Pharmacists and Ramadan: From education to practice - A mixed methods systematic review

As the global Muslim population continues to grow, many patients choose to fast during Ramadan despite religious exemptions, often modifying their medication regimens without professional supervision, thereby increasing the risk of adverse clinical outcomes. Although pharmacists are well-positioned to support informed and safe fasting practices, no comprehensive review has synthesized the evidence on their knowledge, training, attitudes, education, and clinical interventions in the context of Ramadan. This review addresses this gap.

This mixed-methods systematic review drew on searches of bibliographic tools (Web of Science, PubMed) to identify empirical studies published through April 2026 that examined pharmacists' or pharmacy students' knowledge, behaviors, or interventions related to Ramadan fasting. Eligible studies were independently screened, extracted, and appraised using the Mixed Methods Appraisal Tool, with data synthesized and integrated according to study design, targeted health conditions, country, sample characteristics, intervention types, outcome measures, and key findings.

Twenty-three studies (26 manuscripts) met eligibility criteria, comprising eight surveys, six qualitative studies, one mixed-methods descriptive study, five patient-focused interventions, and three pharmacy student-focused competency educational modules. Of the 23 studies, 16 (70%) originated from Muslim-majority countries, and of the 26 manuscripts, 18 (69%) focused solely on diabetes, with the remaining eight being non-disease specific. Interventions consistently reported positive patient outcomes, yet surveys revealed inconsistent pharmacist knowledge regarding guidelines on patient care during Ramadan. Qualitative analysis highlighted significant barriers to effective care, primarily knowledge gaps and organizational constraints. Specifically, a lack of specialized training-compounded by high workloads and time limitations-frequently shifted clinical practice from proactive to reactive counseling.

While pharmacist-led interventions are highly effective in improving diabetes outcomes during Ramadan, their real-world application is hindered by significant systemic and educational gaps. To improve the quality of culturally sensitive care, it is essential to empower pharmacists to provide proactive, evidence-based support.