Introduction
Disasters are defined as events that exceed the capacity of individuals or communities to alleviate their suffering or meet their basic needs without external assistance. 1 However, in modern public health epistemology, this situation is viewed as a test of the system’s capacity to maintain universality and equity in service delivery.Reference Jatobá, Castro-Nunes and Rodrigues de Carvalho 2 While these events severely weaken the infrastructure and service delivery capacity of health facilities in affected regions,Reference Kocak, Kinik and Caliskan 3 they necessitate the system to activate its “resilience”—the ability to meet both routine and extraordinary demands. The concept of resilience, as previously defined, encompasses not only the ability to return to the previous state after a shock (recovery) but also the capacity to adapt the system, absorb the shock, and transform it when necessary.Reference Jatobá, Castro-Nunes and Rodrigues de Carvalho 2 Consequently, it is imperative for health care professionals to be prepared for disasters to ensure the functionality of health care facilities. Within this group, pharmacists and pharmacy staff are also integral components of the system.
Pharmacy is a fundamental health profession dedicated to ensuring the effective, safe, and rational use of medications.Reference Anderson 4 Pharmacists play critical roles not only in dispensing medications but also in addressing drug interactions, side effects, treatment monitoring, and collaboration with other health care professionals. Contemporary pharmacy practice has undergone a transformation, transitioning from a technical and product-centric model to a patient-centered, advisory, and expertise-based paradigm.Reference Shirdel, Pourreza and Daemi 5 , Reference Chavan, Kumbhar and Shinde 6 In this context, pharmacies also play an active role in preventive health services such as vaccination, disease screening, substance abuse and smoking cessation counseling, nutrition counseling, maternal and infant health, counseling for vulnerable populations (people with disabilities, the elderly, etc.), and chronic disease management.Reference Shirdel, Pourreza and Daemi 5 , Reference Safaeian, Mostafavi and Changiz 7 , Reference Litvak, Nguyen and Pezzino 8 From a public health standpoint, the management of chronic diseases and preventive services provided by pharmacies during routine periods constitute a critical component of the system’s “resilience” during crises. Resilience, however, is not merely a reaction to major disasters but rather the assurance of the uninterrupted delivery of routine services.Reference Jatobá, Castro-Nunes and Rodrigues de Carvalho 2
Pharmacists occupy a unique position in ensuring the continuity of health care services and maintaining the supply of medications during disasters.Reference Raza, Aziz and Noreen 9 The Statement on Professional Standards, published by the International Pharmaceutical Federation (FIP) in 2006, emphasized pharmacists’ responsibility to provide the community with medications, counseling, and health care services during crises. 10 Pharmacists are expected to go beyond their current roles during disasters to contribute to emergency response efforts.Reference Jairoun, Al-Hemyari and Shahwan 11 , Reference Lydon, Scahill and Arakawa 12 Community pharmacists, frequently the initial point of contact for health care, assume a pivotal role in reducing the burden on emergency services in the aftermath of a disaster.Reference Raza, Aziz and Noreen 9 , Reference Watson, Singleton and Tippett 13 However, in accordance with the fourth axiom of public health resilience epistemology, this adaptive capacity should not be left solely to the initiative or heroism of individual health care workers; it must be grounded in a system-level designed structure. While individual adaptation efforts, also known as informal resilience, may offer short-term solutions, achieving sustainable resilience necessitates institutional and systemic design, otherwise referred to as systems-level design.Reference Jatobá, Castro-Nunes and Rodrigues de Carvalho 2
Pharmacies, as primary health care facilities, are susceptible to the direct impact of disasters and play a critical role in ensuring the continuity of health care services. While factors such as the type, duration, geographic location, affected population, and patient density of a disaster are key determinants of service delivery capacity,Reference Ford, Trent and Wickizer 14 “internal (endogenous)” factors—such as the structural safety and stock capacity of the pharmacy—also determine service delivery capacity.Reference Jatobá, Castro-Nunes and Rodrigues de Carvalho 2 Therefore, the roles of pharmacy staff in the supply of medications and medical supplies during disasters provide critical contributions to the community’s recovery process.Reference Raza, Aziz and Noreen 9 , Reference Alkhalili, Ma and Grenier 15 Pharmacies can be categorized into 2 primary classifications: community pharmacies and hospital pharmacies. While community pharmacies play a dynamic role in promoting public health, the primary responsibility of hospital pharmacists is the management of treatment processes and medication logistics.Reference Chavan, Kumbhar and Shinde 6 , Reference Ozeki and Ojima 16
However, there is a paucity of pharmaceutical education, training, and scientific research in the field of disaster medicine worldwide.Reference Alkhalili, Ma and Grenier 15 , Reference McCourt, Singleton and Nissen 17 A study by Ozeki et al. in Japan demonstrated that the most critical factor in pharmacies’ disaster preparedness is their capacity to procure medications, thereby highlighting the importance of strategic stock management and logistics planning.Reference Ozeki and Ojima 16 Türkiye is located along active fault lines and has experienced numerous destructive disasters over the past 25 years. The 1999 Marmara Earthquake, the 2011 Van Earthquake, the 2020 Elazığ Earthquake, and the 2023 Kahramanmaraş Earthquakes, these events have severely disrupted the continuity of health care services.Reference Demir, Celebi and Ozturk 18 , Reference Achour, Pascale and Price 19 These events have particularly highlighted significant vulnerabilities in primary health care services and the pharmaceutical supply chain. These experiences have demonstrated that the structural safety of the health system and the continuity of service delivery are fundamental components of disaster preparedness. However, extant studies in Türkiye have largely focused on hospital capacity and emergency health services, precluding a comprehensive evaluation of community pharmacies’ disaster preparedness plans, strategic stock management, emergency protocols, and inter-institutional coordination mechanisms. This situation indicates a paucity of empirical data regarding the disaster preparedness level of community pharmacies and complicates the assessment of health system resilience at the primary care level.
