Volume 33 Number 3

Introduction

Effective management of both acute and chronic wounds requires timely assessment, appropriate selection of wound care products, patient education, and when necessary, prompt referral to specialised care. While acute wounds often heal predictably with appropriate care, the development of chronic wounds, such as venous leg ulcers, arterial insufficiency ulcers, diabetic foot ulcers, and pressure ulcers, presents significant challenges.^1,2 These chronic wounds are characterised by a sustained inflammatory response that impedes healing.³ Worldwide, the rising burden of these wounds is leading to increased pressure on healthcare systems and a decline in patients’ quality of life.⁴ The growing impact of an aging population, increasing comorbidities, and declining skin integrity highlights the need for timely and effective wound care.⁵ Addressing this complex challenge necessitates a holistic strategy involving an interprofessional team centered on patient needs, where the contributions of various healthcare professionals are essential.⁶

Pharmacists, with their extensive knowledge of medications and treatments, can play a crucial role in advising patients on the appropriate wound care products and methods.⁷ They are often the first point of contact for patients with minor wounds and can provide essential care and guidance, and also involved in assessing wounds, recommending appropriate over-the-counter treatments, and providing patient education on wound care.⁸ Furthermore, pharmacists can identify the severity of wounds and refer patients to specialised care when necessary, ensuring timely interventions.⁹ Therefore, their role is crucial in ensuring effective wound management and preventing complications. Overall, their role is multifaceted and within the scope of their competency.¹⁰

Despite their critical role, pharmacists face several challenges in providing advanced wound care. Barriers include limited training in wound care, lack of standardised protocols, and time constraints due to high workloads in community pharmacy settings.¹¹ Studies also highlight gaps in pharmacists’ knowledge regarding advanced wound management techniques and the latest treatments.¹² Addressing these gaps through training programs and continuing education is essential to enhance their expertise and ensure they remain updated on current practices.¹³ In addition, pharmacist’s perceptions of their role in wound management can influence their practice. Studies show that pharmacists often perceive themselves as key players in managing minor wounds but may feel less confident handling more complex cases.⁸ Perceptions of their role and the level of involvement can vary based on individual experience, training, and the resources available in their community pharmacy setting.¹⁴ Addressing these challenges is crucial for optimising pharmacists’ contributions to wound care in community settings.

Although the role of community pharmacists in wound management is promising, literature specifically addressing this within the context of Saudi Arabia is limited. Challenges, such as insufficient time for patient counselling and lack of access to advanced wound care products, further complicate the situation. This study aims to investigate the knowledge, attitudes, practices and contributing factors influencing community pharmacists’ involvement in wound care in Saudi Arabia, addressing a critical gap in the literature and paving the way for improved practices in this vital area of healthcare.

Methods

Study design and setting

A cross-sectional study was conducted from September to December 2024 among 378 community pharmacists practicing in Saudi Arabia. Pharmacists from various regions across the country were recruited to ensure the generalisability of the findings. The inclusion criteria required participants to be licensed pharmacists actively working in community pharmacy settings.

Study population and inclusion criteria

The target population included licensed community pharmacists actively working in community pharmacy settings in Saudi Arabia at the time of data collection. Pharmacists of any nationality were eligible for inclusion. Individuals who were not licensed or not currently practicing in a community pharmacy were excluded.

Participant recruitment

Participants were recruited using a combination of purposive and convenience sampling strategies to capture a diverse and representative sample. Recruitment was facilitated through professional pharmacy networks, social media platforms, and direct outreach to community pharmacies. Pharmacists were invited to participate voluntarily, and informed consent was obtained before survey administration.

Sample size calculation

According to the most recent statistical data from the Ministry of Health (MOH), there are 21,648 community pharmacists working across 10,347 pharmacies in Saudi Arabia^.15 Based on a 95% confidence level, a 5% margin of error, and an estimated population proportion of 50%, the required sample size was calculated to be approximately 378 participants using a standard sample size formula for proportions.

Research instrument

A structured questionnaire was developed to assess pharmacists’ knowledge of wound care, their attitudes toward providing wound management services, and the factors influencing their involvement in such services. The survey was validated for face and content validity by a panel of five experts in pharmacy practice and wound care. A pilot study with 20 community pharmacists was conducted to test the clarity and comprehensibility of the questionnaire. Feedback from the pilot was used to revise the wording, structure, and layout of the survey to improve clarity and reliability.

Data collection

Data were collected using a validated structured survey administered both online and in person within community pharmacy settings. The questionnaire comprised multiple-choice questions to evaluate pharmacists’ knowledge of wound care practices, Likert scale items (ranged from “Strongly Disagree” to “Strongly Agree”) to assess their attitudes and perceptions toward wound care services, and open-ended questions were used to gather qualitative insights into their experiences and views. Participation was voluntary, and informed consent was obtained from all respondents prior to completing the survey.

