CHAPTER 1

THE PROBLEM AND ITS BACKGROUND

Background about the study

In December of 2019, SARS-CoV-2, a novel coronavirus was isolated

from the epithelial cells in the nasopharyngeal and oropharyngeal tracts of a

cluster of patients in Wuhan, China who presented with symptoms of

pneumonia (Zhu et al., 2020). It was eventually named 2019-nCoV, short for

novel coronavirus discovered in the year 2019. The newly discovered species

was referred as novel because it has not been seen or studied before.

Collectively, this infectious disease that caused the pandemic in 2019 is known

as COVID-19. Individuals infected by this disease may have mild symptoms,

but others can get very severely ill and die. Most infected individuals will

recover within weeks, but others may experience post COVID-19 symptoms for

more than four weeks from first onset of infection (CDC, n.d.).

Coronaviruses (CoVs) are a family of enveloped, positive-sense, single-

stranded RNA viruses known for their high genetic diversity. These viruses can

lead to a range of diseases affecting the respiratory, gastrointestinal, hepatic,

and neurological systems, with varying degrees of severity in both humans and

animals. (Feng He et al,. 2020). Six species in the family are known to cause

human infection, two of which are particularly fatal — the SARS-CoV (severe

acute respiratory syndrome) and MERS-CoV (Middle East Respiratory

Syndrome) (Cue et al., 2019). SARS-CoV was the pathogen accountable for
the epidemic and deaths in China in the year 2002 and 2003 while MERS-CoV

was the pathogen accountable for respiratory ailment outbreak in Middle East

in the year 2012 (Zaki et al., 2012). Given the prevalence of the virus among

increasing human and animal inter- activities plus the frequent natural

recombination of its genomes, coronavirus remains to be a threat to mankind

and considered to be an always emerging pathogen that poses serious global

threats (Wong et al., 2015). By the culmination of January 2020, the World

Health Organization (WHO) proclaimed COVID-19 disease a public health

crisis and encouraged the coordinated efforts of all nations to avert its speedy

propagation. WHO then affirmed COVID-19 a “pandemic” (Tang et al., 2020).

Since its first recorded case in 2019, COVID-19 continues to infect and claim

millions of lives around the world.

Pharmacies are among the frontlines of this pandemic. Due to their

strategic locations in the communities, they are the ones readily accessible by

the public to buy their necessities, especially medicines. Pharmacists found

themselves with significantly more active roles than ever and became the

primary sources of information. On top of that, their clinical services are free,

so people preferred to come in the pharmacies (Dalton et al., 2017). Public

health became more important and public health educators had an integral and

critical role in preventing the spread of the disease. The demand for clinical

services of pharmacies rose as people were looking for advice and

consultation regarding their ailments (Hosseinpoor et al., 2015).

Tagbilaran City, Bohol has opted for unparalleled and strict

precautionary and counteractive actions against COVID-19 to limit its spread

and protect and guarantee the well-being of their citizens. Strict observance to

preventative measures is influenced by their knowledge about COVID-19. This

scholarship examined the information, outlooks, and tendencies of pharmacy

personnel, where information on public health largely depends on, toward

COVID-19. The fact that COVID-19 is a recurring public health threat, it is

important that we assess pharmacy personnel’s knowledge, attitude, and

practices. Assessing these will be very helpful, especially that the information

about COVID-19 changes over time. Working in the frontlines of public health,

pharmacists have to make sure that the information they are relaying to the

public is accurate and up to date.

Statement of the Problem

Do community pharmacists in Tagbilaran City, Bohol possess accurate

and up-to-date knowledge, attitude, and practices regarding COVID-19?

Objectives

The chief objective of the research is to assess the knowledge, attitude,

and practices of community pharmacists in Tagbilaran City, Bohol regarding

COVID-19.

Hypotheses

Community pharmacists in Tagbilaran City, Bohol possess accurate and

up-to-date knowledge, attitude, and practices regarding COVID-19.

Null

Community pharmacists in Tagbilaran City, Bohol do not possess

accurate and up-to-date knowledge, attitude, and practices regarding COVID-

19.

Significance of the Study

The study will help assess the accuracy of the knowledge, attitude, as

well as the practices of the community pharmacists working in Tagbilaran City,

Bohol regarding COVID-19 disease. Results from the study will be used to

enhance their professional skills as healthcare frontiers through promulgations

of effective trainings and programs, and to promote a more open environment

for collaborations among the other members of the healthcare team.

