MULTI-LEVEL BARRIERS TO EFFECTIVE PEPTIC ULCER MANAGEMENT AND THE STRATEGIC ROLE OF COMMUNITY PHARMACISTS: A MIXED-METHODS CROSS-SECTIONAL EVALUATION FROM BAYELSA STATE, NIGERIA

Background: Effective management of peptic ulcer disease (PUD) and Helicobacter pylori infection in low- and middle-income countries depends on the coordinated functioning of patient-, provider-, and health-system-level processes — yet the barriers operating across these levels, and the strategic role that community pharmacists could play in mitigating them, remain inadequately characterised in the Nigerian context. This study identified the principal barriers to effective PUD management and elicited patient-generated recommendations for the strategic role expansion of community pharmacists in Bayelsa State. Methods: A descriptive analytical cross-sectional study was conducted in randomly selected community pharmacies in Yenagoa metropolis. A structured interviewer-assisted questionnaire was administered to 428 adults with self-reported PUD symptoms; 412 (96.3%) returned complete responses, of whom 183 met the PUD case definition. Data were analysed in IBM SPSS Statistics version 26.0 using descriptive statistics and chi-square tests at α = 0.05. Recommendation domains were scored on a weighted-average scale and ranked by endorsement intensity. Results: Barriers to effective PUD management operated at three convergent levels. At the patient level, side-effect-driven treatment discontinuation (39.3%), low disease awareness (46.4% unaware of H. pylori), and delayed treatment-seeking (30.1% waiting months before consultation) predominated. At the health system level, inconsistent medication availability and geographically constrained access to specialist care emerged as structural constraints. At the provider level, 25.7% of treated respondents reported no follow-up confirmatory testing, indicating systemic deficits in protocol adherence. Across nine recommendation domains, the most strongly endorsed strategies were free public screening programmes (42.1%), onsite H. pylori testing kits in community pharmacies (39.9%), better imaging technology (38.3%), increased funding for ulcer management (36.6%), training in patient communication (35.5%), and patient education on adherence (33.9%). The weighted-average endorsement score across all domains was 2.41 (out of 4.00), indicating consistent moderate-to-strong support for systemic reform. Conclusion: PUD management in Bayelsa State is impeded by a self-reinforcing cycle of patient-level awareness deficits, provider-level protocol non-adherence, and system-level structural constraints. Patients themselves identify the strategic role expansion of community pharmacists — through onsite diagnostic testing, structured adherence counselling, and patient-centred education — as the most actionable lever for breaking this cycle. The findings argue for an integrated reform agenda that positions the community pharmacy as a regulated, evidence-based first point of care for PUD and H. pylori management in Nigeria.