Statistical analysis

Data were analysed using SPSS software. Descriptive statistics (frequencies, means, and standard deviations) were used to summarise demographic characteristics and survey responses. Inferential statistics, including Chi-square tests and univariate regression analyses, were employed to explore associations between pharmacists’ characteristics and their knowledge or perceptions of wound care. A p-value of <0.05 was considered statistically significant. Visual representations of the data (graphs) were created using Microsoft Excel.

Results

Demographic characteristics

Out of the calculated sample size of 387 participants, only 337 responded, resulting in a response rate of 87.1%. Table 1 outlines the demographic characteristics of the participants, showing a statistically significant distribution (p<0.05) across all categories. The sample was predominantly male (82.5%); however, 17.5% of females also participated in the study, and most of the participants were young adults aged 25–34 (65.9%). Most participants held a bachelor’s degree (95.3%) and were primarily of Egyptian nationality (55.2%), 44.5% were Saudis, while 0.3% (one participant) was Yemeni. Most of the cohort had 1-3 years of experience (42.7%) and worked as community pharmacists (90.2%). Chain pharmacies were the most common workplace (71.5%), with the highest concentration of participants practicing in Al-Riyadh (43.6%). Most pharmacies were located in cities (84.9%), and 52.5% of the participants sometimes encountered wound-related cases. Notably, only 3.6% had received formal wound care training, highlighting a gap in this area.

 

Table 1. Demographic characteristics of study participants (N=337).

 

Knowledge of wound management

Table 2 presents the self-assessed knowledge of wound management among the participants. Overall knowledge was rated as fair (45.4%) or good (40.7%) by most participants, with only 11.3% rating their knowledge as excellent. Knowledge of ‘wound types and management’ and ‘infection control’ followed a similar pattern, with the majority rating their knowledge as fair or good, and less than 15% rating it as excellent. Participants reported stronger knowledge of dressing types and use (51.3% rated good). Pain management and referral processes were areas of relative weakness, with a substantial proportion of participants rating their knowledge as poor or very poor.

 

Table 2. Self-assessed knowledge of wound management among community pharmacists (N=337)

 

Attitudes and perceptions regarding wound care

Table 3 summarises participants’ attitudes and perceptions regarding wound care. A strong majority of participants agreed or strongly agreed that pharmacists should be involved in wound care (over 75%), that pharmacists can play a proactive role, and that pharmacist involvement can lead to improved patient outcomes. There was also strong support (91% agreement) for including wound care education in pharmacy curricula. Most participants (77.7%) reported using a combination of sources to improve their wound care knowledge. All items had a p-value of <0.05, indicating statistical significance.

 

Table 3. Pharmacists’ attitudes and perceptions regarding wound care (N=337)

 

Participants expressed a strong belief in the influence of their wound care knowledge on their practice. A high percentage agreed or strongly agreed that their knowledge influenced patient care decisions, and a similar proportion believed that short courses enhance their selection of wound care products. Conversely, a substantial proportion acknowledged that their current knowledge limits the wound care services they can provide.

Factors motivating engagement in wound care

Table 4 presents the factors motivating pharmacists’ engagement in wound care. The most frequently cited motivating factors were improving patients’ healing rates, achieving sales targets for wound care products, and receiving positive feedback from patients. Building strong patient relationships and collaborating with local healthcare providers were also identified as important motivators. All items had a p-value of <0.05, indicating statistical significance.

 

Table 4. Factors motivating pharmacists’ engagement in wound care (N=337)

 

Challenges to pharmacist involvement in wound care

Table 5 outlines the challenges affecting pharmacists’ involvement in wound management. The most frequently reported challenges included limited facilities, time constraints, and difficulties in accessing detailed patient information. Lack of specialised training, poorly defined guidelines, and insufficient access to advanced wound care products were also identified as significant barriers. All items had a p-value of <0.05, indicating statistical significance.

 

Table 5. Challenges affecting involvement of pharmacists in wound management (N=337)

 

Factors influencing engagement and knowledge

Table 6 presents the results of the ANOVA examining factors influencing pharmacist engagement and knowledge in wound management. The corrected model explained a small but significant portion of the variance (R²=0.058, p=0.001). Practicing experience (p=0.004) and age (p=0.017) were significantly associated with engagement and knowledge, with more experienced and older pharmacists demonstrating greater knowledge and engagement. Nationality, sex, and education were not significantly associated with engagement and knowledge.

 

Table 6 presents ANOVA examining factors affecting pharmacist engagement and knowledge in wound management

 

Preferred training topics

Figure 1 illustrates the wound care topics pharmacists were interested in learning more about. Chronic wound care management, acute wound care management, and pain management were the most frequently selected topics. Other areas of interest included infection control and prevention, wound care guidelines, patient education, new wound care products, and collaboration with other healthcare professionals.

