In GB, most pharmacist qualification is awarded upon completion of a GPhC-accredited four-year Master of Pharmacy degree (MPharm), followed by a 52-week foundation training programme under the supervision of a registered pharmacist (Sosabowski and Gard 2008). Some universities offer a five-year degree that includes the foundation training year. Successful completion of the GPhC registration assessment (formerly the pre-registration exam) allows prospective pharmacists to join the statutory pharmacy register. In 2021, the GPhC introduced new standards for the initial education and training of pharmacists, outlining the knowledge, skills, and professional behaviours required to become a pharmacist, leading registered pharmacists to be independent prescribers following the graduation of new 2021 MPharm and completion of foundation training in 2026 (General Pharmaceutical Council 2021). The MPharm degree aligns with the Bologna agreement as an “undergraduate master’s programme,” making it accessible without a prior bachelor’s degree and recognised across Europe. This allows European Union (EU) citizens to register as pharmacists in any EU member state after completing necessary adjustments like language tests and supervised work (Chamberlain 2005; European Council 2005). As for the GPhC regulations, pharmacists who qualified in the European Economic Area (EEA) may be able to apply for recognition of their qualifications. To do this, they must hold a ‘relevant’ qualification that is from an EEA country listed in Annex, Section 5.6.2 of Directive 2005/36/EC, started after the reference date specified against the EEA country in which the qualification was awarded, and complies with all the minimum training requirements described in Article 44 of Directive 2005/36/EC. Once the qualification is recognised, an application can be made to register and practice as a pharmacist in Great Britain. However, pharmacists who qualified in the European Free Trade Association (EEA-EFTA) countries (Iceland, Liechtenstein, or Norway) will need to complete a different route to registration (General Pharmaceutical Council 2024). Additionally, non-EU pharmacists or EU pharmacists qualified outside the EU can join the GPhC register through the Overseas Pharmacist Accreditation Programme (OSPAP), a year-long postgraduate programme followed by the same one-year foundation training. Entry to MPharm programmes is typically based on A-Level results, especially in chemistry, with universities varying in their use of interviews or entrance exams. Admissions also consider the applicant’s fitness to practice, assessing candidate credentials to ensure they meet professional registration requirements (Sosabowski and Gard 2008).

In Italy, pharmacists can qualify by completing either a MUR accredited master’s degree in pharmacy or chemistry and pharmaceutical technologies (CTF) (Italian Ministry of University and Research (MUR) 2007). Both courses last five years and include a six-month training placement within community or hospital pharmacies. The Italian curriculum, which aligns with a specific competency framework, consists of 300 European Credit Transfer and Accumulation System (ECTS) credits, strongly emphasising chemistry and basic sciences (Italian Ministry of University and Research (MUR) 2007, 2; Montepara et al. 2021). Previously, graduates were required to pass the State Examination, a written, oral, and practical examination covering key subjects such as pharmacology, pharmaceutical analysis, chemistry, and compounding, as well as relevant pharmaceutical legislation, to join the professional register/pharmacist board and practice as community pharmacists (Italian Ministry of Public Education, 1957). However, this requirement was lifted with Legislative Decree n.163 of 8 November 2021 (Italian Government 2021). Indeed, from 2023/2024, graduating from a pharmacy degree programme will be sufficient for practising as a community pharmacist. The new legislation aims to streamline and simplify the process of becoming a pharmacist while upholding high standards of education and professionalism. Although further four-year postgraduate qualifications (established in the mid-1990s) are necessary to practice in hospital settings (Polidori et al. 2022), most Italian pharmacists (65%) work in community pharmacies, pharmaceutical industries, or engage in university research (Federfarma 2022).

Other European countries follow similar routes. However, a study from Atkinson and Rombaut (2011) highlighted a high level of heterogeneity in pharmacy curricula in Europe (Atkinson and Rombaut 2011). Since international migration of healthcare professionals is a widespread phenomenon that contributes to and impacts individual healthcare systems, it is important to equip pharmacists with the skills and knowledge required to meet diverse healthcare needs (Arakawa et al. 2020b). Doctors, nurses, and pharmacists often seek career opportunities abroad to improve their skills, enhance their knowledge, and broaden their professional experience. Individual motivation, such as job satisfaction, remuneration, and working conditions, also contributes to the movement of the healthcare workforce (Stilwell et al. 2004).

