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Pharmacy 2023, 11, 7. https://doi.org/10.3390/pharmacy11010007 www.mdpi.com/journal/pharmacy
Article
Characteristics of Successful International Pharmacy
Partnerships
Gina M. Prescott 1,*, Lauren Jonkman 2, Rustin D. Crutchley 3, Surajit Dey 4, Lisa T. Hong 5, Jodie Malhotra 6,
See-Won Seo 7, Marina Kawaguchi-Suzuki 8, Hoai-An Truong 9, Elizabeth Unni 10, Kayo Tsuchihashi 11,
Nubaira Forkan 12 and Jeanine P. Abrons 13
1 Department of Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University at Buffalo,
Buffalo, NY 14214, USA
2 Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh,
Pittsburgh, PA 15261, USA
3 Department of Pharmacotherapy, Washington State University, Yakima, WA 98901, USA
4 College of Pharmacy, Roseman University of Health Sciences, Henderson, NV 89014, USA
5 Department of Pharmacy Practice, Loma Linda University School of Pharmacy,
Loma Linda, CA 92350, USA
6 Department of Clinical Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of
Colorado, Aurora, CO 80045, USA
7 Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, NY 12208, USA
8 Department of Pharmacy, Pacific University Oregon, Forest Grove 97116, USA; marina.suzuki@pacificu.edu
9 Department of Pharmacy Practice & Administration, University of Maryland Eastern Shore,
Princess Anne, MD 21853, USA
10 Social, Behavioral, and Administrative Sciences, Touro College of Pharmacy, New York, NY 10027, USA
11 School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15261, USA
12 School of Pharmacy, University of Toronto, Toronto, ON M5S, Canada; nubaira.forkan@utoronto.ca
13 Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa,
Iowa City, IA 52242, USA
* Correspondence: gmzurick@buffalo.edu; Tel.: +1-716-645-4784
Abstract: Recommendations for global pharmacy collaborations are predominately derived from
US institutions. This study utilized semi-structured interviews of global collaborators to assess im-
portant partnership components. Interviewees stated personal connections and understanding of
each other’s programs/systems were key components. Additionally, collaborators indicate that mu-
tual benefits between partners can exist without the requirement for bidirectional exchange of learn-
ing experiences, and request and value partners and learners who are culturally aware, global citi-
zens. This structured interview approach provided key insight into how to develop mutually ben-
eficial, sustainable partnerships and provides additional confirmation that the five pillars of global
engagement align with an international audience.
Keywords: global health; partnerships; pharmacy education; international; experiential education
1. Introduction
Global collaborations between colleges and schools of pharmacy have been increas-
ing over the past decade [1,2]. Developing international collaborations can be time-con-
suming and challenging due to differences in policies, laws, infrastructure, and cultural
considerations. These collaborations are often initiated by an institution in a high-income
country and may or may not reflect a sustainable, mutually beneficial relationship. The
American College of Clinical Pharmacy (ACCP) has developed an expert-based opinion
paper on developing collaborations that are centered around five pillars including: sus-
tainability, shared leadership, mutually beneficial partnerships, local needs-based care,
and host-driven education [3]. There are also additional recommendations available for
Citation: Prescott, G.M.; Jonkman,
L.; Crutchley, R.D.; Dey, S.; Hong,
L.T.; Malhotra, J.; Seo, S.-W.;
Kawaguchi-Suzuki, M.; Truong,
H.-A.; Unni, E.; et al. Characteristics
of Successful International Pharmacy
Partnerships. Pharmacy 2023, 11, 7.
https://doi.org/10.3390/
pharmacy11010007
Academic Editor: Daisy Volmer
Received: 29 November 2022
Revised: 23 December 2022
Accepted: 29 December 2022
Published: 1 January 2023
Copyright: © 2023 by the authors. Li-
censee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and con-
ditions of the Creative Commons At-
tribution (CC BY) license (https://cre-
ativecommons.org/licenses/by/4.0/).
Pharmacy 2023, 11, 7 2 of 13
colleges and schools of pharmacy for planning and managing short-term medical mission
trips and advanced pharmacy practice experiences [4–7]. These recommendations have
been mainly derived from pharmacists/faculty in the United States (US). There are few
recommendations based on direct input from non-US-based pharmacists. Furthermore,
no available recommendations used a semi-structured interview approach. This study
aims to provide standardized themes and direct feedback on collaborative agreements to
US institutions from the perspectives of international partners.
