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Abstract

Establishing and maintaining a highly-trained pharmaceutical workforce is crucial for serving the healthcare needs of the population. Globally, various factors have been associated with the decision of students leaving high school to pursue an undergraduate degree in pharmacy, however, this topic has not yet been explored in Vietnam. To explore the motivations of first-year undergraduate pharmacy students to study pharmacy at university. A cross-sectional study was conducted on 428 first-year pharmacy students enrolled in undergraduate pharmacy programs from across all universities in Can Tho, Vietnam, including one public university (193 students) and two private universities (235 students), from November 2022 to February 2023. Exploratory factor analysis identified five underlying factors associated with the choice of students to study pharmacy, with internal consistency assessed using Cronbach’s Alpha (α): personal factors (α = .86), career (α = .88), advice (α = .74), reputation (α = .84), and promotion (α = .76). Of these factors, personal factors had the greatest impact (mean = 4.13), while the least influential factor was promotion (mean = 2.92). Compared to public university students, private university students were more influenced by career (p = .019), advice (p = .002), and promotion (p < .001) when making the decision to study pharmacy. This study identifies the factors associated with the decision to pursue pharmacy education. These findings may be of interest to educational institutions addressing how they attract students and meet the workforce needs of the pharmaceutical industry and healthcare system.

Plain Language Summary

Purpose: This study aimed to investigate the motivations of first-year undergraduate pharmacy students in Vietnam for choosing to study pharmacy at university. Methods: A cross-sectional study was conducted among 428 first-year pharmacy students from public and private universities in Can Tho, Vietnam. Data was collected between November 2022 and February 2023. Exploratory factor analysis was used to identify underlying factors related to the students’ decision to study pharmacy. Internal consistency of these factors was assessed using Cronbach’s Alpha. Results: The study identified five factors associated with the choice to study pharmacy: personal factors, career, advice, reputation, and promotion. The factors demonstrated good internal consistency. Personal factors had the strongest impact, while promotion had the least influence. Comparisons between public and private university students showed that private university students were more influenced by career, advice, and promotion in their decision to study pharmacy. Conclusions: This study sheds light on the factors influencing first-year undergraduate pharmacy students in Vietnam to pursue pharmacy education. The findings have implications for educational institutions seeking to attract students and meet the workforce demands of the pharmaceutical industry and healthcare system. Understanding these motivations can assist in the development of targeted strategies to recruit and retain students in pharmacy programs.

Keywords

motivation pharmacy education factor analysis first-year pharmacy student Vietnam

Introduction

Pharmacy workers provide medication and other healthcare products and services, alongside the information needed to use them effectively. This includes identifying, preventing, and resolving drug-related issues, promoting proper medication usage and general health education, and ultimately achieving improved therapeutic outcomes through patient-focused interventions (Toklu & Hussain, 2013). Consequently, the pharmacy profession is highly regarded and valued in society (Woldekidan et al., 2020). In Vietnam, the development of the pharmacy profession started with the establishment of the Indochina Medical School in 1902, which is considered the first and oldest pharmacy university in Vietnam and a precursor to the current Hanoi University of Pharmacy (Hanoi University of Pharmacy, 2022b). The official training of pharmaceutical professionals began in 1914, and in 1926, the school began training pharmacists at the undergraduate level (Hanoi University of Pharmacy, n.d.).

In Vietnam, besides military universities, there are 16 public universities that offer a pharmacy program (Baecker et al., 2022). The number of private universities offering a pharmacy program is even higher and has increased in recent years (Baecker et al., 2022), likely due to the growing demand for pharmacy professionals. Hanoi University of Pharmacy stipulates that the curriculum of a pharmacy program consists of at least 150 credits for a 5-year undergraduate program, and 120 credits for a 4-year undergraduate program (Hanoi University of Pharmacy, 2017). After graduating as a pharmacist, students can work in both public and private healthcare sectors throughout Vietnam or pursue further education in the form of a master’s or doctoral degree, or a range of specialty training programs to improve their likelihood of finding work in either the domestic or international setting. Over the years, pharmaceutical education has significantly improved in its capability of fulfilling the demand for high-quality trained pharmacists, while striving for international integration (Woldekidan et al., 2020). Students are provided with an inclusive learning environment, tuition from world-class faculty, and opportunities for personal development (Hanoi University of Pharmacy, 2022a).

The strict undergraduate admissions process aims to produce competent pharmacists who can contribute to the healthcare system. Consequently, the entry grades to study pharmacy are higher than for many other majors. Nonetheless, pharmacy remains a popular field of study. In Vietnam, the total number of pharmacy students enrolled in public universities in 2020 was 12,466 (Baecker et al., 2022). Despite this, the pharmacy industry in Vietnam still experiences a shortage of personnel. According to the World Health Statistics 2022 (World Health Organization, 2022), there were 3.4 pharmacists per 10,000 people living in Vietnam (World Health Organization, 2022), which is lower than in some neighboring countries such as Thailand (6.3:10,000), Singapore (5.1:10,000), and Malaysia (3.5:10,000). The Ministry of Health has set a goal for clinical pharmacists to account for 30% of all pharmacists, but the actual percentage was reported to be only 3.78% in 2019 (Prime Minister of Vietnam, 2021). Despite the high number of pharmacy graduates each year, there is still a shortage of pharmacists in hospitals and healthcare facilities due to many pharmacists preferring to work in other pharmacy-related fields (Baecker et al., 2022). The Ministry of Health reported that Vietnam became an aging population country in 2011, and it is estimated that the proportion of elderly people living in Vietnam will increase from the current 11% to 18% by 2030 and further to 26% by 2050 (Tien Phong Online, 2020). With this increase in the aged population, there will be an increasing demand for healthcare and regular medication use, creating more job opportunities for pharmacy graduates. Additionally, the government’s development strategy for the pharmacy industry and investment from domestic and foreign businesses are driving forces for the growth of the pharmacy industry, attracting more students to the field (Prime Minister of Vietnam, 2014).

