Attitudes and Perceptions Toward Drive-thru Community Pharmacy Services Questionnaire

Abstract

The Attitudes and Perceptions Toward Drive-thru Community Pharmacy Services Questionnaire (DTCPS) is a psychometric and evaluative survey instrument developed by Bayan F. Ababneh, Siew Chin Ong, and Rabia Hussain in 2023 at Universiti Sains Malaysia. Designed primarily against the backdrop of ambulatory pharmaceutical care adaptations during the COVID-19 pandemic, the DTCPS measures public awareness, cognitive perceptions, and behavioral attitudes regarding the implementation and utilization of drive-thru dispensing models in community pharmacy settings. The instrument operationalizes multidimensional constructs across three primary domains: factual and experiential awareness, perceived advantages and disadvantages (including logistical convenience, infection mitigation, privacy, and medication counseling quality), and public attitudes encompassing behavioral adoption intentions and professional practice evolution. Originally developed in English, the tool integrates dichotomous, categorical, and five-point Likert-scale response formats. Psychometric validation established rigorous face and content validity through expert panels in social and administrative pharmacy and community practice, alongside pilot testing. The scale exhibits robust internal consistency, demonstrated by an overall Cronbach’s alpha of 0.84. By systematically assessing public readiness, perceived service trade-offs, and consumer preferences, the DTCPS provides a standardized, empirical methodology for health service researchers, healthcare policymakers, and pharmacy practitioners seeking to optimize ambulatory drug delivery channels and patient-centered pharmaceutical care models.

Keywords

Drive-thru community pharmacy, Health services research, Patient perceptions, Public attitudes, Community pharmacy practice, Medication counseling, Healthcare accessibility, Ambulatory care, Survey validation, Psychometrics, COVID-19 health adaptations, Patient satisfaction.

Authors

The instrument was conceptualized, developed, and validated by researchers affiliated with the Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia:

• Bayan F. Ababneh, M.Sc., Ph.D. Candidate: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. ORCID: 0000-0002-6223-5599.
• Siew Chin Ong, Ph.D. (Corresponding Author): Associate Professor, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. Email: [email protected]. ORCID: 0000-0002-9750-9588.
• Rabia Hussain, Ph.D.: Senior Lecturer, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia. Email: [email protected]. ORCID: 0000-0001-8183-0855.

Purpose

The primary purpose of the Attitudes and Perceptions Toward Drive-thru Community Pharmacy Services Questionnaire is to systematically capture, quantify, and analyze public awareness, subjective perceptions, and behavioral attitudes regarding drive-thru dispensing models within the community pharmacy sector. While drive-thru services have historically been deployed within hospital-based outpatient pharmacy departments in select national health systems (such as Malaysia’s Ministry of Health ambulatory care facilities), their expansion into the private community pharmacy sector represents an operational paradigm shift. The introduction of this delivery model accelerated rapidly during the COVID-19 pandemic to balance uninterrupted medication supply with strict physical distancing measures.

From an applied perspective, the DTCPS serves dual clinical and administrative functions. Clinically, it identifies patient apprehensions regarding the potential dilution of clinical interactions, such as compromised confidentiality, truncated pharmacotherapeutic counseling, and communication barriers across a vehicle window. Administratively, the questionnaire assesses consumer willingness to adopt alternative dispensing channels, preference for digital pre-ordering modalities (e.g., mobile applications, instant messaging platforms), and expectations regarding physical store infrastructure (e.g., parking alleviation, vehicular traffic flow). For health system administrators and independent pharmacy proprietors, the scale yields actionable diagnostic data to guide logistical investments, workflow redesigns, and patient communication protocols.

The theoretical rationale of the instrument rests on identifying cognitive and environmental determinants of public acceptance toward innovative healthcare delivery mechanisms. By dissecting public beliefs into distinct positive valences (perceived convenience, contagion mitigation, mobility accessibility) and negative valences (communication attenuation, commercialization risks, vehicular queuing), the DTCPS facilitates targeted quality improvement initiatives. It bridges the gap between public demand for frictionless consumer convenience and the mandatory preservation of clinical pharmacy care standards.

