ISSN 2806-5638

South American Research Journal, 6(1), 5-13

https://www.sa-rj.net/index.php/sarj/article/view/100

https://doi.org/10.5281/zenodo.20739635 5

Evaluation of a teaching manual for

the dispensing of over-the-counter

medicines

Evaluación de un manual didáctico para

dispensación de medicamentos de venta libre

Tatiana Paola Idrobo Bermeo

, Lizbeth Rocío Calle

Allaico

, Yessi Carla Guadalupe Espinoza

Instituto Superior Tecnológico San Gabriel,

Riobamba, Ecuador

Email: t_idrobo@sangabrielriobamba.edu.ec

Received: April 13, 2026 - Accepted: June 3, 2026 -

Published: June 6, 2026.

ABSTRACT

The study evaluated a didactic manual for the dis-

pensing of over-the-counter medicines, focused

on improving the competencies of pharmacy per-

sonnel without professional training. The starting

point was the problem of inappropriate medicine

use, associated with self-medication, absence of

guidance during dispensing and lack of staff train-

ing. The objective was to design and evaluate a di-

dactic manual to improve knowledge and dispens-

ing practices for over-the-counter medicines in

community pharmacies. The methodology in-

cluded the participation of 20 pharmacies and was

developed in three phases: an initial survey to

measure knowledge, the implementation of a man-

ual with didactic strategies and a final evaluation

after one month of application. Data were ana-

lyzed using descriptive statistics. After the appli-

cation of the tool, significant improvements were

observed in knowledge, understanding of dispens-

ing and delivery of indications, especially non-

pharmacological recommendations. However,

limitations persisted in the communication of ad-

verse effects due to the lack of pharmacology

knowledge. The didactic manual is a useful tool

for improving dispensing, but its effectiveness de-

pends on strengthening pharmacology knowledge.

The importance of continuous training for phar-

macy staff to ensure the safe and appropriate use

of medicines is also highlighted.

Keywords: manual, OTC, over-the-counter, dis-

pensing, community pharmacy

RESUMEN

El estudio evaluó un manual didáctico para la dis-

pensación de medicamentos de venta libre, enfo-

cado en mejorar las competencias del personal de

farmacia sin formación profesional. Se partió del

problema del uso inadecuado de medicamentos,

asociado a la automedicación, ausencia de indica-

ciones en la dispensación y falta de capacitación

del personal. El objetivo fue diseñar y evaluar un

manual didáctico que permita mejorar el conoci-

miento y las prácticas de dispensación de medica-

mentos de venta libre en farmacias comunitarias.

La metodología incluyó la participación de 20 far-

macias y se desarrolló en tres fases: una encuesta

inicial para medir conocimientos, la implementa-

ción de un manual con estrategias didácticas y una

evaluación final después de un mes de aplicación.

El análisis de los datos se realizó mediante esta-

dística descriptiva. En los resultados posteriores a

la aplicación de la herramienta, se observaron me-

joras significativas en el conocimiento, la com-

prensión de la dispensación y la entrega de indica-

ciones, especialmente en recomendaciones no far-

macológicas. Sin embargo, persistieron limitacio-

nes en la comunicación de efectos adversos debido

a la falta de conocimientos en farmacología. Se se-

ñala que el manual didáctico es una herramienta

útil para mejorar la dispensación, pero su efectivi-

dad depende del fortalecimiento de conocimientos

en farmacología. También se resalta la importan-

cia de la formación continua del personal de far-

macia para garantizar un uso seguro y adecuado

de los medicamentos.

Palabras clave: manual, OTC, venta libre, dis-

pensación, farmacia comunitaria

INTRODUCTION

Unlike other consumer products, medicines

are directly related to health (Aguzzi and Virga,

2009); however, the population does not always

understand that they are substances foreign to the

body, that they involve risks and that they should

be used with the guidance of a trained professional

(Heineck et al., 1998). On the other hand, access

to medicines is an indicator of a country's standard

of living, since it reflects the efficiency and

strength of a health system. In Ecuador, although

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https://doi.org/10.5281/zenodo.20739635 6

the process of medicine supply has improved,

there is no systematic control of dispensing, which

affects their appropriate use (Ortiz et al., 2014).