Surveys have found that the percentage of first-year pharmacy students who chose pharmacy as their first choice varies across different countries. In Sudan, it was reported to be 79.3%, compared to 67.5% in Ethiopia, 53.2% in the United States, and 52.3% in South Africa (Woldekidan et al., 2020; Yousif et al., 2014). However, there is a lack of published evidence regarding this within the context of Vietnam. Many factors that influence the decision to study pharmacy have not been investigated comprehensively. For instance, several studies have focused primarily on career advice without including the influence of universities on students (Alshehri et al., 2021; Hanna et al., 2016; Hussain et al., 2021). While one study addressed this limitation, it failed to consider the possibility of the pharmacy profession affecting the decision to study pharmacy (J. K. Jesson et al., 2009). Hence, there is a notable absence of any comprehensive investigation into the diverse array of factors that may influence a student’s decision to pursue a career in pharmacy. This study endeavors to bridge this gap by conducting a thorough examination of the diverse aspects that shape students’ choices. By exploring these factors comprehensively, the study can provide a holistic understanding of the decision-making process and shed light on this in the unique context of pharmacy education. Existing findings have relied mostly on the use of descriptive statistics (Anderson et al., 2008; Truter, 2009; Woldekidan et al., 2020; Yousif et al., 2014), which may be a less valuable approach compared with exploratory factor analysis. Descriptive statistics, such as means, standard deviations, and percentages, offer a basic understanding of each variable individually. However, they do not capture the underlying relationships and interdependencies between variables. In contrast, exploratory factor analysis offers a more robust and nuanced approach to data analysis. It allows for the exploration of the latent factors that contribute to the observed patterns in the data. By employing exploratory factor analysis instead of relying solely on descriptive statistics, this research aims to delve deeper into the complex relationships and underlying constructs that may contribute to a student’s decision to study pharmacy. While there are published reports of the results from surveys exploring the factors that influence the decisions of pharmacy students to study pharmacy in the United Kingdom, the United States, Saudi Arabia, Ethiopia, and Malaysia, there is a conspicuous absence of research on this topic in Vietnam. Thus, this study aims to identify the factors that contribute to the decision of first-year pharmacy students to study pharmacy across all universities offering pharmacy programs in Can Tho City, Vietnam. This study’s strength lies in its comprehensive coverage of potential factors influencing the decision to study pharmacy, adjusted for the Vietnamese context. This study’s findings will assist admissions staff at universities offering pharmacy courses in understanding students’ needs and desires and developing appropriate methods for increasing enrollment in pharmacy programs.

Literature Review

One’s choice of profession is influenced by several factors, such as a passion for science, employment opportunities, and earning potential (Capstick et al., 2007; Keshishian et al., 2010; Savage et al., 2009). Other factors include ease of finding employment (Lobb et al., 2004), a desire for a career in healthcare, job stability, respect for the profession, and the influence of family members, pharmacists, pharmacy students, high school teachers, and other healthcare professionals (Anderson et al., 2008; Capstick et al., 2007; Keshishian & John’, 2010; Woldekidan et al., 2020). In addition, career guidance programs offered by universities also play a significant role in attracting students to the pharmacy field (Anderson et al., 2008). Several studies have identified the primary reason for choosing pharmacy as a desire to help others, especially those in need (Capstick et al., 2007; Keshishian & John’, 2010). When analyzing the findings of previous studies, as presented above, it is generally possible to categorize the motivational factors influencing the choice of the pharmacy field into four main groups: advice, personal, university, and career.

Advice Factor

Teachers and educators play crucial roles in the career decisions made by young people. A study conducted by F. M. Cheung et al. (2013) demonstrated that teachers significantly influence the career development and decisions of students, both in collective and individual environments (F. M. Cheung et al., 2013). These findings also indicate that students in Hong Kong perceive teachers to be more effective influencers than their parents, possibly due to the lower levels of educational attainment typically achieved by their parents (F. M. Cheung et al., 2013). Additionally, R. Cheung and Arnold (2014) have shown that students rely strongly on teachers, followed by peers, and to a lesser extent, parents (R. Cheung & Arnold, 2014). In a study by Alshehri et al. (2021), pharmacy students considered family and friends to be the most influential contributors (61.1%) to their career choices.

Personal Factor

Personal benefits are an important factor in career selection (Atitsogbe et al., 2018; Gokuladas, 2010). Students from urban areas tend to prioritize personal benefits over social benefits when choosing a career (Gokuladas, 2010). In Chinese culture, personal benefits are important, but personal preferences are influenced more by social comparisons (Li et al., 2015). Swiss students are influenced more by personal preferences and differences related to individual identity (Atitsogbe et al., 2018). Korean students tend to focus on salary, job positions, and advancement opportunities, while American students are more typically concerned with personal goals and practicalities (Choi & Kim, 2013). Pharmacy students reported that the most important influences on the decision to pursue a pharmacy major were internal factors related to students’ individual attributes (interest in science, scientific ability) and factors related to self-desires such as good career prospects, respected profession, healthcare, and job-relatedness (J. Jesson et al., 2010).

University Factor

The findings of Ciriaci and Muscio (2011) support the notion that prestigious universities tend to attract talented individuals, emphasizing the influence of educational institutions on student choices (Ciriaci & Muscio, 2011). Kusumawati et al. (2010) highlighted that a university’s reputation plays a crucial role in a student’s decision to pursue further studies there (Kusumawati et al., 2010). Additionally, the quality of teaching is considered a significant determinant of student preferences (Agrey & Lampadan, 2014).

Hodges and Corley (2016) reported that, among female college students, the perception of difficulty of Information Systems courses influenced their choice of subject (Hodges & Corley, 2016). According to Zhang’s research, the difficulty of the program is an important factor affecting female students’ decisions to major in Information Systems (Zhang, 2007). Regarding the decision to study a specific course program, pharmacy students indicated that they were primarily influenced by the university’s marketing activities, the university’s reputation, and the enrollment date (J. Jesson et al., 2010). Additionally, studies by Rababah (2016) and James et al. (2018) found that the school’s communication activities had a low impact on students’ choice of major (James et al., 2018; Rababah, 2016).