Scope and Delimitations of the study

The study will interview pharmacists working in a community pharmacy

within Tagbilaran City, Bohol. Considering the time frame of the study, resources,

size of the city, and the fact that there are only several pharmacies in Tagbilaran

City, the researcher will conduct a paper-based questionnaire survey to at least

one pharmacist per pharmacy within the locality. The majority of the current KAP

studies concerning COVID-19 were virtual assessments. A paper-centered

version has advantages: produce advanced response rates than an online

review, straightforwardly and appropriately tactic several types of respondents

who are not technology perceptive. However, it will also have limits — age of the

respondents can be one. Young pharmacists’ results cannot be related with that

of older pharmacists, who are anticipated to have lesser KAP scores due to

restricted access to internet and social media where most information can be

found (source). The results can also be affected by stress brought about by the

pandemic that is why it is also appropriate to discuss the stress level of the

pharmacist he/she is experiencing. Lastly, inquiries concerning COVID-19 data

are primarily concentrated on three matters: COVID-19 disease symptoms, its

transmission, and ways to prevent its spread. The outcomes fail to echo the

inclusive information of pharmacy personnel about this epidemic. Another

disadvantage is social distancing which can also become a problem to the

researcher when it comes to risk of contracting the virus.

Definition of Terms

The following terms are theoretically and/or operationally demarcated for

better comprehension of the readers.

Community pharmacists - are board-certified pharmacists, 18 years

old and above, male or female, who have direct interaction with patients,

currently employed in a community pharmacy in Tagbilaran City, Bohol.

Tagbilaran City, Bohol - Tagbilaran, formally the City of Tagbilaran

(Cebuano: Dakbayan sa Tagbilaran), is a third class constituent city and capital

of the province of Bohol, Philippines. Conferring to the 2020 census, it has a

populace of 104,976 people.

 COVID-19 - Coronavirus disease (COVID-19) is an infectious disease

caused by the SARS-CoV-2 virus. The virus can be spread by small liquid

components from an infected person's mouth or nose when they cough,

sneeze, talk, sing, or breathe. The size of these compounds varies from big

respiratory droplets to small aerosols.

Knowledge, attitude, and practice (KAP) study - a type of cross-

sectional study considered to be a good way to assess health outcomes. KAP

comprises of three components — knowledge, attitude, and practice. KAP

studies are relatively easy to conduct, measure, and interpret (Raina, 2013).

Knowledge is the capability to gain, recall and use data; an assortment of

understanding, involvement, judgement, and ability; attitude refers to

predispositions to respond in a definite way to certain circumstances.

Additionally, it also infers to perceive and understand happenings according to

certain dispositions; or to establish sentiments into comprehensible and

interconnected structures; while practice is the solicitation of rules and

knowledge that leads to action (Badran, 1995).

Conceptual Framework
 CHAPTER 2

REVIEW OF RELATED LITERATURE

This chapter offers the available works and studies conducted by other

researchers which will be helpful in the assessment of knowledge, awareness,

and practices of community pharmacists working in Tagbilaran City, Bohol

regarding COVID-19

COVID-19

Origin and pathogenesis. The SARS-CoV-2 virus causes Coronavirus

Illness (COVID-19), which is an infectious disease. Coronaviruses (CoVs) are a

vast category of infections that cause respiratory problems in people, ranging

from the common cold to rare and dangerous illnesses like SARS and Middle

East respiratory syndrome (MERS) Both are noted for their high death rates

and were initially detected in 2003 and 2012, respectively. The majority of

persons who are infected with the virus will get a mild to severe respiratory

disease and will recover without needing any specific therapy. The elderly and

those on main treatment, on the other hand, are at a higher risk. Those who

are older or have major therapeutic illnesses like cardiovascular disease,

diabetes, chronic respiratory disease, or cancer, on the other hand, are more

likely to get serious disease. The four kinds of CoVs are alpha-, beta-, gamma-,

and delta-CoVs. All CoVs that have been identified as causing illness in
humans fall into one of two categories: alpha- or beta-CoV. The bulk of these

CoVs have the potential to infect a wide variety of animals. SARS-CoV infected

civet cats and people in 2002, whereas MERS-CoV infected dromedary camels

and humans in 2012. SARS-CoV-2 isolates from people so far have been

genetically related to coronaviruses secl. Human SARS-CoV-2 isolates are all

genetically connected to coronaviruses obtained from bat populations,

specifically Rhinolophus bats. Coronaviruses identified from bats have been

linked to SARS-CoV, the virus that caused the SARS epidemic in 2003. Bat

populations are assumed to constitute the biological substrate for all of these

neighboring genetic connections. Asia, Africa, the Middle East, and Europe are

all home to Rhinolophus bats. SARS-CoV-2 is genetically distinct from other

coronaviruses that have been linked to farm or domestic animals.

