A Multidimensional Analysis of the Determinants of Medication Counseling Behaviors: A Cross-Sectional Study of Community Pharmacists in Jazan, Saudi Arabia

Background: Community pharmacists serve as the final safety checkpoint in the medication-use system; however, practice patterns often prioritize technical logistics over clinical safety. While the deficit in risk counseling is well-documented, the mechanisms driving this "selective negligence" remain underexplored. Objective: To evaluate the structural and professional determinants of routine versus risk-based counseling behaviors among community pharmacists in Jazan, Saudi Arabia. Methods: A cross-sectional analytical study was conducted (July-September 2024) among licensed community pharmacists (N=230) across the Jazan region. Data were collected using a multi-domain instrument assessing self-reported counseling frequencies. Multivariable beta regression models were employed to estimate the average marginal effects (AME) of predictors, adjusting for workforce structure, workload, and pharmacist demographics. Results: Analysis revealed a functional dichotomy: "core use" instructions were universal (median: 5 (IQR: 5-5)), whereas "risk communication" was significantly lower (median: 4 (IQR: 2-5)). Regression models identified divergent determinants. "core use" was driven by professional habits; "checking patient understanding" was the strongest positive predictor (AME: +10.3%, p<0.001), while lower self-rated quality of counseling significantly reduced performance (AME: -10.7%, p<0.001). Conversely, "risk communication" was structurally driven; the presence of a pharmacy assistant was the primary positive predictor (AME: +9.9%, p=0.010). Notably, holding a Doctor of Pharmacy (PharmD) degree was associated with lower "core use" scores (AME: -4.7%, p=0.004) compared to BSc (Bachelor of Science in Pharmacy) degrees and showed no significant advantage for risk counseling. Conclusion: Routine counseling is sustained by professional habit, but safety-critical risk communication is constrained by operational bandwidth. Closing the safety gap requires structural interventions, specifically the integration of support staff, rather than reliance on educational credentials alone.