R E S E A R C H Open Access
Factors associated with empathy among
community pharmacists in Lebanon
, Souheil Hallit
, Hala Sacre
, Sahar Obeid
, Aline Hajj
and Pascale Salameh
Introduction: Empathy is the cornerstone of the relationship between the healthcare provider and the patient. In
Lebanon, no studies have investigated the factors associated with empathy among community pharmacists. Hence,
the importance of this research to better understand empathy and help community pharmacists with this vital
aspect of their practice.
Objective: This study aimed to evaluate empathy and possible factors associated with it among Lebanese
Methods: This cross-sectional study was carried out between March and July 2018. It enrolled a proportionate
random sample of 435 community pharmacists from all Lebanese districts. The Epi info software calculated the
minimum sample size, based on a total number of 3762 community pharmacists, with an expected frequency of
50% of pharmacists with low empathy, and a 95% confidence interval. The minimal sample size required was 350
community pharmacists; our sample size was 435 to account for missing values.
Results: Our results revealed that 228 (53.4%) pharmacists had low empathy. Lower empathy was significantly
associated with more physical (Beta = −0.331) and mental (Beta = −0.126) work fatigue, higher age (Beta = −0.125)
and a practice experience between 3 years and less than 6 years compared to less than 6 months (Beta = −2.440).
Conclusion: This study shed the light on some factors associated with empathy among Lebanese community
pharmacists. Low empathy levels were significantly associated with factors such as age, practice experience, and
mental and physical work fatigue, all of which impact the practice, as the accepted model of pharmacy practice
requires that pharmacists establish effective communication and use interpersonal skills. Therefore, developing
empathetic communication skills is considered essential. Furthermore, increased mental and physical work fatigue
should not hinder community pharmacists’access to self-care, whether for their mental or physical health.
Keywords: Empathy, Community pharmacists, Work fatigue, Lebanon
Empathy is an ambiguous concept  that has been por-
trayed as a notion hard to define and measure . Mul-
tiple definitions exist, but the one adapted for the patient
care context is: “predominantly a cognitive attribute that
involves an understanding of patients’concerns, the cap-
acity to communicate this understanding, and an intention
to help”[1,3]. It is divided into three components:
affective or emotional, cognitive, and somatic. In this
paper, empathy will refer to emotional empathy.
Previous studies have established that empathy is the
cornerstone of the relationship between the healthcare
provider and the patient [1,4]. Indeed, greater empathy
was linked to better patient compliance [5,6], more
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* Correspondence: firstname.lastname@example.org;email@example.com
Eva Hobeika and Souheil Hallit are first co authors and contributed equally
to this work.
Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et
Toxicologie, Beirut, Lebanon
Full list of author information is available at the end of the article
Hobeika et al. Journal of Pharmaceutical Policy and Practice (2020) 13:32
accurate diagnosis  and prognosis , and increased
patient satisfaction . Among the various categories of
healthcare professionals, community pharmacists are
considered to be the most accessible
. Previous findings
showed that pharmacists who can communicate em-
pathetically build a good rapport with patients, thus im-
proving patient outcomes .
Evidence showed a negative association between empathy
and burnout, higher empathy being associated with lower
levels of burnout [10,11], noting that burnout includes
mental exhaustion, negative attitudes, and physical deple-
tion. Moreover, the increased psychological distress among
healthcare providers is related to decreased empathy and,
consequently, alters the quality of care provided .
Furthermore, higher depressive symptoms have been corre-
lated with lower empathy, suggesting that efforts to reduce
depression may improve levels of empathy . Also, good
quality of sleep and recreational activities and exercise were
also associated with higher empathy .
On the other hand, the relationship between empathy
and gender showed that women had higher empathy
levels compared to men, to a nearly significant degree [15,
16]. Although empathy is essential for patient care, it de-
clines as medical students progress through training .
However, evaluations of the relationship between age and
empathy among healthcare professionals, reveal that older
practitioners have a higher level of empathy, mainly attrib-
uted to the maturity acquired over the years .
