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

Reviewer Comment

Author Response and Changes Made

Comment 1: The paper addresses an important topic regarding pharmacists safety and provides insights that could be valuable to researchers and practitioners. The study is well-structured, but there are areas where improvements can be made in terms of clarity, methodology, discussion, and referencing. Below is a detailed review:

Response 1: We sincerely thank the reviewer for the positive feedback and for recognizing the importance of our study on pharmacist safety, as well as the value it may offer to both researchers and practitioners. We also appreciate the acknowledgment of the overall structure of the paper. In response to the reviewer's suggestions regarding clarity, methodology, discussion, and referencing, we have carefully reviewed the manuscript and implemented all necessary revisions as detailed in our responses below. We trust that these changes have improved the quality and clarity of the manuscript.

Comment 2: The abstract is too long and contains not needed information. You need to make it concise and focused.

Response 2: We thank the reviewer for this valuable feedback. In response, we have revised the abstract to make it more concise. Please see the abstract section (Page 1, in the revised manuscript)

Comment 3: The research gap being addressed should be more explicitly stated in the abstract.

Response 3: We thank the reviewer for this suggestion. We would like to respectfully highlight that the research gap has been stated in the abstract with the sentence: “However, in Saudi Arabia, there is little research on violence in the workplace among pharmacists working in different sectors.” This statement aims to emphasize the lack of studies specifically focusing on workplace violence among pharmacists across various settings in Saudi Arabia. Please see the abstract section (Page 1, lines 19–20, in the revised manuscript).

Comment 4: In the introduction, the research problem is stated, but a stronger justification for its importance is needed.

Response 4: We appreciate the reviewer’s feedback. We would like to clarify that the justification for the importance of the research problem is outlined in the introduction. In this section, we emphasized that:

·       Workplace violence (WPV) is a growing global concern among healthcare providers (Page 2, lines 49-50).

·       Pharmacists may be more vulnerable due to their accessibility, visibility, and role as the first point of contact (Page 3, lines 114–116).

·       WPV can lead to negative consequences such as physical and emotional harm, reduced productivity, and poor job satisfaction (Page 2, lines 63–65).

·       Although WPV has been studied in other healthcare professions, there is limited research focusing specifically on pharmacists in Saudi Arabia, especially across various sectors (Page 3, lines 121-123).

We believe these points provide a clear rationale for the study. However, in response to the reviewer’s suggestion, we have added one sentence, page 3, lines 123, to stress the importance for national policy.

Comment 5: The way of locating the IEEE references is not correct, you need to add the bracket number at the end of the sentence before the comma or the period, not at the start of the following sentence. This is confusing. We do not know that the reference is for the preceding sentence or the following one. If it is for the following one, you may also rephrase the way you are using by for example saying X and Y [500] performed a study in Saudi Arabia ….

Response 5: We thank the reviewer for pointing out the issue related to reference placement. We have carefully reviewed all in-text citations and revised their locations to ensure proper IEEE formatting. Specifically, reference bracket numbers have been moved to appear at the end of the relevant sentence or clause, directly before the period or comma, as recommended. Please see page 2, lines 53-59, in the revised manuscript.

Comment 6: The equation you have used for calculating the sample size needs a reference.

Response 6: We thank the reviewer for this important observation. In response, we have now added a citation to support the sample size calculation equation used in the methodology. The reference has been inserted in materials and methods section, sample size sub-section, page 4, line 163 of the revised manuscript.

Comment 7: What is the population you have considered, I understand it’s those pharmacists in Saudi Arabia, however, how many they are with reference?

Response 7: We thank the reviewer for this helpful comment. The target population considered in our study includes pharmacists working in Saudi Arabia across various sectors. According to the Statistical Yearbook published by the Saudi Ministry of Health, there were approximately 34,398 licensed pharmacists working in the country as of the most recent report [19]. We have now clarified this information in the Methods section, sample size sub-section, page 4, line 157-158 of the revised manuscript and provided the appropriate reference to support the total population size used in estimating the sample.

Comment 8: Why you have included those pharmacists who work in academia, they are not in the same environment as those in health sector.

