Social Attitudes Towards Public Health Interventions in Community Pharmacies in Poland: A Nationwide Cross-Sectional Survey

Introduction

Tobacco smoking remains one of the leading preventable causes of death worldwide, responsible for over 8 million deaths annually and affecting 1.25 billion tobacco users [1]. Furthermore, it is estimated that by 2030, over 1 billion people will be living with obesity (BMI ≥30 kg/m2), which is a significant risk factor for many chronic diseases [2]. These examples of lifestyle-related diseases constitute a serious public health problem both globally and in Poland [3]. The Global Burden of Disease 2023 analysis for Poland indicates that the main source of years of life lost is lifestyle-related non-communicable diseases, primarily cardiovascular diseases, cancer, and type 2 diabetes [4]. Between 1990 and 2017, a significant decrease in the number of premature deaths due to non-communicable diseases was observed in Poland (by approximately 31.7%). However, many people still live with chronic conditions that limit their daily functioning, highlighting the long-term nature of these diseases [5]. These data underscore that prevention and early interventions, including lifestyle modification (diet, physical activity, smoking cessation, and reduced alcohol consumption), should be key elements of health policy.

In this context, pharmacists can play a crucial role by supporting patients with health education, health monitoring, and promoting healthy behaviors. Although pharmacists in Poland are traditionally classified as a medical profession responsible for drug delivery, pharmaceutical advice, and ensuring pharmacovigilance [6], the role of community pharmacies has expanded significantly in recent years. For example, during the COVID-19 pandemic, pharmacists were granted the authority to certify and administer vaccinations, a significant step towards the development of public health services in pharmacies [7].

Legislative changes were introduced in parallel. The Pharmacist Profession Act (2020) [8] introduced the concept of pharmaceutical care, creating a legal framework for the provision of additional services in pharmacies and enabling pharmacists to expand their scope of activities beyond traditional drug-related activities. Currently, public debate in Poland considers the expansion of pharmaceutical care, including the introduction of preventive health interventions in pharmacies (eg, blood pressure measurements, medication reviews, counseling on chronic disease prevention). However, there are no detailed regulations governing the financing and scope of these services in pharmacies. Only vaccinations available in pharmacies are financed by the public payer, the National Health Fund (NFZ), but the scope of reimbursement vary depending on the patient group (eg, age, pre-existing chronic diseases). As of August 25, 2025, 11 vaccinations, financed in whole or in part by public funds (including influenza, pneumococcal, and shingles), are available in Polish pharmacies that have signed agreements with the public payer [9].

In Poland, public authorities are increasingly considering the implementation of healthcare services in pharmacies as part of their preventive and health promotion policies. Polish pharmacists are also increasingly well-prepared to provide healthcare services in pharmacies, including blood pressure and glucose measurements, cardiovascular risk assessments, and brief advice on healthy lifestyles. In addition to professional development training, this preparation includes, among others, guidelines of the Polish Pharmaceutical Society and the Supreme Chamber of Pharmacists regarding standards for performing measurements [10] and conducting pharmaceutical consultations [11]. At the same time, pilot projects are being implemented, such as “Blood pressure measurement service and basic diagnostic screening tests (point-of-care) in a public pharmacy”, implemented in partner pharmacies by the Medical Center of the Cardinal Stefan Wyszyński University in Warsaw (CM UKSW), which aim to assess the effectiveness and safety of such interventions [12]. Furthermore, case law, including the judgment of the Supreme Administrative Court of 11 January 2012 (ref. II GSK 1365/10) [13], confirms that a public pharmacy may have a blood pressure monitor and perform free blood pressure measurements in the interest of public health, creating a formal basis for implementing similar services. Particular attention is being paid to the provision of smoking cessation counseling services in pharmacies, which, according to research, can effectively increase the percentage of people who quit smoking and reduce the risk of chronic diseases. The effectiveness of these efforts is confirmed by, among others, randomized controlled trials that have verified urinary cotinine concentrations 6 months after quitting smoking [14]. The public increasingly perceives pharmacists as specialists to whom one can turn for assistance with nicotine addiction therapy and available treatment options [15]. These observations suggest that pharmacies can play a vital role in chronic disease prevention and health promotion, extending beyond their traditional role in drug distribution. However, data on public attitudes towards public health interventions implemented in pharmacies remains lacking, highlighting the need for further research in this area.

This study aimed to assess public attitudes towards public health interventions in community pharmacies in Poland and to identify sociodemographic factors associated with willingness to use such services. Specifically, the study focused on 4 types of pharmacy-based interventions: smoking cessation support, brief healthy lifestyle advice, brief vaccination-related advice, and support for adherence to physician lifestyle recommendations.