This is particularly the case in Istanbul and the Marmara Region, which are at high risk of earthquakes. Events such as the 1999 Marmara earthquakes have demonstrated that health services can be disrupted.Reference Ersoy and Koçak 20 –Reference Aker 22 It is estimated that approximately 17.6% of community pharmacies in Türkiye are located in Istanbul, thereby establishing it as a distinctive study area with respect to both pharmacy density and the size of the population it serves. 23 Furthermore, Istanbul is situated along the North Anatolian Fault, which has been identified as a high-risk seismic zone. The strategic importance of evaluating the disaster preparedness level of pharmacies in this metropolis is twofold. Firstly, the city’s increasing population density and complex urban infrastructure render it a prime location for the operation of the pharmaceutical supply chain, a matter of critical importance during disasters. Secondly, the city’s status as a major hub for pharmaceutical activity necessitates a thorough evaluation of its disaster preparedness level. The disaster preparedness of primary health care facilities in high-risk earthquake zones is evaluated as a multidimensional framework encompassing structural safety, mitigation of non-structural risks (e.g., securing shelves and equipment), the existence of written disaster plans, critical medication stock management, data backup systems, and regular training and drill programs. These components are recognized as fundamental elements in ensuring the continuity of health care services following an earthquake. Therefore, Istanbul was selected as the study area not only due to logistical accessibility but also because of its high disaster risk, high density of health care service provision, and central role in the national pharmaceutical distribution system. The public health system’s resilience is contingent upon the integration of structural capacity and operational functionality.Reference Jatobá, Castro-Nunes and Rodrigues de Carvalho 2 Consequently, the objective of this study is to evaluate not only the physical preparedness of pharmacies in Istanbul but also their capacity to maintain system operations and adapt during a crisis.
The Pharmacy System in Türkiye
In Türkiye, community pharmacies function under the framework of independent ownership. Each pharmacy is licensed and operated by a pharmacist responsible for its oversight. According to current legislation, the operation of chain pharmacy systems is prohibited. In addition to the role of responsible pharmacists, regional and district representatives are tasked with coordinating activities among pharmacies within their designated regions. However, systematic requirements for practices such as developing written disaster plans, conducting regular drills, or providing mandatory disaster preparedness training are not in place at the national level. Consequently, the level of disaster preparedness in community pharmacies is largely shaped by individual awareness and professional initiative.
Materials and Methods
Study Design
The design of this study is characterized as a descriptive cross-sectional epidemiological investigation. In the course of this study, a structured questionnaire was developed by the researchers to assess the disaster preparedness of community pharmacies. A subset of the survey questions was derived from the study by Ozeki et al.Reference Ozeki and Ojima 16 The study was conducted in Istanbul, Türkiye’s largest city and the one with the highest pharmacy density.
Participants
The study population consists of 5,684 pharmacies located in Istanbul as of December 2024. To determine the average using the
$ n=\frac{DEFF\times N\times p\left(1-p\right)}{d^2/{Z}_{1-\alpha /2}^2\times \left(N-1\right)+p\left(1-p\right)} $
formula and a 95% confidence interval (CI) in studies with a known population size, it was calculated that a minimum of 360 pharmacies would be required.
24 Systematic sampling involved listing all the pharmacies in Istanbul, determining the sampling interval, and reducing the risk of bias in sample selection.
Inclusion Criteria
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• Be aged 18 or over,
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• Agree to participate in the study as an employee of the pharmacy, as selected through systematic sampling,
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• Be a responsible pharmacist or other health care personnel working at the pharmacy (e.g., assistant pharmacist, community pharmacy dispenser, technician).
Exclusion Criteria
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• Be under 18 years of age,
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• Not giving informed consent to participate in the study,
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• Not being a responsible pharmacist or other health care personnel working in a pharmacy (e.g., assistant pharmacist, community pharmacy dispenser, technician).
The process of sampling continued until the calculated minimum sample size (n = 360) was attained. Pharmacy staff who declined to participate were excluded from the study, and the next eligible pharmacy on the systematic sampling list was selected. Questionnaires that exhibited significant omissions were excluded from the analysis. Although the number of individuals who refused to participate was recorded, data on sociodemographic or outcome variables were not collected from non-participants for ethical reasons. Consequently, it was not possible to make a comparison between the participants and the non-participants. This potential for non-response bias was identified as a limitation of the study.