In 1994, Mark H. Davis introduced a social psycho-
logical approach to empathy. It suggested that the indi-
vidual’s empathic abilities can plausibly influence their
management of conflict or other relationship-related be-
haviors. To inclusively define empathy, Davis proposed
an organizational model that would take into account
the different constructs falling under the broad heading
of “empathy”. This organizational model breaks
down a typical empathy encounter into an exposure of
the observer to the target, followed by a cognitive,
affective, and/or behavioral response taking place from
the observer’s side . Four related constructs make up
the skeletal structure of this model. Antecedents, pro-
cesses, intrapersonal, and interpersonal outcomes are de-
lineated by associations between them; especially with
constructs adjacent to each other. Davis’model (1994)
has been used extensively as the underlying theoretical
framework , in healthcare-related literature, aiming
at understanding the organizational approach to em-
pathy between healthcare providers and patients. It
opened the door towards a better understanding of em-
pathetic interactions in the workplace. Moreover, Gerace
et al. integrated themes into Davis’linear model of em-
pathy, delineating nurses’efforts for empathic communi-
cation with patients . This study has also added a
double-headed arrow to indicate perspective-taking as a
means to regulate nurses’emotions towards patients
(not present in the original model) . Other scales
have been used extensively among health professionals,
such as the Jefferson Scale of Empathy. However, it does
not offer theoretical tools necessary to establish a text-
book basis for the works of empathy, as compared to
Davis’model that provides an organizational aspect to
the empathic interactions between healthcare providers
Lebanon is a country with a political instability, espe-
cially after the displacement of over a million Syrian refu-
gees since 2012, which had a negative impact on the
country economically and socially [21,22] and created
higher xenophobic attitudes among Lebanese in general
. Furthermore, community pharmacists are not satis-
fied financially especially after the drop in the medications
prices following the decisions taken by the Ministry of
Public Health , which added more stressors to their
daily life and a lower quality of life .
Based on Davis and Gerace models, Fig. 1presents an
adapted version of the organizational model shedding
the light on empathy among community pharmacists. In
this figure, the antecedents construct enumerates several
factors that community pharmacists have brought to the
situation. These factors have the potential to influence
both processes and outcomes towards empathy  and
will be assessed throughout our study.
To the best of our knowledge, no studies have investi-
gated the factors associated with empathy among commu-
nity pharmacists. Hence, the importance of this research
to better understand empathy and help community phar-
macists with this vital aspect of their practice.
Therefore, this study aimed to evaluate empathy and
possible factors associated with it among Lebanese com-
General study design
This cross-sectional study was carried out between
March and July 2018. It enrolled a proportionate ran-
dom sample of 435 community pharmacists from all five
Lebanese Mohafazat. Geographically, Lebanon is divided
into five major districts, termed Mohafazat, Beirut,
North, Mount Lebanon, Beqaa, and South. This sample
is based on an exhaustive list provided by the Lebanese
Order of Pharmacists (OPL, the official association of
pharmacists in Lebanon). The methodology used is de-
scribed elsewhere [24,25].
Sample size calculation
According to the OPL list, a total of 3762 community
pharmacists (employers and employees) practice in 3157
community pharmacies distributed across all regions.
Hobeika et al. Journal of Pharmaceutical Policy and Practice (2020) 13:32 Page 2 of 9
The Epi info software calculated the minimum sample
size, based on a total number of 3762 community phar-
macists, with an expected frequency of 50% of pharma-
cists with low empathy (in the absence of since similar
studies in the country), and a 95% confidence interval.
The minimal sample size required was 350 community
Out of the 500 randomly distributed questionnaires (in
500 pharmacies), 435 (87%) were completed and col-
lected back; the remaining 65 (13%) corresponded to
pharmacists who refused to participate in this study.
Thus, the total sample included 435 participants.
Questionnaire and variables
The questionnaire was self-administered, closed-ended,
and available in either French or English, the teaching
languages in Lebanese schools of pharmacy. Well-
trained field workers distributed it to the pharmacists
after explaining the study objectives and obtaining writ-
ten informed consent. To ensure optimal objectivity,
pharmacists filled out the questionnaire without getting
any guidance on any of the questions. The average com-
pletion time was between 15 and 20 min. Field workers
collected back the questionnaires and sent them in
closed boxes for data entry. This process allowed to pre-
The questionnaire consisted of two sections. The first
section included socio-demographic and practice charac-
teristics, i.e., age, gender, demographic area, level of edu-
cation, years of practice, location of the pharmacy, the
approximate number of patients per day, job position,
working hours per week. A house crowding index was
also assessed. It was calculated by dividing the total
number of individuals living in the house by the total
number of rooms, excluding bathrooms and kitchen.
The second section included the following scales:
Toronto empathy questionnaire
It consists of 16 items . A five-point scale, ranging
between “never”and “often”, is used to rate each item.