 

Figure 1. Wound care topics pharmacists seek to enhance their involvement in wound management

 

Methods for training

Figure 2 shows the preferred training methods to enhance pharmacist involvement in wound management. Hands-on workshops and certification programs were the most favored approaches. Online courses, continuing education seminars, and interactive case studies were moderately popular. Simulation exercises and peer learning/group discussions were less frequently selected. Most participants expressed a preference for a combination of training methods.

 

Figure 2. Preferred training methods to enhance pharmacist involvement in wound management

 

Discussion

This study investigated the knowledge, attitudes, and practices of community pharmacists regarding wound care in Saudi Arabia. Our findings indicate that while most pharmacists demonstrate fair to good knowledge across various wound care domains, important gaps remain particularly in pain management and referral processes. This highlights the need for targeted training to address these specific knowledge deficits. These findings align with other studies, including a study in Jordan, where pharmacists showed good knowledge of wound management but reported a lack of skills in dealing with wounds.¹¹ Similarly, research in the UAE found that 43% of pharmacists rated their wound care knowledge as fair or poor, highlighting a regional trend of suboptimal preparedness among pharmacists.¹²

In addition to assessing knowledge, this study also explored pharmacists’ attitudes and actual practices, offering a more comprehensive understanding of their readiness to participate in wound care. A considerable number of participants expressed dissatisfaction with their current level of knowledge and a strong interest in further education. These findings mirror observations in other pharmacy practice areas, such as diabetes management and immunisation—where pharmacists frequently acknowledge knowledge gaps but demonstrate a strong willingness to expand their roles and clinical competencies.^16.17

The study found that experience and age significantly influenced pharmacist engagement and knowledge in wound care. This is consistent with previous literature suggesting that more experienced pharmacists often possess greater clinical confidence and competence.¹⁸ In contrast, demographics, such as nationality, sex, and education, did not significantly impact engagement and knowledge in this study, further research may be needed to explore these factors in more detail.

The majority of pharmacists expressed positive attitudes towards expanding their role in wound care, recognising its potential to enhance patient outcomes. Participants recognised the potential of their involvement to improve patient outcomes, a view supported by studies involving other healthcare professionals. For example, nurses and general practitioners who receive wound care training have shown improved patient satisfaction and healing outcomes.¹⁹ By comparison, pharmacists are still an underutilised resource in wound care, despite being among the most accessible healthcare professionals.

The commonly cited barriers of limited facilities, time constraints, and restricted access to patient data not only impede pharmacist involvement in wound care but also resonate with similar challenges encountered a recent study on the implementation of a clinical pharmacist-driven comprehensive medication management program in an outpatient wound healing center.⁷ These findings indicate the need for systemic support, such as policy changes and infrastructure improvements, to facilitate more active pharmacist participation in wound care

Hands-on workshops and certification programs emerged as the most preferred training methods, indicating a strong preference for practical, experiential learning and formal recognition of acquired skills. This is in line with global trends in healthcare education, where blended learning approaches combining face-to-face and online methods have been shown to enhance knowledge retention and clinical application.²⁰ A systematic review of educational interventions in wound care supports the effectiveness of such blended models, particularly when they include interactive and case-based elements.²¹

This study has several limitations. The cross-sectional design limits the ability to establish causal relationships between variables. Additionally, the reliance on self-reported data may be subject to recall bias and social desirability bias. Furthermore, the findings may not be fully generalisable to all community pharmacists in Saudi Arabia, nor to other countries with differing healthcare systems.

Conclusions

This study provides valuable insights into the current state of wound care knowledge and practice among community pharmacists in Saudi Arabia. Key findings reveal significant knowledge gaps, particularly in pain management and referral processes. To enhance pharmacist involvement in wound care, targeted training programs incorporating preferred methods, such as hands-on workshops and blended learning approaches, are crucial. Addressing systemic barriers, such as limited facilities and time constraints, is essential. Fostering interprofessional collaboration is vital for optimising patient outcomes. Future research should explore the impact of training interventions on pharmacist knowledge, attitudes, and practices through longitudinal studies. Qualitative research methods, such as interviews and focus groups, can provide deeper insights into the challenges and facilitators of pharmacist involvement in wound care. Economic evaluations can assess the cost-effectiveness of pharmacist-provided wound care services. Additionally, exploring regional variations in pharmacist knowledge, attitudes, and practices regarding wound care is crucial for a comprehensive understanding of this critical area.

Conflict of interest

The author declares no conflicts of interest

Ethics statement

This study received approval from the Research Ethics Committee at the University of Hail (Approval No: H-2024-409). Informed consent was obtained from all participants before they took part in the survey. Participants were made aware that their involvement in the study was entirely voluntary.

