Abstract
This study aimed to assess community pharmacists’ knowledge, attitudes, intentions,
and dispensing and counselling behaviors related to medication use in pregnant and lactating
women; to examine factors associated with dispensing intention and behavior using the Theory
of Planned Behavior (TPB); to develop an educational program to enhance dispensing and
counselling knowledge; and to evaluate the preliminary effectiveness of the developed
program. The study was conducted in three phases. Phase 1 was a survey of 360 community
pharmacists. Phase 2 involved the development of an educational program based on literature
review findings, survey results, and brainstorming sessions with experts and community
pharmacists. Phase 3 was a preliminary effectiveness evaluation using a one-group pretest–
posttest design among 21 community pharmacists who completed all program activities.
The survey findings showed that most community pharmacists had positive attitudes
and strong intentions to provide services for pregnant and lactating women. However,
knowledge gaps remained in several clinically important areas, including physiological changes
during pregnancy, the use of reliable drug information resources, assessment of drug transfer
into breast milk, and appropriate medication selection in specific clinical situations. In addition,
follow-up and patient referral behaviors appeared to be less consistently practiced than
history taking, drug information searching, medication selection, and patient counselling.
The TPB-based analysis indicated that attitudes, subjective norms, and perceived
behavioral control were associated with dispensing intention and behavior. For pregnant
women, attitude and perceived behavioral control were significant predictors of dispensing
intention, whereas for lactating women, all three TPB constructs significantly influenced
intention. Intention was also positively associated with dispensing and counselling behavior in
both groups. These findings suggest that educational interventions should not focus solely on
knowledge transfer, but should also strengthen pharmacists’ confidence, professional
reasoning, and decision-making in real-world practice.
The developed program consisted of 23 video-based learning modules, supplementary
learning materials, infographics, and a knowledge calendar delivered through the Mahidol
University Continuing Education (MUCE) online platform. The content covered rational drug
use in pregnant and lactating women, communication techniques, risk–benefit assessment,
use of drug information resources, medication selection for common minor ailments, care for
lactating women, and case-based learning relevant to community pharmacy practice. The
program therefore provides a prototype for an online continuing education resource grounded
in the needs and practical challenges of community pharmacists.
The preliminary effectiveness evaluation showed positive changes in selected
outcomes after program participation, particularly increased recognition of the importance of
patient referral and improved referral-related behaviors when necessary among both pregnant
and lactating women. In addition, medication selection behavior for lactating women
improved significantly. However, the overall knowledge score after program participation was
not significantly different from the pre-program score, although the proportion of participants
meeting the knowledge passing criterion increased from 90.5% to 100%. These findings suggest
that the program has potential to improve selected aspects of practice behavior, but further
refinement may be needed to produce stronger effects on deeper knowledge and knowledge
application in real-world situations.
The findings should be interpreted in light of several limitations. The preliminary
effectiveness evaluation used a one-group pretest–posttest design without a comparison
group, involved a small sample size below the calculated minimum sample size, relied
primarily on self-reported measures, and did not assess actual practice performance or
patient-related outcomes. Therefore, the results should be considered preliminary evidence
of program effectiveness rather than definitive evidence of generalizable effectiveness.
In conclusion, this study highlights both the need and feasibility of developing an
educational program to strengthen community pharmacists’ capacity to provide medication
dispensing and counselling services for pregnant and lactating women. The developed
program can serve as a foundation for future continuing education courses or practice-support
tools for community pharmacy settings. Future studies should employ controlled or
comparative designs, include larger sample sizes, assess longer-term outcomes, and
incorporate objective measures of actual practice behavior and patient-related outcomes to
further confirm program effectiveness and support broader implementation.
