{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:40:45Z","timestamp":1766515245754,"version":"3.48.0"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background and aim<\/jats:title>\n                    <jats:p>Nausea and vomiting of pregnancy (NVP) is the most common medical condition of gestation, affecting up to 90% of women and significantly impacting their quality of life. Community pharmacists (CPs) are often the first point of contact for these women, yet there is a lack of objective data on their practice quality in Jordan. This study aimed to conduct the first national, simulated patient study to assess objectively the assessment, management, counseling, satisfaction and predictors of appropriate practice among Jordanian community CPs when managing NVP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A national, cross-sectional study using a simulated patient methodology was conducted in 380 community pharmacies, selected via proportionate stratified random sampling. Two validated scenarios (mild NVP and severe NVP with red flags) were used. A validated structured data collection form documented CPs \u2018 assessment, management, counseling, and patient satisfaction. Multivariable logistic regression was used to identify independent predictors of \u201cAppropriate Practice.\u201d All data were analysed using SPSS (V28.0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant gap between guideline-recommended care and actual practice was evident, particularly in high-risk situations. While most CPs (84.2%) initiated symptom inquiry, crucial assessment of red flags in the severe NVP scenario was dangerously low (e.g., inquiry about dehydration, 21.1%). This assessment failure translated directly to practice: only 56.8% of CPs correctly referred the high-risk patient, while 43.2% inappropriately sold an over-the-counter medication, delaying necessary medical care. Counseling on medication safety was consistently poor, with only 29.9% of CPs discussing potential side effects. Despite these clinical deficiencies, the overall patient satisfaction was high, appearing to be driven more by interpersonal skills than clinical accuracy. Multivariable analysis revealed that appropriate practice was independently predicted by prior maternal health training (aOR = 3.48,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and being a female pharmacist (aOR = 2.01,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009). Conversely, a high pharmacy workload was a significant independent barrier, reducing the odds of providing appropriate care by 50% (aOR = 0.50,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.018).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Jordanian community CPs are a critical but currently underperforming resource in maternal care. The prevalent gaps in clinical assessment and referral for severe NVP represent a significant patient safety risk. A one-size-fits-all approach to quality improvement is unlikely to succeed. Instead, a dual-pronged strategy is essential: (1) national professional pharmacy bodies must mandate targeted continuing professional development in maternal health, focusing on risk assessment and referral protocols; and (2) health policymakers and community pharmacy owners must address systemic barriers, particularly the detrimental impact of high workload on the delivery of safe and effective patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0339327","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:30:14Z","timestamp":1766514614000},"page":"e0339327","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing community pharmacists\u2019 responses to pregnancy-related nausea and vomiting: A national simulated patient study in Jordan"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4260-1117","authenticated-orcid":true,"given":"Khalid","family":"Al Kubaisi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derar H.","family":"Abdel-Qader","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia","family":"Al Mazrouei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abduelmula R.","family":"Abduelkarem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yahya H. Dallal Bashi","family":"Dallal Bashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moh\u2019d Ahmad","family":"Shara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"issue":"1","key":"pone.0339327.ref001","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1186\/s12884-020-03472-z","article-title":"The effect of a pharmacist consultation on pregnant women\u2019s quality of life with a special focus on nausea and vomiting: an intervention study","volume":"20","author":"MB-T Truong","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0339327.ref002","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s12884-017-1249-0","article-title":"The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again - results from a cross-sectional study","volume":"17","author":"K Heitmann","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"issue":"11","key":"pone.0339327.ref003","article-title":"Associations