This leads to an increase in irresponsible medicine

consumption, the addition or removal of drugs in

pharmacological treatment, or the erroneous con-

sumption of drugs. In addition, problems of self-

medication or misuse of pharmacological treat-

ments occur because patients obtain their medica-

tion from non-medical sources, such as recom-

mendations from neighbors, relatives, or phar-

macy personnel who are not trained. In Ecuador,

formal pharmacy studies are not mandatory to

work in a pharmaceutical establishment, a situa-

tion that has been associated with the inappropri-

ate use of medicines. These antecedents make it

possible to identify where attention should be pri-

oritized to mitigate the problem, since continuous

training of professionals and pharmacy personnel

is important for better health management (Luiza

et al., 2019).

Among the most frequent reasons for self-

medication are pain, particularly headache, flu and

nasal congestion, abdominal pain and muscle

pain. According to previous studies, in 1 out of

every 3 cases, no prescription is required to sell a

medicine; therefore, medicine consumption goes

beyond over-the-counter products (Martínez et al.,

2013). Solano et al. (2017), in their study on over-

the-counter medicines, mention that the National

Poison Control Center reports paracetamol as the

medicine that causes the highest number of intox-

ications in Costa Rica, followed by combined flu

medicines.

Within the professional field and medicine

management, the dispensing of medicines and

health products is the basic professional activity

of pharmacy personnel and concentrates the great-

est number of actions in community service. It is

oriented toward ensuring that patients receive and

use their pharmacological treatments according to

their clinical needs and at the appropriate time

(Barreiro et al., 2021). Currently, changes are tak-

ing place in health disciplines, which have had an

impact on competency training, including skills

and techniques based on experience and clinical

practice, especially in people related or close to

the pharmaceutical field. According to the World

Health Organization (WHO) and the International

Pharmaceutical Federation (FIP), the role of the

pharmacist is to participate in improving health

through patient education and guidance for better

use of medicines and pharmaceutical products

(Garcés, 2024). Therefore, the mission of phar-

macy personnel is to support health improvement

in general and help patients make the best use of

medicines. Their objectives include identifying,

managing or detecting health problems, ensuring

the efficacy of medicines, preventing harm caused

by medicines, and making responsible use of re-

sources in pharmaceutical care (Baixauli et al.,

2013); these activities require continuous training

of professional competencies, maintaining up-

dated skills and experiences (FIP/OMS, 2012),

which allow the provision of professional care ser-

vices.

Training is understood as a way of operation-

alizing the training skills of a company's human

talent, through education related to areas that ben-

efit job performance (Rojas and Paniagua, 2013).

In the case of the pharmacy office, constant train-

ing and practice are required to meet institutional

objectives. Although evidence suggests that ac-

quiring knowledge about a topic does not guaran-

tee better performance, performance is supported

by the application of acquired knowledge, compe-

tencies and experiences. An updated professional

practice strengthens quality of care and patient

protection (Guerra, 2025).

Training in the health area is a strategy that

generates tools to reduce the irrational use of med-

icines. Health education actions have been shown

to be beneficial in school contexts and in commu-

nities related to health activities (Nagem et al.,

2020). In general, courses and regulations related

to health are taught by people who master the field

but lack strategies to transmit knowledge effi-

ciently, comprehensibly and constructively (Hi-

dalgo et al., 2017). By contrast, more pleasant and

engaging representations suggest better learning

than traditional texts or regulations, since they are

retained for longer periods and constitute a more

accurate, memorable and pleasant medium (Ne-

grete, 2002).

Fernández (2024) states that there are several

antecedents that show a deficit in the training of

pharmacy assistants, the presence of dispensing

errors, non-compliance with good pharmacy prac-

tices and the lack of follow-up of steps in the dis-

pensing process. In addition, knowledge about

dispensing processes was poorly known by phar-

macy staff.

The importance of manuals lies in the fact that

they explain procedures in detail. Through the use

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of this method, errors can be avoided, failures can

be detected and new personnel can be guided

when they enter the institution (Estrada, 2018).

This study presents a study and training tool

on the correct way to dispense over-the-counter

medicines in community pharmacies. This tool is

aimed at personnel who do not have formal studies

and seeks to identify the level of learning and im-

provements in dispensing activities through its

use.

METODOLOGÍA

A quantitative study with a one-group pretest-

posttest design was conducted, taking care of the

methodological quality of the applied measures as

recommended by Vera-Quiñonez et al. (2025).

The user guide on good practices for receiv-

ing, storing and dispensing medicines in pharma-

cies and first-aid medicine cabinets, issued by

ARCSA in 2015, and the pharmaceutical care

manual for pharmacies in the comprehensive pub-

lic health network, complementary private net-

work and private pharmacies, delivered by the

Ministry of Public Health in 2021, were used as

references.