Pharmacy education in the EU and the recognition of pharmacy degrees are harmonised by the Bologna Declaration (Chamberlain 2005) and the EU Directive 2005/36 (European Union 2013). The former aims to harmonise qualifications and facilitate academic recognition and professional mobility. The latter allows professionals with qualifications from one member state to pursue the same profession in another. This harmonisation, which enables Italian pharmacists to practice in different EU and non-EU countries, such as GB, is often considered a gold standard for clinical pharmacy education and attracts pharmacists seeking career opportunities (Patel 2016). Additionally, the integration of internationally trained pharmacists, particularly those from the EU, plays a significant role in the British healthcare system. According to Schafheutle and Hassell (2009), in 2007, 40.6% of internationally trained pharmacists registered in Great Britain were from Europe (Schafheutle and Hassell 2009). These pharmacists are generally younger, with a mean age of 31.7 years, and a higher percentage of them are women (68%) compared to their British-trained counterparts (56%). The study also highlights that these pharmacists are more likely to be based in urban areas such as London and are predominantly employed full-time, indicating their crucial role in the delivery of pharmacy services across Great Britain. This trend has been unchanged. Lovel (2023) stated that there was an increase of the number of overseas pharmacists applying to train to work in GB through the OSPAP in 2022/23 by over 265 compared with the previous year (Lovell 2023).

The Italian pharmacy curriculum reflects the role and responsibilities of the pharmacist working in community settings, which primarily focuses on safe dispensing and counselling for patients on the safe use of medicines. Community pharmacists in Italy have experienced a shift in their role towards a more integrated approach to patient care. This transformation is supported by scientific bodies such as Federfarma (National Federation of Pharmaceutical Entrepreneurs) and aligns with the Federation of the Orders of Italian Pharmacists (FOFI) and the Pharmaceutical Group of the European Union guidelines (Pharmaceutical Group of the European Union (PGEU) 2018, 2019). While medication dispensing and counselling remain an essential duty, community pharmacists also provide specialised services such as point-of-care testing, electrocardiogram monitoring, and interventions to monitor adherence and manage chronic diseases. Community pharmacists also play a crucial role in preparing personalised medications and orphan medicinal products using galenic formulations (Carvalho and Almeida 2022).

A shift within the profession in Italy was facilitated by recent legislation following the COVID-19 pandemic, allowing pharmacists to deliver clinical services aimed at preventing the spread of the virus (“Farmacia dei servizi”: provision of pharmacy services) (Italian Ministry of Health 2013). During the pandemic, community pharmacists provided essential healthcare services, offering professional advice, urgent treatments, and support to patients. They also conducted screening activities and administered vaccines, contributing to the vaccination campaign (Giua et al. 2021). These expanded clinical services became permanent through the “aperture” decree in May 2022 (Italian Government 2022). Currently, community pharmacists in Italy administer COVID and influenza vaccines as part of their services, significantly contributing to public health (Ciliberti et al. 2020).

Although Italy has made a significant step forward in facilitating the provision of clinical services delivered in community pharmacies, the pharmacy degree curriculum has not changed accordingly. The gap in knowledge and lack of necessary clinical skills to provide clinical services can be a barrier to service provision (Onozato et al. 2020). A comparative study conducted by Nunes-da-Cunha et al. (2016) revealed that the Italian pharmacy degree curriculum has comparatively fewer clinical courses with respect to the United States, offered throughout the five-year programme (Nunes-da-Cunha et al. 2016). Indeed, the number of clinical subjects taught in other countries’ pharmacy degrees varied between 1 (Slovenia) and 18 (United States), while the percentage of patient-centric courses ranged between 19.7% (Greece) and 54% (Malta). In such regard, in the latter study, Italy accounted for 2 clinical courses and an overall of 23.8% patient-centred courses.

To ensure that the pharmacy programme meets the required competencies of the pharmacy profession, FOFI, the Italian Ministry of Health, and the National Conference of University Deans (CRUI) worked together to review the programme delivered by Italian universities. Indeed, a decree issued in October 2022 outlined the pharmacy curriculum reform, which has been enriched by adding disciplines focused on delivering clinical experiential models and a wider range of core competencies related to evidence-based practice and patient-centred care (Italian Ministry of University and Research (MUR) 2022). The new pharmacy curriculum includes 10 university learning credits covering topics such as internal medicine, endocrinology, paediatrics, radiotherapy, and imaging. The CRUI and local academic representatives now face the task of implementing these recommendations.