Funding

The authors received no funding for this study.

Author(s)

Alia Alshammari
Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 55476, Saudi Arabia

*Corresponding author email alia.alshammari@uoh.edu.sa

References

1. Sen CK. Human Wounds and Its Burden: An Updated Compendium of Estimates. Adv Wound Care (New Rochelle). 2019;8(2):39–48.
2. Bowers S, Franco E. Chronic Wounds: Evaluation and Management. Am Fam Physician. 2020;101(3):159–166.
3. Popescu V, Cauni V, Petrutescu MS, Rustin MM, Bocai R, Turculet CR, et al. Chronic wound management: from gauze to homologous cellular matrix. Biomedicines. 2023;11(9):2457.
4. Martinengo L, Olsson M, Bajpai R, Soljak M, Upton Z, Schmidtchen A, et al. Prevalence of chronic wounds in the general population: systematic review and meta-analysis of observational studies. Ann Epidemiol. 2019;29:8–15.
5. White-Chu EF, Conner-Kerr TA. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective. J Multidiscip Healthc. 2014:111–117.
6. Veličković V, Janković D. Challenges around quantifying uncertainty in a holistic approach to hard-to-heal wound management: Health economic perspective. Int Wound J. 2023;20:792–798.
7. Rebolledo JA, Rhodes NJ, Valdes AM, Kulekowskis A, Kliethermes MA. Implementation of a clinical pharmacist-driven comprehensive medication management program in an outpatient wound healing center. J Am Pharm Assoc. 2022;62(2):475–480.e3. doi:10.1016/j.japh.2021.10.021
8. Ilardo ML, Speciale A. The community pharmacist: perceived barriers and patient-centered care communication. Int J Environ Res Public Health. 2020;17(2):536.
9. Rebolledo JA, Rhodes NJ, Valdes AM, Kulekowskis A, Kliethermes MA. Implementation of a clinical pharmacist-driven comprehensive medication management program in an outpatient wound healing center. J Am Pharm Assoc. 2022;62(2):475–480.e3.
10. Cheung DH, Schneider CR, Um IS. The role of community pharmacy in wound care: a scoping review. J Wound Care. 2023;32(11):728–737.
11. Ayyash M, Jaber K, Moghli MA, Mukattash TL, Farha RA. Pharmacists’ knowledge and perceptions regarding wound management at the community pharmacies in Jordan. J Appl Pharmaceut Sci. 2021;11(8):36–42.
12. Abduelkarem A, Dada M, Sharif S. The provision of wound management services by community pharmacists. Jordan J Pharmaceut Sci. 2012;5(3):194–201.
13. Wheeler JS, Chisholm-Burns M. The benefit of continuing professional development for continuing pharmacy education. Am J Pharm Educ. 2018;82(3):6461.
14. Dores AR, Peixoto M, Carvalho IP, Jesus Â, Moreira F, Marques A. The pharmacy of the future: pharmacy professionals’ perceptions and contributions regarding new services in community pharmacies. Healthcare (Basel). 2023;11(18):2580.
15. Jarab SA, Muflih S, Almomani R, Abu Heshmeh S, Abu Hammour K, L. Mukattash T, et al. Hospital pharmacists’ knowledge, attitudes and practice of pharmaceutical care and the barriers for its implementation at the hospital setting. Heliyon. 2024;10(8):e28227.
16. Rendrayani F, Alfian SD, Wahyudin W, Puspitasari IM. Pharmacists’ knowledge, attitude, and practice of medication therapy management: a systematic review. Healthcare (Basel). 2022;10(12):2513.
17. Salem HH, Bazan NS, Addal WA, et al. Evaluation of community pharmacists’ knowledge, practice and barriers towards diabetes management in Asir region, Saudi Arabia. J Eval Clin Pract. 2025;31(1):e14121. doi:10.1111/jep.14121
18. Ozdemir N, Kara E, Bayraktar-Ekincioglu A, Buyukcam A, Celiker A, Demirkan K, Kara A. Knowledge, attitudes, and practices regarding vaccination among community pharmacists. Prim Health Care Res Dev. 2022;23:e38.
19. Gunningberg L, Pöder U, Ulander K, Karlsson M. Nurse, assistant nurse and physician experiences of wound management: a qualitative study from a primary care setting. Int Wound J. 2013;10(5):580–588.
20. Gray TA, Wilson P, Dumville JC, Cullum NA. What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework. BMJ Open. 2019;9(7):e024859.
21. Martinengo L, Yeo NJY, Markandran KDO, Olsson M, Kyaw BM, Car LT. Digital health professions education on chronic wound management: A systematic review. Int J Nurs Studies. 2020;104:103512.