Response 8: We thank the reviewer for this thoughtful comment. We included pharmacists working in academia because many of them remain actively involved in clinical practice, hospital committees, patient care activities, or training pharmacy interns in hospital or community settings. Additionally, workplace violence is not limited to traditional clinical environments; academic pharmacists may also experience forms of verbal abuse, harassment, or threats from students, staff, or the public, particularly in patient-facing academic roles or while participating in institutional operations.

To clarify this point, we have added a justification for including academic pharmacists in the in materials and methods section, setting, samples, recruitment, and data collection sub-section, page 4, line 145-148 of the revised manuscript. We hope this addresses the reviewer’s concern and demonstrates the relevance of including academic pharmacists in the study.

Comment 9: The methodology looks good, however, the sample size required more justification and statistical analysis would improve clarity.

Response 9: We thank the reviewer for this valuable comment. Kindly refer to our detailed responses to comments 5 and 6.

Comment 10: Since you have more males then females, this might introduce some bias, you need to explain this and may be to add it to the limitations.

Response 10: We thank the reviewer for this important comment. We agree that the gender imbalance in our sample may introduce response bias and affect the generalizability of the findings. In response, we have added a sentence acknowledging this as a limitation in the discussion section, strengths and limitations of the study sub-section, page 18, lines 553-556. Specifically, we note that the overrepresentation of female participants may influence the perception and reporting of workplace violence and should be considered when interpreting the results.

Comment 11: I suggest adding more figures in the result section will improve it understanding.

Response 11: We thank the reviewer for this suggestion. While we agree that visual representations can enhance clarity in many cases, we believe that the key findings in our results are already clearly presented through well-structured tables and narrative descriptions. After careful consideration, we concluded that adding more figures would likely be redundant and may not provide additional value beyond what is already conveyed. Therefore, we opted to keep the results section concise and focused.

We hope the reviewer finds the current presentation sufficiently clear and informative.

Comment 12: In discussion, you need to connect the paper’s results with those in literature.

Response 12: We thank the reviewer for this helpful suggestion. The Discussion section has now been reviewed, and additional comparisons to previously published literature have been added to further connect our findings to existing evidence. These enhancements are highlighted in red font in the revised manuscript. Specifically, we strengthened the discussion of:

·       The prevalence and type of WPV compared with national and regional studies. Please see discussion section, page 15 of the revised manuscript, lines 366-367 and 374-376.

·       The reported causes of WPV and institutional response in light of similar findings from local studies. Please see discussion section, page 15 of the revised manuscript, lines 392-393.

·       Additionally, we noted that “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].” Please see discussion section, page 16 of the revised manuscript, lines 428-431.  

In addition, we respectfully note that several comparisons to the literature were already present in the original manuscript, linking our results to prior studies on WPV among healthcare workers in Saudi Arabia and the broader region. Please see discussion section, pages 14-17 of the revised manuscript.

Comment 13: In conclusions, avoid introducing new information that was not discussed in the results, and you need to make it provide clearer statement on the contribution of the study is needed.

Response 13: Thank you for your valuable comment. In response, we have restructured the Conclusion section to ensure it aligns closely with the study’s objectives and results. The Conclusion now stands as a separate section that provides a concise summary of the main findings, all of which are directly supported by the data presented in the Results section.

As you rightly pointed out, some content in the original Conclusion went beyond the results. To address this:

·       The paragraph beginning “The findings highlight the urgent need to strengthen …” has been moved to a newly created sub-section in the Discussion titled 4.6. Implications for Practice and Policy, where it appropriately contextualizes the practical relevance of the findings. Please see page 18.

·       Recommendations for further research, including the need to explore violence from the offender’s perspective and to conduct longitudinal research, are now placed under a separate subheading, 4.7. Suggestions for Future Research, also within the Discussion. Please see page 19.

Please see the revised Conclusion section on Page 19 and the new Discussion sub-sections 4.6 and 4.7 in the updated manuscript. We appreciate your feedback, which helped us improve the structure and clarity of the paper.

Response 14: Make sure all references are following the journal’s format

Response 14: Thank you for your comment. We have carefully reviewed and revised all references to ensure they are fully aligned with the journal’s required citation and formatting style. Please let us know if any specific entries need further adjustment.

