This cross-sectional study was conducted via an online questionnaire, prepared using Google Forms®. The questionnaire was written in English, as the official teaching language for pharmacy programmes in Jordan. The form link was shared by the researchers amongst multiple Jordanian pharmacists-designated groups on Facebook® and WhatsApp®. The questionnaire was open for responses from 15 until 30 November 2023.

The cover section of the questionnaire included the study title; researchers contact details; study approval; eligibility criteria (i.e. adult age, an undergraduate bachelor degree in pharmacy and active working status in a community pharmacy in Jordan); an explanation of the study aim and significance; confidentiality and data protection statement (i.e. that no personal identifying information will be asked and the collected data will solely be used for scientific research purposes); voluntary participation and the right to withdraw statement (the participants were not paid or compensated); and lastly, an informed consent note, which had to be submitted prior to participation.

The calculated representative sample size was 380 (population size = 32,446 (JPA 2023), 95% confidence interval and 5% margin of error), which was determined using the following equation (SurveyMonkey 2023):

$\text{ Sample Size }=\frac{\frac{z^2\times \mathrm{p}(1-\mathrm{p})}{e^2}}{1+\left(\frac{z^2\times \mathrm{p}(1-\mathrm{p})}{e^{2}N}\right)}$

A total of 400 complete responses were received and included in the study.

The study was approved by the Deanship of Scientific Research and Graduate Studies at Jerash University (approval number: 1543/6/2/9/ب ع, Date: 13.11.2023) and was conducted with strict adherence to the guidelines of the Declaration of Helsinki regarding anonymity, voluntary participation and data protection (WMA 1964). The Copenhagen Burnout Inventory (CBI) (Kristensen et al. 2005) is in the public domain (no permission is required), as highlighted in a previous correspondence with Prof. Dr. Tage Kristensen.

A total of 400 community pharmacists, from all 12 governorates of Jordan, participated including males (n = 145, 36.3%) and females (255, 63.8%). All participant responses were complete; thus, none was omitted. The age of the participants ranged from 21 to 74 years, with a mean of 30.96 ± 7.92 years and was higher, by ranks, amongst male (33.7 ± 9.92) compared to female participants (29.4 ± 6.01, U = 13695, P < 0.01, r_rb = 0.259, d = 0.562). In addition to age and gender, various other demographic factors were collected and are summarised in Table 1.

The self-reported body weight and height were used to calculate BMI, which was higher, by ranks, for males (26.037 ± 4.012 kg/m²) compared to females (23.898 ± 3.443 kg/m², r_rb = 0.328, d = 0.584, P < 0.01). Most participants reported being single (51%), non-smoking (64.5%), not having children (66.3%), living with family (85%) and exhibiting moderate exercise level (43.5%), sleep quality (45%) and financial status (66.3%). The smoking status, exercise level and living arrangements were dependent on gender (P < 0.05), with males showing a higher level of smoking, exercise and living alone status than females.

The occupational factors that may influence the burnout level amongst community pharmacists were assessed next. The sample participants had an average of 5.29 ± 5.89 years of community pharmacy practice or experience, ranging from 1 to 35 years and each participant has worked in 2.76 ± 1.69 different community pharmacies so far. The results show that, on average, community pharmacists in Jordan work 8.85 ± 2.08 hours per day and 5.89 ± 0.78 days per week. Most participants report being employees (84.5%) rather than owners, are not in a management position (65.5%), have not worked in other pharmacy sectors (63.75%) and, amongst those who have most preferred the other sectors (64.1%), do not have health insurance (60.8%), but have social security (55%) from their current job, are required to work on national holidays (63%), are paid extra for working overtime or on national holidays (52%), live a moderate distance from their work (42.8%), find it easy (36.5%) or moderately difficult (36.5%) to travel between home and work, are neutral in regards to their salary being sufficient (33.8%), describe their workload as moderate (50.8%), agree that they enjoy being community pharmacists (36%), have a good relationship with their employer/other employees (38%), work during mid-day shift (40.3%), do not have a fixed number of allowed vacation days per year (60.75%), usually work with others rather than alone (54%) and describe themselves as good community pharmacists (42.8%). Of the 22 assessed occupational factors, 13 factors were significantly associated with and, thus, dependent on gender. The impact of gender on occupational factors amongst the participants is presented in Table 2.

