Community pharmacist and adolescent relationship in Johannesburg: use, knowledge and attitudes regarding emergency contraceptive pills

Abstract

Community pharmacy in the 21st century has become more patient and disease orientated. Consequently, South African community pharmacies are inundated with queries from the public for advice and treatment on a wide variety of medical conditions, including use of ECPs. Although community pharmacists are often the first port of call for Emergency Contraceptive pills (ECPs), limited practitioner-patient skills and insufficient knowledge often hinder pharmacists from providing the necessary clinical management. Central to this research undertaking were two primary goals: Determination of the knowledge of community pharmacists regarding ECPs; when and how these drugs may be used, the adverse effects, safe sexual practice and spread of STls including HIV/AIDS, pharmacists' attitude towards dispensing these drugs to adolescents and their willingness to counsel, discuss and educate the adolescent members of the community. To determine gender, age, present education level at school, race and religion of adolescent respondents and to ascertain both under each demographic, as well as overall, at which age teenagers felt it was appropriate to engage in sexual activity, their knowledge of ECP drugs and use thereof, from where these may be obtained, as well as their attitude towards community pharmacists. Questions were added to determine knowledge on alternate forms of sexual activity, 5Tls including HIV / AID5 and finally to determine whether they believe that they have been adequately educated on these topics. A total of 149 completed questionnaires were received from 278 surveys which were previously e-mailed to community pharmacists registered in Johannesburg and surrounding areas, and were analysed (54% response rate). Results showed that pharmacists' knowledge that these drugs have no effect on established pregnancy, that no situation exists where these drugs are absolutely contra-indicated, and knowledge of frequency of ECP use permitted, among others, were lacking. Furthermore, results showed that only 54% of pharmacists routinely discuss use of regular contraceptives with teenagers requiring ECPs, only 24% discuss the contracting of 5Tls including HIV/AID5, and 14% of pharmacists only advise on use and adverse effects of 5Tls if the adolescent asks. A total of 1950 questionnaires were sent out to schools for voluntary completion by teenage learners, of which 1346 were returned completed (69% response rate). Almost 30% of adolescent respondents did not know what these drugs were used for, less than 13% knew that they should be ingested as soon as possible after coitus and maximally within 72 hours (in terms of the drug registration), and 32% believed or were unsure if these drugs could prevent 5Tls or HIV. A large proportion of teenagers were reluctant to discuss use of ECPs with any pharmacist and an even larger proportion with their regular family pharmacist. They also showed a distinct lack of knowledge in alternative forms of sexually activity. However, only 32% of respondents believed their training in sex education to be insufficient. Pharmacists are frequently called upon to provide ECP treatment, but their knowledge is limited and could certainly be improved upon perhaps by utilizing CPO programs. They also need to be properly trained in how to deal with the younger members of the community, in order to create a professional yet caring attitude, and encourage adolescents to feel confident of the advice they will receive, yet comfortable in seeking their advice. Adolescents' sexual behaviour should not be morally judged by members of the healthcare team, which makes the teenager feel self-conscious and uncomfortable in discussing their problems. They could doubtlessly benefit from further and improved education via the media, properly-trained educators and the medical fraternity, including community pharmacists. This would doubtlessly have a noticeably positive effect on high levels of unwanted teenage pregnancies and on the contracting of 5Tls including HIV/AID5 which is so prevalent in South Africa.