Thank you once again for your valuable feedback and for considering our revised manuscript.

Again, we appreciate all your insightful comments. We worked hard to be responsive to them. Thank you for taking the time and energy to help us improve the paper. We really hope these modifications can meet with your approval. Thank you very much.

23/06/2025

Reviewer Comment

Author Response and Changes Made

The article addresses the important issue of workplace safety, with a special focus on pharmacists. It has the standard structure of such studies.

Below are my observations on the article.

Abstract:

Comment 1: I found the abstract to be very detailed and to include information that should have made the "Materials and Methods" chapter more specific. The Authors also refer to studies by other Authors on workplace violence in the abstract. It would be worth making minor corrections.

Response 1: We appreciate your comment, and we want to clarify that the abstract was slightly shortened during revision to meet your request. The full “Materials and Methods” section provides comprehensive and detailed information that aligns with the summary presented in the abstract, including the study design, sampling strategy, survey tool development, and data analysis procedures. In addition, we would like to confirm that the abstract contains no references to external studies or specific authors. Please see the abstract section, page 1.

Comment 2: Introduction - The Authors began with explanations of concepts that I consider important to the study. Through further analysis of scientific research, the authors point out the prevalence of violence among certain professional groups. Have the authors reviewed other researchers' proposals for reducing violence? It would also be worthwhile to provide recommendations that have appeared in other works. This would also help fill the gap that this study aims to address.

Response 2: Thank you for your thoughtful comment. In response, we would like to clarify that recommendations and proposals for reducing workplace violence, drawn from both our data and previous literature, have been included in multiple sections of the manuscript. Specifically:

1.       In the Introduction, we highlighted proposed risk factors and causes of WPV that have been addressed in earlier research, including understaffing, poor communication, and absence of institutional policies. Please see the Inroduction section, page 4, lines 100–112.  

2.       In the Discussion, particularly section 4.4 ("Workplace Violence Prevention Strategies"), we incorporated previously published evidence-based recommendations, including enhancing security measures, staff training, and limiting working alone—all of which align with international best practices. Please see the discussion section, 4.4. sub-section, page 17, lines 481–486. 

3.       In the Discussion, particularly section 4.6 ("Implications for Practice and Policy"), we further expanded on these by recommending comprehensive violence prevention strategies, establishing zero-tolerance policies, strengthening reporting systems, and increasing community awareness.Please see the discussion section, 4.6. sub-section, pages 17 and 18, lines 512–536. 

These additions help bridge the identified gap and support the formulation of actionable policies and interventions to address workplace violence against pharmacists.

Comment 3: While a broad analysis of violence and the research conducted is important, why did the Authors focus exclusively on this professional group? They should have justified their choice of this professional group.

Response 3: Thank you for this important comment. We agree that providing a clear justification for focusing on pharmacists is essential. In response, we would like to highlight that the rationale for selecting pharmacists is provided in the manuscript.

Pharmacists are often front-line healthcare providers, regularly interacting with patients and being one of the most accessible members of the healthcare team, which places them at higher risk of violence compared to other professionals. Please see the introduction section, pgae 3, lines 114-123.

While WPV has been well-documented among physicians and nurses in Saudi Arabia, there is a lack of reporting and research on WPV among pharmacists, despite growing concerns about its increasing occurrence.  Please see the introduction section, pgae 3, lines 114-123.

On Page 3, Lines 100–112, we note that pharmacists in Saudi Arabia are increasingly subjected to workplace stressors—such as long working hours, staff shortages, and patient overload—that contribute to their vulnerability to violence.

Finally, to the best of our knowledge, only one prior study has focused on workplace violence against non-Saudi male community pharmacists in the Kingdom of Saudi Arabia [Reference 4]. This underscores the novelty and importance of the current study, which broadens the scope by including pharmacists across various healthcare and academic sectors.

Comment 4: The Authors point out the possibility of developing strategies and policies to ensure safety and prevent violence. A review of the literature on the subject would show what recommendations have already been made and what still needs special attention in terms of violence prevention.

