japan and Ireland. To minimize the problem, Welch’s t-test was used to assess the statistical significance of the differences between the two samples. Another major limitation was the time lag between the survey conducted in Ireland and Japan. The survey was issued in each country once ethics approval was granted and researchers were available to conduct the survey. A self-reported questionnaire can lead to response bias. As the participants were self-selecting, some respondents may have had a predisposed interest in diabetes care which may influence the survey results. Since data were also cross-sectional, no causal interpretations were possible. Due to the non-availability of demographic data, we could not assess the impact of demographic factors like age and gender on various variables. Finally, the questionnaire was distributed differently in each country. This is reflected in the sample size and geographical spread of participating pharmacists in each country. Since the study sample was small, the generalizability of the results may be limited. Also, in Japan a researcher was present in some cases when the survey was being completed and this may have influenced participant responses. There are cultural differences between the two research settings, and it is possible that pharmacists in Japan and Ireland may have a different interpretation of certain concepts in the survey. Future research may use qualitative methods to further explore and better understand results that were specific to each participating country.
The study results demonstrate less confidence in diabetes management and practice of diabetes management care among Japanese pharmacists compared to Irish pharmacists. These results can be used to identify education needs and to develop training programs for pharmacists in Japan and Ireland that may contribute to developing community pharmacy-based interventions for diabetes management.
The authors wish to thank all the community pharmacists in Takatsuki city, Japan, and Ireland who participated in the study.
For the survey in Japan, funding was provided by SPIRITS (Supporting Program for Interaction-based Initiative Team Studies) at 2017 Kyoto University. In Ireland, no funding was received for the work.
The authors declare no conflict of interest.
