Behind the counter, behind the discourse: The paradox of pharmacist influence in Arabic women's health online.

Background: Social media is now a major arena for Arabic women's health discourse in the MENA region, yet it is unclear how pharmacists' expertise influences both the accuracy and visibility of information across platforms. Objective: To compare pharmacists' visibility and accuracy with other author groups and to assess how platform, sentiment, and follower dynamics shape the gap between information quality and reach. Methods: We conducted a cross-sectional content analysis of 682 public Arabic-language posts on women's self-medication and over-the-counter care from Instagram, YouTube, TikTok, Threads, Facebook, and X (January 2024-March 2025). Two independent coders rated accuracy on a four-point scale and classified sentiment (κ > 0.80). Engagement was summarized using the Virtual Presence Index (VPI), an equally weighted composite of standardized likes, comments, and shares/reposts. Proportional-odds ordinal logistic regression modeled predictors of higher accuracy; a non-circular binary logistic model examined determinants of high engagement (above-median VPI) with platform, author type, sentiment, topic, and linear plus quadratic log₁₀(follower count) as covariates. Results: Pharmacists authored 49.6 % of posts; physicians and other health professionals contributed 37.1 %. Overall, 71.8 % of posts were rated accurate, rising to 94.1 % for pharmacist-authored content. Platform was the strongest predictor of accuracy: compared with Instagram, Facebook, YouTube, Threads, and X had higher odds of higher accuracy, with TikTok showing a smaller but significant advantage. Pharmacist authorship independently predicted higher accuracy, whereas follower count did not. For engagement, platform dominated. With X as the reference, all other platforms had lower adjusted odds of high VPI. Positive sentiment increased the likelihood of high VPI, and follower count showed a U-shaped association, with mid-sized accounts disadvantaged. After adjustment, author-type differences in visibility were modest: pharmacists' posts were more accurate but did not enjoy consistent visibility advantages, especially on highly visual, fast-scroll platforms. Conclusion: In Arabic women's health discourse online, who speaks matters less for reach than where and how they speak. Pharmacists deliver the most accurate content but often remain "invisible experts" in environments that reward aesthetics and emotion over credentials. The VPI helps quantify this quality-reach gap and can guide platform-specific, culturally attuned strategies to make evidence-based voices more discoverable.