Pharmacists under pressure to concede: Why pharmacists provide non-prescribed antibiotics in the Arab minority in Israel

Background: Antibiotics overuse has become a global health threat because of increased antimicrobial resistance. Consumption of non-prescribed antibiotics contributes to this problem and has been found particularly among minority populations. One source for non-prescribed antibiotics are pharmacists. This study focuses on perspective of Arab pharmacists working in the Arab society in Israel–a minority reported to overconsume antibiotics–in order to learn why Arab pharmacists might accede to customers’ requests for non-prescribed antibiotics. Design: Face-to-face interviews were conducted with 60 Arab pharmacists working in private pharmacies in different regions in Israel. Qualitative data were analyzed thematically by focusing on the characteristics of pharmacist-customer relations, conceptions of social norms, and perceived expectations to provide non-prescribed antibiotics. Key results: The findings highlight how perceived normative expectations associated with a collectivist orientation predispose pharmacists to concede to customers' requests. The analysis identified two inter-related factors serving to pressure pharmacists to dispense non-prescribed antibiotics: personal customer-pharmacist relationship and cultural collectivist values. Pharmacists faced dilemmas between obligation to comply with customers' requests and going against professional ethos and described strategies to resist customers’ requests. Conclusions: This study illuminates the central role of sociocultural contexts and social norms in pharmacist-customer relations in a collectivist-oriented minority, resulting in pressuring pharmacists to go against regulations. The findings have implications to understanding reasons for dispensing prescription-only medications. Interventions to reduce antibiotics use could enlist the centrality of social ties and commitment in pharmacist-customer relationships to resist dispensing prescription-only medications without prescriptions and to strengthen pharmacists’ role in providing pro-health messages.