Response 4: Thank you for your insightful comment. We agree that including a review of prior recommendations is essential to contextualizing our findings and identifying remaining gaps. In response, we would like to confirm that we have reviewed the literature and included existing recommendations throughout the manuscript. Specifically:

-          On Page 4, Lines 100–112 (Introduction), we present key factors from prior literature that contribute to workplace violence (WPV), such as staff shortages, lack of training, and absence of policies, setting the stage for why preventive strategies are urgently needed.

-          On Page 15, Lines 391–406 (Discussion – Section 4.2), we discuss causes of WPV reported in other studies, including insufficient penalties and poor reporting systems, which our findings also confirm as critical issues needing intervention.

-          On Page 17, Lines 817–486 (Section 4.4 – Workplace Violence Prevention Strategies), we explicitly include literature-supported recommendations such as:

ü  Employing security staff,

ü  Training on how to manage WPV,

ü  Reducing solo shifts,

ü  Increasing staffing levels.

-          On Page 18, Lines 512–536 (Section 4.6 – Implications for Practice and Policy), we outline a comprehensive set of interventions that integrate both prior recommendations and our own findings. These include:

ü  Establishing zero-tolerance policies,

ü  Strengthening reporting systems,

ü  Public awareness campaigns,

ü  Use of security technologies (e.g., panic buttons, surveillance cameras),

ü  Designated safe areas,

ü  Support systems for affected staff.

We have also clarified in the revised text that while many recommendations exist, certain areas—such as pharmacists' inclusion in national WPV strategies and standardized reporting procedures—still require focused attention and policy development. These additions directly address your comment by presenting what has already been proposed in literature and identifying gaps that our study highlights for further attention.

Comment 5: Materials and Methods - Section 2.1 is not fully understood. The authors referred to it as a project and indicated that it is a cross-sectional study design. It would be helpful to explain what type of study it is.

Response 5: Thank you for your comment. The term "project" appears only once in the manuscript, specifically in the Author Contributions section, where it refers to project administration responsibilities. We have already clarified the study type in the Methods section (Page 3, Lines 134) by stating that this is a cross-sectional study design.

Comment 6: Did the authors try to obtain information about the group of pharmacists who meet the established study criteria?

Response 6: Thank you for your comment. To ensure that only eligible pharmacists participated, we applied predefined inclusion criteria: 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, or the pharmaceutical industry—and had internet access. The questionnaire was distributed electronically via social media platforms, and official email channels of the Saudi Commission for Health Specialists, which reach licensed pharmacists in Saudi Arabia. Respondents who did not consent or did not meet the eligibility criteria were excluded from the analysis. Please see the methods section, pages 3 and 4, Lines 136–144.

Comment 7: It would also be useful to justify the choice of question format in Section 2.3.

Response 7: Thank you for your thoughtful comment. We agree that clarifying the rationale behind the question format enhances the transparency of the study design. In response, we have revised Section 2.4 (Page 5, Lines 201–206) to include a justification for our choice of question types.

Specifically, we used a combination of close-ended multiple-choice questions and Likert scale items to ensure standardization, ease of analysis, and to minimize respondent burden. This format allowed us to collect structured data on the frequency, type, and context of workplace violence (WPV) while maintaining participant anonymity and maximizing response completion. This approach also aligns with previous WPV studies cited in the literature, allowing comparability across findings. This justification has now been added to Section 2.4 to address the reviewer’s concern.

Comment 8: Results - In Section 3.3, the authors point out the importance of safety measures. It would be worthwhile to critically analyze the possibility of their application taking into account the workplace.

Response 8: Thank you for this important feedback. In response, we have expanded the Discussion section (Sub-section 4.4, Page 17, Lines 487–498) to include a critical analysis of the feasibility of implementing the recommended safety measures based on different pharmacy practice settings in Saudi Arabia.

Our findings in Sub-section 3.3 indicate that participants recommended a range of preventive strategies, including hiring security personnel, installing alarm and communication systems, redesigning workspaces, staff training, and reducing lone work shifts. While these measures are supported by other studies [7, 24], we acknowledge that their application may vary in feasibility depending on the setting.

