Violence in the Workplace Towards Pharmacists Working in Different Settings in Saudi Arabia: A Cross-Sectional Study

Abstract

Workplace violence (WPV) is a prevailing global concern among healthcare providers (HCPs). Pharmacists may be more vulnerable to WPV than other HCPs due to being the most trusted, approachable, and accessible healthcare workers. However, in Saudi Arabia, there is little research on violence in the workplace among pharmacists working in different sectors. This is a cross-sectional survey study. An online survey was adopted from previous studies and distributed to a convenience sample of pharmacists by email and social media using a link to a web-based survey platform in QuestionPro. SPSS 28 was used for analysis. Logistic regression was employed to assess the association between WPV exposure and the participants’ characteristics. Three hundred and nineteen pharmacists participated in the study. A total of 156 (48.9%) reported exposure to workplace violence. Most participants had experienced verbal abuse (39.7%). Most offenders were male (84.6%), and aged 21–45 years (66.7%). Common causes included lack of a penalty (13.3%), and absence of reporting systems (11.4%). Seventy-eight percent of participants reported that the violence affected them negatively, leading to hopelessness (19.7%), and decreased work performance and productivity (15.1%). Logistic regression indicated that working as a staff (OR: 3.165; 95% CI 1.118–8.96, p = 0.030), working evening or night shift (OR: 2.4456; 95% CI 1.340–4.503, p = 0.004), and lacking procedure for reporting the violence (OR: 0.412; 95% CI 0.236–0.717, p = 0.002) were more likely to be victim of workplace violence than their counterparts. In Saudi Arabia, the risk of WPV events occurrence among pharmacists is high. The findings can guide the creation of appropriate policies, actions, and safety procedures to prevent and address WPV against pharmacists.

1. Introduction

Workplace violence (WPV) is a prevailing global concern among healthcare providers (HCPs) [1]. According to the World Health Organization (WHO), “Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation” [1]. WPV is defined as “Incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health” [1]. Violence can take many forms in the workplace, including physical violence and/or psychological violence. Physical violence is defined as “The use of physical force against another person or group that results in physical or psychological harm” [1]. It involves kicking, beating, stabbing, slapping, pushing, shooting, pinching, and biting among others. Psychological violence is a behavior that aims to cause mental or emotional harm [1]. It comprises verbal abuse, bullying, and racial and sexual harassment.

Violence against healthcare employees might seriously impact their work performance, staff morale, productivity, attendance to work, job satisfaction, emotional commitment, intention to quit, safety, mental health, and quality of care provided [1,2,3]. All this combined impacts patients’ final health outcomes and students’ success [2,3]. Exposure to WPV may impact individual workers, the organization, and society.

According to Alshahrani (2023), the community pharmacists in the Kingdom of Saudi Arabia (KSA) are highly likely to be exposed to violence, with 81% of the community pharmacists interviewed in his study reporting some form of violence during the last 12 months prior to the study [4]. Previous studies in Saudi Arabia have primarily focused on WPV against physicians and nurses [5,6,7,8,9,10,11,12,13]. Research has shown that between 28% and 91% of physicians and nurses have experienced workplace violence at some point in their career lives [5,6,7,8,9,10,11,12,13]. They frequently face verbal and physical abuse from patients and their families [5,6,7,8,9,10,11,12,13]. Studies often highlight the high prevalence of WPV in psychiatric units and emergency departments [5,6,7,8,9,10,11,12,13]. A lack of security measures, long waiting times, overcrowding, high patient stress levels, insufficient staff training, and inadequate policies have contributed to WPV in healthcare settings [5,6,7,8,9,10,11,12,13]. Violence can occur more than once in frequent incidents that might cause serious harm [1].

According to Roche et al. (2009), workplace violence has been associated with treatment delays and medication errors [14]. It is also the world’s most significant cause of workplace fatalities, with women accounting for the majority of cases [15]. WPV causes over 1.5 million worker deaths per year [15]. Pharmacists play a crucial role in the healthcare system. As frontline HCPs, pharmacists encounter diverse interactions with patients, healthcare providers, and other stakeholders, sometimes leading to conflicts [4,16]. Pharmacists are known for being trusted, approachable, and accessible healthcare providers [4,16]. They provide numerous services, including dispensing and compounding medications, offering patient counseling on the proper use of medicines, providing education, evidence-based advice, vaccinations, and home delivery services, organizing public health campaigns, and conducting different pharmacy services [4,16]. Pharmacies are easily accessible to the public without the need to schedule appointments or waiting rooms, which might increase the risk of violent behavior from customers [4,16]. Thus, pharmacists may be more vulnerable to violence than other healthcare professionals [16]. Pharmacists also work in various multidisciplinary fields such as academia, the pharmaceutical industry, hospital and community pharmacies, and regulatory administrative positions, which give them daily face-to-face contact with customers, patients, and students. This may put them at high risk of workplace violence. Studies have shown that pharmacists who dispense medications, work in retail pharmacies or education are more likely to encounter WPV [1,4,16].

Understaffing, dissatisfaction with the care provided, patients’ unmet expectations, overcrowding, shortage in medication supplies, long waiting times to receive care, anger, stress, and anxiety among patients and their families, poor communication, and misconception about staff behavior are just a few examples that could lead to violence against pharmacists in the workplace [13,17]. Coupled with inadequate security staff, lack of staff training for dealing with violence, and lack of policies or reporting systems to prevent violence [13,17]. Offender’s personality issues, relatives of the offender’s lack of education, altered mental states of an offender, behavioral issues, and substance abuse may also contribute to violence against pharmacists in the workplace [13,17]. In academia, long working hours, unpaid work, interaction with students and staff from different backgrounds, and intense pressure to teach, do administrative work, publish papers, and secure funding may put academicians under high levels of stress, which could increase workplace violence [18].