Briefly, male participants have significantly higher experience, have worked in more community pharmacies and work for longer hours per day and more days per week than female participants. In addition, males exhibit a higher distribution of individuals who are pharmacy owners, are in a management position, have worked in other pharmacy sectors, have health insurance and social security, are paid extra for overtime work, live further away from their work, work at night and exhibit a very high or very low level of enjoying their work compared to females who are more neutral. On the other hand, there was no association (P > 0.05) between gender and the remaining occupational factors.

The total burnout level and its three main domains, personal burnout, work-related burnout and client-related burnout, were assessed using the CBI questionnaire, which showed an adequate internal reliability (α = 0.897). The total burnout scores amongst the participants were elevated with a mean of 49.72 ± 16.65; however, their distribution deviated from normal (SW test statistic = 0.976, P < 0.01, skewness = 0.551, kurtosis = 0.645). The median total score was 48.68 and 172 participants (43%) had a total score above 50, indicating a high total burnout level. The three burnout domain scores were also calculated and are summarised in Table 3. The score means were very similar across the three burnout domains: personal burnout (50.23 ± 21.6), work-related burnout (50.06 ± 18.3) and client-related burnout (48.81 ± 19.81). Analysis of variance by ranks showed no statistically significant differences across the burnout domains in scores (H = 0.634, P > 0.05) or distribution of burnout levels (H = 0.628, P > 0.05).

In relation to participant demographics, six factors were significantly associated with burnout level and influenced the ranks of burnout scores. These include age, weight, exercise level, sleep quality, household living arrangement and financial status. A negative correlation was observed between age and total burnout scores (ρ = -0.115, P < 0.05), while a positive correlation was observed for body weight (ρ = 0.113, P < 0.05) and BMI (ρ = 0.108, P < 0.05) with total burnout scores (ρ = 0.113, P < 0.05). The level of exercise was significantly associated with total burnout level (χ2 = 11.47, P < 0.05) and showed a significant negative correlation with total burnout scores (ρ = -0.237, P < 0.01). Indeed, the burnout score ranks varied significantly across exercise levels (H = 24.56, P < 0.01) with the mean burnout scores ranging between 59.2 ± 20.4 for participants with sedentary lifestyle, the lowest level of exercise and 43.7 ± 14.3 for participants reporting high or very high level of exercise. From a different perspective, participants with sedentary or low exercise levels have 130% increase in the odds for having a high burnout level compared to participants with moderate, high or very high level of exercise (OR = 2.303, 95% CI: 1.37–3.88, P < 0.01). This is similar to perceived sleep quality, which was significantly associated (χ2 = 20.19, P < 0.01) and negatively correlated (ρ = -0.298, P < 0.01) with total burnout levels and scores, respectively. Analysis of variance by ranks showed significant variation across sleep quality levels (H = 38.74, P < 0.01) with post-hoc analysis indicating that participants reporting excellent (mean burnout score: 38.01 ± 14.55) and good (44.13 ± 13.41) sleep quality have lower burnout ranks than participants with moderate (51.3 ± 16.57), bad (54.01 ± 16.07) or very poor (64.34 ± 21.44) sleep quality. Accordingly, participants with very poor, bad or moderate sleep quality have higher odds for high burnout (OR = 2.65, 95% CI: 1.69–4.16, P < 0.01) than participants with excellent or good sleep quality. The financial status of the participants was also associated (χ2 = 14.68, P < 0.01) and negatively correlated (ρ = -0.189, P < 0.01) with burnout levels and scores, respectively. The burnout score ranks varied across financial levels (H = 24.7, P < 0.01) with very high (mean score: 31.91 ± 9.97) and high (41.34 ± 14.89) financial status participants having lower burnout ranks than those with minimal (52.97 ± 16.3) or very poor status (52.85 ± 22.52). Accordingly, participants with very poor, bad or even moderate financial status had significantly higher odds (OR = 3.51, 95% CI: 1.64–7.49, P < 0.01) for having a high burnout level than high or very high financial status participants. Lastly, the household living arrangement, which impacted the distribution of burnout levels (χ2 = 20.45, P < 0.01) and score ranks (H = 20.43, P < 0.01), revealed that living alone (mean burnout score: 58.42 ± 20.02) leads to 269% increase in odds for high burnout (OR = 3.69, 95% CI: 1.5–9.05, P < 0.01) than living with family (50.06 ± 16.42) or room-mates (40.23 ± 11.5). The remaining demographic factors: height, gender, marital status, smoking status and parenthood status were not associated with total burnout levels (P > 0.05). The impact of occupational factors on total burnout levels was assessed next and the results are summarised in Table 4.