Positively worded items 1, 3, 5, 6, 8, 9, 13, and 16 were
scored as: 0 (Never); 1 (Rarely); 2 (Sometimes); 3
(Often); 4 (Always), whereas negatively worded items 2,
4, 7, 10, 11, 12, 14 and 15 were reversed. All the scores
were summed to derive the total empathy score. Higher
scores designated higher empathy. The Cronbach’s alpha
in this study was 0.729.
The three-dimensional work fatigue inventory (3D-WFI)
This inventory consists of 18 questions divided into
three 6-question packs. Each pack measured one dimen-
sion of work fatigue: physical (e.g., feeling physical ex-
haustion at the end of the workday), mental (e.g., facing
Fig. 1 The Organization Model of Empathy in Community Pharmacists. Framework built using Davis’s (1994) linear antecedents, processes, intrapersonal and
interpersonal outcomes framework 
Hobeika et al. Journal of Pharmaceutical Policy and Practice (2020) 13:32 Page 3 of 9
difficulty to think and concentrate at the end of the
workday), and emotional (e.g., facing difficulty to show
and deal with emotions at the end of the workday) .
The score ranged from 0 (never) to 4 (every day). Higher
scores indicated higher fatigue in all three dimensions.
The Cronbach’s alpha values were 0.880 (physical work
fatigue), 0.710 (mental work fatigue), and 0.848 (emo-
tional work fatigue).
Hamilton depression rating scale (HDRS)
This 17-item scale is validated in Lebanon . It mea-
sures the severity of depressive symptoms (e.g., feelings
of guilt, depressed mood, suicide, etc.) . The total
score is computed by summing the answers to the 17
questions, with higher scores indicating higher levels of
depression. The Cronbach’s alpha value was 0.870 for
Beirut distress scale (BDS-22 scale)
This 22-item scale, validated in Lebanon, is used to
screen for stress . It assesses six factors in adults,
over the past week: demotivation, depressive symptoms,
psychosomatic symptoms, mood deterioration, intellec-
tual inhibition, and anxiety. The total score is calculated
on a 4-point Likert scale from 0 (not at all) to 3 (all of
the time), with higher scores indicating higher levels of
stress. In this study, the Cronbach’s alpha was of 0.935.
Lebanese insomnia scale (LIS-18)
This scale, validated in Lebanon, is used to screen for in-
somnia . It consists of 18 items scored on a 5-point
Likert scale from 1 (never) to 5 (always). Items 4, 18,
and 22 are reversed. Higher scores indicate higher in-
somnia. In this study, the Cronbach’s alpha was 0.811.
Forward and back translation procedure
The translation from English into French was carried
out by a translator and validated by a healthcare profes-
sionals’expert committee, and a language professional.
A backward translation was then performed by a native
English-speaking translator, fluent in French and un-
familiar with the notions of the scales. The expert com-
mittee compared the back-translated English version to
the original one and resolved discrepancies and incon-
sistencies by consensus. Both versions were piloted on a
sample of 20 pharmacists, before launching data collec-
tion. The results of the pilot sample were excluded from
the final datasheet.
A study-independent person, not involved in the data
collection process, performed the data entry. The statis-
tical analysis was done on SPSS version 23. Student t-
test was applied to check for associations between the
empathy score and dichotomous variables (i.e., gender).
The ANOVA test was used to compare means of 3 or
more groups (i.e., educational level). Finally, a stepwise
linear regression was performed, taking the self-reported
empathy score as the dependent variable, and all the var-
iables that showed a significant association in the bivari-
ate analysis as independent variables. A p-value was
significant when p< 0.05.
Sociodemographic characteristics of the participants and
Out of 500 distributed questionnaires, 435 (87%) were
completed and collected back. The mean age of the par-
ticipants was 38.97 ± 11.13 years, and 52% were males
Since the Toronto empathy scale does not have a cut-
off point, the median (= 60) was used as the cut-off
point. The mean empathy score was 59.02 ± 7.32, with
228 (53.4%) of the pharmacists having low empathy.
Table 2summarizes the scores of the intended measured
The results of the bivariate analysis related to the factors
associated with the empathy score are summarized in
Tables 3and 4. The mean empathy score was slightly
higher in females compared to males (59.95 vs. 58.17;
p= 0.013). The mean empathy score was significantly
higher in those having a Pharm.D degree (59.94) versus
all other education levels, in those living in South
Lebanon (61.41) compared to all other districts, and in
those having a practice experience of fewer than 6
months. Lower empathy was significantly associated with
older age (r = −0.135), higher mental (r = −0.401) and
physical (r = −0.399) work fatigue, higher insomnia (r =
−0.098), and higher stress (r = −0.233).