A total of 20 independent pharmacies in the

city of Riobamba were considered. These pharma-

cies had a current operating permit and personnel

with more than 1 year of experience as pharmacy

assistants, who did not have third-level studies re-

lated to the pharmaceutical area. The selection of

the 20 pharmacies was non-probabilistic and

based on acceptance of participation in the re-

search; therefore, the sample is not representative

of the population.

The creation of an exclusive didactic manual

was proposed to present the correct dispensing of

over-the-counter medicines, aimed at pharmacy

personnel in a didactic manner, emphasizing key

points and the types of patients who may be at-

tended.

A data collection tool was developed and used

before and after the application of the manual in

the pharmacies. It consisted of 3 parts: the first

was an open-ended question on the definition of

dispensing. For the analysis, keywords such as

'delivery of information', 'prescription validation',

'informing' and 'providing pharmaceutical care'

were established, and responses containing these

elements were considered correct. In addition, a

second question was included about knowledge of

the pharmaceutical care manual, with an affirma-

tive or negative response.

In the second part of the tool, 3 questions were

included about the dispensing of medicines for a

mild condition that could be treated without a pre-

scription. The first question sought to determine

whether indications on the correct use of medi-

cines were provided, such as dose, frequency and

treatment duration; the second, whether possible

effects of the medicines or warnings were indi-

cated; and the last, whether non-pharmacological

recommendations aimed at improving general

health were provided. Each question corresponded

to 1 point, and a maximum score of 3 was consid-

ered a complete dispensing process.

For the last part of the form, participants were

asked to identify banal symptoms from a list of 10

options. For tabulation, 1 point was assigned for

each correct answer: chest pain 'no', headache

'yes', muscle pain 'yes', high fever 'no', abdominal

stabbing pain 'no', stomach discomfort 'yes', cough

'yes', nasal congestion 'yes', respiratory allergy 'no'

and swelling of the extremities 'no', for a total of

10 points.

Different study techniques were combined for

the preparation of the manual. Initially, theory was

presented through readings about pharmacy and

first-aid medicine cabinet regulations, as well as

excerpts from the dispensing manual where over-

the-counter medicine dispensing is mentioned.

This type of training helps transmit a unified mes-

sage.

The second part corresponded to programmed

instruction. The researchers interpreted the read-

ings together with the beneficiaries, practical ex-

amples were used, doubts were resolved and the

topics were explored in greater depth.

The third part involved exercises, correspond-

ing to training with simulators; that is, the work-

place or a specific experience was simulated in or-

der to put the manual into practice.

Throughout the manual, simple, practical and

graphic language was used for faster identification

of the topic. In the end, a 20 page document was

prepared with theory and practical cases for the

correct dispensing of over-the-counter medicines.

The document was given to each pharmacy

assistant, and, through general training, each part

was analyzed so that it could be applied in each

pharmacy. After 1 month, the questionnaire was

applied again to the participating personnel, and

open-ended questions about the experience and

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usefulness of the manual were added (see the in-

strument in the Appendix).

The results were tabulated according to the

scores assigned to each part and analyzed using

SPSS version 25. Inferential analysis was applied.

RESULTADOS

In the preliminary data collection before the

application of the manual, it was observed that

60% of the participants stated that they did not

know the national dispensing manual. Confusion

was also identified between this document; the

good practices guide and other regulatory pharma-

ceutical documents. For the question about the

definition or what was understood by dispensing,

the aforementioned keywords were used as refer-

ence; 70% of the people considered that pharma-

ceutical dispensing only meant selling or deliver-

ing the requested medicine, which was considered

an incorrect answer.

Figure 1

Knowledge of the medicine dispensing manual

Source: Own authorship, figure created in SPSS 25

In the subsequent analysis of the same ques-

tions, it was observed that 90% identified the phar-

maceutical care manual. The remaining group

mentioned that they still did not recognize the doc-

ument and showed a lack of interest in searching

for it or in learning. The definition of dispensing

was clearer: 80% of participants correctly defined

dispensing in their own words. In the remaining

percentage, doubts still existed, since they in-

cluded the act of selling or quickly dispatching the

customer. This response occurred because phar-

macy assistants understood that their main func-

tion was to sell more products and promote the es-

tablishment.