WPV has gathered significant attention in Saudi Arabia, particularly within the healthcare sector [4,5,6,7,8,9,10,11,12,13]. Pharmacists are often front-line HCPs and frequently visited members of the healthcare team and are the most accessible, making them potentially more vulnerable to violence compared to other healthcare providers [4,16]. WPV has been documented mainly among physicians and nurses in KSA. There is a lack of reporting WPV among pharmacists, despite the growing concern about the rising occurrence of WPV [4,5,6,7,8,9,10,11,12,13]. This is possibly due to a lack of an encouraging environment to report WPV and a lack of policy that protects healthcare professionals [8]. This may lead to underestimation of the problem. In KSA, there is little research on violence in the workplace against pharmacists working in different healthcare and academic sectors [4]. Only one study investigated this issue against non-Saudi male community pharmacists in KSA [4]. Addressing this gap is essential to inform national policy and workplace interventions.

This study aimed to examine the frequency, timing, possible causes, reactions, and consequences of WPV against pharmacists working in different sectors in Saudi Arabia. It also evaluated the incident reporting patterns and suggested violence prevention measures from pharmacists’ perspectives. The study also aimed to investigate whether the occurrence of WPV differs by occupational and participants’ characteristics. The findings of this study can shed light on the urgent need for developing strategies and policies to ensure safety and prevent WPV and serve as a foundation for future research.

2. Materials and Methods

2.1. Design

A cross-sectional study design.

2.2. Setting, Samples, Recruitment, and Data Collection Method

Data were gathered between March and April 2024. A self-administered online questionnaire was created using the QuestionPro tool and distributed to a convenience sample of participants through pharmacist-focused social media platforms (e.g., Facebook, Twitter, WhatsApp, Telegram, and LinkedIn). The electronic survey was also sent to the Saudi Commission for Health Specialists (SCFHS) through the university email network to help distribute it to pharmacists registered with the SCFHS. These channels were selected due to their widespread and active use among pharmacists in Saudi Arabia. The study included pharmacists with at least one year of work experience who worked in at least one of the following settings (hospitals, community pharmacies, primary care clinics, academia, pharmacy regulation, and pharmaceutical industries) and had Internet access. Academic pharmacists were included because many maintain active roles in clinical training, patient care, and hospital committee participation. Additionally, they may face WPV in the form of verbal abuse, threats, or harassment from students, staff, or external stakeholders within the academic environment [1,4,16]. Interns, trainees, and individuals who could not speak Arabic or English were excluded from the study.

The internet-based survey site QuestionPro hosted the online survey, allowing anonymous and secure participation. The survey was designated to take 5–10 min to complete. Participants’ written consent was obtained after being informed of the study’s purpose and its confidentially and voluntary participation.

2.3. Sample Size

According to the Saudi Ministry of Health, the total number of pharmacists in Saudi Arabia was approximately 34,398 [19]. The majority were employed in the pharmaceutical industry and related companies (41.2%), followed by community pharmacies (29.4%) and hospital settings (23.5%). The remaining 5.9% worked in other sectors, such as academia and various non-clinical roles [19]. As there is no information on the proportion of workplace violence towards pharmacists who work in different settings in Saudi Arabia, we used the following equation to measure the sample size (n) [20]:

Z^2 × p(p−)/e^2

Z is the z score, e is the margin of error, n is the population size, and p is the population proportion. Assuming a 95% confidence interval, a margin of error (e) of 0.5%, and a z value 1.96, a sample size of 384 was determined.

2.4. Study Instrument and Translation of the Instrument

The survey was developed by the researchers based on previous similar studies [6,21] and the International Labour Office/International Council of Nurses/WHO/Public Services International Questionnaire from previous studies [1,2]. Three expert pharmacists reviewed the instrument to improve its validity. Experts evaluated the instrument’s clarity, applicability, thoroughness, and cultural sensitivity. The questionnaire was slightly modified based on expert suggestions. Then, the modified instrument was piloted to test its validity with five pharmacists who were not included in the study.

The English version of the instrument was translated into Arabic using the Parallel translation technique [22], where two bilingual researchers independently translated the instrument from English to Arabic. These researchers were proficient in English, native Arabic speakers, experienced in research interviewing, and knowledgeable in health-related topics relevant to the study. After comparing both versions, suggested changes were reviewed before the translations were finalized. The face validity of the questionnaire was screened. An experienced academic pharmacist and a community pharmacist fluent in both English and Arabic were invited to review the face validity of the questionnaire before distributing it to the participants. No major suggestions or comments were received from them. The questionnaire was pretested on a panel of two speakers of the target language for content, readability, and comprehension. No major suggestions or comments were received from them.

The questionnaire was divided into three main sections with 34 items. The first section (17 items) gathered data on sociodemographic information (e.g., age, gender, education, etc.) and occupational characteristics (e.g., job roles, years of experience, work in shift, etc.) about the respondents. The second section (16 items) collected information on exposure to physical and psychological violence over the previous 12 months, frequency and types of incidents encountered, offender characteristics, and the severity and effect of the violence. The third section (1 item) contained incident reporting, procedures, and policies pharmacists recommended to minimize violence and improve workplace safety measures. These sections were designed as multiple-choice questions. Some questions had either single-select, multi-select, or open-text response options. Two questions were designed in Likert Scale type questions: question 15 part A (1 = Not at all worried, 2 = Not very worried, 3 = Somewhat worried, 4 = Worried, and 5 = Very worried), and question 14 part B (1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, 5 = very satisfied).

A combination of close-ended multiple-choice questions and Likert scale items were used to ensure standardization, ease of completion, and facilitate statistical analysis. This structured format was chosen to minimize respondent burden while still capturing detailed information on the frequency, type, and consequences of WPV. Furthermore, it aligns with prior studies in this field [1,2], enhancing the comparability and reliability of this study findings.