Data Collection Instrument
The items in the disaster preparedness section were adapted based on the questionnaire used in a study conducted in Japan by Ozeki et al.Reference Ozeki and Ojima 16 The relevant items were translated from English into Turkish by the researchers, and the translated text was linguistically reviewed and edited to ensure coherence. During the adaptation process, the suitability of the questions for the context of community pharmacies in Türkiye was assessed, and necessary wording adjustments were made. Furthermore, the content and face validity of the survey items were evaluated by the research team. The final version of the survey instrument was utilized during the data collection process. The administration of the questionnaire occurred in Turkish. The questionnaire items were reviewed by the research team for both language and content. No separate pilot study was conducted prior to data collection. The questionnaire employed in this study is comprised of seven sections and a total of 34 items, and the complete questionnaire is provided in the Supplementary File. The inquiries posed are of a categorical nature and are structured as multiple-choice or short-answer questions.
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• Section 1: General Information (6 Items)
In this section, participants were asked to provide information regarding their role at the pharmacy, gender, year of birth, educational background, length of professional experience, and whether they had received disaster preparedness training.
In this study, disaster preparedness training is defined as the participant’s prior enrollment in an official or semi-official training program that is administered by an institution (e.g., Disaster and Emergency Management Authority, a university, a professional association, or a private training organization) and which covers at least one of the following subjects: disaster awareness, fundamental disaster response behaviors (e.g., drop, cover, and hold on), fire safety, evacuation procedures, basic first aid, or crisis management. The duration and standardization of the training may vary; in this study, only the participant’s status (yes/no) was evaluated.
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• Section 2: Disaster Preparedness (9 Items)
This section evaluates the pharmacy’s disaster plan, the securing of furniture and equipment, emergency water supply, the availability of disaster supplies, the status of cooperation with neighboring pharmacies and regional representatives, knowledge of proper behavior during an earthquake, previous experience in providing support to disaster-affected areas, and the presence of a person or team responsible for disaster preparedness.
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• Section 3: Medication and Supply Inventory (2 Items)
The assessment entailed evaluating the presence of medication and supply inventory available for utilization in the pharmacy following a disaster, as well as the frequency of inventory updates.
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• Section 4: Data Backup (2 Items)
In this section, the presence of a data backup system in the pharmacy and the backup method used were evaluated. Given the variety of data backup systems used in pharmacies, which could not be fully anticipated in advance, and given the potential for system names to be numerous and varied, the question was designed as an open-ended one and placed in a separate section at the end of the survey form to allow participants to freely describe the systems they used.
The evaluation of open-ended responses employed a content analysis approach. The differences in wording and phrasing were standardized, and similar responses were grouped under a single category. The resulting categories were then analyzed by calculating their frequency and percentage distributions. However, it should be noted that some of the responses to this question did not technically qualify as data backup systems.
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• Section 5: Drill (4 Items)
An assessment was conducted to evaluate the number of drills conducted at the pharmacy, the frequency of drills in the past year, the implementation of safe behavior practices during drills, and the type of drills that were carried out.
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• Section 6: Pharmacy and Surroundings (9 Items)
In this section, the awareness of and distance to the nearest assembly area, the age of the building housing the pharmacy, and the presence and number of fire extinguishers, smoke detectors, and fire alarms were assessed.
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• Section 7: Expectations (2 Items)
An examination was conducted to determine the pharmacy’s endeavors to secure financial assistance from public or private institutions for disaster preparedness, as well as the institutions from which support was received.Reference Ozeki and Ojima 16
Data Collection Procedure
The survey data were collected by the researcher between December 2024 and April 2025 using face-to-face interviews. Although the majority of participants completed the survey in its entirety, some items were left blank. To ensure the integrity of the dataset, missing responses were completed by selecting the option corresponding to the order of the response given in the previous question.Reference Shrive, Stuart and Quan 25 This approach led to a reduction in data loss, while concurrently ensuring the survey’s internal consistency and the reliability of the analysis.
Ethical Considerations
As part of this study, informed consent was obtained from the participants after providing them with the necessary information regarding the study’s purpose, methodology, and procedures. The collected data were utilized exclusively for scientific purposes, were not disseminated to third parties, and were stored in accordance with privacy principles. The study was deemed ethically acceptable by the Hamidiye Scientific Research Ethics Committee of the University of Health Sciences, as evidenced by approval on February 6, 2025, meeting number 2025/2, and decision number 2/8.
Data Analysis
The collected data were imported into IBM SPSS Statistics Version 22.0 and analyzed. 26 The participants’ demographic characteristics (e.g., gender, age group, education level, occupational group, years of professional experience) and disaster preparedness-related characteristics (e.g., whether they had received disaster preparedness training, the presence of a disaster plan, possession of disaster supplies, experience with drills, preference for safe behavior, age of the building housing the pharmacy, data backup systems, collaboration with neighboring pharmacies, etc.) were evaluated, and the results were summarized using frequency and percentage distributions. The chi-square test was employed to ascertain relationships between categorical variables. Fisher’s exact test was applied when the expected frequency in a cell was less than 5. The level of statistical significance was set at P < 0.05 for all analyses.
Results
Sociodemographic Characteristics of Participants
Table 1 presents the sociodemographic characteristics of the participants. Of the 360 participants in the study, 25.9% (n = 93) were pharmacists, 31.4% (n = 113) held a bachelor’s degree, and 54.7% (n = 197) had 0-5 years of professional experience. The sample included 181 participants, of which 50.3% were female, with a mean age of 30 years (mean ± standard deviation [SD]; minimum–maximum; 30 ± 0.832; 19–62). A total of 173 participants were included in the study, of which 48.1% had not received any training on disaster preparedness.