The results of the stepwise linear regression, taking the
empathy score as the dependent variable, revealed that
lower empathy was significantly associated with more
physical work fatigue (Beta = −0.331), more mental work
fatigue (Beta = −0.126), a practice experience between 3
years and fewer than 6 years compared to fewer than 6
months (Beta = −2.440), and older age (Beta = −0.125)
A better understanding of empathy leads to a clearer
comprehension of the patient-pharmacist interaction
and, therefore, to a constructive relationship. The results
of the multivariable analysis demonstrated that lower
empathy was significantly associated with older age,
Hobeika et al. Journal of Pharmaceutical Policy and Practice (2020) 13:32 Page 4 of 9
more physical and mental work fatigue, and a practice
experience between 3 years to fewer than 6 years com-
pared to fewer than 6 months.
Our results showed that 53.4% of the Lebanese com-
munity pharmacists have low empathy, consistent with
those found among American community pharmacists
(58% low empathy) . Professional interactions are usu-
ally based on objectivity and ethical standards. Hence,
the blurring of the line becomes understandable in pro-
fessions that involve a certain degree of care-giving.
Healthcare providers, such as pharmacists, get to a point
where they either get too carried out by patients’con-
cerns, or too little (low empathy). To reach an inter-
active balance, where empathy is not surpassed by either
sympathy or lack of care for patients, pharmacists must
learn to manage their empathetic behaviors .
In the present study, higher physical and mental work
fatigue were associated with lower empathy, in agree-
ment with results from previous research showing that
community pharmacists with emotional exhaustion,
depersonalization, and average job levels had mental dis-
engagement, and reduced their commitment to helping
patients [32–34]. Lebanese community pharmacists, al-
though held in high esteem by the population  have
a low level of job satisfaction due to financial constraints
. This dissatisfaction can explain the fact that phar-
macists feel less concerned about communicating with
patients and show less empathy towards them. Since the
literature establishes a connection between financial
constraints and lower empathy, it was used here to
hypothesize an explanation for physical and mental work
fatigue mediated by financial constraints.
Table 1 Sociodemographic and socioeconomic characteristics
of the participants (n= 435)
Factor N (%)
Male 223 (52.0%)
Female 206 (48.0%)
Beirut 77 (18.0%)
Mount Lebanon 150 (35.1%)
North 66 (15.5%)
South 48 (11.2%)
Bekaa 48 (11.2%)
Bachelor of science 250 (58.4%)
Pharm.D 106 (24.8%)
Masters 60 (14.0%)
PhD 12 (2.8%)
Employer 299 (68.7%)
Employee 128 (30.0%)
Less than 6 months 24 (5.6%)
6 months to 1 year 20 (4.6%)
1 year to less than 3 years 36 (8.4%)
3 years to less than 6 years 64 (14.8%)
6 years to less than 12 years 118 (27.4%)
More than 12 years 169 (39.2%)
Approximate number of patients seen per day in the pharmacy
< 10 3 (0.7%)
10–50 131 (30.8%)
50–100 188 (44.2%)
> 100 103 (24.2%)
Working hours per week
1–16 h per week 27 (6.3%)
17–31 h per week 48 (11.2%)
32–40 h per week 96 (22.3%)
More than 40 h per week 259 (60.2%)
Social status of the patients
Poor 26 (6.1%)
Middle 193 (45.6%)
High 16 (3.8%)
Do not know 185 (43.7%)
Family income per month
< 1000 USD 35 (8.9%)
1000–2000 USD 90 (20.7%)
2000–3000 USD 129 (32.7%)
Table 1 Sociodemographic and socioeconomic characteristics
of the participants (n= 435) (Continued)
Factor N (%)
> 3000 USD 140 (35.5%)
Mean ± SD
Age (in years) 38.97 ± 11.13
House crowding index 0.89 ± 0.44
Table 2 Description of the intended measured parameters in
Variables Mean ± SD
Empathy score 59.02 ± 7.32
Stress score 42.37 ± 13.49
Insomnia score 37.53 ± 8.44
Depression score 6.90 ± 7.01
Emotional work fatigue score 17.38 ± 10.42
Mental work fatigue score 8.36 ± 6.50
Physical work fatigue score 7.63 ± 8.29
Hobeika et al. Journal of Pharmaceutical Policy and Practice (2020) 13:32 Page 5 of 9
Our results showed that the third dimension of work
fatigue, called emotional work fatigue, was not signifi-
cantly associated with lower empathy. We speculate that
emotional work fatigue is affected by several factors, i.e.,
pharmacist’s state of mind, personality and other envir-
onmental cues that are not necessarily related to work
performance. Thus, it is not directly affected by one
source (the job at hand), like in the case of mental and
physical work fatigue.