For example, hospital and institutional settings in Saudi Arabia often have better infrastructure and resources, making it more practical to implement physical security systems and structured training programs. In contrast, community pharmacies, which are typically privately owned and may operate with a single pharmacist per shift, may face financial and logistical barriers in applying such measures. As a result, strategies in these settings may need to focus more on policy enforcement, communication training, improved staffing, and reporting mechanisms that are low-cost but effective. This clarification has now been added to the manuscript to reflect interventions' varying feasibility and better align with the reviewer’s recommendation. Please see the discussion section, sub-section 4.4, Page 17, Lines 487–498.

Comment 9: Why is the group of workers under 35 years of age the most vulnerable to existing risks?

Response 9: Thank you for your important comment. In the bivariate analysis using the chi-square test, age under 35 years was found to be significantly associated with exposure to workplace violence (WPV), suggesting that younger pharmacists may be more vulnerable. However, in the multivariate regression analysis—where other factors such as work setting, shift type, and years of experience were controlled for—this association was no longer statistically significant.

This indicates that while younger age may initially appear to be a risk factor, the increased vulnerability is likely influenced by confounding variables, such as less work experience, higher likelihood of working night shifts, or employment in high-risk settings (e.g., community pharmacies). These factors may explain the observed association in the unadjusted analysis but not in the adjusted model.

Comment 10: Conclusions - What is missing from the conclusions is a reference to quantitative data. It would be useful to provide specific recommendations based on the compiled quantitative data. The conclusions should take the form of a compilation of information based on specific data.

Response: Thank you for this helpful comment. In response, we have revised the Conclusion section (Page 19, Lines 568–578) to include key quantitative findings that support our conclusions and recommendations. Specifically, we now highlight that 49% of pharmacists reported exposure to WPV, with verbal abuse being the most common form. Factors such as working in community pharmacies (66%), working evening or night shifts (65%), and the absence of reporting systems were statistically associated with increased risk (p < 0.05). These quantitative insights are now integrated into the conclusion to provide evidence-based support for our recommendations, including the need for formal reporting mechanisms, workplace-specific prevention strategies, and policy-level interventions to protect pharmacists. Please see the conclusion section, page 19, lines 568-578.

Comment 11: I found the study interesting because it raises an important issue: safety. Unfortunately, the authors did not address the role of employers.

Response 11: Thank you for your valuable comment. In response, we have revised the Conclusion section (Page 19, Lines 576–579) to explicitly address the role of employers in workplace violence (WPV) prevention and response. The revised conclusion now includes the following sentence:

“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.”

This addition emphasizes the importance of employer accountability and involvement in ensuring pharmacist safety and aligns with the recommendations presented throughout the manuscript.

Thank you once again for your valuable feedback and for considering our revised manuscript.

Again, we appreciate all your insightful comments. We worked hard to be responsive to them. Thank you for taking the time and energy to help us improve the paper. We really hope these modifications can meet with your approval. Thank you very much.

23/06/2025

Reviewer Comment

Author Response and Changes Made

Comment 1: This study explores the issue of workplace violence (WPV) faced by pharmacists in different work environments in Saudi Arabia, filling the gap in WPV research among pharmacists in the region. The research design is reasonable, the data presentation is clear, and the results have reference value for policy formulation and preventive measures.

Response 1: We sincerely thank the reviewer for their positive and encouraging feedback. We are pleased to know that the study’s focus, design, data presentation, and implications for policy and prevention were found to be valuable. Your recognition of the relevance of this research to addressing workplace violence among pharmacists in Saudi Arabia is greatly appreciated.

The suggested modifications are as follows:
Comment 2: Optimize and streamline the summary presentation.

Response 2: Thank you for your constructive feedback. We have revised the conclusion section to enhance clarity and briefness. The updated version summarizes the key findings and their implications, ensuring a more focused and impactful conclusion. Please see conclusion section page 19.

Comment 3: If there are secondary headings in the discussion section, don't just have 4.1, at least 2 secondary headings.

Response 3: Thank you for your valuable suggestion. Section 4 (Discussion) has been revised and divided into multiple sub-sections with appropriate subheadings to improve clarity, structure, and readability, which aligns with your recommendation. Please see the discussion section.

Comment 4: Do not include references in the conclusion section.