2. Materials and Methods
2.1. Study Design
The American Association of Colleges of Pharmacy Global Education Special Interest
Group (SIG) Global Outreach Committee (GOC) was comprised of eleven faculty mem-
bers with and without global partnerships from US-based pharmacy institutions. After a
review of the literature and several discussions, the committee developed an interview
guide consisting of twenty-one questions organized into five categories, based on princi-
ples of developing international partnerships (See Table 1). These categories were further
mapped to the five pillars of global health engagement. Committee members pre-tested
the interview questions with an international collaborator and modified the guide for clar-
ity and purpose. These modifications made the question categories more specific. This
included replacing the category of “structure” with “student placement and student/fac-
ulty exchanges” and combining outcomes into the assessment category. An additional
change included opening the interview with a broad question to set the tone for the inter-
view. This question was “What factors might you consider when deciding whether to
partner with a US University or College of pharmacy?” Finally, we rearranged our ques-
tion order for better context based on the changes with the categories of questions. The
research team reviewed the finalized interview guide to ensure coverage of all five pillars.
The COREQ checklist was applied to the study (Appendix A) [8].
Table 1. Interview Guide.
Category
Questions
Pillar 1
General
What factors might you consider when deciding whether
to partner with a US University/College of Pharmacy?
1–5
Process
What challenges might exist in creating a formal agree-
ment, such as a
memorandum of understanding (MOU)?
2–3
What would you expect to see in such an agreement?
1–5
Student Placement
How do you weigh the benefits or harms of student ex-
changes or placements at your institution?
1–5
What preparation should students be aware of when trav-
eling to a host
country?
Can you tell me about factors that impact the num-
ber/type/time of student placements?
What factors are consistent from year to year and what
factors are dependent upon the current context?
What factors would influence the time of year that would
be appropriate for students to travel?
What supervision would be expected for students partici-
pating in international placements? From the host site?
From the institutional site sending students?
In what types of experiences would you consider involv-
ing students at your institution or partner institutions?
Pharmacy 2023, 11, 7 3 of 13
What is expected of the US students while at the site and
what
contributions could they make?
From your perspective, what hands-on roles do you feel
are most
appropriate for US-trained students
What strategies have you seen that might allow for stu-
dent
involvement?
What limitations or challenges exist that would limit inter-
national learners at your site?
Student or Fac-
ulty/Staff Exchange
In thinking about mutually beneficial partnerships, what
would be the value for your students or faculty/staff to re-
ceive?
3
What might be some challenges that exist in developing
bilateral exchanges for either students or faculty/staff?
1–5
Assessment
How do you evaluate exchange students on rotation?
2, 5
What are your thoughts about completing evaluations for
US students?
3, 5
What would make you more comfortable or less comforta-
ble with evaluating US students?
3, 5
How would you define a successful collaboration between
a US school of
pharmacy and your institution?
1–5
What measures define a valuable experience for students?
For the site? For
others?
1–5
1 Pillars include: 1—Sustainability, 2—Shared Leadership, 3—Mutually Beneficial Partnerships, 4—
Local Needs Based Care, 5- Host Driven Education.
2.2. Participants
The GOC developed a list of pre-existing collaborators with a minimum of two to
three collaborators from each WHO region (Africa, Americas, Eastern Mediterranean, Eu-
rope, South East Asia, and Western Pacific). Collaborators were known by the committee,
either through direct affiliation or through professional pharmacy organization service
and had experience in global collaborations. Collaborators were selected to be interviewed
on a first-listed basis and upon response to a standardized recruitment email from the
study investigators. Interviewers contacted collaborators at week one; if there was no re-
sponse, one additional contact was made at week two, requesting an interview. Upon
contact, collaborators were made aware of the study purpose and that investigators were
members of the GOC.
2.3. Data Collection
If the collaborator agreed to participate in the standardized interview, two investiga-
tors and the collaborator established a mutually agreed-upon time using Zoom Video
Communications, Inc™ (San Jose, CA, USA). The collaborator was also provided with an
informed consent document to review prior to the interview. One investigator conducted
the interview, while the other scribed. Both faculty members had prior experience with
global collaborations and the faculty interviewers had previous experience conducting
qualitative research.