Career Factor

In a study by Alhaddad, the most important factor for students choosing to study Pharmacy was the prospect of a stable job after graduation (83.2%) (Alhaddad, 2018). In a study by Wüst and Leko Šimić (2017), high income was the most influential characteristic reported by students in Germany as influencing their choice of a profession. Conversely, the findings of a study by Gokuladas (Gokuladas, 2010) suggest that financial factors do not have an impact on career choice. Professional reputation is identified as a crucial determining factor in career selection for young adults, as reported by Bojuwoye and Mbanjwa (Bojuwoye & Mbanjwa, 2014) and Wüst and Leko Šimić (2017).

The provision of career development opportunities is also an important intrinsic factor influencing career choice, as demonstrated in studies by Guan et al. (2015) and R. Cheung and Arnold (2014). Jobs with good career prospects (27.8%), self-employment opportunities (27.8%), and careers in the healthcare sector with patients (16.7%) are the most valued career-oriented factors influencing students’ choices (James et al., 2018). Having a high salary after graduation is considered important by students but is deemed less significant than the perception of Pharmacy as a respected profession with indispensable knowledge (Alshehri et al., 2021).

Methods

Study Design and Setting

Study Design

A cross-sectional descriptive survey was conducted, recruiting first-year pharmacy students admitted to all universities offering pharmacy programs in Can Tho, Vietnam, during the academic year 2022 to 2023. The universities included one public institution, Can Tho University of Medicine and Pharmacy, and two private institutions, Nam Can Tho University and Tay Do University. The survey was administered from November 2022 to February 2023.

Sample Size

The required sample size for this study was calculated using Raosoft (http://www.raosoft.com/samplesize.html). The total population of the present study comprises 561 pharmacy students studying at three universities offering pharmacy programs across Can Tho, Vietnam. With a predefined margin of error of 5% and a confidence level of 99%, the recommended sample size was determined to be 305 students. In this study, the survey was completed by 428 students, which is considered appropriate and increases the level of confidence in the findings.

Questionnaire

The survey tool used in this study comprised two sections: (i) characteristics of participants and (ii) factors influencing their decision to choose pharmacy as their major. The first section included 17 items about the participant’s characteristics including the type of university (public or private), gender (man or woman), age (≤18 or >18), religion (non-religious or religious), province of permanent residency (Can Tho, neighboring provinces of Can Tho, other provinces in the Mekong Delta region, or other provinces outside the Mekong Delta region), their place of residence before attending university (rural or urban), type of high school they graduated from (public or private), and highest educational attainment level of their parents (university or postgraduate, vocational school, high school or lower). This section also included questions on other information such as whether the high school attended was specialized, a self-evaluation of their natural science and social science performance in high school, their interest in natural science and social science subjects in high school, whether family members or friends work in healthcare, whether pharmacy was their first choice of major, whether they had held a leadership position in high school or a team, and whether they had attended conferences/workshops organized or participated in by universities with Pharmacy programs, each using “Yes” and “No” as response options.

The second section of the survey tool in this study consisted of 38 questions about potential factors influencing the decision of first-year pharmacy students to have chosen pharmacy as their major. These questions were developed based survey tools used and referred to in previous studies with similar research objectives (Alhaddad, 2018; Alshehri et al., 2021; Hanna et al., 2016; Hussain et al., 2021; J. Jesson et al., 2010; J. K. Jesson et al., 2009; Keshishian & John’, 2010; Scarbecz & Ross, 2002; Woldekidan et al., 2020). These questions were initially grouped into the four main categories (dimensions) (i) advice (8 items), (ii) personal (13 items), (iii) university (7 items), and (iv) career (10 items) (Figure 1). A 5-point Likert-type scale (1-Strongly disagree; 2-Disagree; 3-Neutral; 4-Agree; 5-Strongly agree) was used to assess the respondent’s level of agreement with each item influencing their choice.

Figure 1.

(a) The initial theoretical model of the main influencing factors on students’ choice to study pharmacy, developed by the authors and (b) The revised model after factor analysis.

To ensure the validity of the questionnaire, face validity was assessed. Three experts in the field of pharmaceutical practice reviewed and provided feedback on the clarity and structure of the questionnaire and the appropriateness of the terminology used. The consequence of this assessment was that 6 items measuring factors influencing the decisions of students were shortened and simplified. Subsequently, the revised questionnaire was tested on 15 students who met the sampling criteria to improve clarity and accuracy. The results showed that all items were clear and easily understandable and that no further changes to the questionnaire were necessary. Furthermore, construct validity was also evaluated using exploratory factor analysis (specifically presented in the results section of this study). The Cronbach’s alpha coefficients of the extracted factors were all greater than 0.7, indicating high levels of internal consistency and appropriate reliability of the obtained structure.

Data Collection

The self-administered printed questionnaire was distributed directly to pharmacy students during their designated break time immediately following a class session. A comprehensive sampling technique was implemented to ensure representation. Every student present was extended an invitation to participate in the study. The survey took approximately 5 minutes to complete and was collected promptly upon completion. In the event of absences during the survey period, individuals were contacted through the class manager using the class membership list, and the questionnaire was sent to them. Students were allowed to freely decide whether to participate in the study or not. Of the 561 pharmacy students admitted to these universities, all were invited to participate in this study, resulting in 428 complete responses being received (response rate: 76.3%).

Data Analysis

Data were analyzed using the SPSS 20.0. Descriptive statistics such as frequency, percentage (%), mean, and standard deviation (SD) were used to present an overview of the data. The threshold of statistical significance was set at p < .05.

Factor analysis (FA) was used to determine the main factors that influenced the decision to choose pharmacy as a major. FA with principal component analysis as the extraction method and Varimax rotation was used to group the initial variables into meaningful factors (Hair, 2009). To evaluate the appropriateness of the data set for FA, the following tests were applied: the Kaiser-Meyer-Olkin (KMO) coefficient should be greater than or equal to 0.5 (Hutcheson, 2011), and the Bartlett test should be statistically significant (p-value < .05) (Hair, 2009). Based on the factor extraction results, the number of factors to retain would be determined according to criteria such as: the eigenvalue of each factor retained must be greater than 1 (Guttman-Kaiser rule) (Hair, 2009), and the total variance explained by the factor solution must be at least 50% (Hair, 2009). During factor rotation, variables were evaluated to meet the following conditions: each variable should have a factor loading with a significance level of at least 0.4 (for a sample size of 428) (Hair, 2009), no variable should have a factor loading of ≥0.4 on two or more factors, and each factor should have at least three variables with significant factor loadings (Henson & Roberts, 2016). The reliability of the extracted factors was assessed using Cronbach’s alpha, with a value >.7 considered acceptable (Nam et al., 2023). Variables with a corrected item-total correlation greater than 0.3 were included in the analysis (Cristobal et al., 2007; Hair, 2009).