Response 4: Thank you for your comment. In response, we have revised the conclusion section accordingly. All references have been removed from the conclusion, and relevant cited content has been relocated to the discussion section. Additionally, the discussion has been organized into clearer sub-sections. Specifically, 4.6. Implications for Practice and Policy and 4.8. Suggestions for Future Work have been included to enhance clarity and structure. Please see the discussion section, 4.6. and 4.8. sub-sections, pages 18 and 19.

Thank you once again for your valuable feedback and for considering our revised manuscript.

Again, we appreciate all your insightful comments. We worked hard to be responsive to them. Thank you for taking the time and energy to help us improve the paper. We really hope these modifications can meet with your approval. Thank you very much.

23/06/2025

Reviewer Comment

Author Response and Changes Made

Dear Authors,

Below are my comments on the proposed manuscript.

Comment 1: Title – In my opinion, the first part of the title is unnecessary. It does not contribute anything to the title. It could be if it were a popular science journal.

Response 1: Thank you for your valuable feedback. We understand your concern regarding the first part of the title. In response, we have revised the title to focus more directly on the study's main topic, removing the introductory phrase to enhance clarity. Please see the title, page 1.

Comment 2: The abstract could be shorter, indicating the most important results.

Response 2: We thank the reviewer for this valuable feedback. In response, we have revised the abstract to make it more concise. Please see the abstract section (Page 1, in the revised manuscript).

Comment 3: The introduction is written sufficiently.

Response 3: Thank you for your positive feedback. We are pleased to know that the introduction was clear and sufficiently addressed the background and rationale for the study.

Comment 4: Methodology - Estimation of the study sample – please provide information on how many pharmacists are working in Saudi Arabia, as well as the structure of their employment (pharmacies, hospitals, etc.). I assume that there are official statistics on this topic.

Response 4: Thank you for your suggestion. We have addressed this comment by adding information on the total number of pharmacists in Saudi Arabia, along with the structure of their employment based on official statistics from the Saudi Ministry of Health. Please see the materials and methods section, sample size sub-section, page 4, lines 157-161.

Comment 5:

(a) In addition, how were the social groups selected? How many members are there in these groups? This should be determined in order to estimate the number of respondents.

(b) What was the questionnaire return rate? How many people had the chance to complete it?

Response 5:

(a) Thank you for your valuable comment. The survey was distributed using a convenience sampling strategy through several pharmacist-focused social media platforms (e.g., Telegram, WhatsApp, and Twitter) as well as via email through the Saudi Commission for Health Specialties (SCFHS). These channels were selected due to their widespread and active use among pharmacists in Saudi Arabia. This point has been clarified in the revised Methods section, 2.2. sub-section (Page 3, Lines 141–142).

(b) 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. Please see results section, 3.1. sub-section, page 5, lines 226-229.

Comment 6: Vers 177: “The questionnaire is divided into” – change to “was”

Response 6: Thank you for your observation. The suggested change has been made accordingly. Please see the materials and methods section, 2.4. sub-section, page 4, line 188.

Comment 7: Paragraph 177-190 – verify so that it is written in the past tense

Response 7: Thank you for your comment. We have carefully reviewed Paragraph 177–190 and revised the text to ensure it is consistently written in the past tense. Please see the materials and methods section, 2.4. sub-section, pages 4 and 5, lines 188-195.

Comment 8: Tables: Percentages should be given to the second or at least the first decimal place.

Response 8: Thank you for your suggestion. We appreciate the attention to detail. However, we respectfully believe that reporting percentages as whole numbers is more appropriate in our case, given the descriptive nature of the data and the sample size. Using additional decimal places may suggest a level of precision that exceeds the accuracy of the survey responses. Therefore, we have retained the original format to ensure clarity and avoid overstating the precision of the findings.

Comment 9: Table 2 will be much more interesting if the authors show the distribution of results in relation to selected variables characterizing the population (e.g. Province, Job sector, and another variable).

Response 9: Thank you for your valuable suggestion. We would like to clarify that the relationship between the prevalence of workplace violence and key participant characteristics—including age, gender, province, occupation, and years of work experience and other variables—has already been comprehensively analyzed and presented in Table 5. This table includes chi-square test results to demonstrate the significance of these associations.