Descriptive statistical findings for participants
Table 1. Long description
Table 1 presents the descriptive characteristics of the participants (N = 360). Most participants were other pharmacy staff (74.1%), while 25.9% were pharmacists. Females accounted for 50.3% of the sample and males for 48.9%. The largest age groups were 18–25 years (25.8%) and 30–34 years (25.0%). Regarding education, 34.6% had a high school education or below, 31.4% held a bachelor’s degree, and 29.7% had an associate degree. More than half of the participants (54.7%) had 0–5 years of professional experience, followed by 20.6% with 6–10 years. Regarding disaster preparedness training, 48.1% reported that no staff member had received training, 32.5% indicated that only they had been trained, 16.9% reported that all staff had received training, and 2.5% stated that only other staff members had been trained.
Emergency Preparedness Characteristics of Pharmacies
As illustrated in Table 2, the findings reveal the disaster preparedness status and characteristics of pharmacies. This study revealed that only 118 pharmacies, representing 32.8% of all surveyed, have implemented an emergency preparedness plan. In 105 of all pharmacies (29.2%), there are unsecured medicine cabinets, refrigerators, and medication preparation equipment that could cause serious injuries or lead to major accidents in the event of a destructive earthquake. It is noteworthy that 50 pharmacies (13.9%) have not implemented measures to ensure a water supply during emergency situations. In reference to the deliberations undertaken with proximate pharmacists and regional pharmacy representatives concerning the prospect of collaborative endeavors in the event of a disaster, the preponderance of pharmacies (87.5%) have attested to the occurrence of such dialogues. In the event of a potential earthquake, 207 participants (57.5%) would perform the “drop, cover, and hold on” safety maneuver. With respect to post-disaster support, a division of pharmacies was observed into 2 groups: 50% reported the provision of assistance, while the remaining 50% reported a lack of participation. The low percentage of individuals or teams responsible for disaster preparedness suggests that the institutional structure is limited.
Availability of disaster preparedness materials in community pharmacies
Table 2. Long description
Table 2 presents the availability of disaster preparedness practices and emergency resources in community pharmacies (N = 360). An emergency/disaster preparedness plan was available in 32.8% of pharmacies, while 30.3% had a designated disaster preparedness coordinator or team. Collaboration for disaster situations was reported by 94.7% of pharmacies. More than half of the participants (57.5%) identified the recommended “Drop–Cover–Hold” action for earthquakes, whereas only 8.3% reported conducting disaster drills. Regarding emergency water supplies, 70.8% had a water dispenser and 65.6% stored bottled water, while 13.9% reported having no emergency water supply. Among disaster preparedness materials, wet wipes (93.9%), garbage bags (92.5%), face masks (90.8%), disposable gloves (90.0%), and phone chargers (89.4%) were the most commonly available items, whereas radios (37.8%) and isopropyl alcohol (41.4%) were the least frequently reported.
* Section A includes single-response variables; percentages sum to 100% within each item. Section B includes multiple-response items; percentages represent the proportion of pharmacies reporting each item and therefore do not sum to 100%.
Stock and Material Preparedness
A sample of 215 pharmacies revealed that 59.7% of them have stockpiles of supplies that can be used in the post-disaster period. The findings indicate that a significant portion of pharmacies (n = 134, 37.2%) update their stockpiles of materials usable in the post-disaster period at intervals ranging from 1 to 29 days. In 43 pharmacies (11.9%), these stockpiles are updated at intervals ranging from 30 to 59 days.
Data Backup Practices
In the study, participants were posed an open-ended inquiry to ascertain the data backup practices of pharmacies. Of the total 360 participants, 222 (61.7%) responded to the open-ended question, while 138 (38.3%) did not.
A review of the responses indicated the mention of pharmacy automation systems with data backup functionality (e.g., BAY.t Perfectus, Eczanem, Farmakom), infrastructure systems without direct backup features (e.g., MEDULA, Havan), and physical or online backup tools (e.g., cloud systems, external storage, USB). Although such responses fall outside the scope of the study, they were included in the evaluation to ensure that data is presented comprehensively and to maintain transparency.
The findings indicate that the most commonly used data backup systems among pharmacies are BAY.t Perfectus (n = 75, 20.8%) and Eczanem (n = 46, 12.8%). While the utilization rates of alternative systems remained relatively low, a substantial proportion of the participants (n = 138, 38.3%) reported not employing any data backup system.
Disaster Drills
The study entailed the collection of information from participants regarding their practices in this area, with the objective of ascertaining the extent to which pharmacies conduct disaster or emergency drills. The findings indicated that the overwhelming majority of pharmacies do not engage in disaster preparedness exercises. The vast majority of participants (n = 330, 91.7%) reported never having conducted a drill in the past, while only a small portion indicated having experience with one or more drills.
Structural and Fire Safety Characteristics
Table 3 presents findings regarding the distance of assembly areas from the pharmacy, the age of the building, and fire safety equipment. A significant proportion of participants (n = 247, 68.6%) stated that they knew the location of the nearest assembly area.