2.5. Ethical Consideration

Ethical approval was obtained from the Deanship of Scientific Research at Imam Abdulrahman Bin Faisal University (IAU) [IRB-2024-05-221].

2.6. Data Analysis

Data were analyzed using the Statistical Package for Social Sciences SPSS version 28 (release 28.0, SPSS Inc., Chicago, IL, USA). Descriptive statistics were performed to describe the baseline characteristics of the participants, which were reported as counts and percentages for categorical variables. In the bivariate analysis, a chi-square test (X²) was used to assess the association between exposure to violence in general (yes/no) and occupational and participants’ characteristics. Chi-square (X²), degree of freedom (df) and p values were reported.

Multivariate logistic regression analysis examined risk factors associated with exposure to workplace violence (yes/no) and occupational and participants’ characteristics. Odd ratios (ORs) and their corresponding 95% confidence intervals (CIs) were reported. All p-values were two-tailed. A p-value < 0.05 was considered statistically significant in the analysis.

3. Results

3.1. Survey Response and Participants’ Demographic and Occupational Characteristics

A total of 1443 individuals accessed the survey link. Of these, 489 participants initiated the questionnaire, and 319 completed it in full, resulting in a completion rate of 65%. Additionally, 170 participants dropped out before completing the survey.

The majority of participants were females (65.5%), and were aged between 25–34 (80.9%), singles (56.1%), holding an undergraduate degree (84.6%), living in the Eastern Province of Saudi Arabia (46.1%), worked in a community pharmacy (38.3%) or hospital pharmacy (48.9%), in private sector (66.8%), as a staff (90.5%), full time (91.5%), in shifts (59.3%), with one to five years of experience (87.5%). The gender that most participants worked with was male and female (66.1%), and the number of staff presented with participants in the same work sitting most of the time during their working hours was from 1 to 5 (54.5%). Almost half of the participants worked between 6 p.m. and 7 a.m. (51.4%).

A total of 161 participants (50.5%) reported feeling somewhat, moderately, or very worried about violence in their current workplace. Almost half of the participants reported that there are no procedures for the reporting of violence in their institute (49.5%), and there is no encouragement to report violence in their institute (67.7%). Among those who reported available procedures, 42.1% did not know how to use them. A full description of participants’ demographic and occupational characteristics is provided in

Table 1. Data on the demographic and occupational characteristics of the 319 participants in the study.

	Variable	N	%
Gender	Male	110	34.5
	Female	209	65.5
Age	<35	258	80.9
	≥35	61	19.1
Marital status	Married	140	43.9
	Unmarried	179	56.1
Education	Undergraduate	270	84.6
	Postgraduate	49	15.4
Province	Eastern Province	147	46.1
	Other provinces	172	53.9
Occupation *	Hospital pharmacy	156	48.9
	Community pharmacy	122	38.3
	Other (Academia, Research center, Pharmaceutical company and industry, Saudi FDA, Ministry of Health)	66	12.8
Job Sector	Government	106	33.2
	Private	213	66.8
Current position	Senior manager	30	9.5
	Staff	289	90.5
Work experience	≤10 years	279	87.5
	˃10 years	40	12.5
Work status	Full-time	292	91.5
	Part-time	27	8.5
Work in shifts	Yes	189	59.3
	No	130	40.7
Gender of people you most work with	Male	82	25.7
	Female	26	8.2
	Both	211	66.1
Number of staff present in the same work sitting with you during most of your work time	None	56	17.6
	≤10	174	54.5
	˃10	89	27.9
Worked anytime between (6 PM) and (7 AM)	Yes	164	51.4
	No	155	48.6
Are there procedures for the reporting of violence in your workplace?	Yes	161	50.5
	No	158	49.5
Is there encouragement to report violence in your workplace?	Yes	103	32.3
	No	216	67.7
How worried are you about violence in your current workplace?	Not worried at all	96	30.1
	Slightly worried	62	19.4
	Somewhat worried	65	20.4
	Moderately worried	39	12.2
	Very/Extremely worried	57	17.9

* Percentage adds up to more than 100% as participants could tick more than one option.

.

3.2. Prevalence and Pharmacists’ Perception and Experience of Exposure to Workplace Violence in the Previous 12 Months

A total of 156 (48.9%) reported exposure to at least one type of workplace violence in the past 12 months prior to the study (

Table 2. Types, sources, characteristics, and exposure to violence.

	Variable	N	%
Did you experience any workplace violence over the past 12 months?	Yes	156	48.9
	No	163	51.1
What type of violence did you experience in the past 12 months? *	Physical violence	11	3.2
	Verbal violence	137	39.7
	Bullying/mobbing	50	14.5
	Threat	63	18.2
	Sexual harassment	32	9.3
	Racial harassment	52	15.1
How often do you face violent attacks in the last 12 months?	All the time	19	12.2
	Sometimes	107	68.6
	Once	30	19.2
Who was the offender the last time you were violated?	Patient/client	93	59.6
	Student	2	1.3
	Relative of patient/client/student	4	2.6
	Staff member	15	9.6
	Management/supervisor	39	25.0
	External colleague/worker	1	0.6
	General public	2	1.3
Age of offender (approximately)?	≤20 years	5	3.2
	21–45 years	104	66.7
	≥46 years	47	30.1
When did the violation (attack) take place?	Morning time	47	30.1
	Afternoon time	57	36.5
	Evening time	52	33.4
Gender of offender	Male	132	84.6
	Female	24	15.4

* Participants were allowed to select more than one answer.