According to the viral genome classifications, SARS-CoV-2 is also

extensively changeable. According to viral genome categorizations, SARS-

CoV-2 is well adapted to human cell receptors, allowing it to easily attack

human cells and infect people. The genetic classifications of all known SARS-

CoV-2 isolates from human patients are very identical, indicating that the

pandemic started with a single point establishment in the human population

around the time the virus was first identified in people in Wuhan, China.

The overflow from an animal source to humans happened in the fourth

quarter of 2019, according to known genomic sequences. The first cases of

COVID-19 were reported virtually as soon as they were discovered. When the

first cases of COVID-19 were identified in late December 2019, scientists

began investigating the disease's epidemiology and the outbreak's etiology.

Towards the end of December 2019 and the beginning of January 2020, the

Huanan Wholesale Seafood Market in Wuhan City, where seafood, wild, and

farmed animal species were sold, was connected to a significant number of

preliminary cases. The bulk of the first patients were market stall owners,

market workers, or frequent visitors. SARS-CoV-2 was detected in ecological

models obtained from this market in December 2019, indicating that the market

in Wuhan City was the source of the infection. Ecological models obtained from

this market in December 2019 tested positive for SARS-CoV-2, showing that

the Wuhan City market was either the origins of the outbreak or played a role in

its early stages. The market was shuttered, cleaned, and sanitized on January

1, 2020 (WHO).

COVID-19 has the potential to make someone sick, make them

extremely ill, or cause them to die at any time. The greatest way to avoid and

reduce conduction is to be well-versed with the illness and how the virus

spreads. To protect yourself and others against infection, keep at least 1 meter

away from others, wear a properly fitted mask, and hand-wash or use an

alcohol-based rub on a regular basis. Get immunized and follow local

guidelines when it's your turn. The virus spreads in minute liquid particles from

an infected person's lips or nose when they cough, sneeze, speak, sing, or

breathe. From massive respiratory droplets to extremely microscopic aerosols,

these particles come in a variety of sizes. Breathing exercises are quite

beneficial. If you become ill, it's vital to practice good respiratory hygiene, such
as coughing into a bent elbow, and to stay at home and isolate yourself until

you feel better (WHO).

Impact to pharmacies and public health. Several studies involving

impact of COVID-19 to public health were published. Among these is the study

conducted by Kumar et al. (2020). This article revolves around the problems

concerning the supply- chain and operation management systems of various

products that have been disrupted after the outbreak of the pandemic, which

has left economic destruction in its wake. Links that filled the gap between the

suppliers, retailers and the customers have been disrupted due to the

lockdowns prevalent in most countries of the world, which has consequently led

to a complete deterioration of businesses worldwide. The paper discusses the

disarray caused by the pandemic, with regards to the shutdown of business

activity, and proposes policies to tackle the challenges the world faces or could,

potentially, face in the future. Before doing that though, it sheds light on the

consequences of this disruption, and points out the increasing unemployment

rate in countries like India. To tackle the demand of essential products, and

medical equipment, the authors propose that companies that may manufacture

various other products, can shift their focus upon the production of what is

required, for example ventilators etc. Pandemic based requirements should be

listed as the topmost priority of manufacturing leaders, as it would lead to a

counterstrike against the increasing disruptions in the operations management

and supply-chain systems. The authors also place emphasis on the

digitalization of the manufacturing system to create a safer environment for the

workforce, leading to added resilience and sustainability in the manufacturing

industry. The study shows the relevance of disruption in supply-chain and

operations management systems, with the unavailability of the essential

medical supplies like vaccines, masks, sanitizers etc. in pharmacies.

Shafi et al. (2020) addressed in an article the the impacts suffered by

the micro, small, and medium-sized enterprises (MSMEs) that are operating in

Pakistan. Great losses have been incurred by business globally, and

considering Pakistan is a developing economy, its enterprises took a harder hit

than their counterparts in developed nations. Since lockdowns are common

these days, supply chains have been disrupted which is why the lack of exports

have hindered the ability of enterprises to make profits. Also, it notes that the

unavailability of labor is on the rise since people are staying indoors as

precautionary measures to safeguard themselves from exposure to the virus.

This factor, coupled with the lack of raw materials due to disruptions in the

supply-chain, has had an adverse effect on many businesses. The article,

divided in 8 different sections, provides insight on the current situation of

Pakistan with regards to the pandemic, and the measures taken to reduce the

ramifications suffered. The article focuses on MSMEs because of their inability

to cope with such severe disruptions as they do not possess enough finances

like large enterprises. To tackle all these problems, the article recommends

policies so as to negate the effects upon the MSMEs. It urges enterprises to

protect their employees from the virus so that they can work in a safe

environment, consequently boosting the income. Furthermore, it advises the

government to support the MSMEs so that they do not end up liquidating, as

they contribute greatly to the Pakistani economy. In conclusion, the article

highlights the importance of proper planning, and strict adherence to the

national protocols, for safety, survival, and ultimately, sustainability. This article

highlights various the toll that the pandemic has taken over various businesses,

the pharmaceutical industry included, and provides potential strategies to

neutralize these effects, so that they may keep on working smoothly.

