Exploring the perspective of Malaysian Community Pharmacists on Sports Pharmacy Services: A qualitative study

Abstract

Introduction:

Pharmacists have emerged as important healthcare professionals in the field of sports, playing a crucial role in ensuring athlete safety and well-being. This study aims to explore the perspective of community pharmacists in Malaysia on sports pharmacy services, an emerging and underexplored area within community pharmacy practice.

Methods:

Semi-structured online interview were conducted among community pharmacists between February and August 2024. Data were transcribed verbatim and analyzed using framework method, with themes mapped to the constructs of the Integrated Behavioral Model.

Results:

Eleven pharmacists were interviewed, yielding three themes: the moral imperative and gatekeeper role; structural and capability deficits; and the conditional intention to adopt a new niche. Participants demonstrated a positive attitude toward clean sport and identified a professional gap in protecting amateur athletes from unregulated supplements. However, a significant intention-behavior gap was revealed where the willingness to act is currently obstructed by environmental constraints, specifically the lack of standardized policies, remuneration models, and private counseling infrastructure, alongside low personal agency regarding the specialized needs of athletes. Furthermore, intention was found to be conditional on knowledge as those with prior anti-doping education viewed the service as a strategic business niche, while those without focused on professional risk.

Conclusion:

Community pharmacists need enhanced knowledge and training to deliver extended services related to sports. Addressing identified barriers will require collaboration between government, pharmacy bodies, and anti-doping agencies. Findings may guide future studies to develop sports pharmacy as a valuable niche in community pharmacy services.

Significance for public health

This study is the first to qualitatively explore community pharmacists’ perspectives on sports pharmacy services in Malaysia, revealing important implications for public health. Although pharmacists expressed strong disapproval of doping and recognized the importance of clean sport, they demonstrated limited understanding of their extended roles and lacked specific training in this area. Most had advised recreational athletes, gym users, or bodybuilders – groups also at risk of substance misuse – highlighting an untapped opportunity for harm reduction. As accessible healthcare professionals, pharmacists are well-positioned to engage with recreational athletes and the public on safe medication and supplement use. By identifying key barriers and facilitators to implementing sports pharmacy services, this research supports the integration of pharmacists into broader public health strategies for harm reduction, substance misuse prevention, and health promotion in sports settings. Strengthening pharmacists’ roles in this area can contribute to improved public awareness, safer sporting practices, and enhanced community well-being.

Introduction

The increasing use of dietary supplements by elite, amateur, and recreational athletes has raised significant public health concerns.^1,2 Despite the perceived health benefits, many athletes have a poor understanding of the supplements and medications they consume, placing them at risk of accidental doping violations. ³ Doping is defined by the World Anti-Doping Agency as the occurrence of one or more anti-doping rule violations, such as the presence or use of a prohibited substance or method. Beyond the regulatory implications, the misuse of such substances or methods to enhance performance exposes users to severe health consequences and, for competitive athletes, the risk of sanctions including the forfeiture of medals. ⁴

In Malaysia, while elite athletes typically consult doctors or nutritionists, younger or non-elite athletes often turn to coaches or self-manage their supplement intake.^3,5 Nevertheless, self-medication and curiosity-driven exploration of nutritional supplements puts athletes at risk of violating anti-doping rules if they purchase products without seeking professional guidance.^1,3,6 This lack of guidance may increase the risk of consuming adulterated products, which are supplements containing undeclared illegal substances or pharmaceutical ingredients that can lead to inadvertent positive drug tests. ¹ Although elite athletes receive structured anti-doping education through the Anti-Doping Agency of Malaysia (ADAMAS), non-elite groups, including amateur athletes, gym-users, and recreational sports participants, have limited access to structured anti-doping education.^3,5 These gaps represent a public health challenge, where inadvertent doping and unsafe supplement use can result in long-term health consequences and ethical violations in sport.