Factor scores were computed by taking the average of the variables loading onto each factor, with a higher value indicating a greater influence on the decision to choose pharmacy as a major. The relationships between the demographic characteristics of the students and different extracted factors were evaluated using t-tests or a one-way ANOVA, as appropriate.

Results

Table 1 shows the characteristics of the study participants. The majority of participants were women (75.5%), aged 18 or younger (83.6%), and identified as non-religious (75.7%). They mostly attended public high schools (93.2%) that were not specialized (88.6%). Most rated themselves as performing well in natural science subjects (80.6%) but not in social science subjects (68.0%), with natural science being their favorite subject (79.9%) and not finding social science enjoyable (70.1%). The majority came from rural areas (67.1%) and provinces neighboring Can Tho city (45.6%). Most had family members, relatives, or friends working in the healthcare field (66.1%) and their parents had achieved high school or lower education (61.4%). Regarding the choice of major, pharmacy was the first choice for 65.7% of participants, whereas 50.7% had not held a leadership position in high school or a team, and 82.7% had never attended a conference or workshop organized by a pharmacy university.

Table 1.

Characteristics of Study Participants (n = 428).

Variables	n	%
Type of university currently attending
Public	193	45.1
Non-public	235	54.9
Gender
Women	323	75.5
Men	105	24.5
Age (year)^§
≤18	358	83.6
>18	53	12.4
Religion^‡
None	324	75.7
Practicing	94	22.0
Permanent address^‡
Can Tho	67	15.7
Provinces adjacent to Can Tho*	195	45.6
Other provinces in the Mekong Delta	133	31.1
Other provinces outside the Mekong Delta	29	6.8
Place of residence before entering university^‡
Rural	287	67.1
Urban	137	32.0
Type of high school education completed^‡
Public	399	93.2
Non-public	24	5.6
High school graduated from was a specialized school^‡
No	379	88.6
Yes	40	9.3
Self-assessment of academic performance in natural science in high school^‡
No	81	18.9
Yes	345	80.6
Self-assessment of academic performance in social science in high school^†
No	291	68.0
Yes	135	31.5
Interest in natural science subjects in high school^†
No	84	19.6
Yes	342	79.9
Interest in social science subjects in high school^†
No	300	70.1
Yes	126	29.4
Highest level of education attained by father or mother^‡
University or postgraduate education	118	27.6
Vocational school or college	43	10.0
High school or lower	263	61.4
Having relatives, or friends work in the healthcare field^‡
No	140	32.7
Yes	283	66.1
Pharmacy was the first choice of major^‡
No	137	32.0
Yes	281	65.7
Held a leadership position in high school or in a team^‡
No	217	50.7
Yes	208	48.6
Attended conferences/workshops hosted or participated in by the School of Pharmacy^†
No	354	82.7
Yes	72	16.8

Provinces include An Giang, Hau Giang, Kien Giang, Vinh Long, and Dong Thap.

†

Missing values ≤ 0.5%.

‡

Missing values ≤ 2.3%.

Missing values ≤ 4%.

Factor Analysis

The evaluation of data suitability revealed that the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was 0.87, which falls within the acceptable range of 0.5 < KMO ≤ 1.0 (Hutcheson, 2011). Additionally, the Bartlett’s test of sphericity (p < .001) met the requirement for the threshold of statistical significance (p < .05) (Hair, 2009). These results indicate that the data were appropriate for further FA.

The factor extraction yielded nine factors with eigenvalues greater than 1, which were retained for the subsequent factor rotation step. In the first factor rotation, six variables (A₂, A₃, A₇, B₈, D₂) were removed due to having factor loadings of more than 0.4 on two or more factors, and B₁₃ was also removed because its factor loading was less than 0.4 on all factors. In the second factor rotation, four variables (B₉, B₁₂, C₃, D₄) were removed due to their factor loadings being less than 0.4 on all factors. One variable (D₃) was removed in the third-factor rotation as its factor loading was less than 0.4 on all factors. In the fourth factor rotation, two variables (B₇, B₁₀) were removed because they did not meet the condition of having at least three variables with significant loadings on each factor (Henson & Roberts, 2016). In the final rotation, 25 variables (that met the FA conditions) were grouped into five factors with eigenvalues greater than 1, with the fifth factor having the lowest eigenvalue of 1.41. The total variance explained by these five factors was 60.06%. Therefore, these results indicate that the 5-factor solution is appropriate for the dataset, as presented in Table 2.

Table 2.

Factor Analysis Results and Descriptive Statistics for the Factors Influencing the Choice to Study Pharmacy (n = 428).