The undergraduate pharmacy programmes in Italy and GB share some similarities, albeit with the implementation of a more outcome-based approach (General Pharmaceutical Council 2021). GB’s MPharm curriculum might vary significantly between universities. Both curricula cover basic and applied sciences (biology, chemistry, biochemistry, pathophysiology, etc.), clinical sciences (physiology, pharmacology, therapeutics, etc.), and professional practice subjects (legislation, ethics, pharmacokinetics, pharmacodynamics, etc.). The Italian and English programmes feature a training period to be completed in a patient-facing setting under the supervision of a qualified registered pharmacist (Italian Ministry of University and Research (MUR) 2007; Jacob and Boyter 2020).

With the implementation of the GPhC standards in 2021 (General Pharmaceutical Council 2021). GB universities are adapting their MPharm courses to include learning outcomes for independent prescribing so that, from 2026, all newly qualified pharmacists will become prescribers from the point of registration (Lovell and Clews 2024). To achieve this, the GPhC recommends a progressive and integrated approach to teaching and learning, following the spiral curriculum model developed by Harden (Harden 1999) (Fig. 1). Students are expected to demonstrate a deeper understanding and competence in the core areas of their degrees as they progress.

Figure 1. 

The spiral curriculum, image inspired by Harden (1999): What is a spiral curriculum? Medical Teacher 21:141-3.

Table 1 illustrates the variations in curriculum between the Italian pharmacy and CTF degrees. These curricula are based on specifications for accreditation provided by the MUR (Italian Ministry of University and Research (MUR) 2007). The Italian pharmacy degree emphasises the chemistry and physical science of medicines, providing a thorough understanding of the pharmacological properties of drugs. However, topics such as pharmacy practice, pharmaceutical care, and clinical pharmacy are not taught extensively. Although the CTF programme places a strong focus on chemistry and physics-related subjects, both Italian courses enable graduates to work as pharmacists in Italy once the degree has been obtained (Italian Government 2021).

GB students undertake short placements in community pharmacies, hospitals, or general practices throughout the undergraduate programme to gain practical experience and apply learnt skills (Jacob and Boyter 2020). This practical learning approach provides valuable real-world experience, a procedure that has been shown to garner appreciation from an educational point of view (Fantinelli et al. 2024) and also aligns with the Canadian NHS’s emphasis on confidence-building in professional practice for pharmacists (Bartle 2005). Such an experiential approach could also bridge the gap between educational outcomes and labour market demands, a discrepancy that has been notably problematic in Italy, where the educational system has been criticised for not adequately preparing tertiary graduates for employment (Montanari et al. 2015). This contrasts with the Italian model, where experiential learning typically occurs only in the later years of pharmacy training (Italian Ministry of University and Research (MUR) 2007).

Indeed, undergraduate pharmacy programmes in Italy and GB differ significantly in terms of clinical exposure and practice. The Italian course focuses more on theoretical learning, while the GB programme combines theory with practical experience in clinical settings (Sosabowski and Gard 2008; General Pharmaceutical Council 2011; Jacob and Boyter 2020), allowing newly qualified pharmacists to work in various healthcare settings, including hospitals and general practices. In contrast, Italian pharmacists must complete a postgraduate 4-year degree in a hospital pharmacy to practice in secondary care [Scuola di Specializzazione in Farmacia Ospedaliera (SSFO) in Italian] regulated by the Italian Society of Hospital Pharmacy and Pharmaceutical Services (SIFO in Italian) (Polidori et al. 2022).

This, in turn, has also provided for a discrepancy in the collection and perception of (and ultimately, utilisation) of the pharmacy workforce between GB and Italy. The impact of community pharmacies within the UK healthcare system has now a long tradition of published research in public health (Horgan et al. 2010; Pearce et al. 2016; Peletidi et al. 2016) and keeps evolving, especially with the recent introduction of the Pharmacy First service (NHS England 2024). Hospital pharmacies also play a vital role in enhancing patient care and outcomes, while playing a pivotal role in pharmacy practice research projects with the endorsement of a specific curriculum for consultant pharmacists (Forsyth et al. 2022). Moreover, in the UK, there is a significant emphasis on integrating clinical pharmacists into primary care settings (Chopra et al. 2022). Indeed, such an addition has been demonstrated to reduce GP appointments and emergency department visits and was associated with overall healthcare cost savings despite increased primary care use (Hayhoe et al. 2019). On the other hand, Italy lacks a similar figure of primary care pharmacists, pharmacist prescribers, and consultants, albeit hospital pharmacy competencies are evolving towards a more clinically oriented role (Polidori et al. 2022).