Findings regarding assembly areas, building age, and fire safety equipment in pharmacies
Table 3. Long description
Table 3 presents findings related to assembly areas, building age, and fire safety equipment in community pharmacies (N = 360). Overall, 30.0% of pharmacies were located within 200 meters of the nearest assembly area, whereas 31.4% of participants were unaware of the distance. Buildings were relatively evenly distributed by age, with 23.1% located in buildings aged 11–20 years, 22.8% in buildings aged 0–10 years, and 22.5% in buildings aged 21–30 years. Regarding fire safety equipment, 38.1% of pharmacies had two fire extinguishers and 37.5% had one, while 13.3% had none. Smoke detectors were absent in 85.6% of pharmacies, and fire alarm devices were unavailable in 71.4%. Only 3.3% of pharmacies had three or more smoke detectors, and 1.4% had three or more fire alarm devices.
Each pharmacy was counted once and assigned to a single category according to the number of devices available.
A significant proportion of the pharmacies (n = 108, 30.0%) are situated within a very short distance (0-200 m) from the nearest gathering area. However, 113 participants (31.4%) indicated that they were unaware of the location of the nearest gathering area. An analysis of the age of the buildings housing the pharmacies revealed that 68.4% (n = 246) are located in buildings constructed no more than 30 years ago. Approximately 20% of the participants (n = 61, 16.9%) operate in buildings that are 31 years old or older. An evaluation of findings related to fire safety equipment revealed that 38.1% of pharmacies (n = 137) had 2 fire extinguishers, while 13.3% (n = 48) had none. The majority of these pharmacies (n = 308, 85.6%) lack smoke detectors. Furthermore, 71.4% of the participants (n = 257) reported that their pharmacies lacked a fire alarm. Pharmacies with a single alarm device were limited to 17.5% (n = 63).
Inferential Analysis
As illustrated in Table 4, the results of the Pearson chi-square test are presented, with the aim of elucidating the relationships between disaster preparedness training and various variables. The findings of this study suggest a robust correlation between disaster preparedness training and specific structural and safety elements. Initially, a substantial discrepancy was identified between gender and pharmacist status (P = 0.01). The proportion of female pharmacists (n = 57, 62%) exceeded that of male pharmacists (n = 35, 38%). In pharmacies that have received disaster preparedness training, the presence of fire extinguishers (P < 0.001), the preparation of a disaster plan (P = 0.008), securing of items (P = 0.03), having a team or designated person (P = 0.03), post-disaster supply stock (P = 0.02), smoke detectors (P = 0.03), and fire alarms (P = 0.01) were found to be significantly higher than in pharmacies that had not received such training. Conversely, no substantial correlation was identified between disaster preparedness training and the awareness of the proximity to the nearest assembly area (P = 0.68) or the execution of safety protocols (P = 0.12).
The relationship between disaster preparedness training and various variables (Pearson Chi-Square test results)
Table 4. Long description
Table 4 presents the relationships between disaster preparedness training and selected pharmacy characteristics and preparedness indicators based on Pearson chi-square analysis. Significant associations were identified between disaster preparedness training and the availability of fire extinguishers (p<0.001), disaster preparedness plans (p=0.008), securing items against hazards (p=0.034), designated disaster preparedness personnel or teams (p=0.027), material stock availability (p=0.002), smoke detectors (p=0.032), and fire alarm devices (p=0.010). Female pharmacists outnumbered male pharmacists (62.0% vs. 38.0%, p=0.012). No significant associations were found between disaster preparedness training and knowledge of the nearest assembly area (p=0.680) or appropriate earthquake response behavior (p=0.116).
Discussion
This study comprehensively examined the disaster preparedness levels of pharmacies, and the findings were compared with the national and international literature. The study found that more than half of the participants were women, a finding consistent with the global distribution of the pharmacy workforce. The extant literature indicates that the proportion of female pharmacists exceeds that of male pharmacists in most countries (UAE 71.4%; USA 61.5%; Jordan 78.6%; Lebanon 85.2%).Reference Jairoun, Al-Hemyari and Shahwan 11 , Reference Popovici and Carvajal 27 –Reference Zeenny, Ramia and Akiki 32 This finding suggests that the presence of a predominantly female workforce in the pharmaceutical sector is a pervasive global phenomenon.Reference Nguyen, Dinh and Nguyen 31 , Reference Bukhari, Manzoor and Rasheed 33 The gender distribution observed in this study, with a slight predominance of female participants, is consistent with the broader demographic profile of the pharmacy workforce both in Türkiye and internationally. However, the preparation gaps identified in this study appear to be more strongly associated with structural and regulatory factors rather than workforce demographics alone. This finding suggests that system-level policies and institutional frameworks are more likely to play a more decisive role than gender composition.
The observation that a considerable proportion of the pharmacists participating in the study belong to the younger age group and are in the early stages of their careers indicates that young professionals are a critical target group in terms of disaster preparedness. This finding suggests that disaster awareness and crisis management content should be reinforced in undergraduate education and during the early years of the profession. In the context of disasters, community pharmacies emerge as a pivotal source of health care, particularly in scenarios where hospitals reach their capacity. Consequently, the preparedness level of pharmacies is not merely an institutional issue but rather a direct public health determinant in terms of medication continuity and chronic disease management. The World Health Organization identifies the continuity of primary care services as a critical element in disaster-resilient health systems. Inadequate preparedness has been demonstrated to have a statistically significant relationship with increased morbidity in the aftermath of a disaster.