). In specific, 39.7% (137/345) reported verbal abuse, followed by threat (63/345, 18.2%), bullying/mobbing (50/345, 14.5%), and racial harassment (52/345, 15.1%). Participants expressed that violence occurred to them sometimes (107/156, 68.6%). Participants said that patients committed 59.6% (93/156) of violent events, while 25% (39/156) were perpetrated by managers/supervisors. Violent incidents occurred equally during the morning (47/156, 30.1%), afternoon (57/156, 36.5%), and evening shifts (52/156, 33.4%). The vast majority of the offenders were male (132/156, 84.6%), and 66.7% (104/156) of them were aged 21–45 years, followed by 30.1% (47/156) aged 46 years or above.

Further analysis explored workplace violence patterns across different pharmacy sectors (hospital, community, and other settings). Verbal abuse was the most common type of violence reported in all sectors, with 68 community pharmacists (49.6%), 58 hospital pharmacists (42.3%), and 11 pharmacists in other settings (8.0%) reporting this type of abuse. Threats were reported by 30 community pharmacists (47.6%), 25 hospital pharmacists (39.7%), and 8 pharmacists (12.7%) in other sectors. Bullying or mobbing was most prevalent in community pharmacies (31; 62.0%), followed by hospitals (14; 28.0%) and other settings (5; 10.0%). Violence occurred sometimes for most pharmacists: 57 community pharmacists (53.3%), 42 hospital pharmacists (39.3%), and 8 (7.5%) in other sectors. Violence that occurred all the time was most commonly reported by community pharmacists (9; 47.4%) compared to hospital (6; 31.6%) and other (4; 21.1%) settings. Male offenders were most frequently reported, accounting for 68 cases (51.5%) in community, 53 cases (40.2%) in the hospital, and 11 cases (8.3%) in other settings. The most common offender age group was 21–45 years: 52 cases (50.0%) in community, 43 cases (41.3%) in hospital, and 9 cases (8.7%) in other settings. Evening incidents were particularly frequent in community pharmacies (28; 53.8%) and hospitals (21; 40.4%). These findings indicate that community pharmacists may face a higher frequency of workplace violence and more varied forms, underscoring the importance of sector-specific preventive strategies.

The most commonly reported perceived causes of violence were lack of a penalty for the offender (70/528, 13.3%), followed by lack of policies or reporting systems to prevent violence (60/528, 11.4%), dissatisfaction with the service provided, and unmet service demand (56/528, 10.8%), shortage of staff (48/528, 9.1%) and in medication supply (47/528, 8.9%). See

Table 3. Causes of violence.

	Variable	N	%
What do you think caused the violent event?	Overcrowding	37	7.0
	Shortage of staff	48	9.1
	Dissatisfaction with the service provided and unmet service demand	56	10.8
	Shortage in medication supplies	47	8.9
	Long waiting time to receive service	37	7.0
	Poor communication and misunderstanding	34	6.4
	Anxiety/fear/stress	15	2.8
	Mental illness	30	5.7
	Influence of illness/pain	11	2.0
	Influence of substance (drug/alcohol)	16	3.0
	Inadequate security staff	29	5.5
	Lack of penalty for the offender	70	13.3
	Lack of staff training for dealing with violence	20	3.8
	Lack of policies or reporting systems to prevent Violence	60	11.4
	Do not know	12	2.3
	Other (e.g., misuse of authority by managers)	6	1.1

.

Participants’ reactions towards violence varied; (62/247, 25.1%) said that they told the person to stop, (55/247,22.3%) took no action, (44/247, 17.8%) reported the violent event to their senior staff member, and (40/247, 16.2%) reported it to a friend/family/colleague. Gender differences were observed in responses to workplace violence. Among those who reported taking no action, 24 (43.6%) were male and 31 (56.4%) were female. Twenty-eight males (45.2%) and 34 females (54.8%) reported telling the person to stop. Telling friends/family/colleagues was more common among females (29; 72.5%) than males (11; 27.5%). Reporting to a senior staff member was reported by 30 females (68.2%) and 14 males (31.8%).

Eighty-seven percent of participants reported that the violence affected them negatively. A high proportion of pharmacists reported negative effects of workplace violence across all subgroups—regardless of age, gender, province, or work experience—ranging from 77% to 80%. This highlights the widespread emotional and professional impact of WPV on pharmacists. As for consequences, the majority of participants reported feelings of hopelessness/disappointment (85/431, 19.7%), decreased job satisfaction (90/431, 20.9%), decreased work performance and productivity (65/431, 15.1%), and minimized communication, and interaction with patients/families/students/staff (63/431, 14.6%).

Overall, 82.1% of participants believed that the violent incident was preventable. Among those who experienced WPV, this perception was especially common among younger pharmacists (<35 years) and those with less than 5 years of experience (81% and 79%, respectively). Similarly, high preventability beliefs were reported by staff pharmacists (79%) and those working in the Eastern and Central Provinces (70%).

Eighty-four percent reported that their institute took no action to investigate the causes of the attack. Eighty-one percent of participants reported being dissatisfied or very dissatisfied with how the incident was handled. The uselessness of incident reporting (85/238, 35.4%) and dealing with the problem themselves (57/238, 23.9%) were participants’ most commonly mentioned reasons when asked why they did not tell others about the incident. See

Table 4. Reactions, consequences, and investigative actions following violence.