Item no.	Items	Factor loading					Mean (SD)	Disagree^†n (%)	Neutral n (%)	Agree^‡n (%)
Item no.	Items	Factor 1	Factor 2	Factor 3	Factor 4	Factor 5	Mean (SD)	Disagree^†n (%)	Neutral n (%)	Agree^‡n (%)
	Factor 1—Personal
B3	Aspiration to work in healthcare	0.82					4.21 (0.81)	12 (2.8)	54 (12.6)	361 (84.3)
B4	Aspiration to assist and provide healthcare to impoverished individuals	0.79					4.23 (0.82)	8 (1.9)	65 (15.2)	355 (82.9)
B1	Interest in collaborating with other healthcare professionals	0.72					4.13 (0.87)	21 (4.9)	64 (15.0)	343 (80.1)
B2	Profession involving direct interaction with patients	0.71					3.82 (0.89)	26 (6.1)	116 (27.1)	286 (66.8)
B11	Wanting to do meaningful work for society	0.64					4.16 (0.79)	11 (2.6)	57 (13.3)	359 (83.9)
B5	Aspiration to be an entrepreneur in the pharmaceutical field	0.64					4.14 (0.87)	14 (3.3)	76 (17.8)	337 (78.7)
B6	Profession helping me to become self-employed	0.61					4.20 (0.83)	11 (2.6)	64 (15.0)	353 (82.5)
	Factor 2—Career
D6	A career in Pharmacy provides long-term stability		0.82				3.86 (0.82)	17 (4.0)	103 (24.1)	306 (71.5)
D5	Pharmacy offers a stable source of income		0.80				3.79 (0.80)	15 (3.5)	123 (28.7)	290 (67.8)
D7	Pharmacy profession offers an easy job search for graduates		0.79				3.50 (0.90)	46 (10.7)	169 (39.5)	212 (49.5)
D10	High societal demand for a Pharmacy workforce		0.70				3.70 (0.82)	21 (4.9)	152 (35.5)	255 (59.6)
D9	Desire to work in a respected field such as Pharmacy		0.66				3.81 (0.88)	23 (5.4)	128 (29.9)	275 (64.3)
D8	Many job position options within the Pharmacy field		0.60				3.82 (0.78)	19 (4.4)	106 (24.8)	303 (70.8)
D1	Pharmacy degree from a university provides a well-respected job		0.52				3.96 (0.77)	10 (2.3)	91 (21.3)	327 (76.4)
	Factor 3—Advice
A4	Encouragement from people with similar personality and career orientation			0.80			3.19 (0.97)	88 (20.6)	175 (40.9)	165 (38.6)
A6	Advice from high school teachers			0.71			2.94 (0.95)	121 (28.3)	199 (46.5)	106 (24.8)
A8	Encouragement from friends to study pharmacy			0.70			2.98 (0.95)	112 (26.2)	201 (47.0)	112 (26.2)
A1	Career counseling at high school			0.63			3.07 (0.98)	104 (24.3)	182 (42.5)	137 (32.0)
A5	Self-guidance on career choice through information found online			0.47			3.56 (0.99)	56 (13.1)	128 (29.9)	243 (56.8)
	Factor 4—Reputation
C1	The reputation of the pharmacy course at the university is well-known				0.86		3.64 (0.91)	37 (8.6)	104 (32.7)	251 (58.6)
C2	The university is located in a well-known, large city				0.81		3.62 (0.86)	36 (8.4)	146 (34.1)	245 (57.2)
C4	The modern facilities for Pharmacy education are widely recognized in the region as being suitable for my learning and research needs				0.74		3.70 (0.80)	20 (4.7)	145 (33.9)	263 (61.4)
	Factor 5—Promotion
C6	University prospectus advertising a Pharmacy program					0.80	3.14 (0.89)	73 (17.1)	216 (50.5)	137 (32.0)
C5	Pharmacy training school is advertised as having a dormitory					0.77	2.93 (1.02)	128 (29.9)	190 (44.4)	109 (25.5)
C7	Had the opportunity to visit and experience the pharmacy training activities through school promotional programs					0.77	2.70 (0.98)	173 (40.4)	180 (42.1)	74 (17.3)
	Factor score, mean (SD)	4.13 (0.62)	3.78 (0.62)	3.15 (0.68)	3.65 (0.74)	2.92 (0.79)
	Cronbach’s alpha	.86	.88	.74	.84	.76
	Percentage of explained variance	15.89	15.65	9.99	9.75	8.77

Note. Factors loading of less than 0.40 are not displayed. Extraction Method: Principal Component Analysis. Rotation Method: Varimax with Kaiser Normalization.

†

Disagree including 1-strongly disagree and 2-disagree.

‡

Agree including 4-agree and 5-strongly agree.

The findings of the factor analysis indicated that out of the initial 38 variables, 25 variables were retained and reorganized into 5 distinct factors, specifically factor 1: personal; factor 2: career; factor 3: advice; factor 4: university reputation; and factor 5 university promotion.

To evaluate the reliability of the questionnaire, Cronbach’s alpha was calculated for each of the 5 factors. As shown in Table 2, all 5 factors had a Cronbach’s alpha > .7. Additionally, the observed variables in each factor had a corrected item-total correlation above 0.3. This indicates that the obtained factor solution was reliable.

The results of the analysis of the relationship between demographic characteristics of students and factors influencing the choice of pharmacy major (Table 3) showed that out of a total of five factors, four factors were significantly associated with students attending different types of universities. Private university students were significantly more influenced by career (mean = 3.84 vs. mean = 3.70, p = .019), advice (mean = 3.24 vs. mean = 3.04, p = 0.002), and promotion factors (mean = 3.08 vs. mean = 2.73, p < .001) compared to students attending a public university. In contrast, reputation was a more significant factor in the choice of major for public university students (mean = 3.82 vs. mean = 3.51, p < 0.001) compared to private university students. Similarly, students who chose pharmacy as their first choice were significantly influenced by four out of five factors, including personal (mean = 4.20 vs. mean = 3.99, p = .002), career (mean = 3.90 vs. mean = 3.54, p < .001), advice (mean = 3.23 vs. mean = 3.02, p = .003), and reputation (mean = 3.75 vs. mean = 3.47, p = .001) factors, in contrast to their counterparts who did not chose pharmacy as their first choice. Students permanently residing in provinces in the Mekong Delta (mean = 4.04 vs. mean = 3.87, p = .030) who had parents with a high school education or less (mean = 4.21 vs. mean = 4.03, p = .006) were significantly more likely to be influenced by personal factors compared to other students. Career factors were more influential for students who identified themselves as following a religion (mean = 3.92 vs. mean = 3.73, p = .009), graduated from non-specialized high schools (mean = 3.81 vs. mean = 3.55, p = .014), and held leadership positions in high school or in a team (mean = 3.85 vs. mean = 3.71, p = .022), in comparison to other students. Furthermore, students who graduated from non-specialized high schools (mean = 2.95 vs. mean = 2.67, p = .030) and attended conferences/seminars with participation or organization by pharmacy universities (mean = 3.09 vs. mean = 2.88, p = .047) were significantly more likely to report promotion as being a factor compared to other students (Table 3).

Table 3.