Pharmacy 2023, 11, 7 4 of 13
Upon initiating the interview, the interviewer obtained informed consent, changed
the interviewee’s name to a number (for anonymity), and recorded the conversation for
transcription purposes. Interviews lasted approximately one hour and were conducted
between November 2021–June 2022.
2.4. Data Analysis
Qualitative data analysis followed an inductive and deductive content analysis pro-
cess. A sample size was not determined a priori, instead the GOC team aimed to include
participants from diverse regions and continued interviews until thematic saturation was
achieved meaning that no new concepts emerged from additional interviews. First, upon
completion of each interview, an investigator reviewed and corrected the auto-transcrip-
tions and removed any identifiable information before sharing the transcript with the full
GOC. Next, a codebook was developed from the review of two de-identified transcripts
using an open coding process. Using axial coding, the GOC then integrated the five pillars
into the codebook. Two independent coders reviewed each transcript and discussed and
reconciled any discrepancies. Additional codes were added to the codebook as required
through the analysis process. The final thematic analysis was completed through an im-
mersion-crystallization process whereby themes were coalesced from the codes and then
interrogated by reviewing supportive quotes to ensure that themes aligned with the data.
Overall, the analytic strategy proceeded through an iterative process requiring review of
transcripts and team discussion where, the team developed and confirmed key themes.
3. Results
Fourteen interviews, out of 17 attempts, were completed with 17 international part-
ners representing 14 countries from five WHO regions: Africa (3), Americas (3), Europe
(3), Eastern Mediterranean (2), and the Western Pacific (3).
Four themes were developed and connected to the pillars of global health engage-
ment (Table 2).
Table 2. Global Health Interviews Major Themes and Supportive Pillars.
Theme
Global Health
Pillar
Personal connec-
tions are critical to
partnership devel-
opment and sus-
tainability
Sustainability,
Shared Leader-
ship
Understanding of
each other’s pro-
grams and sys-
tems is essential
for a successful
collaborative part-
nership
Shared Leader-
ship, Host-
driven Educa-
tion
Mutual benefits
can exist without
bidirectional ex-
change and may
be different for
each partner
Mutually Bene-
ficial Partner-
ships, Local
Needs-Based
Care, Host-
Driven Educa-
tion
Pharmacy 2023, 11, 7 5 of 13
Key qualities for
supporting overall
collaboration and
partnership in-
clude open-mind-
edness, adaptabil-
ity, global citizen-
ship, and cul-
tural/structural
awareness
Sustainability,
Mutually Bene-
ficial Partner-
ships, Host-
Driven Educa-
tion, Shared
Leadership, and
Local Needs-
Based Care
The first theme highlighted how personal connections are critical to partnership de-
velopment and sustainability. Participants gave examples of the importance of personal
connections to developing international partnerships but noted that sustainability re-
quires expansion beyond just one faculty member. Participants also described the value
of partners with global health experiences as those partners have a better understanding
of differences and similarities and adapt smoothly. Participants described building trust
and rapport with the institution and individual partners as a crucial to relationship devel-
opment. Participants noted the importance of a transition plan if the faculty lead at either
institution leaves to ensure the partnership remains and thrives. Supportive quotes:
“ I know (the collaborator). There is a personal, level of trust, and we can get
something done. I know MOUs are good to get institutional support. But, if we
don’t have an inside person that we can deal with, the MOU becomes not use-
ful.”
“ When you sign an MOU, the partners need to agree to what would be the
benefits in a partnership…I was lucky…those people that approached us, they
knew upfront what they could contribute in terms of research, collaboration, a
teaching collaboration, and so our biggest benefit was this.”
“I really look at relationships I have when I’m at different conferences, and we
look to see whether or not there are any similarities within our institutions or
where we can work together. And that’s where I start from.”