Given these differences, it is uncertain whether Italian pharmacists have the necessary skills and competencies to face the challenges posed by the current healthcare system. A questionnaire was developed to explore and gather the perceptions of Italian pharmacists who migrated to GB for employment purposes.

As for the choice of the GB as a migration site for Italian-qualified pharmacists, as referenced in Eden et al. (2009), pharmacists experience higher job satisfaction levels when afforded more opportunities for clinical involvement (Eden et al. 2009). Additionally, it is important to consider the finding that “application-based pharmacotherapy, clinical decision-making, and team-based care models are not a common focus of the pharmacy curriculum in Italy, which is predominantly centred on the scientific disciplines,” as reported by Montepara et al. (2021) (Montepara et al. 2021). Furthermore, Schafheutle and Hassell (2009) offered critical insights into the mobility of EU pharmacists to the UK by analysing registration data of internationally trained pharmacists in Great Britain (Schafheutle and Hassell 2009).

Taking all this into account, we hypothesised that Italian pharmacists in particular would be more inclined to move to the UK rather than other EU countries, attracted by the potential for greater job satisfaction due to the broader clinical opportunities available in the UK.

To date, no previous studies have evaluated the challenges, opportunities, and perceived barriers stemming from the potential lack of clinical skills among qualified Italian pharmacists when transitioning to a more clinical-focused role in a foreign country, particularly in GB. The findings from this study will form foundational information on current Italian knowledge/skill gaps for the future restructuring of Italian pharmacy courses.

To identify challenges and opportunities for Italian pharmacists moving to GB, exploring their experiences, motivations, and adaptation processes in a new professional environment, along with the factors potentially affecting their possibility of finding a job in GB. This study aims to inform the Italian government and related stakeholders (MUR) about the need to update the Italian MPharm curriculum to make it more clinically relevant and aligned with international standards.

How do the experiences, challenges, and opportunities encountered by Italian pharmacists practicing in Great Britain illustrate the need for updates to the Italian MPharm curriculum to enhance its clinical relevance and international alignment?

The key research questions of this survey were:

1. Assess the experiences of pharmacists working in Italy (evaluated in Section B of the survey).
2. Understand the motivations behind pharmacists’ decisions to move to Great Britain (GB) (evaluated in Section C of the survey).
3. Identify any gaps between the knowledge gained during pharmacy education in Italy and the knowledge required to practice in GB (evaluated in Section D of the survey).
4. Explore the challenges and opportunities encountered by pharmacists in GB (evaluated in Section E of the survey).

The results of the survey have been reported following the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) (Sharma et al. 2021) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists (Ghaferi et al. 2021) (Fig. 2).

Figure 2. 

STROBE flow diagram of participants.

A cross-sectional survey was conducted by the Italian Society of Clinical Pharmacy (SIFAC) in collaboration with the Sapienza University of Rome (Italy), the University of Central Lancashire (UCLan, GB), and the University of Nottingham (GB) to collect data in GB in November 2022.

All of the hereby included criteria needed to be met by study participants in order to be enrolled in the survey.

Inclusion criteria:

1. Participants who were qualified in Italy as pharmacists (i.e., obtained an Italian degree in either pharmacy or CTF) before moving to GB;
2. Participants registered in GB GPhC as pharmacists;
3. Participants who had experience in GB as a pharmacy assistant/trainee, pharmacy technician or pharmacist;

Exclusion criteria:

1. Participants who could not access the internet to complete the survey;
2. Participants who did not provide informed consent or chose to withdraw from the study at any time.