The Relationship Between Characteristics of Students and Five Factors Affecting the Choice of Pharmacy Major (n = 428).

Variables	Personal		Career		Advice		Reputation		Promotion
Variables	Mean (SD)	p-Value	Mean (SD)	p-Value	Mean (SD)	p-Value	Mean (SD)	p-Value	Mean (SD)	p-Value
Type of university currently attending^†
Public	4.09 (0.61)	.285	3.70 (0.66)	.019	3.04 (0.67)	.002	3.82 (0.75)	<.001	2.73 (0.82)	<.001
Non-public	4.15 (0.62)		3.84 (0.58)		3.24 (0.67)		3.51 (0.71)		3.08 (0.74)
Religion^†
None	4.12 (0.61)	.519	3.73 (0.64)	.009	3.12 (0.68)	.087	3.65 (0.75)	.869	2.90 (0.80)	.412
Practicing	4.16 (0.66)		3.92 (0.52)		3.26 (0.69)		3.66 (0.75)		2.98 (0.76)
Permanent address^‡
Can Tho	4.04 (0.63)	.030	3.70 (0.64)	.609	3.15 (0.65)	.865	3.72 (0.79)	.792	3.01 (0.88)	.344
Provinces adjacent to Can Tho	4.13 (0.59)		3.80 (0.60)		3.18 (0.69)		3.64 (0.67)		2.96 (0.70)
Other provinces in the Mekong Delta	4.21(0.60)		3.77 (0.63)		3.13 (0.70)		3.61 (0.79)		2.82 (0.88)
Other provinces outside the Mekong Delta	3.87 (0.79)		3.84 (0.69)		3.09 (0.57)		3.69 (0.89)		2.84 (0.70)
High school graduated from was a specialized school^†
No	4.12 (0.63)	.975	3.81 (0.61)	.014	3.16 (0.68)	.521	3.66 (0.74)	.357	2.95 (0.78)	.030
Yes	4.12 (0.57)		3.55 (0.66)		3.09 (0.66)		3.55 (0.83)		2.67 (0.83)
Highest level of education attained by father or mother^‡
University or postgraduate education	4.03 (0.64)	.006	3.74 (0.68)	.671	3.11 (0.69)	.569	3.64 (0.79)	.765	2.82 (0.82)	.274
Vocational school or college	3.97 (0.66)		3.78 (0.67)		3.10 (0.81)		3.59 (0.68)		2.92 (0.80)
High school or lower	4.21 (0.59)		3.80 (0.59)		3.18 (0.66)		3.67 (0.73)		2.97 (0.78)
Pharmacy was the first choice of major^†
No	3.99 (0.73)	.002	3.54 (0.70)	<.001	3.02 (0.65)	.003	3.47 (0.83)	.001	2.86 (0.72)	.286
Yes	4.20 (0.54)		3.90 (0.54)		3.23 (0.68)		3.75 (0.69)		2.95 (0.83)
Held a leadership position in high school or in a team^†
No	4.07 (0.64)	.086	3.71 (0.67)	.022	3.13 (0.73)	.440	3.63 (0.78)	.602	2.92 (0.83)	.888
Yes	4.18 (0.59)		3.85 (0.57)		3.18 (0.62)		3.67 (0.71)		2.93 (0.76)
Attended conferences/workshops hosted or participated in by the School of Pharmacy^†
No	4.12 (0.62)	.870	3.76 (0.64)	.309	3.14 (0.70)	.360	3.63 (0.74)	.106	2.88 (0.80)	.047
Yes	4.14 (0.62)		3.85 (0.56)		3.22 (0.59)		3.78 (0.77)		3.09 (0.74)

Note. All student characteristics variables were evaluated for their relationship with the five factors affecting the choice of pharmacy major. Only variables that showed significant differences in at least one of the five factors were presented in the table. Gender, Age, Place of residence before entering university, Type of high school education completed, Self-assessment of natural science academic performance in high school, Self-assessment of social science academic performance in high school, Interest in natural science subjects in high school, Having family members, relatives, or friends work in the healthcare field were not found to be significantly related to the five factors and were not included in the table.

†

By using t-test.

‡

By using one-way ANOVA test.

Discussion

The study identified five main factors that were significantly associated with the choice of undertaking a pharmacy major among students in Can Tho, including personal, career, advice, reputation, and promotion factors. Among these, personal factors were found to have the strongest association with students’ decision-making. This finding is consistent with a study by Borchert et al., which also indicated that personal factors were the most significant determinant of career choice among students (Borchert, 2002). In contrast, a study by Alhaddad et al. found that career factors had a greater influence on students’ choice of major (Alhaddad, 2018).

Personal Factors

It is evident that the decision to pursue a particular major is often driven by personal motivations rather than external factors (Bojuwoye & Mbanjwa, 2014). This study highlights that the primary reason most students cite for their choice to pursue pharmacy as a major is their own passion for healthcare (84.3%), their desire to help the underprivileged (82.9%), and to do meaningful work for society (83.9%). This is consistent with several studies conducted in Saudi Arabia (Woldekidan et al., 2020), South Africa (Truter, 2009), Sudan (Yousif et al., 2014), New Zealand (Capstick et al., 2007), and Jordan (Abdelhadi et al., 2014). The desire to help others, which involves emotional behaviors such as empathy and compassion, is a crucial advantage in the pharmacy profession, due to its focus on patient-centered care (Bloom et al., 2020; Brown et al., 2001; Wood, 2015). In recent years, the Pharmacy profession has shifted toward patient-centered care (Hanna et al., 2016), and clinical pharmacy in hospitals is one of the top priorities for investment and development by the Ministry of Health in Vietnam (Hanoi Department of Health, 2022; The Vietnam Government, 2020). Therefore, stimulating students’ own interest (personal factors) in pharmacy is crucial for universities and regulatory agencies to promote the development of the Pharmacy profession (Hanna et al., 2016)