Another study is by Koster et al. (2020). This study is based on the

problems regarding the lack of pharmaceutical care provided to the public ever

since the pandemic struck. The fact that these healthcare professionals have

had their abilities hindered, with regards to communication and provision of

services, as the pandemic has led to a complete shutdown of most industries.

The core location that the authors have laid their emphasis on is the

Netherlands, carrying out an online survey by sending out questionnaires to

certified pharmacies in the country, asking about the post- pandemic changes

that have occurred in the pharmacies, with regards to logistics and supply, as

well as communication regarding medication procedures. The results did not

exactly come as a shock as the overall agenda of the pharmacies was based

upon hygienic measures, that consequently resulted in a drastic decrease in

the direct patient-provider contact, leaving an overall gap in effective

communication. Not surprisingly, most of the customers expressed grave

concerns regarding the issue of the lack of proper communication as it could

potentially be fatal for patients in more dire conditions. Statistics of various

topics discussed in the questionnaires are shown as percentages in the article.

The outcomes of the scholarship shed light upon the impact that the pandemic

has had on the overall procedures regarding logistics and services, that have

been left ineffective due to the increased disruption in proper communication

between the healthcare professionals and the patients. Though the article is

primarily based on the pharmacies in the Netherlands, it reflects the impact of

covid on the communication and logistics department of pharmacies at a larger

scale, meaning, similar issues could be prevalent in the Philippines.

Shafi et al. (2020) also made a study on the impression of the COVID-

19 pandemic on rural communities. This research study lays focus on the roots

of the outbreak of the pandemic and lays its focus on the Chinese territory.

More precisely the Sichuan Province. The participants primarily belonged to

the rural villages present in the province and were asked to give their takes on

the impact that the on-going epidemic has left upon their lives, psychologically

and socioeconomically. The indications that the results brought were quite

predictable. Naturally, the people did get impacted psychologically, which,

consequently, led to socioeconomic impacts. Since the covid situation put a

temporary stop on most of the business activities, many households suffered

from the aftereffects of unemployment and economic losses, which led them to

be quite stressed. The surprising part was that the people were more worried

about the economic destruction that the pandemic has left in its wake, and not

about the disease itself, having firm belief in the government’s ability to

safeguard the common people’s lives with their protective measures. The study
finished by looking at the results of the econometric regression models,

concluding that the pandemic has had a major psychological, social, and

economic impact on people living in remote communities in Sichuan province..

The importance of this study is that it was done at a household level, finding

critical information about the psyche of people with regards to the pandemic,

that could prove to be quite helpful in coming up with new strategies that could

prevent further harm to be done at community and household levels. The

research highlights the priorities of the people living in rural communities of

Sichuan, and it is probable that the case will be quite similar in the rural

communities of the Philippines, which could help the country’s healthcare

system and pharmacies devise strategies to tackle the impacts in the

respective rural communities.

The researcher also found Jordan et al. (2021)’s study on how COVID-

19 has influenced the role of pharmacists around the globe important. This

article highlights the fact that the pharmaceutical industry has stepped up ever

since the outbreak of the pandemic and has been a key warrior in the fight to

prevent the infection from spreading and, ultimately, eradicate it. The authors

believe that the role of the community pharmacists has suddenly evolved, and

they have proved their worth by fiercely combatting the spread of the virus and

keeping it at bay. These professionals have tackled the problems at hand in

several different ways; by supporting government initiatives, ensuring patients

get proper medication, taking care of the critical ones in the ICUs, and trying to

come up with vaccines for the virus. The study discusses examples from
several different countries, including Germany, Switzerland, Canada, and the

UK, providing insight upon the growth of this profession and its prospects. It

highlights the professionals’ adept nature and the way they have adapted to the

digital technology because of the issue of face-to-face communication. The

article also notes that the International Pharmaceutical Federation (FIP) has

been working tirelessly to support the community pharmacists and asks for

support from the governments of the respective countries to recognize their

activities and provide access for expansion and scientific research. The

authors also commend the FIP’s effort of striving against the lack of equity of

access to medicines, since the younger, and healthier people are being

vaccinated before the more vulnerable ones in rich countries. This article sheds

light upon how the professionals of this field have adapted to a world gripped

by a pandemic, and how their activities have suddenly evolved into more

tiresome, yet necessary ones.