Pharmacists, particularly those in community settings, are well-positioned to address this gap due to their accessibility and established trust within local populations. Internationally, pharmacists have taken on active roles in supporting clean sport – a concept that extends beyond mere rule compliance to encompass a sporting environment where athletes compete fairly, free from the misuse of prohibited substances, thereby upholding the spirit of sport.^7–9 In Japan, for instance, sports pharmacists are certified to advise athletes and were integrated into the Olympic Village health team.^8,9 Global bodies such as the International Pharmaceutical Federation (FIP) have also issued detailed guidelines encouraging pharmacists’ involvement in doping prevention and provide relevant service to athletes.^8,9 This is also consistent with the collaboration between ADAMAS and the Ministry of Health Malaysia, which includes health promotion activities, the identification of adulterated products, and the publication of lists of banned substances in sports.^10,11

As neighborhood healthcare providers, many community pharmacists have adopted and promoted additional services known as extended pharmacist services (EPS), including diabetes care, geriatric care, asthma care, smoking cessation, obesity management, harm reduction programs and methadone therapy, alcohol consumption counseling, etc.^12,13 These specialized services aim to enhance public health and awareness, improve patients’ quality of life, and contribute to community-level screening and health.^12,14

In the context of sports, previous studies have indicated that approximately half of the community pharmacists in Malaysia have either dispensed or been asked to dispense medications, supplements, or substances for enhancing body image. ¹⁵ This is particularly pronounced among those working in major town area, where approximately 70% of the community pharmacists surveyed reported selling nutritional supplements to athletes. ¹⁵ Besides, pharmacists reported that their clientele includes both amateur and professional athletes, yet they do not feel confident enough to provide professional advice to athletes.^15,16 Despite their frequent encounters with athletes from different backgrounds and competing levels, only a minority of pharmacists have attended formal training in drugs in sports or stayed updated about drug use in sports, suggesting a need for further improvement in this area. ¹⁵

Thus, this preliminary qualitative study aims to explore the views of community pharmacists on clean sport, their perceived contributions to fostering a clean sports environment, and perceived barriers to conducting EPS related to sports pharmacy. It also captures pharmacists’ interactions with non-elite athletes and the general public, populations often overlooked in structured anti-doping initiatives. Findings from this study will be useful for informing future research and guiding the development of targeted services that position sports pharmacy as a promising and impactful public health niche within community pharmacy practice.

Methods

Study design and theoretical framework

This study was underpinned by a post-positivist epistemology, which acknowledges an objective reality such as existing barriers to sports pharmacy but recognizes that this reality is interpreted imperfectly by individuals.^17,18 This philosophical stance supports the use of the Framework Method, allowing for a structured, deductive analysis grounded in pre-existing theory while remaining open to participants’ subjective experiences.^17,18 The qualitative inquiry was grounded in the Integrated Behavior Model (IBM), which served as the theoretical lens for both data collection and analysis. ¹⁹

The IBM proposes that a specific behavior is determined by the intention to perform it, which is in turn shaped by three primary constructs: attitude (experiential feelings and instrumental beliefs about outcomes), perceived norms (injunctive social pressure and descriptive observation of others), and personal agency (self-efficacy and perceived control over performance). Additionally, the model recognizes that even with strong intention, behavior can be facilitated or impeded by contextual factors such as knowledge, skills, and environmental constraint. ¹⁹ In this context, IBM is applied to understand intention-driven behavior, which is central to community pharmacists adopting new roles in providing sports pharmacy services. The IBM was selected deductively to guide the inquiry, allowing the researchers to explore how these specific psychological and environmental constructs facilitate or inhibit pharmacists’ readiness to adopt this new extended professional service.

Study setting and participants

Malaysia’s healthcare system comprises government-subsidized and private hospitals and clinics. Most medications are dispensed directly from these facilities rather than community pharmacies. ²⁰ Community pharmacies in Malaysia are mainly independent or part of corporate chains. While community pharmacists in Malaysia do not have prescribing authority, their role as accessible healthcare providers enables them to complement general practitioners by providing public health education, supplements counseling, and referrals if necessary.

The inclusion criteria were full-time community pharmacists actively practicing, retained on the register of pharmacists, and with at least 1 year of experience in community settings. Pharmacists with or without specific experience in completing anti-doping educational courses were included to explore diverse perspectives on this new EPS. Community pharmacists who were unable to provide consent, those holding License A for wholesale business only, and provisionally registered pharmacist during the study period were excluded. To ensure impartiality, the research team verified that no prior professional or personal relationships existed with the participants by cross-referencing names against the team’s professional networks and confirming non-acquaintance prior to the interview.