A survey of the extant literature suggests that disaster preparedness training is not a universal practice among pharmacists. In a similar vein, a study by Ahmad Suleiman M and colleagues reported that 44.1% of pharmacists and pharmacy staff had received training on emergency and disaster planning.Reference Ahmad Suleiman, Magaji and Mohammed 34 This finding suggests that disaster preparedness training is administered at a limited level in various countries as well. This study identified a series of notable associations between disaster preparedness training and various structural and safety measures. The higher incidence of documented plans, fire safety equipment, and drills in pharmacies that received training suggests that the training encompasses not only theoretical knowledge but also tangible preparedness practices. Indeed, while a study by Zeenny et al. conducted following the emergence of the novel coronavirus reported that a significant proportion of pharmacists possessed emergency response knowledge, a study by Habte et al. in Ethiopia indicated that pharmacists’ knowledge levels were inadequate.Reference Zeenny, Ramia and Akiki 32 , Reference Habte, Addisie and Azazh 35 , Reference Liao, Ma and Lau PharmD 36 These discrepancies can be attributed to variations in disaster preparedness training infrastructure, health systems’ emergency response experience, and national disaster management policies across countries. In this context, the systematic, regular, and practical dissemination of disaster preparedness training and international guidelines (FIP, WHO, Sendai, etc.) into the curriculum will enhance the resilience of community pharmacies against disasters.
The paucity of written disaster plans in pharmacies suggests that a culture of institutional disaster management has yet to be adequately established. In contrast, Ozeki et al. reported a higher level of structured disaster planning in Japanese pharmacies, which likely reflects Japan’s integration of disaster preparedness into professional standards.Reference Ozeki and Ojima 16 Concurrently, studies conducted in the United Arab Emirates (UAE) and Jordan have reported higher self-reported preparedness scores among community pharmacists.Reference Jairoun, Al-Hemyari and Shahwan 11 , Reference Karasneh, Al-Azzam and Muflih 28 The relatively low prevalence observed in Türkiye may be related to the absence of mandatory preparedness requirements for community pharmacies. The absence of formal disaster plans can result in ambiguous roles and responsibilities during times of crisis, delays in decision-making processes, and disruptions to service continuity. The absence of a structured action plan during the initial 24-72 hours of a disaster can result in the temporary closure of the pharmacy, ineffective management of medication stocks, and significant disruptions in the community’s access to medication. This phenomenon has the potential to exacerbate existing disparities in disaster response, giving rise to a “service continuity gap.” An analysis of emergency supplies revealed that while basic equipment is largely available, a significant portion of pharmacies were found to lack fundamental fire safety equipment. It is particularly noteworthy that fundamental fire safety equipment, such as smoke detectors and fire alarms, is absent in a significant number of pharmacies. This deficiency may be attributed to the fact that training programs do not adequately address the development of practical fire safety and evacuation plans. Theoretical knowledge may not translate into actual preparedness without the support of equipment and alarm systems. The limited availability of fundamental fire safety equipment in pharmacies may be associated with national inspection mechanisms, spatial characteristics of pharmacy environments, financial considerations, and the extent of disaster safety awareness. This situation underscores the necessity for both professional organizations, such as the Pharmacists’ Association, and local governments to enhance their capacity and inspection programs. According to international standards, such as those set forth by Sphere and the World Health Organization (WHO), health care facilities must be equipped with fundamental safety equipment as a requisite component of their infrastructure.Reference Noe and Smith 37 Inadequate physical security measures pose a dual threat: they endanger the well-being of staff members and have the potential to render a pharmacy completely inoperable. In particular, during sudden disasters such as earthquakes, damage caused by the collapse of unsecured shelves and equipment can result in the loss of medications and prolonged service disruptions. The closure of a single neighborhood pharmacy has the potential to reduce regional health care capacity. Consequently, the mitigation of non-structural risks directly contributes to the protection of public health.
The investigation revealed that 58.8% of pharmacies had furniture and equipment securely anchored. While this rate is lower than the 64.8% reported in the study by Ozeki et al. in Japan, it reflects a similar trend.Reference Ozeki and Ojima 16 Non-structural hazards are among the leading causes of severe injury and death, particularly during sudden disasters such as earthquakes. Indeed, it has been reported that approximately 50% of injuries and 3% of deaths in the 1999 Kocaeli earthquake were caused solely by non-structural elements; this finding underscores the critical importance of securing practices for disaster safety. 38 Given the potential for unsecured furniture and appliances to cause severe injuries, particularly during seismic events, it is evident that enhancements are required in this domain.