Career Factors

The choice of pharmacy as a major is also influenced by career-related factors. These include long-term job stability, steady income, available employment opportunities after graduation, and high social demand for pharmacy professionals, as found in this study and previous similar studies (Beggs et al., 2008; Digital Works Rowan Digital Works Theses & Edmonds, 2012; Hanna et al., 2016). In the current context, stable employment and income play a crucial role in ensuring individual and societal stability and sustainable development and are among the reasons contributing to students’ career choices (El-Hammadi, 2013; Hasan et al., 2010; Osmond et al., 2023; Wüst & Leko Šimić, 2017). Although the salary of Pharmacy professionals varies greatly worldwide and across different job positions (Hanna et al., 2016), pharmacy work provides a stable income, as reported in a US study (Anderson et al., 2008). Thus, it is essential to help students understand the stability of Pharmacy careers and financial remuneration alongside other factors to guide their career choices (Hanna et al., 2016). Additionally, Pharmacy is a highly respected and reputable profession (Woldekidan et al., 2020). Professional reputation is an important factor in career choice, as reported in studies conducted in India (Agarwala, 2008), South Africa (Bojuwoye & Mbanjwa, 2014), Croatia (Wüst & Leko Šimić, 2017) and in the present study. Furthermore, the Pharmacy profession offers diverse job opportunities, indicating great potential for future development (Albanese et al., 2010). Studies conducted in the US and China have demonstrated career development opportunities to be a significant factor in career choice (R. Cheung & Arnold, 2014; Guan et al., 2015). This suggests the need for a more effective admissions approach, where educational institutions provide students with a better understanding of the advantages of pursuing the Pharmacy profession.

Advice Factors

In the present study, advice ranked fourth among the five factors that influenced the decision to choose pharmacy as a major. Specifically, less than half of the respondents considered advice from individuals with similar personalities and career orientations, teachers, peers, and counseling activities at high school important in guiding their career choices. In contrast, previous studies have reported advice from others to have a significant impact on the decision to study pharmacy (Anderson et al., 2008; R. Cheung & Arnold, 2014; Truter, 2009). Although teachers and educators have been shown to be influential in students’ career decisions (R. Cheung & Arnold, 2014) more so than peers and parents (R. Cheung & Arnold, 2014), only 24.8% of respondents in the present study acknowledged the influence of advice from high school teachers in their decision-making process. Therefore, appropriate measures are needed to improve and enhance the role of high school teachers in counseling, especially homeroom teachers, as students’ awareness and preparation for their future careers during high school is crucial (Bardick et al., 2006; Bayraktar, 2018). Additionally, career guidance activities at high school are necessary to assist students in identifying suitable majors and gaining a deeper understanding of the profession they wish to pursue (Alshehri et al., 2021).

Reputation Factors

It has previously been reported that the characteristics of a university also influence the choice of major (Cao Bao, 2022; J. K. Jesson et al., 2009; Proboyo & Soedarsono, 2015; Qasim et al., 2021; Sharif & Sharif, 2014), including its reputation (Cao Bao, 2022; Sharif & Sharif, 2014), facilities (Qasim et al., 2021), and geographic location (Proboyo & Soedarsono, 2015). These factors have been found to impact the selection of a major in many previous studies, consistent with the present findings. This may be due to the belief that a reputable university will provide better quality education and employment prospects (Mehboob et al., 2012; Qasim et al., 2021), leading students to make their decisions based on these expectations (Mehboob et al., 2012). This is particularly relevant to the field of Pharmacy, which is constantly evolving and updating with scientific advancements, and improving modern facilities to keep up with the ever-changing healthcare industry. To maintain their reputation, universities need to continuously improve their facilities and faculty, and enhance the quality of their programs to compete with other universities both domestically and internationally, to continue to attract students (Qasim et al., 2021) and contribute to the development of the Pharmacy profession in Vietnam (Qasim et al., 2021).

Promotion Factors

Information technology is rapidly developing, leading to the prevalence and ease of access to information through the media. However, it is noteworthy that our study showed that communications from the university (mean = 2.92) were the least influential factor among the factors surveyed, in agreement with studies by J. K. Jesson et al. (2009), Rababah (2016), and James et al. (2018). This may reflect that the information in such communications has little effect on decisions, and is more likely to reinforce decisions already made (Mishra et al., 2014). Conversely, communications from universities in Vietnam may not be attractive enough to students. Higher education is a competitive market in which universities continuously compete to attract the best students. Therefore, universities should establish more effective communication channels such as websites (Hagedorn, 2012), in addition to conducting outreach by visiting high schools to attract students to study pharmacy (Chen & Divall, 2018). This is a factor that universities can actively influence and improve.

The Relationship Between Student Characteristics and the Five Influencing Factors

In Vietnam, private universities typically have higher tuition fees, but lower admission thresholds, than public universities. Therefore, private universities are often the preferred option for students who have a passion for pharmacy but do not achieve sufficiently high grades to get into public universities. Along with this, the increasing number of private universities has led to fierce competition among schools. Universities have been actively promoting their image to attract students, especially private universities. These promotional methods seem to be effective, as we found communication to have a greater influence on students attending private universities.

In contrast, students attending public universities are more influenced by the reputation of the university. Public universities often have a long-standing tradition and extensive teaching experience, making great investments in their facilities and imposing strict admission standards, often resulting in higher graduation standards and better quality graduates (Hemsley-Brown & Oplatka, 2015; Zhou et al., 2019). The shortage of skilled labor (an inevitable consequence of low-quality higher education) and the high number of unemployed graduates are reasons why students strive for an environment with high-quality education to provide themselves with a competitive advantage when job-seeking (Zhou et al., 2019). One way of achieving this is by enhancing the reputation of the university and building trust with students (Harahap et al., 2018).

For individuals with religious beliefs, religion can be a spiritual support and ethical standard, with the belief of living a good life resulting in enlightenment (Nguyen, n.d.). Pharmacy, being a health science profession, aligns with the life principles of following a religion (Bloom et al., 2020; Brown et al., 2001; Wood, 2015). This is consistent with our findings that individuals with religious beliefs are more influenced by the career factor in their decision to study pharmacy. However, to better understand the impact of religion on the decision to study pharmacy, further studies are needed. Personal factors have a greater influence on students residing in the Mekong Delta provinces (p = .030). Can Tho is a city and a major economic center in the Mekong Delta, with many reputable universities providing quality education and training. The cost of living in Can Tho is the lowest among the five centrally-run cities in Vietnam (Livingcost.org, n.d.). This may explain why students living in this region tend to choose to study in Can Tho.