Development of an interview guide

An interview guide was developed deductively based on a comprehensive review of previous studies, theoretical frameworks, and expert consensus.^17–19,21 The interview guide contained several open-ended questions that explored the following aspects: the sports environment, their roles in anti-doping and clean sport environment, expanding pharmacists’ roles in sports, the training needs in sports pharmacy, and the benefits of including sports pharmacy as EPS. Examples include: “How important do you feel it is for the sport environment to be clean and free of doping?” (Attitude), “How would you describe your confidence in assisting athletes with the use of medications and supplements” (Self-efficacy), and “What are the external barriers you may perceived to provide the new pharmacy services related to sports” (Environmental factors; see Supplemental File 1). The guide was reviewed by three academic experts (AMA, TMT, and EWC) with experience in qualitative research and the area of community pharmacy and then piloted on two community pharmacists to ensure the questions effectively elicited data relevant to the theoretical constructs.

Recruitment and data collection

Participants were invited to participate in this study through online advertisement on Facebook and the official bulletin of the Malaysian Pharmaceutical Society. The poster explained the objectives and provided a brief description of the study. Purposive sampling was used to achieve maximal variation based on three criteria: years of experience in community settings, types of practice (independent or chain pharmacies), and experience in joining anti-doping courses. This stratification was essential as the difference between independent and chain pharmacies may affect the flexibility and freedom of pharmacists to adapt and adopt new services, a key environmental constraint within the IBM theoretical framework.

The chosen pharmacists were contacted via email, informed about the purposes of the session, and asked to provide written informed consent prior to the session. The invited participants were given sufficient time to consider on their participation, and they will not be sharing any information that is sensitive or uncomfortable to them. Upon agreement to join, participants were scheduled for interview sessions at mutually convenient times. No incentives were offered to the respondents, and sampling stopped upon thematic saturation.

Interviews were conducted online via Google Meet by LMC, a male pharmacist trained by AMA and TMT to ensure consistency and competence. Sociodemographic data were collected before the interviews. Interviews were conducted in English, lasted 30–45 min, and were audio-recorded with participant consent. Field notes were taken to capture additional observations. Participants’ anonymity was maintained throughout transcription and analysis. None of the research team had prior relationships with the participants.

Reflexivity and researcher characteristics

The research team comprised pharmacists and academics with varying levels of experience in sports pharmacy. We acknowledged that our professional background might predispose us to view the pharmacist’s role positively. To mitigate potential bias during data collection and analysis, the interviewers practiced reflexive journaling, documenting their assumptions after each interview. Furthermore, the use of the IBM framework provided a structural guardrail, ensuring that analysis remained focused on participant perspectives rather than researcher expectations.

Data analysis

Audio recordings were transcribed verbatim and managed using Microsoft Excel. Data were analyzed using the Framework Method. This matrix-based analytic approach was selected over reflexive thematic analysis to answer the research question because it enabled a deductive analysis where findings could be systematically mapped against the IBM theoretical constructs, while simultaneously facilitating the comparison of themes across different participant characteristics.^17,18

The analysis proceeded through the five distinct stages of the Framework Method.^17,18 First, during familiarization, the first author (LMC) engaged in repeated reading of the transcripts and listening back to audio-recordings to gain a comprehensive overview of the dataset. Initial impressions and recurrent ideas were noted in the margins of the transcripts to facilitate later retrieval. Second, a thematic framework was identified by developing a coding index using a combined approach; IBM constructs (Attitude, Norms, Agency) served as deductive categories, while inductive codes were integrated for emerging themes not covered by the theory.

Third, the indexing stage involved applying this coding framework to all transcripts. To ensure rigor and consistency, three researchers (LMC, AMA, TMT) independently indexed a subset of transcripts, subsequently discussing discrepancies to establish a standardized coding scheme through consensus. Fourth, charting was conducted by lifting data from the transcripts and summarizing it verbatim into a framework matrix, where rows represented individual participants and columns corresponded to the IBM constructs and sub-themes. Finally, during mapping and interpretation, the team reviewed the charts to define final themes, map the range of phenomena, and explain the associations between pharmacists’ perceptions and their readiness to practice.

