Pharmacy robberies and occupational safety risks: A national cross-sectional study of community pharmacies

TL;DR

This study explores robbery risks in Jordanian community pharmacies and identifies factors that increase the likelihood of such incidents.

Contribution

The study provides the first robust investigation of pharmacy robbery risk in Jordan and the Middle East, identifying novel correlates of robbery exposure.

Findings

Robbery exposure was reported by 4.3% of pharmacists and was more common among men and those over 30 years old.

Pharmacy-level risk factors like late opening, single staffing, dispensing narcotics, and lack of surveillance cameras were frequently endorsed.

Abstract

Community pharmacies face substantial exposure to workplace violence. However, pharmacy robberies remain critically under-studied. No robust investigation has examined robbery risk in community pharmacies in Jordan or the broader Middle East region, representing a significant research gap.

To quantify robbery exposure in community pharmacies, identify perceived pharmacy-level risk factors for robbery, and compare risk perceptions between pharmacists with and without robbery exposure.

Analytical cross-sectional survey. A self-administered questionnaire with demonstrated content validity (CVR ≥ 0.74) and internal consistency (Cronbach's α > 0.70) was used. Data from 975 respondents were analyzed using chi-square tests with Cramer's V and multivariable logistic regression; ethical approval was obtained from the institutional review board.

Robbery exposure was reported by 4.3% of respondents and was significantly more frequent among men and pharmacists aged >30 years (p < 0.01). The most frequently endorsed pharmacy-level robbery risk factors were late opening (81.2%), single staffing (77.3%), dispensing narcotics (77.2%) and absence of surveillance cameras (72.6%). In adjusted analyses, agreement that robbery risk depends primarily on offender-related personal factors (OR 6.28, 95% CI 2.48–15.90) and prior experience with aggressive customers (OR 3.11, 95% CI 1.25–7.76) emerged as the strongest independent correlates of robbery exposure. Encounters with customers perceived as dangerous (72.1%) or aggressive (68.0%) were also common.

Robberies, alongside widespread dangerous and aggressive customer behavior, pose meaningful risks in community pharmacies. Differences between pharmacists exposed and not exposed to robbery in how they evaluated pharmacy-level robbery risk factors, together with the strong influence of offender- and behavior-related factors on robbery exposure underscoring the need for evidence-informed security policies, minimum staffing standards, and training to recognize and manage high-risk customer interactions.

Full text

Introduction

1

Pharmacy practice in retail community settings is increasingly recognized as a site of occupational violence1., 2., 3 and workplace aggression, with pharmacists exposed to both external aggression and criminal threats, including robbery and burglary,1,2.4., 5., 6 These risks underscore the precarious position of pharmacists within the broader healthcare system In addition to these external threats, pharmacies also contend with underreported internal vulnerabilities, such as drug diversion – redirection of medicines from legal supply chains to unauthorized or illegal use - and patient initiated behaviors that compromise safety and integrity,1,2.4., 5., 6, 7.

Several studies have documented high rates of verbal abuse, physical aggression, and other forms of workplace violence directed towards community pharmacy staff,1., 2., 3,5.8 Recent incidents in the United Kingdom further illustrate the risks faced by pharmacy staff.9., 10., 11., 12., 13. Reports indicate a continuing rise in pharmacy-related violence, with tangible consequences for both staff and operations. For instance, in 2025, nearly nine out of ten pharmacies in Ireland reported experiencing criminal incidents, with a substantial proportion subjected to repeated offenses.9 In Scotland, an incident was reported in which a man generated significant “fear or alarm” by shouting and swearing at pharmacy staff after being informed of a prescription delay.13 Evidence from Denmark further illustrates that patient behavior can materially influence safety risks in community pharmacies.14 In Saudi Arabia, pharmacists report substantial workplace violence, with nearly 40% indicating exposure to verbal abuse alone.2 In addition, they frequently encounter inappropriate requests, including customer demands for medicines that do not meet clinical or regulatory criteria.15 In Jordan almost 25% of pharmacists have encountered suspected illegal requests from consumers, this aligns with broader evidence of illicit medicine-seeking behavior in Jordan, where almost one-third of pharmacists reported receiving customer requests to obtain doping agents.16

Within this broader pattern of workplace violence, pharmacy robbery emerges as a distinct, pharmacy-specific security problem that requires focused investigation and targeted efforts,1.6 A recent study from South-East Europe (Croatia, Serbia, Bosnia and Herzegovina, and Montenegro) reported that 26% of community pharmacy staff had experienced at least one robbery during their career, and almost one-third of these (30%) had been exposed to robbery on more than one occasion.1 To address the critical issue of pharmacy robberies and advocate for the addition of a lecture on pharmacy robberies to pharmacy curricula, McFarland and Devine conducted a comprehensive analysis of this phenomenon. Their investigation underscored the scale of robbery incidents; an internet search for “pharmacy robberies 2022 and 2023” returned over 2000 news reports on investigations and arrests involving armed pharmacy robberies in the United States and Canada.6 Complementing this, more than a quarter of pharmacy students reported their workplace had been robbed, which supports a longitudinal data reveal that between 2010 and 2019, the United States recorded more than 7500 robbery incidents.6 In the United Kingdom, as well, recent reports highlight a continuing trend of pharmacy-related crime, with offenders receiving custodial sentences for burglary incidents,11 and others being arrested on suspicion robbery at community pharmacies.10