Material and Methods

MEASURES:

The study questionnaire comprised questions assessing public attitudes towards public health interventions provided in community pharmacies, including basic health measurements, smoking cessation support, healthy lifestyle advice, preventive care advice (particularly regarding vaccinations), and support for adherence to medical lifestyle recommendations.

The questions were prepared based on a literature review. The questionnaire used a 5-point Likert scale with possible answers of “definitely yes”, “rather yes”, “rather no”, “definitely no” and “hard to say/not sure”. To facilitate the analysis, the responses of “definitely yes” and “rather yes” were combined [23].

In addition, all participants provided information on their age, gender, educational level, marital status, place of residence, household size, number of children, occupational status, self-reported household economic status, presence of chronic diseases, regular medication use, and smoking status.

The questionnaire was designed as a descriptive and exploratory tool, consisting of conceptually independent items assessing attitudes towards specific pharmaceutical services and public health interventions. Therefore, it did not form a unified scale, and calculation of Cronbach’s alpha was not appropriate or statistically justified.

A pilot test–retest study was conducted with 8 adults (aged 18–68 years). Participants completed the questionnaire twice, 5 days apart, to assess test–retest stability at the item level. The pilot study was conducted for methodological purposes only, and pilot data were not included in the main analysis, which was performed on an independent sample. Based on the pilot findings, 2 items were revised to improve clarity.

OPERATIONAL DEFINITIONS:

The presence of chronic diseases was defined as self-reported diagnosis of at least 1 chronic condition. Regular medication use was defined as taking any prescribed medications on a continuous basis for chronic conditions. Smoking status was categorized into 3 groups: conventional cigarette smoking, use of e-cigarettes or heated tobacco products, and non-smoking.

STATISTICAL ANALYSIS:

The survey results, presented as categorical variables, are displayed in tables using response counts and proportions. The chi-square test of independence was used to assess associations between participants’ sociodemographic characteristics and questionnaire responses.

Sociodemographic factors associated with the odds of a given response were examined using logistic regression analyses. Univariable logistic regression analyses were used as an initial exploratory step to identify candidate variables for inclusion in multivariable models [24]. The assumptions of the logistic regression models were verified, including assessment of multicollinearity and evaluation of model goodness-of-fit. The results of logistic regression analyses are expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) and corresponding P values. Although a conventional threshold of P<0.05 was applied, statistical significance was not interpreted as the sole criterion for relevance. IBM SPSS Statistics version 29 was used for all analyses. Because the study used a non-probability purposive/quota sampling approach, inferential statistics (including P values) should be interpreted with caution and are presented primarily as exploratory indicators of associations within the study sample.

This study used non-random, quota-based sampling; therefore, all reported statistical associations (chi-square tests, logistic regression analyses) are specific to the study sample, should be interpreted accordingly, and should not be generalized beyond the participants included in this research.

Results

CHARACTERISTICS OF THE STUDY POPULATION:

The survey included 1102 adult participants, mean age 48.2±15.9 years. Of this group, 604 (54.7%) were female and 498 (45.3%) were male. The largest proportion of participants was aged 60 years and older (29.4%). Over half of the respondents reported being married (51.1%) and raising children (62.0%). The majority of participants were professionally active (63.5%) and rated their household economic situation as good (48.6%) or moderate (38.0%), while 13.3% reported having a bad economic situation.

Regarding health status, more than half of the participants (55.6%) reported having chronic conditions, and 45.6% indicated regular use of medications, while 54.4% did not follow a continuous pharmacotherapy regimen. Analysis of tobacco use habits showed that 231 (20.9%) participants smoked conventional cigarettes, 84 (7.6%) used e-cigarettes or heated tobacco products, and the majority, and 787 (71.5%), reported not smoking. Detailed distributions of sociodemographic and clinical characteristics are presented in Table 1.

PUBLIC ATTITUDES TOWARDS PUBLIC HEALTH INTERVENTIONS IN COMMUNITY PHARMACIES:

The study revealed predominantly positive attitudes towards public health interventions offered in community pharmacies. The most highly accepted service was support for adherence to physician lifestyle recommendations, with 818 participants (74.3%) answering “definitely yes” or “rather yes”. High levels of acceptance were also recorded for receiving brief advice on preventive measures, particularly vaccinations (66.8%), as well as basic health measurements performed by a pharmacist (57.7%). The lowest acceptance rates were observed for lifestyle counseling services (40.9% positive responses, n=451) and smoking cessation support (53.1% positive responses, n=585). A notable proportion of “hard to say/not sure” responses (32.0%, n=353) was observed for smoking cessation services. The detailed distributions of support for various public health interventions are presented in Table 2.