Previous findings  evaluating the correlation be-
tween empathy and age among pharmacists from all sec-
tors (not just community pharmacists) have shown that
older health professionals had greater empathy and were
more assertive. Oppositely, our results revealed that older
age was significantly associated with lower empathy; this
difference can be explained by the job dissatisfaction expe-
rienced by the Lebanese community pharmacists .
Through continuous job dissatisfaction, pharmacists
become less concerned and caring, expressing lower em-
pathy levels towards their patients. As they get older, their
relationship with loyal patients is affected by the lack of
time taken to bond and empathize. So, this low level of
empathy might affect the pharmacist-patient relationship
and result in losing recurring customers over time, which
in turn ends in job frustration because of a dissatisfactory
income. Hence, the observed loop-cycle of older age lead-
ing to continuous job dissatisfaction, which leads to lower
Our study showed that having a practice experience
between 3 years and less than 6 years was significantly
associated with lower empathy. Previous studies  sug-
gest that professional experience years play a role in the
empathetic development process of community pharma-
cists: those more experienced develop empathetic skills
socially, through a social learning model. Thus, pharma-
cists look up to fellow pharmacists or professional men-
tors during their formative professional years and use
these observed attitudes and behaviors later on in their
professional interactions . Therefore, pharmacists hav-
ing 3–6 years of experience are in transition between
learning from experienced mentors and developing their
empathetic social skills. These pharmacists are in a mid-
dle zone, where they don’t need mentors anymore but
lack enough experience to navigate empathetic
Table 3 Bivariate analysis of factors associated with the
Variable Mean Empathy Score
Male 58.17 ± 6.93
Female 59.95 ± 7.61
Bachelor of Pharmacy 59.36 ± 6.83
Pharm.D. 59.94 ± 7.65
Master’s degree 56.96 ± 7.78
PhD 56.50 ± 7.30
Beirut 56.85 ± 7.58
Mount Lebanon 59.87 ± 6.89
North 58.28 ± 7.93
South 61.41 ± 5.64
Bekaa 58.72 ± 7.45
Years of practice
Less than 6 months 63.16 ± 4.87
6 months to less than 1 year 62.15 ± 8.73
One year to less than 3 years 59.25 ± 8.84
3 years to less than 6 years 57.85± 7.32
6 years to less than 12 years 59.46 ± 7.69
12 years or more 58.18 ± 6.49
Post hoc analysis: Districts (Beirut vs Mount Lebanon p= 0.033; Beirut vs Bekaa
p= 0.007); Years of practice (less than 6 months vs 3 years to less than 6 years
p= 0.034; less than 6 months vs 12 years or m ore p= 0.025)
Table 4 Bivariate analysis of continuous variables associated
with the empathy score
Emotional work fatigue
Mental work fatigue
p-value < 0.001
Physical work fatigue
p-value < 0.001
p-value < 0.001
Hobeika et al. Journal of Pharmaceutical Policy and Practice (2020) 13:32 Page 6 of 9
interactions on their own. Being in this intermediate
level can explain why they exhibit low empathy levels
when compared to the other groups, keeping in mind
that empathy is a social skill, mostly acquired through
social practice and interactions with as many patients as
possible through time. One way to improve empathy, in
this case, is to develop continuous and integrated strat-
egies to enhance empathic skills, and to progressively
evaluate the ability of pharmacists to respond empathic-
ally throughout their clinical progression .
Statistically, our results found no significant relation-
ship between depression score and empathy level. This
may seem counterintuitive, but several well-cited studies
explain the lack of association between different mea-
sures of empathy and depression. O′Connor et al. 
suggest that the ability to know what people are think-
ing, termed Theory of Mind (ToM), is a prerequisite for
empathy and is common in depressed people. However,
healthy empathy also requires an understanding of caus-
ality, which is affectively distorted in depression. There-
fore, the presence of depression is not associated with
empathy levels since depressed people may have normal
cognitive empathy levels, but a different empathy experi-
ence (due to the misinterpretation of empathy).
This study showed that lower levels of empathy were
significantly associated with older age, increased physical
and mental work fatigue, and practice experience be-
tween 3 years and less than 6 years. No future measures
or adopted solutions can affect the age-related factor.