The second theme emphasized the importance of understanding each other’s pro-
grams and systems is essential to successful collaborative partnership. Participants noted
that due to differences in pharmacy education around the globe, it is critical for partners
to understand each other’s programs. This understanding includes recognition of: the tim-
ing of the academic year, holidays, and other cultural events or weather conditions; the
evaluation strategies used for student assessment and expectations of students; the struc-
ture of the overall program including priorities and how students are trained; student
levels (i.e., expectations for first year students versus third year students as well as differ-
ent global educational programs such as Bachelor of Pharmacy versus Masters of Phar-
macy versus Doctorate of Pharmacy); and prior knowledge before coming on site includ-
ing priorities for the country, the university, and the profession. Further, it’s essential to
consider the needs of partner sites, particularly in countries where resources are limited,
including staff support to coordinate experiences and space/capacity restrictions. Finally,
participants discussed the need to understand each other’s overall health systems, includ-
ing how the training programs fit into the context of the overall health system. Adequate
planning of logistics and coordination are critical to ensure the successful execution of
local needs-based care and host-driven education.
“There are differences in practice, which I think being a preceptor, we need to
help the students understand this and how to manage certain issues so that, at
the end of the day, it will be a win-win situation.”
Pharmacy 2023, 11, 7 6 of 13
“Yeah, I think what is most complicated for us, more difficult for us to under-
stand is how the US education system works. Like, you enter the university sys-
tem, and then you take all these different classes and subjects and then you mas-
ter or take your degree. I don’t know at some point you decide you want to, how
do you say that, you want to major at some point. I don’t know”
“Institutional memory has been kept because the champions remained constant.
Other people may think differently. And you remember also cultural exchange
rates. You develop bonds, personal bonds, you know cultural bonds. Those are
taken for granted, because you know, sometimes when there’s no funding the
push to look for funding, this is coming from inside personally, because you
have not developed your bond with the support group or with children by one
part of the world, and so forth.”
The third theme was that mutual benefits can exist without bidirectional exchange,
and those benefits may differ for each partner. Participants felt that equitable partnerships
do not always require identical exchanges. Needs and opportunities vary between insti-
tutions. Participants discussed the benefits of layered learning with different levels of
learners in other programs sharing what each knows. Participants discussed inequities in
funding and resources between global sites and the impact on the physical exchanges of
students. For instance, students from high-income countries may be able to support travel,
while travel may be more difficult for students in low- or middle-income countries. Par-
ticipants discussed sharing knowledge and best practices, including the experience of
working with limited resources such as the WHO essential medicine lists and vice versa.
Finally, participants noted that both parties might perceive and interpret successful col-
laboration differently. Moreover, it is vital to understand a particular institution’s priori-
ties and needs to create a successful partnership and that mutual benefits sometimes carry
different weights for each party. Supportive quotes:
“Partnerships definitely help strengthen our voice when it comes to health care
within the country.”
“Joint publications. You and I published a paper together, or write a book chap-
ter together. And then collaborate [with] students together. That is more than
enough. And then, if we are released into the research, we can write a grant.
Joint grant writing, and we can submit… Okay, otherwise we are jointly training
students, so we might as well jointly develop curriculum.”
“So there has to be trust instead of a document [i.e., MOU]…Once you have a
good partner, that is willing to work on things.”
“I had two students from (institution), they helped me put together the phar-
macy program here. They used their knowledge of pharmacy and my
knowledge, and then the government pharmacist knowledge… If it wasn’t for
that, there would be a massive shortage of pharmacists… right now.”
Finally, partners identified open mindedness, adaptability, global citizenship, and
cultural and structural awareness as essential qualities for partners and learners. Partners
need to be thoughtful about preparing learners who are open-minded, can critically eval-
uate assumptions, can identify collectivist versus individualist perspectives, and maintain
a global rather than ethnocentric mindset. These qualities are necessary for effective part-
nerships and high-quality experiences for learners.
“I wish that going forward when we have a critical mass of mentors that under-
stand global health, what international exchanges is all about. We will do all the
technical, but we must know that we are dealing with a holistic situation…and
a cultural exchange aspect.”
Pharmacy 2023, 11, 7 7 of 13
“I think our biggest expectation is that they should be willing to learn new things
because …working in a low to middle income country you might have all the
knowledge, you might know the best way to treat a patient, but that medicine, all
that treatment is not available in the country so how do you juggle that. So in that
instance, that you must be willing to listen, learn how we do things, and it’s not nec-
essarily that it’s the best way to do things but it’s the only way we have and we have
to make that work. We discussed this earlier, you know, is to be culturally sensitive
because we dealing also with this issue of colonialism. And you know as an academic
bringing in US students I get confronted at management level about colonial-
ism…They need to be sensitive towards that and not get offended……It’s trying to
give them that opportunity to give a plan of how they would treat this patient in the
US, but then to bring the context to them the challenges that we face with access to
medicine and then develop a new plan and that willingness to learn and change be-
comes important.”
