Factors Influencing Antibiotic Dispensing Behaviors of Community Pharmacists in Eastern Thailand An Analysis Using the COM-B Model

Abstract

Community pharmacists play a crucial role in promoting the appropriate use of antimicrobials in Thailand. However, empirical evidence regarding behavioral factors associated with antibiotic dispensing remains limited. In particular, the Capability, Opportunity, Motivation–Behavior (COM-B) model has not yet been applied to examine antibiotic dispensing behavior within the cultural, economic, and environmental context of eastern Thailand. This cross-sectional descriptive study aimed to examine factors associated with antibiotic dispensing behavior among community pharmacists in this region. Data were collected from 185 community pharmacists working in community pharmacies using a self-administered postal questionnaire. The questionnaire assessed capability, opportunity, motivation, and self-reported antibiotic dispensing behavior using five-point Likert scales. The internal consistency coefficients of the four measures were 0.78, 0.71, 0.74, and 0.84, respectively.

The study found that most respondents were female (73.5%), aged 39 years or younger (84.3%), and had graduated from a five-year Bachelor of Pharmacy program (57.8%). The largest proportion had specialized in pharmaceutical care (43.8%). Most pharmacists worked in independent pharmacies (77.3%), while approximately half of the pharmacies had passed the Good Pharmacy Practice (GPP) inspection criteria established in 2018 (B.E. 2561) (53.5%). The respondents demonstrated a high level of capability, whereas opportunity and motivation were moderately high, and self-reported rational antibiotic dispensing behavior was at a high level. Capability, opportunity, and motivation were positively and significantly associated with antibiotic dispensing behavior, with Pearson’s correlation coefficients of 0.63, 0.35, and 0.65, respectively. Stepwise multiple regression analysis identified motivation and capability as variables associated with antibiotic dispensing behavior in the final model. The final model explained 53.8% of the variance in self-reported antibiotic dispensing behavior (adjusted R² = 0.538).

These findings indicate that community pharmacists generally demonstrated a high level of professional capability and that motivation was positively associated with self-reported antibiotic dispensing behavior. However, because this was a cross-sectional study, the findings do not establish causal relationships. Further studies using validated measures and objective or observational assessments of dispensing practice are warranted.