As for the choice of including within the inclusion criteria participants who had experience in GB as a pharmacy assistant/trainee, pharmacy technician, or pharmacist, given the different clinical contexts between the Italian and GB pharmacy curricula and the inherently different roles as pharmacists between the two countries, we assumed that many Italian pharmacists start working in these roles in the UK. Including this criterion (and item) in the survey allows us to explore the hypothesis that Italian pharmacists would possibly encounter skill barriers that do not allow them to find a job directly as pharmacists in GB. They may instead gradually become confident and accumulate experience and knowledge of the actual pharmacy roles in GB by first working in shadowing positions or with less clinical roles, such as pharmacy technicians.

The development of the survey was carried out in two phases. In the first phase, the research team created the first version of the survey, which was pilot tested on a small sample of Italian pharmacy practitioners and members of the Italian Society of Clinical Pharmacy (SIFAC) (n = 6) to assess face and content validity. Based on their feedback (on comprehensibility, clarity, length, and coherence of the questions), the research team adapted the survey. A final questionnaire can be found in Suppl. material 1. The practitioners involved in the pilot test did not participate in the survey.

The survey was designed and conducted on Google Forms. To ensure data integrity, Google Forms was configured to allow only one response per account, preventing participants from submitting multiple entries.

The study examined opinions, experiences, and attitudes of qualified Italian pharmacists’ regarding their previous Italian experiences as pharmacists, their perception of advantages and disadvantages of the pharmacy curriculum, and potential clinical skill gaps after their transfer to a more clinically oriented work setting (GB).

Participants were asked to complete an online survey (please refer to Suppl. material 1 for further details) divided into five sections. The survey commenced with collecting general demographic and professional data to establish a baseline understanding of the participant cohort (Section A). We then explored the professional experiences within Italy to gauge the initial training and working conditions they encountered (Section B). The next part addressed the motivations behind their decision to relocate to GB (Section C). Section D was dedicated to evaluating the Italian pharmacy curriculum; it was split into two subsections where participants discussed which disciplines need to be enhanced (D1) and which could be scaled back (D2). Lastly, the survey focused on the practical aspects of transitioning to the pharmacy sector in GB. This final section (Section E) was further divided into three subsections: the relevance of various disciplines to their new working environment (E1), the process of registration and the dynamics of employment and career progression (E2), and the specific skills deemed essential for successful practice in GB (E3).

The following participant characteristics were collected: age range, sex, degree, final mark, whether pharmacy/CTF was their first choice as a degree, other degrees achieved before moving to GB, previous work experience in Italy before moving to GB, and years of experience in Italy as a pharmacist (Table 2). Five point-Likert-type items (ranging from ‘strongly agree’ to ‘strongly disagree’) were used to investigate participants’ agreement with statements included in sections B to E.

A convenience (non-random) sample was chosen. A sample power calculation was not performed because it was an exploratory and hypothesis-generating study (Jackson et al. 2021).

The invitation to participate in the online survey was disseminated via LinkedIn and Facebook to leverage the strengths of both platforms in reaching our desired audience. On LinkedIn, the invite targeted specific professional groups relevant to our research questions, capitalising on the platform’s ability to reach a professional demographic, as demonstrated by Stokes et al. (2019) and Kozlowski et al. (2021) (Stokes et al. 2019; Kozłowski et al. 2021). On Facebook, the recruitment strategy was designed to complement LinkedIn by reaching a broader demographic, thus enhancing the diversity and representativeness of our participant pool, in line with the findings by Stuart and Moore (2021) (Stuart and Moore 2021).

Each invite included a cover letter and a participant information sheet. The cover letter detailed the study’s purpose, its potential impact, and provided assurances of anonymity and confidentiality to address potential ethical concerns, in accordance with the ethical standards discussed by Gelinas et al. (2017) (Gelinas et al. 2017). The participant information sheet elaborated on the study’s scope, the voluntary nature of participation, the estimated time commitment, and included detailed contact information for the research team for any queries or concerns. Only respondents who agreed with participation on an electronic consent form (please refer to Suppl. material 1 for details) were then directed to the rest of the web questionnaire.

This recruitment strategy was designed to maximise the coverage of the sample population while ensuring ethical standards were upheld, addressing both the opportunities and limitations of using social media platforms for research recruitment. By employing a dual-platform approach, we aimed to mitigate the potential biases of each platform and enhance the overall efficacy of the recruitment process, aligning with the recruitment best practices and challenges discussed in the literature by Stokes et al. (2019), Kozlowski et al. (2021), and Stuart and Moore (2021) (Stokes et al. 2019; Kozłowski et al. 2021; Stuart and Moore 2021).