	Variable	N	%
What was your reaction to the violent event?	Took no action	55	22.3
	Told the person to stop	62	25.1
	Told friends/family/a colleague	40	16.2
	Reported it to a senior staff member	44	17.8
	Sought counselling from a specialist	10	4.1
	Requested to be transferred to another Position	12	4.9
	Completed incident/accident form	11	4.5
	Pursued prosecution	5	2.0
	Other (e.g., resigning from work, reporting the violent event to the police, requesting a transfer to another place)	8	3.1
Did the workplace violence affect you negatively?	Yes	121	77.6
	No	35	22.4
What was the consequence of the violent event?	Decreased my work performance and Productivity	65	15.1
	Minimize communication, and interaction with patients/families/students/staff	63	14.6
	The feeling of hopelessness/disappointment	85	19.7
	Increased absenteeism	17	3.9
	Decreased job satiation	90	20.9
	Occurrence of injury	5	1.2
	Fear and anxiety	58	13.5
	Feeling to take revenge	44	10.2
	Other (e.g., resignation)	4	0.9
Do you think the violent event could have been prevented?	Yes	128	82.1
	No	28	17.9
Was any action taken to investigate the causes of the violence or attack?	Yes	10	6.5
	No	131	83.9
	Don’t know	15	9.6
Satisfaction with the manner in which the incident was handled	Very unsatisfied	83	53.2
	Unsatisfied	37	23.7
	Neutral	28	17.9
	Satisfied	6	3.9
	Very satisfied	2	1.3
If no reaction, why?	It was not important	21	8.8
	I dealt with the problem directly myself	57	23.9
	Felt ashamed and guilty	10	4.2
	Afraid of negative consequences	38	15.9
	Did not know who to report to	28	11.8
	Useless	84	35.4

.

3.3. Violence Prevention Measures

The findings revealed various workplace violence prevention and management measures that participants considered important. As participants were allowed to select more than one option, 227 participants (21.3%) highlighted the need for enhanced security measures (e.g., security guards, alarm systems, metal detectors, and mobile panic buttons). Additionally, 179 participants (16.8%) emphasized the importance of training staff on violence prevention and management, while 142 participants (13.3%) supported reducing periods of working alone. Furthermore, 116 participants (10.9%) recommended increasing the number of staff on duty to mitigate risks.

3.4. Associations Between Exposure to Workplace Violence and Respondents’ Demographic and Occupational Characteristics

Table 5. Participant and occupational characteristics associated with exposure to work place violence in the last 12 months [n = 319] (Chi-square test results).

Variable		Exposures to Workplace Violence
		Yes (%)	No (%)	X2	df	p-Value
Gender	Male	59 (53.6)	51 (46.4)	1.505	1	0.220
	Female	97 (46.4)	112 (53.6)
Age	˂35	136 (52.7)	122 (47.3)	7.839	1	0.005
	≥35	20 (32.8)	41 (67.2)
Marital status	Unmarried	94 (52.5)	85 (47.5)	2.129	1	0.145
	Married	62 (44.2)	78 (55.8)
Education	Undergraduate	141 (52.2)	129 (47.8)	7.751	1	0.005
	Postgraduate	15 (30.6)	34 (69.4)
Province	Eastern Province	68 (46.3)	79 (53.7)	0.763	1	0.382
	Other provinces	88 (51.2)	84 (48.8)
Occupation	Hospital pharmacy	68 (43.6)	88 (56.4)	28.002	3	<0.001
	Community pharmacy	79 (64.8)	43 (35.2)
	Other (Academia, research center, pharmaceutical company and industry, Saudi FDA, Ministry of Health)	24 (36.9)	41 (63.1)
Job Sector	Government	29 (27.4)	77 (72.6)	58.977	2	<0.001
	Private	127 (59.6)	86 (40.4)
Current position	Senior manager	8 (26.7)	22 (73.3)	56.552	1	0.01
	Staff	148 (51.2)	141 (48.8)
Work experience	≤10 years	143 (51.6)	136 (48.4)	4.924	1	0.026
	˃10 years	13 (32.5)	27 (67.5)
Work status	Full-time	144 (49.3)	148 (50.7)	0.235	1	0.628
	Part-time	12 (44.4)	15 (55.6)
Working multiple shifts	Yes	115 (60.9)	74 (39.1)	26.476	1	<0.001
	No	41 (31.5)	89 (68.5)
Gender of people you most work with	Male	45 (54.9)	37 (45.1)	1.694	2	0.429
	Female	13 (50.0)	13 (50.0)
	Both	98 (46.5)	113 (53.5)
Number of staff present in the same work sitting with you during most of your work time	None	32 (57.1)	24 (42.9)	8.752	2	0.013
	≤10	117 (50.0)	117 (50.0)
	˃10	7 (24.1)	22 (75.9)
Working the evening or night shift (6 PM) and (7 AM)	Yes	106 (64.6)	58 (35.4)	33.427	1	<0.001
	No	50 (32.3)	105 (67.7)
Are there procedures for the reporting of violence in your workplace?	Yes	54 (33.5)	107 (66.5)	30.701	1	<0.001
	No	102 (64.6)	56 (35.4)
Is there encouragement to report violence in your workplace?	Yes	32 (31.1)	71 (68.9)	19.363	1	<0.001
	No	124 (57.4)	92 (42.6)

Note: X² = Chi-square value; df = Degrees of freedom; p = Probability value.

represents the association between exposure to workplace violence and respondents’ demographic and occupational characteristics in the past 12 months. There was a statistically significant difference in the prevalence of workplace violence in terms of age category (chi-square 7.839 (df 1), p = 0.005), the prevalence was highest in those aged below 35 (52.7%) (Table 5). Similarly, those with a bachelor’s degree education reported a significantly higher percentage of workplace violence incidents (chi-square 7.751 (df 1), p = 0.005). Participants with less than ten years of experience reported a significantly higher percentage of violent incidents compared to those with more experience (51.6% vs. 32.5%, chi-square 4.924 (df 1), p = 0.026).