Psychological Construct

The DTCPS operationalizes public orientation toward drive-thru community pharmacy services across three core psychological and evaluative constructs:

1. Service Awareness and Epistemic Familiarity

This construct evaluates the cognitive presence and factual knowledge base possessed by the consumer regarding alternative pharmacy service channels. It measures not only basic surface awareness of the “drive-thru pharmacy” concept, but also the public’s nuanced understanding of its regulatory scope and service boundaries. Dimensions include awareness of public versus private sector availability, legal eligibility of prescription versus over-the-counter (OTC) drug dispensing, regulatory limitations on pharmacy-only therapeutic classes, and the viability of ancillary clinical services (such as point-of-care screening coordination). Epistemic deficits in this domain directly influence downstream attitudes and utilization intentions.

2. Cognitive Perceptions: Believed Advantages and Disadvantages

This cognitive domain measures an individual’s mental representations, expectations, and subjective value judgments concerning the operational attributes of drive-thru dispensing. Rather than capturing simple affective reactions, this construct assesses calculated cost-benefit trade-offs across several sub-dimensions:

• Logistical Efficiency and Physical Ergonomics: Beliefs that drive-thru facilities minimize in-store waiting periods, eliminate vehicular parking searches, and assist vulnerable cohorts, such as geriatric patients, individuals with severe physical disabilities, and parents accompanied by young dependents.
• Biosecurity and Infection Risk Mitigation: Appraisals regarding the utility of vehicular barriers in preventing respiratory pathogen exposure during public health emergencies or endemic viral transmission cycles.
• Clinical Communication and Care Quality Apprehensions: Evaluative beliefs regarding the adequacy of verbal and written counseling, interpersonal depth between the client and the pharmacist, acoustic privacy, and the risk that drive-thru windows might commodify professional pharmaceutical care.

3. Public Attitudes and Behavioral Adoption Intentions

The affective and conative construct captures consumer disposition, endorsement, and readiness to engage with drive-thru pharmacy services. Grounded in behavioral intention paradigms, this domain measures positive psychological affect toward service normalization, personal willingness to switch from traditional walk-in dispensing, willingness to utilize remote pre-ordering systems, and advocacy behaviors (such as endorsing drive-thru establishment across national pharmacy networks and recommending services to peer networks).

Theoretical Framework

The architectural foundation of the DTCPS is grounded in established health behavior and technology adoption theories, primarily synthesizing the Technology Acceptance Model (TAM), the Health Belief Model (HBM), and Donabedian’s Health Care Quality Framework.

1. The Technology Acceptance Model (TAM)

Originally formulated by Fred Davis (1989), TAM posits that the acceptance and utilization of any systemic operational innovation are mediated by two principal cognitive constructs: Perceived Usefulness (PU) and Perceived Ease of Use (PEOU). In the context of the DTCPS, Perceived Usefulness is reflected in items addressing rapid medication collection, mitigation of parking bottlenecks, and maintenance of drug therapy continuity under adverse conditions (e.g., inclement weather or pandemic restrictions). Perceived Ease of Use corresponds to the frictionless nature of collecting medications without exiting one’s vehicle, seamless communication via digital pre-ordering pathways, and clear instructional delivery. Under TAM, elevated PU and PEOU directly foster favorable attitudes, which subsequently predict positive behavioral intentions to patronize drive-thru establishments.

2. The Health Belief Model (HBM)

Developed by Rosenstock and colleagues, the HBM explains health-protective behaviors through constructs such as Perceived Susceptibility, Perceived Severity, Perceived Benefits, and Perceived Barriers. Developed during the transmission peaks of the SARS-CoV-2 pathogen, the DTCPS maps directly onto HBM tenets. Patients perceive enclosed retail pharmacy waiting areas as environments of heightened viral transmission susceptibility. The drive-thru pharmacy functions as a structural “cue to action” and an infection risk-reducing mechanism (Perceived Benefit). Conversely, perceived structural barriers—such as concerns over truncated consultation time, auditory privacy infringement, and traffic congestion—act as counterbalancing deterrents that shape net consumer attitude.

