The qualitative phase was conducted first to help develop the survey items (exploratory mixed method). For example, the findings from the qualitative phase helped in the development of the survey items related to identifying potential reasons and suggested solutions for the problem of S/F medications. The interviewees were safety/regulatory agents from international pharmaceutical companies or scientific bureaus.

The interview was semi-structured with open-ended questions. The interview guide was made up of three sections and included 16 questions in total. The first section included participant characteristics (job title, experience years, profession), perceptions about the reasons for S/F, and participant/company experience with S/F medications. This section also asked about how community pharmacists identified S/F medications and the negative impact of S/F medications on registered medicine companies and patients. The second section included questions about participant perceptions of the effectiveness of the MOH, the IqPhvc, and the SIP in preventing S/F medications. Finally, section three included questions about what policy and decision makers can do to minimize the distribution and use of S/F medications.

Contact information for representatives of international pharmaceutical companies was obtained from the IqPhvc. Purposeful sampling was used to select participants from companies who had reported S/F medications to the IqPhvc within the last 4 years.

The researchers conducted interviews with a maximally diverse set of interviewees from stakeholders in areas of pharmaceutical regulations and S/F medications. Interviewees were invited via phone and provided verbal consent before the interviews were conducted and recorded. The seven interviews and the focus group were conducted via the Zoom meeting platform because of the coronavirus disease 2019 (COVID-19) pandemic. The interviews lasted for about 60 min each, whereas the focus group took 2 h. The interviews continued until saturation of the information was reached. The interviews were conducted in English by one researcher (AA, an expert in Social and Administrative Pharmacy), and a second researcher (MZ, a graduate student) acted as notetaker. The interviews were recorded and the recordings transcribed.

The qualitative data were generated from the seven semi-structured interviews and one focus group. The interview records were transcribed and the transcriptions cross-checked by the research team. The names of the interviewees and their companies were deidentified to maintain participant confidentiality. During the qualitative analysis stage, the research team identified and developed themes from the participants’ answers. The analysis followed the six phases of thematic analysis described by Braun and Clarke: familiarizing with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and displaying the findings [11].

Inductive analytic methodology (data driven) was used, and a constructivist paradigm was followed for the qualitative phase. This means we did not rely on a previous framework to generate themes but constructed the themes from the common trends emerging from the participants’ responses. The data item was each sentence of the participants’ answers. Finally, to enhance the credibility and trustworthiness of the findings, peer-checking/debriefing was performed twice to validate the qualitative analysis.

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