For the second part of the tool, participants

were asked to indicate how they would dispense

medicines for a condition in which over-the-coun-

ter medicines could be supplied. In the initial sur-

vey, seasonal flu was used as an example and, in

the subsequent survey, cough was used. This

change in conditions was made in order to obtain

more reliable responses. The question was evalu-

ated by assigning one point to each response: one

point was considered for the delivery of indica-

tions such as dose, frequency and treatment dura-

tion; another point for the delivery of possible ef-

fects of the medication or interactions; and an-

other for the delivery of non-pharmacological rec-

ommendations, with a maximum score of 3.

The written responses showed that, for recom-

mendations related to seasonal flu, only 50% of

the participants provided indications about the

correct use of medicines, 25% provided warnings

about the drowsiness they could cause, and no one

gave non-pharmacological recommendations as

indicated in the dispensing manual. Meanwhile,

the percentage data after the training sessions and

delivery of the manual indicated that 75% of phar-

macy assistants did take into account the dosage

and indications on how to take the medicine cor-

rectly, considering that the condition presented

was simple non-infectious productive cough. In

addition, 75% presented positive responses re-

garding warnings that can be provided for misuse

or storage of medicines, and 100% indicated non-

pharmacological recommendations.

To determine whether there were differences

between the indications provided by pharmacy as-

sistants when dispensing over-the-counter medi-

cines for a given condition, Student's t-test for de-

pendent samples was applied. The results show

that there were differences in the number of indi-

cations delivered to patients during dispensing,

t(19) = -9.658, p = 0.023; 95% CI [-2.190; -1.410].

The fundamental part of the study was the

identification of symptoms considered banal and

suitable for dispensing without a medical prescrip-

tion. The list of 10 symptoms included the most

representative symptoms in pharmacy practice

and those that could generate confusion when dis-

pensing. Each correct identification corresponded

to 1 point, with 10 as the total score.

The Kolmogorov-Smirnov analysis deter-

mined the absence of normality in the data, as well

as in their differences. Subsequently, the Wil-

coxon related-samples comparison test, with a

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95% significance level, showed that there was an

increase in the recognition of banal symptoms af-

ter the introduction of training sessions and the de-

signed over-the-counter medicine dispensing

manual.

By generating a graph of group relationships

before and after the application of the tool and

training sessions, the count of each of the symp-

toms considered was evidenced, which made it

possible to observe differences in the results.

Chest pain decreased from 6 affirmative responses

to only 1; fever went from 14 to 6 responses; ab-

dominal stabbing pain went from 16 responses

considering it a banal symptom to 4 after the ap-

plication of the manual; respiratory allergy de-

creased from 15 to 8; and swelling of the extrem-

ities went from 16 to 6 responses considering it a

banal symptom.

Figure 2

Count of results for identifying symptom banality

Source: Own authorship, figure created in SPSS 25

Tabla 1

Análisis McNemar para la identificación de banalidad de cada síntoma

Pre

Post

p value

Min.

Max.

Mean

St. Dev.

Min.

Max.

Mean

St. Dev.

Chest pain

0.30

0.47

0.05

0.22

0.125

Headache

1.00

0.00

1.00

0.00

N/A

Muscle pain

1.00

0.00

1.00

0.00

N/A

High fever

0.70

0.47

0.30

0.47

0.039*

Abdominal stabbing

pain

0.80

0.41

0.20

0.41

0.000*

Stomach discomfort

0.90

0.31

1.00

0.00

0.500

Cough

1.00

0.00

1.00

0.00

N/A

Nasal congestion

1.00

0.00

1.00

0.00

N/A

Respiratory allergy

0.75

0.44

0.40

0.50

0.092

Swelling of extremities

0.80

0.41

0.30

0.47

0.002*

Sum

8.25

0.79

6.25

0.97

<,001*

Note. The p value for each symptom was calculated with the exact McNemar test, while the Sum was analyzed using the Wilcoxon

signed-rank test. The * marks significant values. N/A indicates that McNemar could not be calculated because all values were

Source: Own authorship, calculations performed in SPSS 25

Because the tool was created to evaluate this

specific case, it has not been validated in a unidi-

mensional or multidimensional way, since the

items themselves were of direct interest. There-

fore, changes between the responses for each

symptom before and after the application of the

manual were statistically analyzed.

The analysis was performed using the

McNemar test. For headache, muscle pain, cough

and nasal congestion, it was not possible to

calculate the p value, since all values were 1. The

data are shown in Table 1 and indicate significant

changes in high fever, abdominal stabbing pain and

swelling of extremities. No significant changes

were observed in chest pain, stomach discomfort

and respiratory allergy.