4. Discussion
This is the first study we are aware of that provides a unique insight into pharmacy
partnerships from internationally based key informants representing different regions
from around the world. Interview approaches with international partners have been pre-
viously utilized to assist with important pharmacist advancements, including pharma-
cists as immunizers and understanding the role of continuous professional development
in the health professions [9,10]. Similarly, US schools of pharmacy utilized a network ap-
proach with healthcare systems to determine how to best meet the needs of their partners
and maximize commitments to each other [11]. Finally, the WHO commissioned a report
that explored themes of global interprofessional collaboration in different WHO regions
to determine how collaborative practice was defined across the world [12]. A strength of
our study was the provision of an open dialogue for global collaborators to discuss their
viewpoints on essential components of global partnerships. While the interview had
structured questions, interviewees could speak freely on any aspect to partnership devel-
opment that they felt was important. The inductive thematic analysis of 17 interviews re-
vealed many key issues that were able to be linked to the five pillars of global health en-
gagement [3].
Personal connections and trust between partners were considered key factors in con-
tributing to the sustainability of programs. This is in accordance with the ACCP pillars on
ethical engagement for sustainability. The reputation of an individual and their ability to
navigate cross-cultural communication as well as understand the collaborators’ perspec-
tive of mutual benefit may be as important as the reputation of a particular institution.
Global partnerships are often started through individual connections, and while the liter-
ature on this is mixed with some recommending utilizing pre-existing relationships al-
ready established at your college or university, the key factor here is likely trust with the
intent to develop a sustainable partnership [6,13].
Personal connections were again mentioned along with a shared understanding of
each other’s systems and programs. These connected to the ACCP pillar of shared leader-
ship. Developing a clear goal for each institution based on their local healthcare or aca-
demic setting was important to the interviewees. This is consistent with literature on the
focusing on needs-based care [6,13]. Importantly, participants discussed challenges that
they have faced with students’ work being evaluated using US-based evaluations. Inter-
viewers discussed the need for cultural and structural sensitivity to avoid using a high-
income country lens to look at local needs-based interventions rather than looking to part-
ners for their feedback on the work of students in non-US settings. Examples of long-term,
sustainable global partnerships focused on local needs-based care, have demonstrated im-
provements in patient outcomes and enhancing workforce training [14–18]. In Zimbabwe,
a focus on HIV clinical pharmacology and post-doctoral training programs has improved
research training, optimization of antiretroviral use, and development of national
Pharmacy 2023, 11, 7 8 of 13
treatment guidelines [14,15]. In Kenya, improvements through inpatient and outpatient
pharmacy settings have improved clinical pharmacy training and workforce development
[16]. In West Africa, an antimicrobial stewardship train-the -trainer program improved
workforce capacity in this identified area of need [17]. Finally, in Thailand, improvements
to advance clinical pharmacy education led to pharmacists’ recognition in national initia-
tives/practice guidelines, post-graduate programs, and pharmacy workforce [18].
The third theme centered around the concept that mutually beneficial goals did not
necessarily mean that an identical experience was needed in exchange of educational ex-
periences. This was connected to the mutually beneficial partnership and local needs-
based goals stemming from the consideration that partners discussed what their institu-
tions valued and needed for their learners. While our research team initially thought it
should be equitable (as in physically exchanging on a student for student basis) our part-
ners reminded our team that equity meant more than just student exchange. Collaboration
outcomes such as publications, the establishment of programs, and positive impacts to a
country’s health system represented alternative markers of collaboration success. All the
sustainable programs previously mentioned have cited these markers as well in their
measures of successful partnerships [14–18]. Travel was not an assumed component of the
collaborations, and in some instances, partners felt that student travel should be deprior-
itized as it has a limited impact on the institution. Bringing US students to areas in which
clinical practice by pharmacists is growing was also discussed as a beneficial opportunity
for collaborative development and has been discussed in the literature as well [6]. An im-
portant component to the mutually beneficial partnership pillar includes providing trans-
parency, developing shared goals, and recognizing a level of equity and mutual respect
[3]. In Taiwan, development of clinical pharmacist services and a residency program
through collaborations has been recognized as an output of successful partnerships. This
can help to improve the overall value of pharmacist globally and with patient care [19,20].