Community pharmacists’ response to pandemic. Sum et al. (2021)

study addresses the issue of infection control in hospitals and other health

departments, and how the community pharmacists have responded to this

threat with innovative and strategic measures. The article is based upon an

online cross-sectional survey that was conducted in Australia, gathering

information from the participants regarding their awareness towards this

problem, and how they managed it. The survey was conducted
in the April of 2020, a time when the pandemic had not reached its peak,

therefore, the results were not exactly satisfactory. The survey had 137

participants, out of which, even though almost all regularly cleaned the

pharmacy, more than half of them did not wear gloves while cleaning. Less

than 50% of them did not clean and disinfect the script baskets. One-third of

them were conscious of the two-step cleaning and sanitizing procedure, and

out of those one-third, only half actually implemented it in their daily

pharmaceutical endeavors. Furthermore, half of the participants acknowledged

the fact that they were having difficulty understanding the protocols and

guidelines regarding infection control, and therefore, they were, ultimately,

unable to adhere to them. The authors state that the results of the study are

not convincing since the pharmacists are generally unaware of the measures

required to be implemented for infection control and need necessary guidance

and professional support to be able to understand the gravity of the situation,

and practice employing measures that are hygienic and take infection control

into account. The article points out the underlying issues within the department

of pharmacy and urges necessary steps to be taken to fix these issues,

especially those concerning infection control, so that pharmaceutical services

are seen as more efficient.

Oi Lam Ung et al. (2020) also studied community pharmacists in public

health emergencies. This article revolves around the quick and effective

response of the community pharmacists immediately after the outbreak of the

pandemic, and the way they handled the immediate influx of a great many
patients. Specifically, the article is based upon first-hand experiences of

pharmacists in one of the first places to be hit by the virus, Macau. The author

sheds light upon the way community pharmacists responded to the

emergency, as if they were always prepared for a pandemic to strike. They

had to modify their roles, perform additional duties, and provide a helping hand

to other healthcare professionals in a collaborative effort against the immediate

rise of the virus. This paper then discusses the new roles that pharmacists

were now asked to do, which included infection control, clinical care as well as

handling of drugs. Their vigilance was vital to the health of the infected cases,

and their prescription of drugs needed to be done with extreme care, as there

was no room for error. The paper then references various first-hand

experiences of pharmacists and their actions in the face of the pandemic. This

helps readers understand the roles of pharmacists better. Also, it compares

these roles with the recommendations made by the International

Pharmaceutical Federation, explaining the protocols and guidelines that were

issued to allow the pharmacists to provide their service and contribute to the

cause in a more effective manner. In conclusion, the article commends the

efforts of pharmacists all around the globe, acknowledging the vital role they

play in the overall fight against the pandemic. The article aims to create a

deeper understanding of the roles of pharmacists during the pandemic, and the

modified duties that they are performing in this situation.

Multilevel response was also noted by Mall et al. (2020). The authors, in

this article, start by acknowledging the existence of the novel coronavirus and

the way it has ravaged the world by engulfing it into its vice grip. They point out
that the excessive demand for healthcare continued to grow exponentially with

the rampant spread of the pandemic, and the need for innovative and adaptive

strategies became a necessity. The consequence of this situation was the

modification of roles of professionals in different industry. One such

modification came in the roles of pharmacists, whose product- oriented

approach of dealing with patients became more service-oriented. The reason

behind the need for the modification of their roles rose because of the ease of

access that the general public had to pharmacies, which are located in almost

every community. The tasks that pharmacists can perform include the provision

of medical supplies to patients, guidance about the coronavirus, clarifying of

misconceptions, and handling of shortages of drugs and protective equipment.

Other possible duties of the pharmacists are also mentioned. Overall, these

contributions by the pharmacists will help decrease the workload of the already

overburdened healthcare facilities as the same services available in those

facilities will be available in more accessible centers, namely pharmacies. The

problems and recommendations for their solutions discussed in this article can

help the government and policy makers to devise inventive strategies that will

utilize community pharmacists to the best of their abilities that may prove to be

decisive in this fight against the pandemic, also leading to them getting the

recognition they deserve. This article provides insight upon the sudden

evolution of pharmacists’ jobs, and the potential in serving as a pharmacist in

this time of trouble. It also recognizes their service to be crucial to the

combined effort of eradicating the pandemic.

KAP

Definition and Methodology. A KAP survey is a illustrative study of a

definite populace to amass data on what is identified, alleged and done relative

to a specific subject. In many KAP assessments, an examiner using an

organized, consistent questionnaire collects data orally. These information then

can be examined quantitatively or qualitatively subject to the intentions and

plan of the investigation. A KAP examination can be premeditated explicitly to

collect data about overall practices and beliefs. A KAP survey means

Information, Outlook and Approaches. To suitably conduct this kind of survey it

is essential to create a basic principle and offer explanations for every word.