The adequacy of the sample size was evaluated using the concept of information power. ²² The study demonstrated high information power due to its narrow aim (specific to sports pharmacy), high sample specificity (experienced community pharmacists), and the application of established theory (IBM) to focus the analysis. Consequently, the final sample of 11 participants was deemed sufficient to answer the research question, a decision further corroborated when no new codes or themes emerged after the ninth interview.^22,23

Ethics and reporting

Ethical approval was granted by the Research Ethics Committee, Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2022-405). This study was conducted in accordance with the principles of the Declaration of Helsinki and implemented relevant sections of the consolidated criteria for reporting qualitative research (COREQ) checklist (see Supplemental File 2). ²⁴

Results

Socio-demographics

From a pool of approximately 60 potential candidates, 11 community pharmacists participated in the study. Non-participation among the remaining candidates was primarily due to the niche nature of sports pharmacy, which many viewed as outside their conventional scope of practice. Their demographics are presented in Table 1. The sample comprised four males and seven females, with a mean age of 32.1 years and standard deviation (SD) of 4.2 (ranged from 28- to 42-year-old). Their mean length of experience in community pharmacy practice was 6.8 ± 4.8 years (Ranged from 2 to 17 years). Four participants worked in independent pharmacies, and seven worked in chain pharmacies. Five participants had completed an anti-doping education course, whereas six had no prior exposure to formal training in this area.

Table 1.

Summary of community pharmacists’ demographic and characteristics.

Descriptions	n	Percentage (%)
Gender
Male	4	36.4
Female	7	63.6
Age (years old)
25–29	4	36.4
30–34	5	45.5
35 and above	2	18.1
Years of experience in community pharmacy
2–5	5	45.5
5–10	3	27.3
11–15	2	18.1
16 and above	1	9.1
Type of pharmacies
Chain pharmacy	7	63.6
Independent pharmacy	4	36.4
Experience in anti-doping educational course(s)
Yes	5	45.5
No	6	54.5

Key findings

The framework analysis identified three major themes which illustrate the cognitive and structural factors influencing community pharmacists’ readiness to adopt sports pharmacy services. These themes are mapped against the constructs of the IBM: (1) The moral imperative and the gatekeeper role (Attitude and Perceived norms); (2) Structural and capability deficits (Environmental constraints and Personal agency); and (3) The conditional intention to adopt a new niche (Intention), as summarized in Figure 1.

Figure 1.

Key themes findings on perspective of community pharmacists in sports among community pharmacists.

The moral imperative and the gatekeeper role (attitude and perceived norms)

Participants universally demonstrated a positive experiential attitude toward the concept of clean sport, defining it not merely as rule compliance, but as an ethical baseline for fair play and safety. They advocated the importance of maintaining such an environment to ensure the integrity of sports. This suggests that the profession aligns culturally with anti-doping values.

Clean sport is where the athletes or the sports participants compete with each other without using any of the prohibited substances to enhance their performance. . . By having a clean sport environment, there’s a fair play, and respect for the rules of sports (is upheld). (Participant 1, Male, attended course)

What I understand is that all athletes can compete fairly, and their performance are not affected by any other substances. . . The sports spirit must be upheld. (Participant 2, Female, attended course)

Regarding perceived norms, participants identified gaps in the current healthcare ecosystem. While elite athletes have access to sports physicians, participants noted that amateur gym users and student-athletes often lack professional guidance, exposing them to high risks of inadvertent doping through unregulated supplements. This perceived gap acknowledged the pharmacists’ belief in their specific role as gatekeepers. By offering expert advice, supplement review, and access to verified products, participants expressed confidence in their ability to ensure athletes receive safe and effective products.

Some doping cases involved athletes taking supplements that are actually contaminated with prohibited substances or medicines. . . if the athletes are buying the supplements from online source, its unreliable. . . Pharmacists can provide guidance on the safe use of supplements. . . I think that this sports service not only for the professional athletes, but (we shall) also include those who are active in sports. (Participant 9, Male, never attended course)

Community pharmacists can help to review and manage the athlete’s medication list to ensure that none of the substances they are taking are on the prohibited list. . . We can check every active ingredient and help them sort out (their medications). We can even identify any potential (medication) interactions. (Participant 7, Male, never attended course)

Participants emphasized that their accessibility allows them to act as the first line healthcare providers, often preferred over hospitals for their convenience and immediate support. They viewed their role as utilizing their general pharmacological expertise within the specific context of sports, such as reviewing medication lists for banned substances.

Coming to the (community) pharmacy will be an easy access to the consultation (with the pharmacists), they don’t need to queue for two hours like in hospitals and wait for long time. I think it is very convenient, and we provide consultation free (of charge). (Participant 3, Female, attended course)

We could help them to check the ingredients (in supplements) or the active ingredients of the medicine to see if any of it is prohibited (in sports). (Participant 2, Female, attended course)

However, a significant barrier to this specialized role is the difficulty in differentiating athletes from non-athlete clients. Participants noted that unlike elite athletes in uniform, gym users and student-athletes rarely self-identify, requiring pharmacists to actively probe for athletic status.