The fourth theme discussed the need for partners and learners to be open-minded,
adaptable, and in general, global citizens. This was a common theme amongst all inter-
viewees. The concept of developing students who are global citizens is a newer phenom-
enon in academia broadly and within pharmacy school curricula specifically [21,22]. The
growing acknowledgement of global interconnectedness reinforced through recent
events, including the pandemic has accelerated a priority on decolonization and identify-
ing and addressing ethnocentrism [22,23]. The Consortium of Universities for Global
Health (CUGH) has competencies related to the development of a global health citizen
and created a toolkit to assist with competency attainment [24,25]. Tools, such as the Cul-
tural Intelligence Tool (CQ), the Intercultural Development Inventory (IDI), or others
could be explored to help further create prospective mindfulness, and reflective abilities
of learners before exchanges [26–28]. In preparing to engage in shared work and learning,
elements that should be presented to learners and discussed to ensure common under-
standing between collaborators include cultural humility, cultural nuances or differences,
and structural factors that may influence the collaboration, health system, and educational
experiences/dynamics.
One area that was not mentioned as frequently but was integrated into many recom-
mendations from participants was the role of an interprofessional approach to global ex-
changes. This is likely due to a few reasons. The importance of interprofessional education
and collaborative practice for the global healthcare workforce has been recognized by the
WHO, and the pharmacist’s role in an interprofessional environment is also noted in the
2022 International Pharmaceutical Federation Global Competency Framework for Educa-
tors & Trainers in Pharmacy [22,29]. So, while there is support for these initiatives and
improvements have been seen in perspective towards interprofessional education and
practice, these experiences still vary widely across the world [30,31]. The lack of specific
commentary in our study may be due to the interview questions not specifically address-
ing interprofessional approaches or that it was implied by discussing advanced practice
models.
Pharmacy 2023, 11, 7 9 of 13
Limitations to our research include the small number of interviewees per geographic
location, although we continued interviews until thematic saturation was achieved. In ad-
dition, interviewed individuals included existing partners, thereby the study has the po-
tential for social desirability bias.
Future areas of research include providing a series of perspectives on individual
WHO regions, expansion on the topic of interprofessional educational efforts and how
successful collaborations achieve these goals, and how didactic education can be linked
to experiential education with both the host and partner institutions in various WHO ge-
ographical regions.
5. Conclusions
Overall, global perspectives on successful and sustainable partnerships are consistent
with expert-based guidance and descriptions published from sustainable programs.
While most partners agreed that mutual respect and understanding of each other’s pro-
grams and goals are essential, how a successful partnership is achieved and measured can
vary. Following a local needs-based approach may assist with developing partnerships.
Author Contributions: Conceptualization, G.M.P.,, E.U., R.D.C., L.T.H., M.K.-S., L.J., J.P.A.,S.D.,
J.M, H-A.T, and S.-W.S.; methodology, G.M.P., E.U., L.T.H., R.D.C., M.K.-S., L.J., J.P.A., S.D., J.M.,
H-A.T., and S.-W.S.; formal analysis, G.M.P., L.T.H., M.K.-S., R.D.C., L.J., J.P.A.,, K.T.,J.M.,H-
A.T.,K.T., N.F., and S.-W.S.; investigation, G.M.P., L.T.H., M.K.-S., L.J., H-A.T., and S.-W.S.; writ-
ing—original draft preparation, G.M.P., E.U., L.J and J.P.A.; writing—review and editing, G.M.P.,
J.M., J.P.A., L.T.H., R.D.C. and M.K.-S.; supervision, G.M.P.; project administration, G.M.P.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted in accordance with the Declara-
tion of Helsinki and approved by the Institutional Review Board of University at Buffalo (protocol
code STUDY00005547 on 06/10/2021), Loma Linda University (IRB# 5210269) on 07/12/2021. Pacific
University (IRB#078-21) on 06/10/2021. University of Pittsburgh (STUDY21100079) on 11/9/2021, Al-
bany College of Pharmacy and Health Sciences (IRB#21-000C on 9/16/2021).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the
study.