Recommendations for Practice and Research

Focus 1: enhancing career counseling and guidance programs in high schools. High schools need to provide comprehensive career counseling programs that help students to understand the different aspects of the pharmaceutical profession. This includes highlighting the personal aspects and career prospects and the importance of the profession in the greater context of the healthcare setting. Special attention should be given to strengthening the skills of high school teachers in the practice of acting as career advisors and ensuring they are able to guide students effectively.

Focus 2: improving communication and outreach efforts. Universities and colleges offering pharmaceutical programs should focus on enhancing their communication strategies and outreach activities. This can include developing more engaging and informative websites, organizing career counseling sessions, and conducting outreach in high schools to attract students to the field of pharmacy. Creating a positive and appealing image of the pharmaceutical profession can significantly impact students’ decisions.

Focus 3: designing and undertaking further research based on the findings of the present study. Firstly, comparative studies should be conducted across Vietnam to identify regional variations in factors influencing students’ choice of pharmacy as a profession. This will inform targeted interventions and strategies to attract and retain students in the pharmaceutical field across a variety of geographical contexts. Secondly, future research should investigate the effectiveness of communication strategies employed by universities and colleges in attracting students to pharmaceutical programs. This evaluation process will facilitate the identification of best practices and further will guide institutions in the development of more impactful communication strategies.

Recommendations for Policy Makers

Focus 1: fostering partnerships between academia and industry. Collaboration between academic institutions and pharmaceutical industry stakeholders will undoubtedly provide valuable insights into the needs and demands of the profession. Such partnerships can help align course curricula with industry requirements, facilitate internships and job placements, and promote research collaborations. Policy initiatives should encourage and support these partnerships to bridge the gap between academia and industry.

Focus 2: investing in infrastructure and faculty development. Universities offering pharmacy programs should invest in modern infrastructure, including state-of-the-art laboratories and facilities. Additionally, they should prioritize faculty development programs to ensure that educators are equipped with the necessary knowledge and skills to provide high-quality education. Adequate resources and support from policymakers are essential to enable institutions to improve their infrastructure and faculty capabilities.

Limitations

The study achieved its objective by identifying five factors significantly associated with the choice of pharmacy major, but there are still some limitations. Firstly, similar to many previous studies (Alshehri et al., 2021; Anderson et al., 2008; Hanna et al., 2016; Hussain et al., 2021; J. K. Jesson et al., 2009; Truter, 2009; Woldekidan et al., 2020; Yousif et al., 2014), the present study did not measure choice of university as a dependent variable, so the statistical significance of the association of factors with the choice of university may not accurately reflect the true impact. Secondly, although the present study aimed to cover as many factors as possible, there may still be factors important in Vietnam that were overlooked, so further qualitative research is necessary to explore other potential influencing factors. Thirdly, participation in this study was voluntary, which may introduce recruitment bias due to students’ subjectivity in choosing whether or not to participate. However, the choice to invite an entire student year group, together with the high response rate achieved, reduces this bias. Finally, the study only included first-year regular pharmacy students admitted to three universities in Can Tho City, Vietnam, so the results can only be generalized to similar pharmacy schools in Vietnam but not to students studying other majors.

Conclusion

The findings of this study provide a valuable addition to the existing literature as the present study represents the first comprehensive exploration of all potential factors influencing a student’s choice to undertake a pharmacy major through exploratory factor analysis. The identification of these influential factors, particularly the prominence of personal factors and the limited impact of promotion prospects offers valuable insights for academic institutions and policymakers, enhancing the level of understanding of the dynamics behind student preferences in the field of pharmacy. By making informed decisions based on these insights, stakeholders will be able to develop effective strategies to attract and retain students in this discipline, thereby strengthening the pharmaceutical workforce and contributing to an overall improvement of the healthcare system. The study’s limitations include its focus on first-year regular pharmacy students from three universities in Can Tho city, limiting the generalizability of the findings to other pharmacy schools across Vietnam. Future research should aim to conduct comparative studies across different regions in Vietnam to explore the potential for regional variations in factors influencing students’ decisions to pursue pharmacy as a profession.

Footnotes

Acknowledgements

We acknowledge the Can Tho University of Medicine and Pharmacy, Nam Can Tho University, Tay Do University, and their faculty staff, and students who partnered with us on the study.

Author Contributions

Conceptualization: V.D.T., T.Q.T.; methodology: V.D.T., N.M.T.T.; validation: V.D.T., T.Q.T.; investigation: N.M.T.T., M.C.N, H.T.N., T.N.M.T.; resource: V.D.T.; writing-original draft: V.D.T., T.Q.T., H.N.D., H.P.L., T.D.P.T., T.N.M.T., K.A.T.P., R.S.D.; writing-review and editing: V.D.T., T.Q.T., H.N.D., H.P.L., T.D.P.T., K.A.T.P., R.S.D.; supervision: V.D.T.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethics Approval

The study was approved by the Medical Ethics Council of Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam (No. 22.042.SV/PCT-HĐĐĐ, 10 May 2022). Participants were informed that taking part in the study was voluntary.

ORCID iD

Van De Tran

Data Availability

The data that support the findings of this study are available from the corresponding author (i.e., upon reasonable request).

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Factors Affecting the Decision of First-Year Pharmacy Students to Study Pharmacy in Can Tho,Vietnam

Abstract

Plain Language Summary

Keywords

Introduction

Literature Review

Advice Factor

Personal Factor

University Factor

Career Factor

Methods

Study Design and Setting

Study Design

Sample Size

Questionnaire

Data Collection

Data Analysis

Results

Factor Analysis

Discussion

Personal Factors

Career Factors

Advice Factors

Reputation Factors

Promotion Factors

The Relationship Between Student Characteristics and the Five Influencing Factors

Recommendations for Practice and Research

Recommendations for Policy Makers

Limitations

Conclusion

Footnotes

Acknowledgements

Author Contributions

Declaration of Conflicting Interests

Funding

Ethics Approval

ORCID iD

Data Availability

References