To further address your suggestion, we expanded our analysis by examining three additional key outcomes in relation to participant characteristics:

1.       Gender of the offender

2.       Age of the offender

3.       Perceived preventability of WPV incidents, and

4.       Impact of WPV on participants.

These variables were selected based on their theoretical and practical significance in the context of workplace violence (WPV) research, as well as their relevance to understanding risk patterns and informing prevention strategies:

1. Gender and age of the offender: These variables help identify who is most frequently responsible for WPV incidents. Analyzing offender characteristics offers valuable insight into potential targeted interventions (e.g., staff training, supervision, policy enforcement tailored to specific dynamics in the workplace).

2. Perceived preventability of WPV: Understanding how participants perceive the preventability of violence highlights gaps in institutional policies, reporting systems, and safety training. It also reflects how pharmacists evaluate the effectiveness (or absence) of preventive measures in their settings.

3. Impact of WPV on participants: This variable was included to assess the emotional and professional toll of WPV. By linking the impact to demographic and work-related factors, we can identify which groups are most affected and where support systems need to be strengthened.

If you have a specific variable in mind that you believe warrants further analysis, we would be happy to address it. Please see results section, 3.2. sub-section, pages 8 and 9, lines 258-267, 282-285, and 291-294.

Comment 10: Table 2 is also too long, it should be divided into two or three tables, selected thematically, e.g. causes of violence, effects of violence, etc. In the current layout, such tables are unacceptable.

Response 10: Thank you for this helpful suggestion. We agree that dividing Table 2 into thematically grouped sub-tables improves clarity and readability. Therefore, we have split the original Table 2 into three separate tables:

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

- Table 3. Causes of violence.

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

Each table focuses on a distinct theme to enhance the reader’s understanding and reduce cognitive load. Please see Tables 2, 3, and 4 in the results section, pages 7-10.

Comment 11: ”3.3. Violence prevention measures” – the text should not repeat exactly what is included in the graphs (or tables). Moreover, if only % are given in the graph, the authors should additionally provide the number n in the text.

Response 11: Thank you for this insightful comment. In response, we have revised sub-section 3.3 to avoid direct repetition of the graph content and instead focused on summarizing the most relevant findings. Additionally, we have added the corresponding absolute numbers (n) alongside the percentages in the text to enhance clarity and transparency, as recommended. Please see results section, 3.3 sub-section, page 10, lines 303-311.

Comment 12: Figure 1 is completely illegible.

Response 12: Thank you for your comment. We acknowledge the concern regarding the readability of Figure 1. To maintain the clarity and quality of the manuscript, we have removed Figure 1 and ensured that the relevant data are now clearly presented in the text with both percentages and absolute numbers. Please see Figure 1, page 11.

Comment 13: Verses 269-277 – the numbers provided do not match those in the table (please correct)

Response 13: Thank you for your comment. We carefully reviewed the numbers mentioned in Verses 269–277 and compared them with the corresponding table. Upon verification, we found that the numbers are accurate and consistent with the data presented. No discrepancies were identified.

Comment 14: Verses 281-297 – the text should not repeat the table; they are unnecessary in the text df.

Response 14: Thank you for your suggestion. We acknowledge your concern regarding redundancy. However, we believe that selectively summarizing key and statistically significant findings in the text—such as percentages and p-values—enhances the reader’s understanding and provides context without requiring constant reference to the table. We have ensured that the text does not duplicate all details from Table 5 but instead highlights only the most relevant results to support the discussion. Please see the results section, 3.4. sub-section, page 13, lines 329-345.

Comment 15: Vers 350 „This study has shown that males of younger ages” - I do not see data for younger men; the authors indicate in the results separately the results for the age and gender variable, but not for both together.

Response 15: Thank you for your valuable comment. You are correct that the variables of age and gender were analyzed separately, not in combination. Accordingly, we have removed the term “younger” from this sentence to ensure accuracy and consistency with the presented results. Please see the discussion section, page 15, lines 408 and 409.

Comment 16: Limitations: Another limitation of the study was the online form of the questionnaire, which could have excluded some pharmacists from the study.