Individuals working in shifts reported experiencing significantly more frequent violence than those not working in shifts (60.9% vs. 31.5%, p < 0.001). Employees working evening or night shifts reported significantly higher instances of violence compared to those working morning shifts (64.6% vs. 32.3%, p < 0.001). A number of coworkers in the same workplace was significantly associated with violence. The fewer staff members present in the same work setting, the more frequent violent incidents are experienced (chi-square 8.752 (df 2), p = 0.013). People working in community pharmacies (chi-square 28.002 (df 3), p < 0.001), private sector (chi-square 58.977 (df 2), p < 0.001), and not holding managerial positions (chi-square 56.552 (df 1), p = 0.01) are at more risk of violence than others (Table 5).

Individuals without a supportive environment for reporting violence experienced significantly more frequent incidents of violence compared to those with a supportive environment (57.4% vs. 31.1%, p < 0.001). Those who lacked procedures for the reporting of violence in their workplace reported significantly more frequent violence than those who had procedures for reporting the violence (64.6% vs. 33.5%, p < 0.001).

Table 6. Un-adjusted and multivariate-adjusted odds ratios for exposure to violence among pharmacists.

Variable		Unadjusted			Adjusted
		UAOR	95% CI	p-Value	AOR	95% CI	p-Value
Age	˂35 (ref)	1.00 a			1.00 a
	≥35	0.438	0.243–0.788	0.006	0.915	0.327–2.565	0.866
Education	Undergraduate (ref)	1.00 a			1.00 a
	Postgraduate	0.404	0.210–0.775	0.006	1.080	0.429–2.717	0.871
Occupation	Hospital pharmacy (ref)	1.00 a			1.00 a
	Community pharmacy	2.766	1.660–4.609	<0.001	1.687	0.875–3.251	0.118
	Other (Academia, research center, pharmaceutical company and industry, Saudi FDA, Ministry of Health)	0.862	0.469–1.585	0.633	1.293	0.605–2.764	0.508
Job Sector	Private (ref)	1.00 a			1.00 a
	Government	0.377	2.361–6.511	<0.001	1.806	0.874–3.731	0.110
Current position	Senior manager (ref)				1.00a
	Staff	2.887	1.244–6.696	0.014	3.165	1.118–8.96	0.030
Work experience	≤10 years (ref)	1.00 a			1.00 a
	˃10 years	0.458	0.227–0.924	0.029	1.434	0.451–4.561	0.542
Working multiple shifts	No (ref)	1.00 a			1.00a
	Yes	3.373	2.106–5.405	<0.001	1.857	0.974–3.542	0.060
Number of staff present in the same work sitting with you during most of your work time	None (ref)	1.00 a			1.00 a
	≤10	0.750	0.417–1.350	0.338	0.949	0.479–1.877	0.880
	˃10	0.239	0.088–0.650	0.005	0.396	0.120–1.302	0.127
Working the evening or night shift (6 PM) and (7 AM)	No (ref)	1.00 a			1.00 a
	Yes	3.838	2.412–6.108	<0.001	2.456	1.340–4.503	0.004
Are there procedures for the reporting of violence in your workplace?	No (ref)	1.00 a			1.00 a
	Yes	0.277	0.175–0.440	<0.001	0.412	0.236–0.717	0.002
Is there encouragement to report violence in your workplace?	No (ref)	1.00 a			1.00 a
	Yes	0.334	0.203–0.550	<0.001	0.581	0.320–1.054	0.074

Note: UAOR = Unadjusted odds ratio; AOR = Adjusted odds ratio; ^a = Reference category for the logistic regressions; CI = Confidence interval; p = Probability value.

represents the regression analysis of factors significantly linked to WPV. The multivariate regression analysis indicated significant unadjusted odds ratios (OR) for participants who were younger than 35 years old (p = 0.006), who held an undergraduate degree of educational level (p = 0.006), who had less than ten years of work experience (p = 0.029), working in community pharmacies (p < 0.001), working in the private sector (p < 0.001), working as staff (p = 0.014), working multiple shifts (OR 3.373, 95% CI 2.106–5.405), working night or evening shifts (p < 0.001), fewer number of coworkers present in the same workplace (p = 0.005), lack of procedures to report violence (p < 0.001) and lack of encouraging environment to report violence (p < 0.001). On the other hand, in multiple regression analysis that included the above-mentioned characteristics, working as a staff (p = 0.030), working evening or night shift (p = 0.004), and lacking procedure for reporting the violence (p = 0.002) were the only variables that remained significantly associated with violence after adjusting for other factors.

4. Discussion

4.1. Prevalence and Type of Workplace Violence Among Pharmacists

The study revealed that 49% of participants reported experiencing WPV in the last 12 months. This finding is relatively lower than the prevalence reported in Alshahrani’s study [4], which found that approximately 68% of pharmacists had been exposed to WPV. Comparing the current findings with the national and international published studies is challenging because of variations in the definitions of WPV, the healthcare providers targeted, the specific type of violence measured, the employment sector, the country where the study was conducted, the methodologies employed, and the duration covered to collect the data. Despite these variations, the results align with previous national and international studies [4,5,6,7,8,9,10,11,12,13,14,21,22,23,24,25,26,27,28].

Our finding that pharmacists are more likely to face psychological rather than physical violence is consistent with the results of Alshahrani’s study [4], which also reported a higher prevalence of psychological abuse among pharmacists. Moreover, the prevalence of sexual harassment (10%) was low in our study, similar to other previous studies performed in other local and Middle Eastern studies conducted in different settings [6,7,8,12,13,17,24,29]. Other studies conducted among physicians and nurses have shown that physicians and nurses experienced high rates of both psychological and physical violence [3,6,8,11,12,24], compared to pharmacists. This is possible because patients have higher expectations of physicians, dissatisfaction with the service provided, and unmet service demand may result in physicians facing more aggression than pharmacists [21]. It could also be related to the nature of physicians’ and nurses’ roles, which require them to closely interact with individuals experiencing unstable conditions such as aggression, confusion, or alcohol or drug intoxication [30]. The high levels of anxiety, stress, and tension experienced during hospital visits or admissions may contribute to this prevalence [31].

