{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:18:20Z","timestamp":1787843900856,"version":"build-2784847793"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Lang &amp; Comm Disor"],"published-print":{"date-parts":[[2026,5]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Pill\u2010swallowing difficulty is a common yet under\u2010recognised barrier to effective pharmacotherapy, with potential consequences for adherence, therapeutic efficacy, and patient safety. Malaysian evidence is scarce, particularly in outpatient populations where long\u2010term oral medication use predominates.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the prevalence, identify associated factors, and examine the consequences of pill\u2010swallowing difficulties among outpatient pharmacy attendees in a Malaysian teaching hospital.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross\u2010sectional online survey was conducted at the outpatient pharmacy of Hospital Al\u2010Sultan Abdullah (HASA), Universiti Teknologi MARA (UiTM), over six weeks in 2025. Adults who received at least one pill (e.g., tablets, capsules or caplets) were invited to complete an electronic questionnaire. Ethical approval was obtained from the UiTM research ethics committee. Binary logistic regression was used to identify associated factors, and descriptive analyses summarised reported problems, coping strategies, medication adherence, psychosocial and behavioural consequences, and consultations with healthcare professionals.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 446 respondents, 185 (41.5%) reported difficulty swallowing pills. Compared with participants aged 18\u201329 years, those aged 30\u201349 years (aOR\u00a0=\u00a00.351, 95% CI: 0.177\u20130.695,\n p<\/jats:italic>\n \u00a0=\u00a00.003) and \u226550 years (aOR\u00a0=\u00a00.208, 95% CI: 0.094\u20130.458,\n p<\/jats:italic>\n \u00a0<\u00a00.001) were significantly less likely to report swallowing difficulties. Tertiary\u2010educated individuals had higher odds of reporting difficulties (aOR\u00a0=\u00a01.878, 95% CI: 1.060\u20133.328,\n p<\/jats:italic>\n \u00a0=\u00a00.031). A self\u2010reported behavioural pattern of taking pills one by one rather than together was independently associated with difficulty (aOR\u00a0=\u00a01.636, 95% CI: 1.086\u20132.462). The most frequent complaints were the sensation of a pill being \u2018stuck in the throat\u2019 (87.0%) and difficulty with caplet shapes (78.9%). Reported consequences included medication non\u2010adherence (36.8%) and psychosocial or behavioural consequences (67.0%). Only 9.7% had sought professional advice.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Pill\u2010swallowing difficulty is prevalent among Malaysian outpatients, with important behavioural and clinical implications. Systematic screening, counselling, and patient\u2010centred formulation strategies are warranted to improve adherence and safety.<\/jats:p>\n <\/jats:sec>\n \n WHAT THIS PAPER ADDS<\/jats:title>\n \n What is already known on this subject<\/jats:italic>\n \n \n Pill\u2010swallowing difficulty, or pill dysphagia, is a common yet under\u2010recognised problem that may compromise medication adherence and treatment outcomes. International studies report that approximately 29%\u201355% of adults experience difficulty swallowing solid oral dosage forms, sometimes resulting in medication modification, delayed dosing, or non\u2010adherence. Both formulation characteristics and psychological factors influence swallowability. However, most available evidence derives from Western or inpatient populations. Data from outpatient settings in low\u2010 and middle\u2010income countries remain limited, despite the central role of long\u2010term oral pharmacotherapy in these contexts.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n \n What this paper adds to existing knowledge<\/jats:italic>\n \n \n This study provides outpatient\u2010based Malaysian data on the prevalence and correlates of pill\u2010swallowing difficulty, identifying a prevalence of 41.5%. Younger adults and individuals with tertiary education were more likely to report difficulty, whereas older age was associated with lower odds. A self\u2010reported behavioural pattern of taking pills one by one rather than together was independently associated with reported difficulty. A substantial proportion reported psychosocial or behavioural consequences and medication non\u2010adherence, while few sought professional advice. The findings extend existing literature by characterising behavioural responses and healthcare engagement in a routine outpatient pharmacy setting.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n \n What are the potential or actual clinical implications of this work?