Evaluating community pharmacists' knowledge, attitudes, and practices toward nutritional counselling and healthy lifestyles: evidence from a lower-middle-income country.

Community pharmacists are among the most accessible healthcare professionals and are primarily responsible for medication management and patient counselling. Their role increasingly includes providing basic education on nutritional and healthy lifestyle practices and referring patients to dietitians when specialized nutritional care is needed. This study aimed to evaluate community pharmacists' knowledge and practices related to nutritional counselling and healthy lifestyles and to identify the barriers that restrict pharmacists' ability to provide nutritional counselling. A cross-sectional study was conducted that included 337 community pharmacists via a structured, self-administered questionnaire distributed through direct visits to community pharmacies and social media platforms. The data were recorded and analysed via SPSS version 21, with significance set at p < 0.05. Descriptive analysis was conducted to summarize and explore the data. The Mann-Whitney U test and Kruskal-Wallis test were used to assess the associations between variables. Of the 337 pharmacists who participated, the majority were female (80.1%) and were in the younger age group (18-29 years). Pharmacists demonstrated relatively strong knowledge in several medication- and nutrition-related areas, with 92.0% recognizing the importance of balanced diets and 95.0% identifying the need to administer certain medications with food. However, only 7.1% correctly acknowledged that dietary supplements are not always safe. Attitudes toward counselling were generally positive, with 69.8% agreeing that counselling improves patient outcomes. Despite this, practices were less consistent; only 24.6% routinely addressed physical activity, and 10.4% provided written educational materials. A lack of time (84.6%) and patients' misconceptions about supplemental safety (68.2%) were the most reported barriers. Knowledge scores were significantly associated with recent graduation (p = 0.023) and supervising trainees (p = 0.037), whereas practice scores differed by employment status, with responsible pharmacists showing higher levels of engagement (p = 0.003). Community pharmacists in Palestine appeared to have relatively good knowledge and generally favourable attitudes toward nutritional counselling; however, reported practices were less optimal. A major knowledge gap was identified regarding dietary supplement safety, as only 7.1% of the pharmacists recognized that dietary supplements are not always safe. Structural and perceived barriers, particularly time constraints and patient misconceptions, may have influenced the provision of counselling services. These findings suggest the need for targeted educational programs and system-level interventions to support and enhance pharmacists' involvement in preventive healthcare while considering the limitations of nonprobability sampling and self-reported data.