The study revealed that the frequency of drills was found to be extremely low. The extremely limited scope of drill exercises indicates that behavioral reinforcement in disaster preparedness has not been adequately achieved. The possession of disaster training does not, in itself, equate to operational readiness. In the absence of regular drills, a discrepancy emerges between training and practice. Conversely, countries with a history of seismic activity, such as Japan, engage in meticulous annual disaster drills, including the nationwide ShakeOut exercises. These exercises have been demonstrated to enhance behavioral coordination during actual seismic events. The absence of routine drills in Türkiye suggests that theoretical awareness is not systematically translated into practice. The inadequacy of drill practices may limit the capacity to develop appropriate and expeditious behavior during a disaster. It is imperative that theoretical knowledge gained through training is reinforced through practical application. Failure to do so can result in personnel panicking during a crisis, delaying evacuation processes and failing to adequately protect critical equipment. This situation poses a dual challenge: it endangers the safety of employees and the integrity of medications, while also jeopardizing the continuity of the cold chain and the uninterrupted delivery of services. These dual threats have the potential to engender secondary risks for public health. The extant literature highlights the pivotal function of disaster drills in enhancing institutional preparedness, and asserts that experiential training engenders more pronounced behavioral change than theoretical knowledge.Reference Habte, Addisie and Azazh 35 An example of regular drill programs is the annual ShakeOut drill, which significantly improves knowledge of the correct protective actions (e.g., “Drop, Cover, Hold On”) and increases the likelihood of these actions being used during actual earthquakes. Furthermore, it encourages additional preparedness behaviors.Reference Vinnell, Wallis and Becker 39 , Reference Adams, Karlin and Eisenman 40 Combining annual drills with SMS alert systems maximizes preparedness by reinforcing learned behaviors and ensuring timely action.Reference Vinnell, Wallis and Becker 39 , Reference Kohler, Smith and Andrews 41 , Reference Cooper, Cooke and Takayama 42 From this perspective, the absence of regular drills in pharmacies indicates a significant gap in preparedness. In light of the exercise year activities conducted by the Disaster and Emergency Management Authority (AFAD) in Türkiye and the national earthquake and evacuation drills, it is imperative to integrate and encourage pharmacies to participate in these processes, and to ensure their participation through professional associations. This is of strategic importance for the continuity of pharmacy services.
The absence of systematic implementation of data backup practices across all pharmacies engenders a substantial vulnerability with respect to post-disaster service continuity, a matter of particular pertinence in the contemporary digital age. The loss of data has the potential to result in delays in the procurement and access to medications for patients suffering from chronic conditions. In countries where there is a centralized system of pharmacy chains, digital backup systems are typically standardized at the corporate level. The independent ownership model in Türkiye may be a contributing factor to the observed variability in digital preparedness. It is imperative to recognize the grave clinical risks associated with the failure to protect digital data, a particular concern for individuals afflicted with chronic illnesses. Consequently, data backup systems should be regarded not only as a technical component of disaster preparedness, but also as a strategic necessity for patient safety. The observation that institutional support is quite limited suggests that pharmacies rely heavily on individual efforts for disaster preparedness. As demonstrated in the extant literature, global frameworks identify inter-institutional collaboration, multi-stakeholder coordination, governance, and the strengthening of professional networks as key strategic components for enhancing the resilience of health systems against disasters.Reference Barasa, Mbau and Gilson 43
The existence of a culture of collaboration among pharmacies with neighboring colleagues and professional representatives is a positive indicator of social resilience. In contrast, Ozeki et al. reported that only 0.4% of pharmacies indicated that they did not feel the need to collaborate. However, the present study indicates that this figure is 5.3%. Furthermore, 50% of pharmacies reported providing post-disaster support. This finding suggests that pharmacies possess disaster response capacity not only at the individual level but also at the societal level. Ozeki et al. reported that only 10% of pharmacies provided post-disaster support.Reference Ozeki and Ojima 16
Open-ended responses indicate that pharmacists have different perspectives on disaster preparedness. A subsequent review of the responses yielded the identification of several prominent themes, including building safety, drill organization, training needs, and individual preparedness levels. While some participants emphasized the necessity of regular drills, others stated that individual awareness and planning were sufficient. This diversity indicates that, rather than a one-size-fits-all approach to disaster preparedness, the development of programs tailored to different needs and expectations is necessary. Bodas et al. similarly emphasize that consolidating different hazards and risks does not always yield optimal results, and that applying differentiated, flexible strategies based on local risks and priorities may be more effective than an “all-hazards approach” in disaster preparedness.Reference Bodas, Kirsch and Peleg 44 Consequently, the necessity of a disaster preparedness model that prioritizes diversity and local needs at both the individual and institutional levels becomes apparent. Türkiye is a country with a high seismic risk. Provincial Disaster Risk Reduction Plans (İRAP) at the local level that include the pharmaceutical sector could increase the preparedness capacity of pharmacies.
The effectiveness of the health care system during disasters is contingent not only on hospital capacity but also on the continuity of primary care providers. In the event of a disaster, a pharmacy that has not been adequately prepared may encounter difficulties in integrating into the coordination mechanisms that are established in the aftermath of the disaster. Furthermore, such a pharmacy may be unable to activate alternative drug supply channels or to meet the increased demand for medications. This predicament may result in treatment disruptions, acute exacerbations, and preventable complications, particularly among individuals afflicted with chronic conditions. The closure of pharmacies has the potential to result in an increased number of patients presenting to emergency departments. This, in turn, could lead to an escalation in the strain on the health care system and an exacerbation of existing gaps in disaster response. Consequently, the disaster preparedness level of pharmacies is not merely an indicator of organizational resilience but one of the key determinants of post-disaster public health outcomes. Consequently, disaster preparedness training must be integrated with mandatory drills, the testing of alarm systems, and the active use of written plans.