Information is a set of considerations, knowledge and of “science.” It is also

one’s ability for visualization, one’s way of recognizing. Information of a health

conduct deliberated to be useful, nonetheless, does not spontaneously imply

that this conduct will be trailed. The grade of information evaluated by the

survey helps to detect parts where information and education efforts persist to

be exerted. Attitude is a way of existence, a position. These are propensities or

“inclinations to....”. This is an in-between inconstant amid the condition and the

retort to this condition. It aids clarify that amid the likely observes for a

participant acquiesced to an inducement, that subject assumes one practice

and not another. Attitudes are not openly noticeable as are accomplishments,

thus it is a good awareness to evaluate them. It is stimulating to note that many

studies. Norms or conducts are the apparent activities of a person in retort to

an inducement. This that contracts with the concrete, with actions. For

practices linked to health, one gathers information on intake of tobacco or

alcohol, the exercise of transmission, vaccination efforts, sporting undertakings,

sexuality, etc.

A KAP assessment is a quantitative kind technique (already defined

enquiries and organized in consistent questionnaires) that delivers admission

to quantitative and qualitative data. KAP queries tend to disclose not only

distinguishing qualities in knowledge, outlook and comportments about health

associated to spiritual, communal, customary factors, but also the notion that

each individual has of the form or of disease. These dynamics are often the

basis of delusions or misinterpretations that might signify hindrances to the

undertakings that we would like to carry out and possible obstructions to

behavior modification (e.g. mindfulness about the dangers of HIV contagion or

campaign of condom usage). The impediment to modification may be a

deficiency of information of the advantages of health, or privation of knowledge

of the issue and its brutality (for the previous instance, misinterpretation the

methods of HIV conduction). It can additionally disclose sociocultural or

spiritual depictions powerfully associated to the alteration in inquiry (utilizing a

condom implies that you are not a reputable individual or that you lack

confidence your companion) or a lack of proficiency (does not know how to use

a condom). Lastly, the hindrance to alteration, resistance or rejection may

additionally be an manifestation of traditional opposition and/or may expose a

partisan standpoint (Gumucio et al. 2011).

KAP studies involving community pharmacists. A number of studies

involving KAP of community pharmacists were conducted amidst COVID-19

pandemic. These includes Nguyen et al (2021) on the information, outlook, and

approaches of community pharmacists in Vietnam concerning COVID-19. This

article revolves around the pharmacist belonging to Vietnam, and their

information, outlook, and approaches regarding the on-going pandemic. The

method of data collection from the participants was through a validated

questionnaire, that aimed to gather information regarding the above-mentioned

variables. This questionnaire was distributed among 1023 certified pharmacists

of the country, and their responses were analyzed statistically to come up with

a solid understanding. The results of the study were quite positive as most of

the pharmacists understood the threats that the pandemic posed and were

working diligently to try and keep it from spreading further in the country. The

linear regression model indicated the relevance of knowledge with the age of

the particular pharmacist, his/her education level and residence. Furthermore,

with regards to their attitude to the pandemic, the pharmacists tried to keep

themselves well informed of the virus, through research and news published on

the internet and social media. Also, it was reassuring to note that their attitude

towards the dangers of the virus was quite serious, as most of them refused to

communicate with patients who did not wear facemasks. Also, pharmacists

kept good care of the personnel in the pharmacy by forcing the need for

protective equipment. The authors conclude by giving positive remarks about

the expertise and willingness to contribute to the fight against the virus and

suggest the government to provide support for the betterment of the

pharmaceutical industry so that it can perform more effectively. The article

outlines the need for the pharmaceutical industry to keep on performing the

way it is against the rampant spread of the pandemic, and confirms the fact

that pharmacists have what it takes to play a decisive role in this effort.

It is essential for the public to routinely practice precautionary behaviors

to limit the spread of COVID-19, due to the unavailability of vaccines and

antiviral treatments. Responding to the pandemic has proven to be a severe

challenge, as there is limited knowledge about the epidemiological evidence

concerning COVID-19, together with the transmission dynamics, reproductive

frequency and epidemic doubling time. It therefore has become increasingly

crucial for the masses to take part in precautionary efforts due to the scarcity of

clinical measures which have raised the heightened concerns. During the

pandemic, measures such as educating, engaging and mobilizing the masses

to become active participants may help to realize the public health emergency

preparedness, and lessen the vulnerability of the general population.

