Pharmacist-Led Flu Vaccination Services in Romanian Community Pharmacies: Barriers, Perceptions, and Implementation Challenges
George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș
How they used Delve
Researchers at the George Emil Palade University of Medicine and Pharmacy in Târgu Mureș used Delve for the qualitative side of a national survey of 208 Romanian community pharmacists, running a three-stage thematic analysis with two independent coders reconciling to consensus while the quantitative analysis ran in R.
“Quantitative analyses was conducted using R version 4.3.1, while qualitative data processing and thematic coding were facilitated by the Delve tool. [...] Two researchers independently coded the responses, and discrepancies were resolved through discussion until consensus was reached [26].”
- Field
- Community pharmacy / vaccination services
- Data
- Survey responses from 208 Romanian community pharmacists across 442 pharmacies, covering barriers, perceptions and implementation challenges around flu vaccination services
- Approach
- Survey with Likert items analysed in R 4.3.1 using Spearman's rank correlation, alongside a three-stage thematic analysis of open responses — open coding for initial concepts, thematic coding to group codes into categories, then conceptualization into overarching themes — with two researchers coding independently and discrepancies resolved by discussion to consensus
- Data types
- Open-ended survey responses
Abstract
Although pharmacist-led vaccination is a global standard for expanding immunization coverage, its adoption in Romania remains at an early stage. While previous studies have focused on early adopters, this research evaluates barriers, perceptions, and readiness among community pharmacies that do not yet provide this service, thereby addressing a critical knowledge gap regarding the “non-vaccinating” majority. A cross-sectional mixed-methods study was conducted among 208 pharmacists representing national chains, regional networks, and independent pharmacies. Quantitative data were analyzed using Chi-square tests and Spearman correlations to identify structural disparities, while a thematic analysis was employed to explore qualitative insights related to professional identity and operational barriers. We identified a clear mismatch between pharmacies’ willingness to provide vaccination services and their practical ability to implement them. Independent pharmacies demonstrated a strong intention to adopt vaccination services (71.4%) but were limited by financial constraints, with high implementation costs identified as a significant barrier (p = 0.014). In contrast, national pharmacy chains had sufficient resources yet faced marked staff resistance, with 43.9% reporting extreme reluctance (p = 0.038). These chains were concentrated in the capital region (p = 0.002), thereby positioning other pharmacies as key providers in underserved areas. Furthermore, thematic analysis revealed a deep-seated “professional identity” crisis, in which pharmacists struggle with the transition from medication specialists to clinical practitioners. The expansion of vaccination services cannot rely on a “one-size-fits-all” strategy. Successful national implementation requires a segmented policy approach, including financial subsidies to support independent pharmacies, change management strategies to engage the corporate workforce, and targeted regulatory education for regional networks to prevent vaccination deserts.
Citation
Marius Călin Cherecheș, Mihaela Simona Naidin, Alexandra Grosan, Radu Antoniu Patrascu, Anca-Maria Căpraru, Marina Daniela Dimulescu, Adina Turcu-Ştiolică (2026). Pharmacist-Led Flu Vaccination Services in Romanian Community Pharmacies: Barriers, Perceptions, and Implementation Challenges. Pharmacy. https://doi.org/10.3390/pharmacy14010036