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Effect of Community Pharmacy Services on Medication Adherence among Adults with Chronic Diseases in Nigeria

Abstract

Community pharmacies are an important component of the healthcare system and provide accessible pharmaceutical services to individuals managing chronic diseases. Adults with chronic diseases often require long-term medication and may experience difficulties maintaining appropriate medication-taking routines because of complex treatment regimens, medication costs, adverse effects, forgetfulness, inadequate understanding of treatment instructions, medicine availability, and limited follow-up support. Community pharmacy services encompass a range of pharmaceutical-care activities provided by pharmacists and other appropriately trained pharmacy personnel, including medication counselling, prescription review, medication-use education, adherence monitoring, identification of medication-related problems, refill services, adverse-effect counselling, health education, and referral to other healthcare professionals when necessary. Medication adherence refers to the extent to which patients take their prescribed medicines according to the recommended dose, timing, frequency, and duration. In Nigeria, accessible and patient-centred community pharmacy services may provide important support for adults managing chronic diseases outside hospital settings. Effective pharmacy services may improve patients' understanding of their medications, identify barriers to adherence, reinforce treatment instructions, and encourage continuity of medication use. Against this background, this study investigates the effect of community pharmacy services on medication adherence among adults with chronic diseases in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Pharmaceutical Care Model. The Health Belief Model provides a framework for understanding medication adherence through patients' perceptions of disease susceptibility and severity, perceived benefits of treatment, perceived barriers, and cues to action. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural reinforcement, social support, and environmental influences in shaping medication-taking behaviour. The Pharmaceutical Care Model emphasizes the pharmacist's responsibility for identifying, preventing, and resolving medication-related problems while supporting patients in achieving appropriate therapeutic outcomes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community pharmacy services may influence medication adherence among adults with chronic diseases in Nigeria. The study will adopt a quantitative cross-sectional research design. Primary data will be collected from adults diagnosed with selected chronic diseases who obtain medicines from selected community pharmacies in Nigeria using a structured interviewer-administered questionnaire, community pharmacy service assessment tool, and standardized medication adherence scale. A multistage sampling technique will be employed to select states, local government areas, communities, community pharmacies, and eligible adult patients. Community pharmacy services will be assessed using indicators such as medication counselling, prescription review, medication-use education, adherence counselling, refill reminders, medication reconciliation, identification of medication-related problems, information on adverse effects, follow-up support, and referral practices. Medication adherence will be assessed using indicators such as adherence to prescribed dosage, adherence to medication timing, missed doses, treatment discontinuation, consistency of medication use, and refill behaviour. Where feasible, self-reported adherence will be complemented by pharmacy refill records, medication cards, pill counts, or other appropriate objective measures. Descriptive statistics will be used to summarize participants' sociodemographic and clinical characteristics, community pharmacy service experiences, medication-use patterns, and adherence levels. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the effect of community pharmacy services on medication adherence. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that effective community pharmacy services have a significant positive effect on medication adherence among adults with chronic diseases in Nigeria. Adults who receive comprehensive medication counselling, adherence support, prescription review, refill services, and follow-up from community pharmacies are expected to demonstrate greater consistency in taking their medicines according to prescribed instructions. Pharmacist-led counselling is expected to improve patients' understanding of medication dosage, timing, treatment duration, possible adverse effects, and the consequences of discontinuing treatment without professional advice. Community pharmacies may also provide an accessible point of contact for identifying medication-related problems and addressing adherence barriers before they result in treatment interruption. However, community pharmacy services alone may not guarantee sustained medication adherence because adults with chronic diseases may continue to face challenges such as medication costs, medicine stock-outs, complex treatment regimens, adverse effects, forgetfulness, limited healthcare access, and inadequate clinical follow-up. Consequently, community pharmacy services may be most effective when integrated with broader chronic disease management and primary healthcare services. The study is expected to contribute to the literature on community pharmacy services, medication adherence, pharmaceutical care, chronic disease management, pharmacy practice, patient counselling, medication safety, health services, and public health in Nigeria by providing empirical evidence on the effect of community pharmacy services on medication-taking behaviour among adults with chronic diseases. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Pharmacists Council of Nigeria, community pharmacists, healthcare institutions, professional pharmacy organizations, physicians, nurses, public health practitioners, chronic disease management programmes, development partners, and policymakers regarding strategies for improving long-term medication adherence. The study will also provide evidence-based recommendations for strengthening pharmacist-led medication counselling, adherence monitoring, prescription review, refill support, medication therapy management, patient follow-up, and referral systems within community pharmacies, while promoting stronger collaboration between community pharmacists and other healthcare professionals in the management of chronic diseases in Nigeria.

Keywords: Community pharmacy services, medication adherence, chronic diseases, Nigeria, pharmaceutical care, community pharmacists, medication counselling, chronic disease management, pharmacy practice, medication safety, patient education, adherence monitoring, healthcare services, public health.