<\/jats:italic>\n \n \n Pill\u2010swallowing difficulty warrants routine consideration in outpatient pharmacy practice. Incorporating a brief screening question into dispensing encounters may facilitate identification and normalise discussions of swallowing concerns. Pharmacists can provide structured guidance on evidence\u2010based swallowing techniques and advise on appropriate alternative formulations when clinically suitable. Clear referral pathways to speech\u2010language therapists or physicians may benefit individuals with persistent or complex symptoms. Greater attention to swallowability in formulation selection and prescribing decisions may support safer medicine use and improve continuity of pharmacotherapy.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1460-6984.70258","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:56:00Z","timestamp":1777982160000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Factors Associated With Pill\u2010Swallowing Difficulties Among Outpatient Pharmacy Attendees at a Malaysian Teaching Hospital: A Cross\u2010Sectional Study"],"prefix":"10.1111","volume":"61","author":[{"given":"Nur Amira Said","family":"Udin","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam Puncak Alam Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8056-8036","authenticated-orcid":false,"given":"Nik Aisyah Najwa Nik Mustaffa","family":"Shapri","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam Puncak Alam Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5618-9110","authenticated-orcid":false,"given":"Mohammad Suhaidi","family":"Sha'ari","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam Puncak Alam Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2591-1690","authenticated-orcid":false,"given":"Muhammad \u2018Izzuddin","family":"Zamery","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Technology, Faculty of Pharmacy Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam Puncak Alam Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2134-9036","authenticated-orcid":false,"given":"Abdul Azim Al\u2010Abrar Ahmad","family":"Kailani","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Al\u2011Sultan Abdullah Universiti Teknologi MARA (UiTM) Puncak Alam Selangor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1621-0828","authenticated-orcid":false,"given":"Ammar","family":"Kamar","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Hospital Kuala Lumpur Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2801-0134","authenticated-orcid":false,"given":"Mohd Shahezwan Abd","family":"Wahab","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam Puncak Alam Selangor Malaysia"},{"name":"Elderly Medication and Safety Research Interest Group, Faculty of Pharmacy Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam Puncak Alam Selangor Malaysia"},{"name":"Non\u2010Destructive Biomedical and Pharmaceutical Research Centre, Smart Manufacturing Research Institute Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam Puncak Alam Selangor Malaysia"},{"name":"Faculty of Pharmacy Universitas Airlangga Surabaya East Java Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-024-10703-4"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14207180"},{"issue":"2","key":"e_1_2_9_4_1","first-page":"195","article-title":"A Cross\u2010Sectional Study on Swallowing Difficulty and Pill Dysphagia Among Older People Residing in Nursing Homes in Selangor, Malaysia. 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M. P.Schneider J.Marquis andB.Bugnon.2011. \u201cPrevalence of Patients' Difficulties in Swallowing Solid Oral Dosage Forms.\u201d In39th ESCP (European Society of Clinical Pharmacy) and European Symposium on Clinical Pharmacy and 13th SFPC (Soci\u00e9t\u00e9 Fran\u00e7aise de Pharmacie Clinique) Congress: Clinical Pharmacy at the Front Line of Innovations."},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S277238"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcsop.2023.100380"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.31436\/imjm.v24i02.2707"},{"issue":"8","key":"e_1_2_9_28_1","first-page":"1","article-title":"Innovative Tool for Taking Large Pills for the Elderly and Patients With Swallowing Difficulties","volume":"1","author":"Sadamoto K.","year":"2012","journal-title":"Pharma Innovation"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-012-1417-0"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1693"},{"issue":"2","key":"e_1_2_9_31_1","first-page":"41","article-title":"Pill\u2010Swallowing\u2013A Bitter Experience for Some Despite the Ease of the Swallow","volume":"4","author":"Seedat J.","year":"2020","journal-title":"Southern African Journal of Public Health Incorporating Strengthening Health Systems"},{"issue":"12","key":"e_1_2_9_32_1","first-page":"3639","article-title":"Evaluating Dysphagia","volume":"61","author":"Spieker M. 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