4.2. Causes and Characteristics of Wrokplace Violence

The most commonly reported perceived causes of violence were the lack of a penalty for the offender and the lack of policies or reporting systems to prevent violence. These findings are in line with previous research conducted in Saudi Arabia and neighboring countries, where the absence of institutional consequences and underreporting systems were also cited as major contributors to WPV [6,8,13,24]. As indicated by the study results, the situation could worsen by the absence of violence prevention and management strategies, such as providing sufficient safety measures, adequate training, procedures, and policies to protect pharmacists from WPV. Studies have shown that these factors and conditions could lead to WPV [21,25,26]. Dissatisfaction with the service provided, unmet service demand, staff shortage, and medication supply were also reported as causes of WPV. Thus, detecting the risk factors for violence is crucial, which will facilitate the creation of suitable WPV prevention strategies. Pharmacy management should optimize resource utilization by reducing waiting times and improving medication supply. This could be done by implementing a system to identify the patients who require immediate attention quickly, applying a centralized inventory management system that can be accessed by all staff members, using an automated inventory management process, and monitoring the inventory level closely.

This study has shown that males predominantly committed WPV. This finding is consistent with previous research, which also reported that males tend to display higher levels of aggression compared to females [4,7,10,24,32]. The existing evidence suggests that men are more likely than women to commit violence, and they are also more physically capable of doing so [4,11,21]. This could be attributed to the maledominant nature of Saudi culture, where women tend to avoid situations or confrontations that might reflect poorly on them. In case of a problem, a guardian is called upon to handle the matter [10,32].

In line with numerous other research, patients were often cited as the initiators of violence [7,11,21,26,27]. When patients experience prolonged waiting times to receive medications or see a doctor, and they are in pain, they may become angry, stressed, or frustrated, increasing the likelihood of violent behavior towards pharmacists. A notable concern arose regarding the proportion of violent incidents initiated by the managers. This might create an uncomfortable environment at the workplace, affecting the entire team’s productivity. This would necessitate recognizing the causes of violence, implementing measures to foster a culture of respect between managers and employees, and adopting effective strategies to reduce violent behavior between managers and employees [17].

4.3. Impact on Pharmacists and Barriers to Reporting

Eighty-four percent of those exposed to WPV reported that their institute took no action to investigate the causes of the attack. This lack of institutional response is consistent with findings from earlier studies in Saudi Arabia and the region, which have also highlighted the absence of administrative support and the failure of healthcare organizations to address or follow up on violence incidents adequately [6,8,13,24]. Workplace administrations need to support the reporters and shield them from any potential punishments caused by their reporting. Addressing reported incidents, taking disciplinary measures against offenders, and providing feedback to those who report these incidents are also essential tasks for administrators and supervisors [21]. The majority of participants reported that the violence affected them negatively. Many participants reported hopelessness/disappointment, decreased job satisfaction, reduced work performance and productivity, and minimized communication and interaction with care or service recipients. Previous research has identified a link between WPV and significant occupational sequences, such as a desire to resign [33], higher absenteeism [33], and reduced productivity [33]. This could have a detrimental effect on patient care safety, the mental health of the staff, and job retention and could lead to a shortage of qualified pharmacists. Thus, it is imperative to focus on implementing WPV prevention measures and policies and ensuring enforcement of the legal framework post-incident. Providing social support and mental health services to limit the adverse physical and mental impacts that may develop among pharmacists reporting WPV incidents is vital.

The low rate of violence reporting in this study (16%) aligns with the findings from previous research [6,11,21,25,26,27]. This could also explain why most victims in our study chose not to report the incident. This lack of reporting causes violence to be underestimated despite being considered widespread. As a result, most pharmacists were dissatisfied or very dissatisfied with how the incident was managed. This is consistent with other studies conducted in Saudi Arabia [10,12,32]. Participants cited unclear reporting procedures and a lack of encouragement from management as reasons for their reluctance to report. They also felt that reporting was useless, as management would not take action, and they feared potential negative consequences such as fear of losing their jobs, fear that reporting would adversely affect their evaluation or future professional career, or fear of retaliation. A lack of an encouraging environment to report violence was also reported as a reason for not reporting violence. Socio-cultural norms and values in the Arabic culture could influence this behavior as many pharmacists view such violence as part of their job, and they have to tolerate it, not seeing the importance of supporting reporting these events [21]. Different clinical risk assessment tools (RATs) were designed in healthcare settings to identify, evaluate and reduce the risk of WPV, such as the Violence Risk Assessment Tool (VRAT), Broset Violence Checklist (BVC), The Aggression Scale, and The STAMP (Staring and Eye Contact, Tone and Volume of Voice, Anxiety, Mumbling, Pacing) [34,35,36,37]. Incident Reporting systems (IRS) have also been used to encourage reporting, tracking, and analyzing violence incidents to improve workplace safety, such as OSHA’s Guidelines for Preventing Workplace Violence and Internal Hospital Incidence Reporting Systems [34,35,36,37].

Additionally, pharmacists may refrain from reporting violent behavior or taking required measures until a physical injury occurs. There is a need to implement strategies and policies for the management and prevention of WPV, improve the reporting of incidents, and ensure that reported events are followed up and that feedback is provided to victims about the reported incidents. Developing explicit protocols to address WPV and clear guidelines on how WPV would be handled is essential. Additionally, it is vital to provide sufficient psychological and physical support to victims of WPV. Educating the staff and providing comprehensive information on reporting WPV during the orientation program provided to new employees is also required. Supervisors and administrators should support individuals reporting violent incidents and protect them from negative consequences.