They [student athletes] will come personally. . . However, most athletes don’t really introduce themselves as athlete unless they are wearing their official uniform. (Participant 2, Female, attended course)

This lack of identification, coupled with a general lack of public awareness regarding the pharmacist’s role in sports, resulting in under-recognition of their ability to deliver such services. Participants felt that because the public does not yet view them as mainstream sports professionals, the demand for the service remains low.

Because many people won’t think of the pharmacists as the mainstream healthcare professionals when they think of sports. (Participant 9, Male, never attended course)

Structural and capability deficits (environmental constraints and personal agency)

Despite the positive attitudes described above, the analysis revealed a discrepancy between willingness to act and ability to act. This gap was driven by several environmental constraints, primarily the lack of standardized policy. Participants compared sports pharmacy with established services like diabetes care, noting that without government-endorsed standard operating procedures, the service lacks validation. Participants also emphasized that such local guidelines should be developed collaboratively with local regulatory bodies and sports organizations to enhance their applicability and relevance.

If we are to provide such services, maybe we need a new guideline in pharmacies providing sports related services, like what we are doing for our diabetes clinic. You will need a guideline so that everyone can standardise their practise. . . (Participant 2, Female, attended course)

And then, we need support from the authorities or pharmaceutical societies to produce guidelines on how to run this service. . . I think collaboration with the anti-doping organization in the country can be helpful, because I believe when we work together in a team and share our knowledge and expertise with each other, then we can create a doping free environment. (Participant 9, Male, never attended course)

Financial viability emerged as a secondary environmental constraint. Participants highlighted a mismatch between importance of the extended service and business reality, arguing that it is unsustainable without a clear remuneration model either from the government or client fees. This is demonstrated by the Participant 7: “Interest solely is not enough. We also need to face the reality that one of the most important things in the community pharmacy is to keep the business alive.”

Additionally, physical infrastructure was identified as a barrier to sensitive anti-doping discussions. Participants argued that open counters are unsuitable for confidential conversations about substance use, implying the importance of private consultation rooms.

Let’s say we have this high-profile athlete coming to us. . . if you don’t have a private room, maybe the athlete doesn’t want to tell us the whole story in front of other customers. (Participant 7, Male, never attended course)

Community pharmacy operational constraints such as lack of time and staff were also cited, with participants noting that crowded pharmacies make it difficult to dedicate time to the in-depth counseling required for sports pharmacy without additional manpower.

I feel that some pharmacy do[es] not have enough staff. . . we need to invest more money and manpower to provide this extra service. (Participant 5, Female, attended course)

Internally, personal agency (self-efficacy) was low among the participants. They categorized athletes as a specialized population with unique physiological demands. Compliance with anti-doping regulations further complicates their care, as even routine medications can lead to violations. Consequently, they felt a lack of control over the outcome, fearing that their knowledge was insufficient to prevent doping violations.

I think we should treat the athletes like a specialized population. . . Without proper training, I feel it’s difficult for us to confront. . . the athletes and give advice to them. (Participant 6, Male, never attended course)

. . .they (athletes) are like a special population, to treat or manage due to their unique physiological demands and the specific (anti-doping) regulations (in which) they must adhere to. (Participant 7, Male, never attended course)

The conditional intention to adopt a new niche (intention)

The intention to adopt sports pharmacy was conditional upon the removal of the barriers identified above. However, a divergence was observed based on knowledge between participants with and without prior exposure to anti-doping education. Participants with prior exposure to anti-doping education exhibited a stronger instrumental attitude (belief in outcomes), framing the service as a strategic business niche that could differentiate them in a competitive market.

I think it’s definitely something new and (would) really make my pharmacy different from other retail pharmacy, so it is quite a good idea (to provide the service). (Participant 4, Female, attended course)

It will become a trend widely recognized by the public in the future. . . because Malaysia is actually quite active in sports, there will be a big role for us (pharmacists) to play. (Participant 2, Female, attended course)

In contrast, participants without such exposure focused heavily on the risks, lacking a thorough understanding of their own professional role and expressing uncertainty about how to provide the service.