Data Availability Statement: Not applicable.
Acknowledgments: We would like to thank our international partners for participating in the in-
terviews.
Conflicts of Interest: The authors declare no conflicts of interest.
Appendix A
Table A1. COREQ Checklist.
Item No
Guide Question/Description
Page No
Domain 1: Research Team and Reflexivity
Interviewer/Facilitator
1
Which author/s conducted the inter-
view or focus group? GP, SS, LJ, JA,
LH, MKS
Methods-4
Credentials
2
What were the researchers’ creden-
tials?
PharmD
Student (KT/NF)
Title Page
Occupation
3
What was their occupation at the
time of the study?
Faculty
Student (KT/NF)
Title Page
Pharmacy 2023, 11, 7 10 of 13
Gender
4
Was the researcher male or female?
Both were represented
Experience and Training
5
What experience or training did the
researcher have?
All interviewers had qualitative re-
search experience
Methods-4
Domain 1: Relationship with participants
Relationship Established
6
Was a relationship established prior
to the study commencement?
Yes, to varying degrees
Methods-3
Participant Knowledge of the Interviewer
7
What did the participants know
about the researcher?, e.g., personal
goals, reasons for doing the research?
Upon contact, collaborators were
made aware of the study purpose
and that investigators were members
of the GOC. Informed consent was
sent to review via email.
Methods-3
Interviewer Characteristics
8
What characteristics were reported
about the interviewer/facilitator?
Faculty, GOC member
Methods-4
Domain 2: Study Design
Methodological Orientations/Theory
9
What methodological orientation was
stated to underpin the study?
Content Analysis
Methods-4
Sampling
10
How were the participants selected?
Purposive
Methods-4
Method of Approach
11
How were the participants ap-
proached?
Email
Methods-3
Sample Size
12
How many participants were ap-
proached?
17 approached; 14 different sites in-
terviewed
Results-4
Non-participation
13
How many people refused to partici-
pate or dropped out?
3 did not respond
Results-4
Setting of Data Collection
14
Where was the data collected?
Workplace, Zoom
Methods-4
Presence of Non-participants
15
Was anyone else present besides the
participants and researchers?
No
Methods-4
Description of Sample
16
What are the important characteris-
tics of the sample?
All participants were engaged in
global health collaborations in their
county
Interviews were conducted between
November 2021-June 2022
Methods-4
Pharmacy 2023, 11, 7 11 of 13
Interview Guide
17
Were questions, prompts, guides pro-
vided by the authors? Was it pilot
tested?
Interview Questions were used; Pre-
testing was performed with one in-
ternational partners
Methods-2
Table 1
Repeat Interviews
18
Were repeat interviews carried out?
No
Audio/Visual Recording
19
Did the research use audio and visual
recording to collect the data?
All interviews were recorded and
transcribed
Methods-4
Field Notes
20
Were field notes made during
and/or/after the interview or the fo-
cus group?
Yes, one researcher served as a scribe
Methods-4
Duration
21
What was the duration of the inter-
views or focus groups?
1 h
Methods-4
Data Saturation
22
Was data saturation discussed?
Yes, continued until enough partici-
pations
Methods-4
Transcripts Returned
23
Were transcripts returned for com-
ments or correction?
Domain 3: Analysis and Findings
Number of Data Coders
24
How many data coders coded the
data?
Two for each interviewer
Methods-4
Description of the Coding Tree
25
Did authors provide a description of
the coding tree?
A code book was developed
Methods-4
Derivation of Themes
26
Were themes identified in advance or
derived from the data?
Yes, immersion-crystallization
Methods-4
Table 2
Software
27
What software, if applicable, was
used to manage data?
None
Methods-4
Participant Checking
28
Did participants provide feedback on
the findings?
No
Reporting
Quotations Presented
29
Were participant quotations pre-
sented to illustrate the themes/find-
ings?
Yes
Results-7,8,9
Data and Findings Consistent
30
Was there consistency between the
data presented and the findings?
Yes
Results
Pharmacy 2023, 11, 7 12 of 13
Clarity of Major Themes
31
Were major themes clearly presented
in the findings?
Yes
Table 2
Results
Clarity of Minor Themes
32
Is there a description of diverse cases
or discussion of minor themes?
No
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