Knowledge can play a critical role in encouraging the practice of public

preventive behavior, and the findings indicated that knowledge was linked to

attitudes and preventive behaviors. Information that is disseminated through

health interventions to control and prevent epidemics must be founded on

scientific evidence and be conveyed on a comprehensible language to

heighten the public knowledge of the issues. Additionally, apart from just

providing precise and sufficient knowledge, efforts to remedy wrong and

misguided information are essential. The attitudes, more so the efficacy beliefs

have a substantial and robust impact on practicing preventive behaviors,

 suggesting that promoting preventive behaviors toward COVID-19, would

necessitate both knowledge and efficacy beliefs among the public. Public

health experts need to recognize that health communications is a dynamic

process primarily shaped by individual cognitive and psychological factors.

Therefore, a particular emphasis should be placed on bolstering efficacy.

Occupation is significantly associated with knowledge and attitude.

Health care workers have a high level of knowledge and positive attitudes

toward COVID-19 pandemic. The pharmacists displayed relatively more

knowledge, which has a higher probability for positive attitudes. There was

however a significant concern among the healthcare workers about contracting

the virus and passing it to their family members, specifically their parents.

During times of health crises and emergencies, the public needs to observe

precautionary behaviors always as the novelty and unpredictability of

pandemics may surpass a health system’s capacity to a noteworthy degree.

Findings suggest that individuals may be disadvantaged from engaging in

health behaviors because of unequal distribution of knowledge, attitudes and

behaviors and probably in combination with a lack of access to healthcare and

pre-existing health conditions.

Please cite any of the following related studies in this sub topic:

Pakistan: 2021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129683/

Pakistan: 2022
https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/
fr/covidwho-1085442

Japan: 2021
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258805
Libya: 2022
https://search.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/
en/covidwho-1689510

Lebanon: 2021
https://joppp.biomedcentral.com/articles/10.1186/s40545-021-00327-6

Saudi: 2021
https://pharmacophorejournal.com/article/knowledge-attitude-and-practice-toward-covid-
19-among-community-pharmacists-in-saudi-arabia-cross-ukrjdghkgucravh

UAE: 2022
https://www.ingentaconnect.com/contentone/jcf/phpr/2022/00000020/00000001/
art00016?crawler=true&mimetype=application/pdf

https://pharmacypractice.org/index.php/pp/article/view/2628

Ethiopia: 2020
https://www.dovepress.com/covid-19-related-knowledge-attitude-and-practice-among-
hospital-and-co-peer-reviewed-fulltext-article-IPRP

https://journals.sagepub.com/doi/10.1177/2050312120973498?icid=int.sj-full-text.similar-
articles.2

Ethiopia: 2022
https://www.hilarispublisher.com/open-access/knowledge-attitude-and-practice-of-
community-and-hospital-pharmacists-towards-the-novel-coronavirus-disease-19-
covid19.pdf

Ethopia: 2021
https://formative.jmir.org/2021/10/e26980/

Baghdad: 2022
https://assets.researchsquare.com/files/rs-1863456/v2/a5e9226e-8667-4e18-b722-
3d0cba66486b.pdf?c=1673897210

Malaysia: 2021
https://www.noveltyjournals.com/upload/paper/Study%20of%20the%20level%20of
%20Knowledge.pdf

Turkey: 2020
https://cms.galenos.com.tr/Uploads/Article_43084/TJPS-0-0-En.pdf

Turkey: 2021
http://openaccess.altinbas.edu.tr/xmlui/bitstream/handle/20.500.12939/2259/
Knowledgeandattitudesofcommunitypharmacistsaboutcovd.pdf?
sequence=1&isAllowed=y

Egypt: 2021
https://aprh.journals.ekb.eg/article_135063.html

Syria: 2020
https://www.authorea.com/users/318186/articles/448113-knowledge-and-attitude-
among-syrian-pharmacists-towards-covid-19

Goa, India 2020

https://www.ijcmph.com/index.php/ijcmph/article/view/7134

Sudan: 2022
https://d-nb.info/126379064X/34

China: 2020
https://www.ajtmh.org/view/journals/tpmd/104/4/article-p1461.xml

CHAPTER 3

METHODOLOGY

This section presents the processes, approaches, and procedures used

in the study of assessing the accuracy of the current information, outlook, and

approaches of community pharmacy personnel in Tagbilaran City, Bohol toward

COVID-19.

Research Design

A research design replicated from a study conducted by Nguyen et al.

(2020) wherein a cross-sectional, paper-based study will conducted using a

validated questionnaire to interview pharmacy personnel working in community

pharmacies in Tagbilaran City, Bohol. Analysis of covariance will be employed

to identify factors associated with the knowledge of these pharmacy personnel.

All statistical analyses were analyzed by using SPSS, version 21 (IBM Corp,

Armonk, NY).

Research Locale

The research design, sampling, tool, gathering of data, and its analysis

and interpretation, and destruction of data will be done in Tagbilaran City,

Bohol where the researcher and respondents are located.