Even myself as the pharmacist [do] not fully understand the field and my role. (Participant 9, Male, never attended course)

To convert this intention into practice, participants identified interactive, case-based training as an effective method to improve their lack of agency. They argued that theoretical knowledge alone is insufficient; they require real-world scenarios to visualize how to apply anti-doping rules in practice.

Maybe we need to incorporate more case studies that guide us on different sorts of scenarios. . . When we counter different scenarios, how we shall respond and provide our advice. Maybe (a) face-to-face practise will be more useful so we can learn how to respond when we encounter similar situation. . . I need to know the sources (of information) that I can refer to. . . (Participant 2, Female, attended course)

Synthesis of findings

In summary, the community pharmacists showed prerequisite attitude toward clean sport and recognized the normative need as illustrated in Figure 1. However, this potential remains under-tapped due to the intention-behavior gap predicted by the IBM. The intention to serve is currently restricted by low personal agency (lack of training) and significant environmental constraints (lack of supporting policy and remuneration). The findings suggest that educational interventions alone will be insufficient; for sports pharmacy to evolve into a more widely adopted standard practice, it requires the simultaneous development of professional competencies (to build agency) and regulatory frameworks (to remove environmental constraints).

Discussion

This is the first qualitative study to explore the views of community pharmacists on sports pharmacy services in Malaysia, contributing to the growing discourse on pharmacists’ involvement in public health interventions related to sports and substance use. The key finding of this study reveals a cohesive story of latent potential which supports and explains trends observed in previous local quantitative studies.^15,16 While those studies identified a paradox where pharmacists held negative attitudes toward doping yet lacked confidence to intervene, our framework analysis using the IBM explains the mechanism whereby high intention is restrained by specific environmental constraints and low personal agency.

The first major theme, the moral imperative, suggests that the profession possesses the requisite experiential attitude to support clean sport. Respondents demonstrated strong ethical stances against doping and an appreciation for fair play, reflecting a shared value system that supports integrity in sport. Their disapproval of doping behaviors is crucial, as pharmacists play a pivotal role in preventing substance abuse and misuse within the community. This aligns with the professional roles recognition and global shift described by the FIP, which positions pharmacists not merely as dispensers but as guardians of public health in the sporting arena.^8,9 The main customers our respondents encountered daily include recreational athletes, gym users and bodybuilders, which are at similar health risks as professional athletes when taking performance-enhancing substances.^1,2,13 Thus, community pharmacists can identify and discourage any apparent intention or attempt by their customers to improve performance illegally. ⁹ This can serve as an efficient prevention and harm reduction strategy, as community pharmacists are among the most easily accessible healthcare providers in the self-care continuum.^13,21

Despite this positive attitude, the structural and capability deficits identified in the results explain why practice remains limited. Respondents demonstrated a basic understanding of their potential roles in sports. They were able to expound only their traditional responsibilities as pharmacists such as providing education and counseling services, as well as ensuring safe and effective use of medications and supplements in sports. This limited perspective is a direct manifestation of low personal agency or self-efficacy which can be ascribed to a lack of specialized training.^13,22–27 From a theoretical standpoint, this aligns with the IBM that without specific skills and knowledge, strong intention cannot translate into behavior. ¹⁹ From a public health perspective, this highlights an urgent need to expand pharmacists’ competencies to include more proactive roles in safeguarding health across a wider sporting population. A well-trained sports pharmacist, particularly in the community setting, has an extended range of responsibilities. These include consulting on the therapeutic use of prohibited substances granted with necessary exemptions, discussing the health benefits of exercise and sports restrictions on certain medications, providing ongoing care to prevent substance misuse in sports, and safeguarding the community by evaluating the safety of medications and supplements based on evidence. Furthermore, they play a key role in preventing harmful practices and inappropriate dosages and sharing key messages about safe and effective medicines use at major or local sports event.^9,26–30

Furthermore, the transition from intention to action is heavily impeded by environmental constraints, primarily the lack of standardized policy and financial models. The respondents’ insistence on government-endorsed guidelines mirrors findings from previous studies on EPS, where pharmacists viewed non-remunerated services as unfeasible due to operational costs.^12,31 Our analysis suggests that without a formal recognition framework comparable to the certification of sports pharmacists in Japan, the service will struggle to gain legitimacy.^6,7 Consequently, stakeholders should explore innovative reimbursement models that can incentivize EPS provided by community pharmacists, ultimately benefiting both customers and providers.^14,32