Respondents provided their informed consent by participating in the anonymous questionnaire.

Data analysis was conducted using different approaches, each providing a different insight into the data and results. For the analysis of participant characteristics, we employed basic descriptive statistics: the Likert-type and categorical items were presented as frequencies and percentages.

The data were downloaded in Excel and .csv formats, managed, and analysed using R software version 4.2.1 (2022-06-23) and IBM SPSS Statistics version 28.

Table 2 presents the characteristics of the study participants. The age range of 41–50 was the most represented, while participants over 50 were the least represented. The survey sample consisted of predominantly female participants, with over two-thirds holding a pharmacy degree and one-third a CTF degree. Participants were categorised into three distinct regions based on the university from which they obtained their degrees. The South, including Sicily, was the most represented, while the Centre, including Sardinia, was the least represented. Over 40% of participants received lower final marks (66–90), based on the Italian university grading system for degrees (European Commission, Directorate-General for Education, Youth, Sport, and Culture 2015), while 27.8% achieved the highest possible marks. Pharmacy was the first choice for 68.5% of participants, and 61% possessed no other degrees. Furthermore, almost 80% of participants worked in Italy before relocating to GB.

20% (n = 11) of the participants had no prior working experience in Italy before migrating to GB. As shown in Fig. 3, more than 50% of respondents chose strongly to disagree (23.3%) or disagree (39.5%) when asked about the adequacy of the Italian MPharm education in preparing them for their profession in Italy. Furthermore, 44.2% of respondents strongly disagreed with regard to recommending pharmacy/CTF studies in Italy to other students, and the majority of participants expressed their dissatisfaction with their Italian experience as pharmacists, choosing responses indicating strong disagreement (48.8%) or disagreement (20.9%).

Figure 3. 

Experiences and views.

In reference to Section C of the survey (Fig. 4), the survey findings revealed that the primary driving force behind the decision to move to GB was not the purported lack of job opportunities in Italy, with 24.1% of respondents in disagreement and 44.4% expressing neutrality on the matter. Instead, the results indicated that participants were motivated by the perceived absence of opportunities for professional growth in Italy, with 83.3% of respondents strongly agreeing and 16.7% agreeing. Additionally, respondents felt that Italian salaries were not commensurate with their actual duties, with 79.6% strongly agreeing. Respondents also expressed a desire to deepen their knowledge of clinical aspects of pharmacy in GB, with 68.5% strongly agreeing and 24.1% agreeing.

Figure 4. 

Motivations for moving to GB.

One of the strengths of our article is its focus on a novel and underexplored topic: the education and experiences of Italian pharmacists who have relocated to GB for work. Additionally, our study revealed significant distinctions between the Italian and GB pharmacy curricula and the impact they have on the professional experiences of Italian pharmacists in GB. These findings provide insights for pharmacy education and practice, highlighting the need for re-evaluation and strengthening of the current curriculum. Overall, our article significantly enhances the understanding of the experiences of Italian pharmacists practicing in GB and identifies key areas for further research and development of the Italian pharmacy curriculum. It potentially sets a course for Italian stakeholders—including the government, the National Conference of University Deans (NCUD), and MUR—to update the existing curriculum. This revision would align the competencies of Italian pharmacists with the clinical core competencies prevalent in more advanced pharmacy systems, such as those in the United States and Great Britain.

Although this study is the first of its kind to focus on a cohort of Italian-qualified pharmacists and has important research objectives, certain limitations should be acknowledged. Convenience sampling was utilised due to constraints such as limited access to a broader population of Italian pharmacists, resource limitations, and the need for timely data collection. The study’s sample size could have been larger to enhance the reliability of the results and enable more robust inferences about the potential factors influencing perceived challenges in a clinically oriented pharmacy setting, as is currently the case in GB. Therefore, the results should be interpreted with caution, as the representativeness of the sample to the wider Italian pharmacist population may be limited. Furthermore, our survey aimed to reach as many Italian-qualified pharmacists as possible using an online system, but we cannot be sure that everyone received the survey. In the interest of improving external validity, future research should consider recruiting a larger sample of participants to conduct, for example, a confirmatory factor analysis to ensure robust consistency of the results and broader generalisability of the study’s findings.