3. Donabedian’s Structure-Process-Outcome Paradigm

Avedis Donabedian’s conceptual model for health service appraisal assesses healthcare delivery through Structure (physical layout, vehicular access windows, communication technology), Process (counseling delivery, prescription verification speed, privacy preservation), and Outcome (patient satisfaction, treatment adherence, professional image). The DTCPS embeds this framework by interrogating how drive-thru architectural structures modulate the clinical process of medication dispensing and how these changes influence broader outcomes, such as public trust in community pharmacists and consumer loyalty.

Validity

The validation protocol for the DTCPS followed established psychometric standards to confirm the instrument’s structural integrity, content coverage, and measurement fidelity:

Face and Content Validity

Content formulation was initiated through an extensive systematic synthesis of existing regional and global pharmaceutical service literature (e.g., Liew et al., 2020; Abu Hammour et al., 2019; Abu Farha et al., 2017; Diri, 2020). Preliminary item pools were designed to capture specific structural gaps in community pharmacy operations. Content and face validity were formally evaluated by an expert multidisciplinary review panel comprising senior academic lecturers and clinical specialists in social and administrative pharmacy at Universiti Sains Malaysia (USM), alongside seasoned licensed community pharmacy practitioners.

Panelists assessed each candidate item for semantic clarity, clinical accuracy, cultural and jurisdictional appropriateness within the Malaysian healthcare context, and relevance to the target constructs. Items demonstrating conceptual redundancy, linguistic ambiguity, or leading phraseology were revised or eliminated. Following panel consensus, a pilot testing phase was executed with a representative cohort of the general public to evaluate comprehensibility, readability, and completion burden, confirming an optimal administration duration of 5 to 7 minutes.

Construct and Discriminant Validity

Construct validity was demonstrated by the instrument’s capacity to discriminate meaningfully between varying demographic strata and user experience profiles. Cross-sectional findings evidenced that individuals who reported prior exposure to public hospital drive-thru services manifested significantly higher perceptual acceptance and perceived usefulness scores than unexposed respondents. Furthermore, the questionnaire documented distinct response distributions between cognitive operational advantages (e.g., time-saving, mobility enhancement) and professional clinical reservations (e.g., counseling depth degradation), demonstrating that respondents differentiated between physical convenience and clinical care adequacy.

Reliability

The internal consistency and measurement precision of the DTCPS have been quantitatively verified through classical test theory metrics:

Internal Consistency Reliability

The global internal consistency of the psychometric sections was established with a Cronbach’s alpha coefficient (α) of 0.84, exceeding the widely accepted psychometric threshold of 0.70 for research instruments in social and administrative pharmacy. This indicates high homogeneity among items while retaining sufficient unique variance to capture the multidimensional nature of the construct.

Subscale Homogeneity and Scale Stability

Individual domain analyses revealed consistent inter-item correlation matrices across the perception and attitude subscales. Items capturing service conveniences demonstrated robust internal coherence, as did items clustering around professional image and counseling quality concerns. The structural stability observed during pilot and field deployment confirms that the DTCPS maintains measurement reliability when administered to diverse adult populations across varied age brackets, socio-economic levels, and urban-rural divides.

Factor Analysis

While the initial validation paper by Ababneh, Ong, and Hussain (2023) focused primarily on expert-driven content validity indexing, pilot empirical screening, and internal consistency testing, the empirical structure of the DTCPS corresponds conceptually to a multi-factor latent variable framework:

Conceptual Dimensionality

The instrument’s evaluative items map onto three dominant underlying factors:

1. Factor 1: Logistical & Ergonomic Utility (Perceived Convenience): Capturing high item loadings for parameters such as waiting time reduction, parking issue mitigation, parental and disabled access, and adverse weather utility.
2. Factor 2: Clinical Interaction & Professional Integrity: Representing items centered on medication counseling depth, privacy during drug handover, safety standard equivalence, and the balance between patient care and pharmacy commercialization.
3. Factor 3: Behavioral Adoption & Systemic Endorsement: Comprising high loadings on items measuring personal intent to utilize, app-based pre-ordering willingness, advocacy for nationwide establishment, and preference over traditional walk-in environments.