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DISCUSSION

The application of the manual, together with

training sessions and didactic exercises, allowed

participants to intervene actively, strengthening

their knowledge of dispensing. According to

Sáenz and Púas (2018), one characteristic of ac-

tive methodologies is their capacity to promote

skills in students that allow them to judge the com-

plexity of the situation they must solve. Through

learning modalities with simulations and applied

practices, students are not spectators but become

protagonists of clinical situations designed from

everyday life, represented with a pedagogical in-

tention, to learn from experience and from error as

a source of learning (Calixto, 2025).

Indirectly, a lack of knowledge about the

medicines to be dispensed was evidenced, show-

ing that training in pharmacology does influence

the level of care provided. This agrees with Castro

and Molineros (2018), who indicate that the edu-

cational level of drugstore sellers decisively influ-

ences whether they recommend medicine uses to

users.

The tool had a positive effect on the level of

knowledge of pharmacy assistants. Although they

are people without previous formal preparation,

work experience allows them to understand the

importance of dispensing and to put care protocols

into practice in a better way. The application of

dispensing activities facilitates the integration of

knowledge, developing skills typical of the com-

munity pharmacist and allowing empowerment,

since it helps develop confidence in their own ca-

pacities and actions (Martin, 2018). This is also

related to Pérez (2022), who states that the ser-

vices performed in community pharmacy should

be communicated correctly, so that the population

becomes aware that, in addition to dispensing the

medicine, pharmacy personnel can help make it

effective and safe, determining the valuable role

of pharmacy staff.

One of the important changes identified was

the delivery of non-pharmacological recommen-

dations, in relation to what Gavilán (2017) states

in his study: the lack of pharmaceutical care

makes the customer live a less positive experi-

ence. Customer experiences are what pharmacy

services seek to guide, highlighting the active role

of those responsible for the service. In addition,

customers value humane treatment and recognize

the need to incorporate tools that optimize care

(Ríos and Villamagua, 2026).

The application of workshops within the man-

ual, where participants could make decisions,

identify patients, relate symptoms and follow pro-

tocol steps, gave prominence to the assistants.

This methodology agrees with Calixto (2025),

who indicates that simulated environments allow

participants to experiment, make mistakes, correct

them and try again, which strengthens autonomy

and ethics.

At the end of the training process and after

putting into practice what was indicated in the

manual, not only better knowledge of dispensing

was evidenced, but also an improvement in the

quality of services delivered, in agreement with

Miró's study (2002). In the training of personnel

dedicated to pharmacy, elements such as profes-

sional attitudes and consultations must be taken

into account, as well as decision-making skills,

awareness and social responsibility.

The importance of constant training is high-

lighted, starting with the dispensing of over-the-

counter medicines, a simple step but one of great

importance for providing pharmaceutical care and

building patient loyalty. The pharmaceutical field

is constantly evolving, with new medicines, tech-

nologies and regulations emerging; therefore, it is

crucial to remain updated through participation in

continuing education courses (Ruiz, 2024).

CONCLUSIONS

The results show that the didactic manual, ac-

companied by training, contributed to improving

knowledge about the dispensing of over-the-counter

medicines and the delivery of indications to patients.

The improvement was more visible in non-pharma-

cological recommendations and in the identification

of symptoms that should not be managed solely

through over-the-counter sales.

In a context in which formal training is not re-

quired for all pharmacy assistants, this type of tool

is necessary to guide minimum dispensing practices

and reduce errors associated with the inappropriate

use of medicines. Nevertheless, its scope depends on

continuous training processes and workplace fol-

low-up. The main limitation identified was the lack

of pharmacology knowledge, especially for com-

municating adverse effects, warnings and precau-

tions during medicine use. Therefore, the manual

should be understood as an initial didactic support,

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https://doi.org/10.5281/zenodo.20739635                                                                                                   11 
not as a substitute for technical training, and it needs 
to be complemented with specific modules on ap-
plied pharmacology and pharmaceutical care. 
 
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AI USE STATEMENT 
The authors declare that they did not use generative 
AI in the preparation of this article. 

ISSN 2806-5638

South American Research Journal, 6(1)

https://sa-rj.net/index.php/sarj/article/view/100

https://doi.org/10.5281/zenodo.20739635 13

APPENDIX

Applied instrument