4.4. Workplace Violence Prevention Strategies

The participants suggested various strategies to decrease the frequency of WPV, such as providing security measures (e.g., security guards, monitoring, alarm and communication systems, cameras, suitable building design), training employees on violence prevention and management, reducing periods of working alone, expanding pharmacists workforce to shorten patient wait times and fostering better inter-professional relationships are vital recommendations to reduce WPV. This is in agreement with other studies [7,24].

While these strategies are essential, their practical implementation may vary depending on the pharmacy practice setting. In hospital and institutional settings, it may be feasible to implement physical safety measures such as installing surveillance cameras, panic buttons, and hiring dedicated security personnel due to the availability of infrastructure and budget. These environments also tend to have structured training programs and administrative support. However, in community pharmacies, especially smaller or privately owned ones, such measures may be challenging due to limited financial and human resources. In these cases, the focus may need to shift toward more feasible actions such as enhancing interpersonal communication, developing simple reporting systems, reducing lone working hours through better shift management, and providing violence de-escalation training. Tailoring prevention strategies to the specific characteristics of each workplace setting is essential to ensure their effectiveness and sustainability [7,24].

4.5. Predictors of Workplace Violence: Findings from Regression Analysis

Consistent with other studies [8,11,21,24,38], the logistic regression analysis showed that working as a staff, working night or evening shifts, and lacking procedures to report violence were significantly more likely to be exposed to violence. Thus, any attempt to tackle violence among pharmacists should focus on these occupational characteristics.

Increased violence during evening and night shifts could be linked to staffing shortages, reduced management and security presence, necessitating personnel to work solo for long hours [8,21]. Additionally, night-time customers are often emergency or critical cases and may need more patience to listen to advice or wait for long periods to receive care from pharmacists [24]. Thus, limiting after-hour care and increasing the number of staff during the night shift could limit WPV.

4.6. Implications for Practice and Policy

The findings highlight the urgent need to strengthen incident reporting systems and follow-up procedures in healthcare settings. Laws should be enforced and a policy that outline a zero-tolerance for violence should be established to prevent assaults against healthcare workers. Establishing efficient communication channels to report violent incidents and fostering open discussion regarding safety concerns are needed. Also, raising community awareness by recognizing signs of potential violence, de-escalation strategies and conflict resolution techniques are required. Offering necessary support to victims, producing firm penalties for offenders, installing security devices such as panic buttons, good lighting in all places and security cameras, secure entry system, secure areas for sensitive tasks and empowering healthcare workers to cope with and report violence, and assuring them that doing so will not negatively impact them are essential measures. It is necessary to provide appropriate training, education, and counseling and mental health support to the victims and ensure that they are familiar with workplace procedures and policies. Administrators should take all necessary steps to investigate reported incidents, which will help prevent similar occurrences and alleviate the stress and injury burdens on staff [6]. Workplace risks for violence should always be assessed and safety measures should be adjusted accordingly. Incidents should be reviewed continuously to identify areas for improvement in safety protocols.

A national policy and prevention program might be necessary to tackle WPV [39,40,41]. This study’s findings could help create recommendations and actions to reduce and address workplace violence against pharmacists. This research should be broadened by professional associations such as the International Pharmaceutical Federation (FIP) to uncover worldwide patterns of WPV against pharmacists. They should create guidelines, advocacy approaches, and operational papers to help their members address and reduce WPV [24].

4.7. Strengths and Limitations of the Study

The study has some strengths and limitations. This research provides a foundation for comprehending WPV against pharmacists in Saudi Arabia. Additionally, several prevention strategies were proposed to inform the creation and implementation of preventive measures. The present study employed the WHO’s standard definition of violence to facilitate a more accurate comparison with other studies.

A convenient sampling strategy was used in the current study, so the findings may not be representative to the broader population of pharmacists in Saudi Arabia. Thus, the findings may be generalizable to only a subset of pharmacists who share similar characteristics with those in the study sample. In addition, as the questionnaire was self-administered, recall bias might be introduced as this might rely on participants’ ability to recall events from the previous 12 months. It is a cross-sectional study that cannot assess causal relationships among the observed factors. This is because the cross-sectional design captures a snapshot rather than following subjects over time. The number of participants recruited did not meet the required sample size. Thus, a larger sample size would have reduced the margin of error. Nevertheless, our findings are consistent with those of more extensive surveys and studies conducted on larger populations. Another limitation is the gender imbalance in our sample, with a higher proportion of female respondents. This may have introduced response bias and could affect the generalizability of the findings, particularly in relation to gender-specific experiences of workplace violence. A further limitation is the exclusive use of an online questionnaire, which may have limited participation among pharmacists with limited internet access or are less active on digital platforms, potentially introducing selection bias.

4.8. Suggestions for Future Work

Further studies are needed to explore whether the recommended safety and violence prevention measures would reduce violence in the workplace. It is recommended to research violence from the attacker’s perspective, focusing on the circumstances that contribute to such behavior. Additionally, longitudinal studies are needed to determine the short- and long-term implications of WPV on healthcare staff’s physical, psychological, psychosocial, and emotional status.

5. Conclusions

In conclusion, the risk of WPV events occurrence among pharmacists is high, with nearly half of the respondents (49%) reporting exposure—most commonly verbal abuse. Key contributing factors included the absence of penalties and lack of clear reporting systems. WPV had substantial negative impacts, with many participants experiencing decreased job satisfaction and hopelessness. The findings underscore the increased risk of WPV among staff pharmacists, those working evening or night shifts, and in settings without formal reporting procedures. These results highlight the urgent need for institutional policies, preventive strategies, and effective incident management systems to protect pharmacists in the workplace. Employers play a critical role in implementing violence prevention measures—such as establishing formal reporting systems, enforcing zero-tolerance policies, providing safety training, and ensuring adequate staffing—by fostering a safe work environment and supporting affected staff.