Sampling Design

Due to the intricacy of the COVID-19 epidemic, a non-prospective

suitability sampling method will be used for enlisting respondents.

Respondents’ insertion criteria will be approved pharmacists and pharmacy

assistants working in drugstores that are open on the times of data gathering,

able to declaim and comprehend English and Cebuano, and at least 18 years

old. Each personnel will be given a single data assemblage form. After the

procedures will be filled in, the researcher will go through them to assure that

all inquiries will be replied sufficiently and clearly. Then, all data gathering

forms will be recorded.

The study's model size will be calculated using the Raosoft sample size

calculator. Grounded from the population size, the margin of error, confidence

level, as well as the sample distribution will be set to the appropriate

percentage value. With the aim of increasing the generalizability and validity of

this research, we will strive to approach as many pharmacists as possible to

collect data. From these values, a sample size will be calculated. With the

purpose of cumulating the generalizability and rationality of this study, the

researcher will strive to get in touch with many pharmacists as possible to

collect information. The general characteristics of the participants will be shown

and the gender and age of the respondents will be analyzed.

Data Gathering Tool

Numerous studies on KAP involving pharmacy personnel from reliable

publications will be reviewed. The researcher will develop its first draft of the

questionnaire. For lucidity and validity of questions, 3 lecturers from the

University of Bohol will assist the researcher in reviewing the questionnaire.

The final questionnaire will start with a brief overview, comprising the purposes,

the techniques, the affirmation of discretion and secrecy, and the volunteer

features of the partakers. It will be premeditated in English with Cebuano

translation and will include the following main parts: pharmacy personnel’s

outline (5 questions), information (10 questions), and outlook/approaches (20

questions). The questions will be built on the four scale likert pattern (i.e. strong

agreement is denoted by SA, agreement is denoted by A, disagreement is

denoted by D, and strong disagreement is denoted by SD.) and a

Cronbach alpha value will be acquired from the pilot scholarship, which will

show if the established instrument is dependable.

Data Gathering Procedure

 The final questionnaire will be distributed to pharmacy personnel

employed in community pharmacies in Tagbilaran City, Bohol. They will

voluntarily answer the questions and data gathered from the questionnaire will

handled with utmost confidentiality following Data Privacy Act of 2012.

Pilot Study

The questionnaire will be used to perform a pilot study with ten

pharmacists from ten different pharmacies in Tagbilaran City, Bohol, before

interviewing the sample quantity from all around the city to check logic,

appropriateness, and reasonableness. The Cronbach’s alpha will be

determined.

Ethical Consideration

The respondents will voluntarily answer the questionnaire and spoken

informed consent will be acquired from all of them. A portion of the

questionnaire stating the Data Privacy Act of 2012 will also be included prior

answering the survey. The ethical committee of Philippine Women’s University

will approve this study.

Data Management Plan

Compliant to the Data Privacy Act of 2012, all data will be managed with

utmost confidentiality. De-identified data to be used in the study will be

obtained from pharmacy personnel in Tagbilaran City, Bohol. The pre-analysis

data obtained from the sample should be requested from the respondents

directly.

Storage. All paper data will be stored in locked file cabinets in locked

storage space accessible only to the researcher at the performance sites.

Paper data will only be labeled with the participant’s ID. Any direct identifiers

such as name, address, contact number, and e-mail, will be redacted from

paper data as soon as it is processed for data entry.

Destruction of Data. After data entry, questionnaires will be cut into

small pieces, soaked in water, and disposed in a biodegradable trashcan and

thrown to landfill.

Data Analysis

The data will be statistically evaluated using the statistical software for

social science (SPSS) form 25.0 once the questionnaire responses are loaded

into an excel spreadsheet. Descriptive analysis will be reported to describe the

socio-demographic, frequency, percentage, and mean information, outlook,

and approach scores of the population. To determine data normality, the

histogram, Q-Q plot, boxplot, and Shapiro-Wilk test (p-value > 0.05 suggesting

a normally dispersed incessant variable) will be utilized. The Wilcoxon rank-

sum test, the Kruskal-Wallis rank-sum test, and the Dunn test will be used to

analyze differences between groups for a range of assessments. Inferential

statistics comprising t-test and ANOVA and Pearson’s association test will be

functional in evaluate the relationship between dependent variables.

 The score for every respondent will calculated based on three key

topics: symptoms, transmission, and prevention. Correct and incorrect

responses will earn 1 point and 0 point for each inquiry, accordingly. The

overall knowledge score of one person will vary from 0 to 15. The scores of ten

and ten indicate that you have sufficient information and, conversely, that you

lack knowledge. Accurate responses were mostly associated to data from the

reliable sites where questions will be gathered from.