However, it is possible to improve work fatigue condi-
tions. One way to decrease fatigue is for pharmacists: to
get proper rest, attend to the body’s physiological needs
by maintaining balanced lifestyles, ensure good physical
health, and receive the support needed for proper men-
tal health. Since empathy is an active dynamic process,
the community pharmacist becomes more receptive to
patients’needs after decreasing work fatigue. This way,
the pharmacist is better equipped to reach out to pa-
tients and fulfill the accepted model of pharmacy prac-
tice, which requires effective communication and the
use of interpersonal skills.
Pharmacy schools took many initiatives to include cur-
riculum modifications, aiming at enhancing empathy in
pharmacists during their training. Indeed, by going to
the source as early as possible, pharmacy students get a
solid formation on empathy and its psychosocial attri-
butes . Implementing different learning techniques
i.e., simulated learning with ethical scenarios, inter-
professional and problem-based learning, can lead to en-
hanced values, ethics, and decision-making . Several
studies show that empathetic relationships with patients
are followed by rewards, with empathetic dialogue lead-
ing to patient satisfaction, adherence to treatment
(sometimes), comprehension, and enhanced clinical out-
Our study has several limitations. First, information bias
may occur since the questionnaire used is based on self-
report of pharmacists’thoughts and interpretation of
symptoms. Social desirability bias may also be noted
since participants may want to seem conforming to so-
cial norms; this was taken into consideration by making
sure that they know that their answers remain anonym-
ous. Secondly, no causality inferences can be made since
this study is cross-sectional. Further longitudinal studies
are warranted to make causality inferences. However, for
this study, we were able to make associations (evaluation
of factors associated with empathy). Thirdly, some of the
scales used in the questionnaire, such as the Toronto
Empathy Questionnaire, are not validated in Lebanon.
Nevertheless, the results derived from these scales were
found to be noteworthy by the authors, since they pro-
vide consistency upon comparison to other studies.
This study shed the light on some factors associated
with empathy among Lebanese community pharmacists.
Low empathy levels were significantly associated with
factors such as age, practice experience, and mental and
physical work fatigue, all of which impact the practice,
as the accepted model of pharmacy practice requires
that pharmacists establish effective communication and
use interpersonal skills. Therefore, developing empath-
etic communication skills is considered essential.
Table 5 Multivariable analysis: Linear regression taking the empathy score as the dependent variable
Variable Unstandardized Beta Standardized Beta p95% Confidence Interval
Physical work fatigue −0.331 −0.375 < 0.001 −0.410 −0.252
Age −0.125 −0.187 < 0.001 −0.185 −0.065
Mental work fatigue −0.126 −0.152 0.015 −0.227 0.025
Years of practice 3 years to less than 6 years compared to less
than 6 months compared to less than 6 months
−2.440 −0.122 0.009 −4.275 −0.605
Hobeika et al. Journal of Pharmaceutical Policy and Practice (2020) 13:32 Page 7 of 9
Furthermore, increased mental and physical work fatigue
should not hinder community pharmacists’access to
self-care, whether for their mental or physical health.
We would like to thank all pharmacists who participated in this study.
SH and PS designed the study; EH ad SH drafted the manuscript; SH and PS
carried out the analysis and interpreted the results; SO and AH assisted in
drafting and reviewing the manuscript; HS edited the paper for English
language. All authors reviewed the final manuscript and gave their consent.
The author(s) read and approved the final manuscript.
The study protocol was approved by the Psychiatric Hospital of the Cross’s
Ethics committee (HPC-006-2019). From each pharmacist, their written
informed consent was acquired.
The authors have no conflicts of interest to disclose.
Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh,
INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et
Toxicologie, Beirut, Lebanon.
Faculty of Medicine and Medical Sciences, Holy Spirit
University of Kaslik (USEK), Jounieh, Lebanon.
Drug Information Center, Order of
Pharmacists of Lebanon, Beirut, Lebanon.
Departments of Psychology and Research,
Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
Laboratory of Pharmacology,
Clinical Pharmacy and Quality Control of Drugs, Faculty of Pharmacy, Pôle
Technologie-Santé (PTS), Faculty of Pharmacy, Saint-Joseph University, Beirut 1107
Faculty of Pharmacy, Saint-Joseph University, Beirut 1107 2180,
Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.
Medicine, Lebanese University, Hadat, Lebanon.
Received: 27 March 2020 Accepted: 1 June 2020
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