The fact that community pharmacies in Türkiye are organized under an independent ownership model is significant for interpreting these findings. Beyond individual awareness and the availability of resources, the preparedness gaps identified in this study appear to be closely linked to the broader regulatory and governance context of community pharmacy practices in Türkiye. Presently, disaster preparedness elements such as written emergency plans, routine drills, and minimum safety equipment are not systematically incorporated into pharmacy licensing, inspection, or accreditation processes. Additionally, while professional pharmacy associations fulfill an important role in professional development and advocacy, disaster preparedness does not appear to be an officially standardized or mandatory component of continuing professional education. Consequently, the preparation efforts are predominantly reliant on individual initiative rather than being bolstered by institutionalized policies or regulatory requirements. This structural reliance on voluntary compliance may partially explain the low level of formal planning, drills, and safety infrastructure observed in this study, particularly when compared to countries where preparedness standards are clearly defined and routinely monitored. In nations where chain pharmacy systems are prevalent, such as the United States, centralized institutional protocols can facilitate more standardized disaster preparedness. Conversely, in systems characterized by an independent structure, such as in Türkiye, the level of preparedness may vary depending on individual training, awareness, and professional initiative. Consequently, the findings of this study are more directly comparable for countries with similar organizational structures.
The findings of this study provide an empirical basis for regulatory and policy-level interventions. Sharing aggregated results with pharmacy chambers, public health authorities, and disaster management agencies may support the development of standardized disaster preparedness requirements, targeted training programs, and funding mechanisms for essential safety equipment in community pharmacies.
Limitations
The present study is not without its limitations. Due to limitations in time and financial resources, including transportation costs, the research was conducted in a single province of Türkiye. This limitation restricts the generalizability of the findings to the entire country. However, given that the study was conducted in Istanbul, Türkiye’s megacity—considering the city’s strategic location, dense population, sociocultural diversity, and its position within an active seismic zone—the findings are assessed as having the potential to offer meaningful and generalizable insights regarding the country as a whole. Secondly, participation was voluntary, and those who declined to participate were not included in the analyses. As no sociodemographic or outcome-related data was collected from non-participants, it was not possible to assess potential differences between participants and those who declined to participate. Consequently, the potential for non-response bias cannot be unequivocally dismissed. A third limitation is that some participants did not respond to all survey questions. To ensure the integrity and consistency of the dataset, missing responses were completed using the method of imputing based on the order of previous responses, which is one of the approaches recommended in the literature.Reference Shrive, Stuart and Quan 25 While this method has been demonstrated to reduce data loss, there is a possibility that it may not fully reflect the actual responses. Fourthly, the data collection method, which entailed face-to-face interviews, may have introduced a social desirability bias, particularly concerning the self-reported readiness levels. In order to mitigate the potential for bias, the participants were assured that their pharmacy identification information would be kept confidential and would not be disseminated to third parties. The interviews were conducted by trained researchers using a structured questionnaire containing neutral statements. Furthermore, the participants were informed that there were no correct or incorrect responses to the questions and were encouraged to provide honest responses. Nevertheless, it is not possible to assert that social desirability bias has been fully eradicated. Finally, the disaster preparedness training variable is based on participant self-reports, and the duration, content, and level of standardization of the training were not measured in detail. This scenario may have resulted in subjective variations in the training variable, which should be considered when interpreting the results.
Conclusion
The study’s findings indicate that while community pharmacies demonstrate strengths in certain domains of disaster preparedness, such as collaboration and the possession of essential supplies, numerous critical pharmacies and regional pharmacy representatives exhibit deficiencies in other areas, including the implementation of drills, the utilization of fire safety equipment, the management of data backup, and the engagement in effective planning. The findings indicate the necessity of expanding disaster preparedness training, conducting regular drills, strengthening fire and earthquake safety equipment in pharmacies, and standardizing data backup systems. Furthermore, public institutions and professional organizations are obliged to provide more active support to pharmacies in their disaster preparedness efforts. In this context, governance among pharmacies, regional pharmacy representatives, and professional associations refers to pharmacies’ participation in decision-making processes and the establishment of a collaborative environment predicated on transparent and mutual communication by representatives. The enhancement of such a governance structure will not only serve to augment the effectiveness of pharmacy services, but will also contribute to the improvement of coordination during crises and disasters. In conclusion, it is imperative to fortify the disaster preparedness strategies of pharmacies, as this will serve to bolster the resilience of community-based health services. Furthermore, this will facilitate the continuity of pharmaceutical and health services, which play a critical role in the post-disaster recovery processes. Subsequent studies, designed at the national level to be multicentered, longitudinal, and inclusive of intervention-based training programs, will provide more in-depth evidence regarding pharmacies’ disaster preparedness capacity.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/dmp.2026.10411.
Data availability statement
Analyses available upon request.
Availability of data and material
Data set is available.
Acknowledgments
In this study, the ChatGPT tool was employed for the improvement of academic language and enhancement of linguistic accuracy. Specifically, this AI technology played a crucial role in refining the linguistic structures of the text, making them more academic and coherent. Additionally, the DeepL translation tool was utilized to ensure an accurate and fluent translation of the text into English.
Funding statement
None.
Competing interests
None.
Consent to participate
Not applicable.
Consent to publication
All authors consent to having this information published.