between Nausea, Vomiting, Fatigue and Health-Related Quality of Life of Women in Early Pregnancy: The Generation R Study","volume":"11","author":"G Bai","year":"2016","journal-title":"PLoS One"},{"issue":"2","key":"pone.0339327.ref004","first-page":"151","article-title":"Hyperemesis Gravidarum","volume":"33","author":"K Austin","year":"2018","journal-title":"Nutrition in Clinical Practice"},{"key":"pone.0339327.ref005","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.ejogrb.2019.04.043","article-title":"Predictive factors of Hyperemesis Gravidarum: A systematic review","volume":"238","author":"P Ioannidou","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"pone.0339327.ref006"},{"issue":"2","key":"pone.0339327.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0262254","article-title":"An exploratory survey on community pharmacists\u2019 service provision for pregnant and lactating women in Sharjah, United Arab Emirates","volume":"17","author":"ZA Akkad","year":"2022","journal-title":"PLoS One"},{"issue":"3","key":"pone.0339327.ref008","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/1077558712459215","article-title":"The effect of community pharmacy-based interventions on patient health outcomes: a systematic review","volume":"70","author":"SJ Blalock","year":"2013","journal-title":"Med Care Res Rev"},{"issue":"1","key":"pone.0339327.ref009","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/ijpp.12570","article-title":"A systematic review of the use of simulated patient methodology in pharmacy practice research from 2006 to 2016","volume":"28","author":"I Bj\u00f6rnsdottir","year":"2020","journal-title":"Int J Pharm Pract"},{"issue":"12","key":"pone.0339327.ref010","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1016\/j.sapharm.2021.04.021","article-title":"The simulated patient method: Design and application in health services research","volume":"17","author":"JC Collins","year":"2021","journal-title":"Res Social Adm Pharm"},{"issue":"1","key":"pone.0339327.ref011","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-018980","article-title":"Community pharmacists\u2019 services for women during pregnancy and breast feeding in Kuwait: a cross-sectional study","volume":"8","author":"A Albassam","year":"2018","journal-title":"BMJ Open"},{"issue":"4","key":"pone.0339327.ref012","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.18549\/PharmPract.2022.4.2739","article-title":"A pseudo-customer cross-sectional study to evaluate the community pharmacist\u2019s management of migraine in pregnant women","volume":"20","author":"KA Kubaisi","year":"2022","journal-title":"Pharm Pract (Granada)"},{"issue":"1","key":"pone.0339327.ref013","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40545-020-00294-4","article-title":"A simulated patient study to evaluate community pharmacist assessment, management and advice giving to patients with asthma","volume":"14","author":"S Hasan","year":"2021","journal-title":"J Pharm Policy Pract"},{"issue":"1","key":"pone.0339327.ref014","doi-asserted-by":"crossref","DOI":"10.1080\/09581596.2025.2493790","article-title":"Exploring the pharmacist\u2019s role in pregnancy care: perceptions, practices, competencies, and barriers","volume":"35","author":"AS Jarab","year":"2025","journal-title":"Critical Public Health"},{"issue":"8","key":"pone.0339327.ref015","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1007\/s11606-014-2860-7","article-title":"Directly observed care: can unannounced standardized patients address a gap in performance measurement?","volume":"29","author":"SJ Weiner","year":"2014","journal-title":"J Gen Intern Med"},{"issue":"2","key":"pone.0339327.ref016","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18549\/PharmPract.2025.2.3171","article-title":"Community Pharmacists\u2019 Current Safe Practice and Educational needs in Dispensing Melatonin Supplements in Jordan: A cross-sectional study","volume":"23","author":"JD Al Shawabkeh","year":"2025","journal-title":"Pharmp Ract"},{"issue":"1","key":"pone.0339327.ref017","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1136\/qshc.2005.014720","article-title":"Factors predicting the guideline compliant supply (or non-supply) of non-prescription medicines in the community pharmacy setting","volume":"15","author":"MC Watson","year":"2006","journal-title":"Qual Saf Health Care"},{"issue":"5","key":"pone.0339327.ref018","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1055\/s-0042-1743101","article-title":"Hematological 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Pharm"},{"key":"pone.0339327.ref021"},{"key":"pone.0339327.ref022"},{"key":"pone.0339327.ref023"},{"key":"pone.0339327.ref024"},{"key":"pone.0339327.ref025"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339327","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:30:20Z","timestamp":1766514620000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0339327"}},"subtitle":[],"editor":[{"given":"Usman 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