Response 16: Thank you for your insightful comment. This limitation has been added to the manuscript as follows: "A further limitation of this study is the exclusive use of an online questionnaire, which may have limited participation among pharmacists with limited internet access or who are less active on digital platforms, potentially introducing selection bias." Please see discussion section, strengths and limitations of the study sub-section, page 18, lines 556-559.  

Thank you once again for your valuable feedback and for considering our revised manuscript.

We appreciate all your insightful comments. We worked hard to be responsive to them. Thank you for taking the time and energy to help us improve the paper. We really hope these modifications can meet with your approval. Thank you very much.

23/06/2025

Reviewer Comment

Author Response and Changes Made

Comment 1: Dear Authors,

First of all, it is a great pity that in the new version of the manuscript the authors did not mark the changes in any way. Although the authors provide line numbers in their responses to the review, they do not correspond to the line numbers contained in the file.

Response 1:  Thank you for your valuable feedback. We sincerely apologize for any confusion regarding the revised manuscript files. In our previous resubmission, we provided two versions of the manuscript:

1.       A revised version with all changes clearly highlighted in red font to facilitate the review process.

2.       A clean version without highlights, as typically requested for production purposes.

We are not sure why the revised version with tracked changes was not accessible on your side, as it was included in our submission.

Comment 2: Below I am sending my comments:

Presentation of results (%)

Regardless of the type of study, authors should report data as accurately as possible. The fact that this is a cross-sectional, descriptive study does not prevent the data from being reported more accurately. Usually, if the percentage is the result of a calculation, it is worth reporting it with a precision that reflects the accuracy of the input data and takes into account any rounding errors, which may mean using one or more decimal places. Therefore, rounding numbers should be avoided and additional errors should be avoided.

Thank you for your helpful suggestion regarding the presentation of results. Per your request, we have revised the manuscript to report all percentages with one decimal place to enhance accuracy and consistency across the results. Please see the results section of the revised version of the manuscript, pages 5-13 and the abstract section, page 1.

Comment 3:

(a) I cannot agree with the authors' response regarding table no. 2. The authors suggest that they included the relevant information in table no. 5. However, these tables contain completely different data. Table 5 is indeed an analysis of whether someone has experienced violence or not. But there is no information/variables from table no. 2 (e.g. how often, what type of violence) - I wrote that this would be very interesting because pharmacists from different sectors may experience it in different ways (for example) and only such a result would be a valuable indication for the introduction of preventive methods.

(b) Another example is how women and men react to violence (currently Table 4). My comment in the first review concerned table no. 2.

Response 3:

(a) Thank you for your thoughtful and constructive feedback. We appreciate your suggestion to provide a more detailed breakdown of workplace violence experiences by sector. In response, we have now conducted additional analyses comparing pharmacists working in hospitals, community pharmacies, and other sectors regarding:

·       the type of violence they experienced,

·       how often violence occurred,

·       the age of the offender,

·       the gender of the offender, and

·       the time of the incident.

The follwoing text has been added to the results section “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 hos-pitals (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 re-ported 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 set-tings. 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, under-scoring the importance of sector-specific preventive strategies.”

These results have been incorporated into the revised manuscript. As you rightly suggested, we believe these analyses provide valuable insights into sector-specific patterns of workplace violence and can better inform preventive strategies. Please see the Results section, 3.2. sub-section, page 7, lines 249-266.

(b) Thank you for your thoughtful comment regarding gender differences in reactions to violence. As you rightly pointed out, this is an important area to explore further. In response, we conducted additional analysis comparing how male and female pharmacists reacted to incidents of workplace violence.

The results showed notable differences in response patterns. To address your comment, the following text has been added to the Results section of the revised manuscript:

“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%).”

These findings provide useful insight into gender-related differences in coping strategies and highlight areas for strengthening organizational support and reporting structures. Please see the Results section, 3.2. sub-section, page 9, lines 281-286.

Thank you once again for your valuable feedback and for considering our revised manuscript.

We appreciate all your insightful comments. We worked hard to be responsive to them. Thank you for taking the time and energy to help us improve the paper. We really hope these modifications can meet with your approval. Thank you very much.

29/06/2025