FACTORS ASSOCIATED WITH PUBLIC ATTITUDES TOWARDS DIFFERENT PUBLIC HEALTH INTERVENTIONS:

The multivariable logistic regression analyses revealed distinct patterns of sociodemographic and health-related factors influencing public attitudes towards various public health interventions offered in community pharmacies among Polish adults.

There were no sociodemographic factors associated with the willingness to have basic health measures in community pharmacy among adults in Poland (Table 3).

Good (aOR: 1.85; 95% CI: 1.27–2.69; P=0.001) or moderate (aOR: 1.59; 95% CI: 1.07–2.33; P=0.02) household economic status and using e-cigarettes or heated tobacco products (aOR: 1.78; 95% CI: 1.11–2.87; P=0.02) were significantly associated with public support for smoking cessation services provided in community pharmacy among adults in Poland (Table 4).

Living in a household with at least 3 household members (aOR: 1.83; 95% CI: 1.25–2.70; P =0.002), active occupational status (aOR: 1.62; 95% CI: 1.18–2.22; P=0.003), moderate household economic status (aOR: 1.59; 95% CI: 1.06–2.39; P=0.03), and having chronic diseases (aOR: 1.49; 95% CI: 1.15–1.93; P=0.003) were significantly associated with willingness to receive brief advice on healthy lifestyle provided in community pharmacy (Table 5).

Male gender (aOR: 1.72; 95% CI: 1.32–2.23; P<0.001), having chronic diseases (aOR: 1.36; 95% CI: 1.05–1.75; P =0.02), and using e-cigarettes or heated tobacco products (aOR: 2.14; 95% CI: 1.21–3.79; P =0.01) were significantly associated with willingness to receive brief advice on preventive vaccinations provided in community pharmacy (Table 6).

Living in a household with at least 3 household members (aOR: 1.75; 95% CI: 1.18–2.63; P=0.006), having chronic diseases (aOR: 1.38; 95% CI: 1.04–1.84; P=0.03), and using e-cigarettes or heated tobacco products (aOR: 2.52; 95% CI: 1.30–4.88; P=0.006) were significantly associated with willingness to use services supporting adherence to medical recommendations on lifestyle provided in community pharmacies (Table 7). The multivariable logistic regression analyses for all sociodemographic and health-related factors are presented in Tables 3–7.

Discussion

PRACTICAL IMPLICATIONS:

Our results suggest that the future expansion of pharmacy-based health services should be grounded in a model of complementarity with existing physician care. Strengthening interprofessional collaboration will enable better utilization of healthcare resources, reduce waiting times for basic services, and improve access to preventive counseling. The gradual implementation of lifestyle counseling and smoking cessation programs will require additional educational efforts directed at patients and pharmacists to enhance trust and understanding of the role of community pharmacies in public health disease prevention.

STUDY LIMITATIONS:

This study has several important limitations. First, its cross-sectional design precludes the determination of causal relationships between individual characteristics and attitudes towards public health services in community pharmacies. Second, data were based on participants’ self-reported willingness to use services rather than their actual utilization. Third, the study did not assess the long-term effects of pharmaceutical interventions, limiting the evaluation of their sustained effectiveness. Fourth, the use of self-prepared questionnaires may have introduced systematic biases that could affect the validity of our findings. There was no full validation of the study questionnaire, only a pilot study. In particular, social desirability bias may have led participants to overstate their willingness to use pharmacy-based preventive services. While measures were taken to minimize this effect, its influence on the results cannot be entirely ruled out. Additionally, the online survey format may have excluded certain population segments with limited internet access or digital literacy, potentially affecting the representativeness of our sample despite quota sampling procedures. The sample cannot be considered representative of the entire population, as the CAWI method was used (approximately 5% of households in Poland do not have an internet access).

All statistical associations reported in this study are specific to the analyzed sample. Due to the use of non-probability quota sampling, P values and regression results cannot be generalized to the broader population. Inferential statistics are presented solely to explore patterns and associations within the study sample, which was structurally matched to the population in terms of gender, age, and place of residence.

This study focused on potential new health services in pharmacies, so general population was selected as a target population. Further studies should be carried out in other groups of respondents, such as those with chronic diseases or smokers.

Conclusions

The highest levels of patient acceptance were observed for pharmacist services that directly support medical recommendations, such as monitoring adherence to lifestyle advice and providing brief vaccination counseling. This indicates that patients prefer complementary rather than substitutive interventions in relation to physician-led care. Health-related factors, including the presence of chronic diseases and the use of e-cigarettes or heated tobacco products, were more strongly associated with acceptance of services than with demographic characteristics. Household conditions, particularly living in families with at least 3 members, as well as active employment and stable economic status, also were significant predictors of positive attitudes. In contrast, services such as lifestyle counseling and smoking cessation support had lower levels of acceptance. These findings show that the development of pharmaceutical care in public health should be oriented towards educational and preventive services.