The occupational factors that significantly influenced total burnout amongst the participants were the number of pharmacies the participants have worked in, the number of work hours per day, the number of work days per week, the requirement to work on national holidays, how they would describe their salary and workload, if they enjoy community pharmacy, the time of their work shift and whether they usually work alone or with others. Rank correlation analysis showed that the number of pharmacies the participants have worked in and the number of work hours per day are negatively correlated with total burnout scores (ρ = -0.113, P < 0.05 and ρ = -0.137, P < 0.01, respectively). In contrast, the number of work days per week positively correlated with total burnout scores (ρ = 0.107, P < 0.05). Working on national holidays associated with burnout levels (χ2 = 24.45, P < 0.01) and the participants who are required to work on national holidays (mean burnout score: 52.71 ± 16.53) had higher burnout score ranks (U = 12566, P < 0.01, r_rb = 0.326) than the participant who are not required to (44.64 ± 15.637, d = 0.498). The participants’ view of their salary level, being sufficient for their work, had the highest impact on total burnout levels (χ2 = 60.5, P < 0.01) and variation in burnout score ranks (H = 76.91, P < 0.01). Post-hoc analysis showed that the participants viewing their salary as very low (mean burnout score: 62.76 ± 15.83) and low (53.45 ± 14.66) have higher burnout score ranks than participants who are neutral regarding their salary (45.02 ± 14.9) and view it as high (42.51 ± 16.05), but not the 10 participants who view it as very high (47.5 ± 16.36). Indeed, the negative correlation (two-tailed) between the salary view, being sufficient and total burnout scores was significant (ρ = -0.38, P < 0.01). The participants’ view of their workload level also had a major impact on burnout levels (χ2 = 24.61, P < 0.01), influenced the rank distribution of burnout scores (H = 24.61, P < 0.01) and positively correlated with burnout scores (ρ = 0.174, P < 0.01). Accordingly, the participants describing their workload as very high (mean burnout score: 59.75 ± 14.3) had higher burnout score ranks than participants describing it as moderate (47.06 ± 15.24) and low (45.93 ± 19.78). In contrast, a negative correlation was observed between burnout scores and how much the participants enjoy their community pharmacy work (ρ = -0.306, P < 0.01), which also influenced the distribution of burnout levels (χ2 = 15.94, P < 0.01) and score ranks (H = 33.5, P < 0.01). The mean burnout scores ranged from 42.93 ± 16.96 for the participants who very highly enjoy their community pharmacy work to 68.2 ± 24.55 for those with very low level of enjoyment, whose score ranks were significantly higher than all participants with other enjoyment levels. The work time influenced burnout levels (χ2 = 10.85, P < 0.01) and score ranks (H = 16.81, P < 0.01) as well, such that working at night (mean burnout score: 54.98 ± 17.29) has higher odds for exhibiting a high burnout level (OR = 2.01, 95% CI: 1.29–3.12, P < 0.01) than working early morning (49.1 ± 16.67) or around mid-day (46.55 ± 15.34). Lastly, the results show that participants who usually work alone have higher distribution of burnout levels (48.4% compared to 38.4%, χ2 = 4.01, P < 0.05) and score ranks (mean burnout score: 52.15 ± 16.92) than the ones who usually work with others (47.65 ± 16.17, U = 23370, r_rb = 0.176, d = 0.273, P < 0.01).

On the other hand, the remaining occupational factors were not associated with the burnout level amongst the participants (P > 0.05).