Stakeholders’ perspectives of factors influencing substance misuse services offered by community pharmacists- a mixed method triangulation study using COM B Model

<b>Background:<br/></b>The escalating misuse of over the counter and prescription-only medicines in Nigeria presents a multifaceted public health challenge. This issue is exacerbated by weak regulatory enforcement, socio-economic instability, and limited access to formal healthcare services. Positioned at the intersection of healthcare delivery and public access, community pharmacists are increasingly recognised as key stakeholders in addressing this crisis. However, their role remains underexplored within Nigeria’s unique healthcare landscape.<br/><br/><b>Aim</b>:<br/>This study critically examines the perceptions and experiences of key stakeholders community pharmacists, policymakers, and service users regarding the role of community pharmacy services in preventing and managing over the counter and prescription-only medicines misuse in Nigeria.<br/><br/><b>Methods</b>:<br/>A sequential mixed-methods design was employed. Qualitative data were gathered through semi-structured interviews with 18 participants (6 pharmacists, 6 policymakers, 6 service users). A hybrid framework analysis, combining inductive and deductive coding, was applied. Findings were triangulated across stakeholder groups and interpreted using the COM-B model of behaviour change, supplemented by the Social Ecological Model to contextualise structural influences.<br/><br/><b>Findings</b>:<br/>Participants identified a broad spectrum of misused substances, including tramadol, codeine-based syrups, cyproheptadine, and clomipramine. Community pharmacists were widely regarded as trusted professionals with strong motivational intent. However, their impact was limited by capability gaps (e.g., insufficient training in addiction management), systemic barriers (e.g., lack of referral systems, understaffing), and weak regulatory support. Service users valued pharmacists’ approachability and counselling efforts but noted challenges such as lack of privacy, time constraints, and limited awareness of pharmacists’ public health role. Policymakers acknowledged pharmacists’ strategic positioning but emphasised the need for systemic alignment through structured training, referral networks, and regulatory reform. Triangulated analysis revealed shared motivation across stakeholders but divergent views on capability and opportunity, highlighting a behavioural policy disconnect.<br/><br/><b>Conclusion</b>:<br/>To the best of the researcher’s knowledge, this is the first study to triangulate stakeholder perspectives on pharmacist-led substance misuse interventions in Nigeria. The findings underscore pharmacists’ social trust and frontline accessibility as critical assets, yet their potential remains underutilised due to fragmented policy, underinvestment, and inconsistent role integration. By integrating COM-B with the Social Ecological Model, the study proposes a multi-level framework for behavioural and systemic transformation. Strategic investment in training, infrastructure, regulatory reform, and public engagement is essential to reposition pharmacists as pivotal actors in Nigeria’s response to medicine misuse.<br/>