Future psychometric extensions utilizing exploratory factor analysis (EFA) with principal axis factoring and oblique rotation, followed by confirmatory factor analysis (CFA) using structural equation modeling, are recommended to evaluate goodness-of-fit indices (such as Root Mean Square Error of Approximation [RMSEA ≤ 0.06], Comparative Fit Index [CFI ≥ 0.95], and Tucker-Lewis Index [TLI ≥ 0.95]) across broader international health systems.

Instrument / Measurement Tool

The Attitudes and Perceptions Toward Drive-thru Community Pharmacy Services Questionnaire is structured as an objective, multi-part assessment:

• Test Type: Original psychometric survey and evaluative inventory.
• Target Population: General adult public (ages 18 and older, including young adults, middle-aged, and geriatric populations).
• Administration Format: Self-administered paper-and-pencil questionnaire or computerized web-based survey.
• Estimated Completion Time: 5 to 7 minutes.
• Total Item Count: 49 total items (10 sociodemographic/background items and 39 standardized assessment items measuring awareness, perceptions, and attitudes).
• Response Formats: Categorical/multiple-choice options for awareness and baseline behavioral metrics; 5-point Likert scales for perceptual and attitudinal evaluative items.
• Scoring Protocol:
  • Awareness Domain: Scored categorically or dichotomously (e.g., Yes = 1, No = 0) to compute aggregate knowledge indices.
  • Perceptions and Attitudes Domains: Evaluated via Likert grading ranging from positive endorsement to negative appraisal.
  • Reverse Coding: Specific items identifying negative attributes or operational limitations (e.g., counseling attenuation, commercialization risks, vehicular queuing barriers) are reversed prior to calculating composite dimensional scores. Higher aggregated domain scores correspond to greater overall positive perception and willingness to adopt drive-thru pharmacy models.

Permissions & Fee and Test Year

The Attitudes and Perceptions Toward Drive-thru Community Pharmacy Services Questionnaire was developed and formally published in 2023. Under its original publication in PLoS ONE, the instrument is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Consequently, the instrument is available free of charge and may be used, adapted, and reproduced by independent researchers, academic institutions, and healthcare organizations for teaching, scholarly inquiry, and non-commercial health system evaluation, provided appropriate scholarly attribution is accorded to the original authors (Ababneh, Ong, & Hussain, 2023).

References

The following peer-reviewed literature underpins the development, validation, and theoretical framework of the DTCPS questionnaire:

• Ababneh, B. F., Ong, S. C., & Hussain, R. (2023). Awareness, attitudes, and perceptions of drive-thru community pharmacy services among the general public in Malaysia during COVID-19: A cross-sectional study. PLoS ONE, 18(3), Article e0282991. https://doi.org/10.1371/journal.pone.0282991
• Abu Farha, R., Al-Amer, R., & Al-Jarrah, A. (2017). Public awareness and perception toward the role of pharmacists in Jordan. International Journal of Pharmacy Practice, 25(2), 160–166. https://doi.org/10.1111/ijpp.12294
• Abu Hammour, A. A., Al-Amer, R. M., Al-Jarrah, A. F., & Al-Hammouri, S. A. (2019). Perception and attitude of the public toward community pharmacy services in Jordan. Journal of Pharmaceutical Health Services Research, 10(2), 175–180. https://doi.org/10.1111/jphs.12292
• Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319–340. https://doi.org/10.2307/249008
• Diri, M. R. (2020). Impact of COVID-19 on community pharmacy services. Saudi Pharmaceutical Journal, 28(11), 1381–1386. https://doi.org/10.1016/j.jsps.2020.09.002
• Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743–1748. https://doi.org/10.1001/jama.1988.03410120089033
• Liana, L. K., & Hasnah, M. N. (2015). Patients’ perceptions on pharmacy services in Kuala Lumpur. International Journal of Pharmaceutical Sciences Review and Research, 30(1), 11–17.
• Liew, Y. J., Lim, H. Y., Lim, Y. C., Liew, P. W., Leong, W. S., Tan, S. Y., & Lee, S. C. (2020). Knowledge, attitudes and perceptions towards COVID-19 during the MCO among the general public in Malaysia. Journal of Public Health and Clinical Pharmacy, 10(1), 1–10.
• Rosenstock, I. M. (1974). Historical origins of the Health Belief Model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403

Items of the Scale