Finally, the conditional intention to adopt this niche highlights the importance of the physical environment. The respondents emphasized the need to respect the privacy and confidentiality of their clients, especially when dealing with professional athletes who may need a private space for consultation, but this is not readily available in most pharmacies. A trusting relationship is a significant determinant of effective client-provider collaboration when discussing sensitive topics related to doping and personal health. This aligns with earlier observations that some of the users of performance-enhancing drugs might hesitate to engage with healthcare providers unless assured of a secure environment.^13,22

In conclusion, while Malaysian community pharmacists show a strong intention to extend their services to the sports arena, this potential is currently latent. To bridge the gap between intention and practice, a dual approach is required: (1) Educational interventions to build personal agency through onsite learning experiences; and (2) Systemic strengthening to remove environmental constraints through the development of national competency standards and remuneration models.^9,14,15,33 From a public health system strengthening viewpoint, creating a national training framework and competency standards would legitimize and standardize this emerging service. Importantly, collaboration with anti-doping agencies, professional bodies, and educational institutions can support the development of pharmacists as public health assets in the sports domain. ⁹ Future research should aim to develop specific training and educational modules that create authentic experiences through onsite learning. These efforts will not only support individual pharmacists but also build long-term system capacity to address health risks associated with unsafe supplement use and doping.

Limitations

Several limitations of this study should be acknowledged. Firstly, while the sample size was sufficient to achieve information power given the specific theoretical aim, the findings reflect the perspectives of a specific group of community pharmacists who were willing to participate. This introduces a potential self-selection bias as respondents with a pre-existing interest in sports or anti-doping may have been more likely to volunteer than those with no interest, potentially overestimating the general enthusiasm of the profession. Second, the study was conducted within the specific context of the Malaysian healthcare system where community pharmacists do not currently possess dispensing separation rights. Consequently, the environmental constraints identified, particularly regarding remuneration and professional recognition, may not be directly transferable to countries with different pharmacy practice models. Finally, data collection was conducted via online video platforms due to logistical feasibility. While this allowed for a broader geographical reach, it may have limited the observation of non-verbal cues compared to face-to-face interactions. Despite these limitations, the application of the IBM theoretical framework provides a robust analytical structure that offers valuable transferrable insights into the psychological and structural determinants of service adoption.

Conclusion

This study illuminates the current state of sports pharmacy in Malaysia as one of latent potential. Community pharmacists possess a strong moral commitment to clean sport and a clear willingness to serve as gatekeepers for amateur athletes, yet this intention is currently stalled by significant structural and capability deficits. The application of the Integrated Behavior Model reveals that the barrier to adoption is not a lack of motivation but a lack of personal agency and an enabling environment. Therefore, transitioning sports pharmacy from a niche concept to a public health service requires a coordinated dual strategy. This involves the implementation of interactive, case-based educational interventions to build pharmacist confidence alongside the simultaneous development of government-endorsed competency standards and remuneration models to ensure service sustainability. Given that this study presents preliminary findings, the insights gathered can serve as a useful foundation for future research and program development aimed at carving sports pharmacy as a valuable niche within community pharmacy services. Addressing the identified challenges and increasing awareness are essential next steps toward realizing this potential.

Supplemental Material

sj-docx-1-phj-10.1177_22799036261428545 – Supplemental material for Exploring the perspective of Malaysian Community Pharmacists on Sports Pharmacy Services: A qualitative study

Supplemental material, sj-docx-1-phj-10.1177_22799036261428545 for Exploring the perspective of Malaysian Community Pharmacists on Sports Pharmacy Services: A qualitative study by Ming Chiang Lim, Eng Wee Chua, Tuan Mazlelaa Tuan Mahmood, Farrah-Hani Imran, Ahmad Fuad Shamsuddin and Adliah Mhd Ali in Journal of Public Health Research

Supplemental Material

sj-docx-2-phj-10.1177_22799036261428545 – Supplemental material for Exploring the perspective of Malaysian Community Pharmacists on Sports Pharmacy Services: A qualitative study

Supplemental material, sj-docx-2-phj-10.1177_22799036261428545 for Exploring the perspective of Malaysian Community Pharmacists on Sports Pharmacy Services: A qualitative study by Ming Chiang Lim, Eng Wee Chua, Tuan Mazlelaa Tuan Mahmood, Farrah-Hani Imran, Ahmad Fuad Shamsuddin and Adliah Mhd Ali in Journal of Public Health Research