Across the Middle East, frequent media reports describe pharmacy robberies in Iraq,17 Jordan,18 Lebanon,19 and Egypt.20 However, to the best of our knowledge, no peer-reviewed studies to date provide reliable incidence or prevalence estimates of robbery acts targeting retail community pharmacies in the region. This conclusion is based on a structured literature search of PubMed, Scopus, and Web of Science (January 2000–June 2025) using combinations of terms such as “community pharmacy”, “retail pharmacy”,” community pharmacy”, “robbery”, “crime”, “violence”, “burglary”, and “Middle East”, which did not identify any studies reporting pharmacy-level crime statistics for the region. Although news reports and qualitative evidence, indicate a notable risk, quantitative data remain limited.5

Pharmacy-related threats, despite their clear implications for healthcare and staff safety, remain underexplored dimensions of pharmaceutical practice and pharmacy administration science. This study aimed to investigate pharmacy robbery in Jordanian community pharmacies from the perspective of pharmacists. The specific objectives were to: (1) quantify the self-reported occurrence of exposure to robbery attempts among community pharmacists; (2) assess pharmacists' perceptions of pharmacy-level robbery risk factors that may increase the likelihood of robbery; and (3) compare, between pharmacists exposed and not exposed to robbery attempts, both the proportion endorsing each robbery risk factor and the resulting rank order of these factors.

Method

2

To achieve the objectives of this cross-sectional study, we administered an online survey using a validated and reliable questionnaire.

Setting

2.1

The survey was administered as an online questionnaire and was accessible between 1 September 2023 and 30 September 2024. Recruitment was undertaken using non-probability convenience sampling. The extended data-collection window was maintained to maximize reach across governorates and work shifts and to achieve a robust overall sample, including an adequate number of pharmacists with self-reported robbery exposure to support comparisons by exposure status and multivariable analysis.

The survey link was disseminated via nationwide professional WhatsApp groups and Facebook pages specialized for community pharmacies across Jordan. This strategy leveraged the widespread use of digital professional communication among pharmacy staff and facilitated participation from individuals working in different governorates and across varied work shifts, irrespective of their geographic location or working hours.

Participants

2.2

Inclusion criteria: Pharmacists and pharmacist assistants, Students who had completed the qualification training (1400 training hours at the community pharmacies, final semester pharmacy students).

Exclusion criteria: Cases where two pharmacists worked in the same pharmacy, ensuring that only one response per pharmacy was collected. (Only one response per pharmacy was collected, avoid clustering and over-representing individual workplaces, as we explicitly requested one response per pharmacy in both the invitation message and the questionnaire instructions. To prevent duplicate entries—particularly among robbery-exposed pharmacies—submissions were screened using the respondent phone number (as approved in the ethical protocol), and only one record per pharmacy was considered.

Identification and prioritization of factors were collected without direct personal identifiers in the main questionnaire, and responses were analyzed on a de-identified dataset and reported only in aggregate. For respondents who indicated that their pharmacy had experienced a robbery incident, the final survey page included an optional field to provide a mobile telephone number for verification and potential follow-up. This item was clearly labelled as voluntary, and declining to provide contact details had no effect on survey completion or participation. For robbery-exposed respondents who voluntarily provided a phone number, the process was not fully anonymous at the point of contact collection; however, contact details were stored separately from survey responses and were not linked to the analytic dataset used for factor identification/prioritization analyses.

Any contact information provided was stored in an encrypted file separate from the survey dataset and was accessible only to the principal investigator and one designated research team member, both bound by confidentiality obligations. These details were used exclusively to verify the reported robbery incidents and, where applicable, to facilitate follow-up contact; they will be securely destroyed after completion of follow-up activities in accordance with the approved protocol.

Of the 42 respondents reporting robbery exposure, 33 voluntarily provided contact details and 9 remained anonymous. The designated research team member contacted those who provided a number solely to verify the reported incident(s). Verified cases may be used as a sampling frame for a future qualitative study under a different design, subject to additional ethical approval.

Questionnaire development

2.3

The initial pool of questionnaire items was drafted by the research team, informed by the available literature and their experience in community pharmacy practice. To strengthen content validity, a multidisciplinary expert panel of eight experts was convened, including representatives from academia (n = 2), social sciences (n = 1), security (n = 1), community pharmacies (n = 3; one of whom had been exposed to a robbery attempt), and law (n = 1). Through panel discussions, factors relevant to the assessment of robbery risk were identified and prioritized for evaluation from the pharmacists' perspective. To ensure content validity, only items achieving Lawshe's Content Validity Ratio (CVR) above 0.741 with a significance level of p < 0.05 were retained for analysis.21 A subset of questions was removed from the final instrument, with the intention of being utilized in a separate study focusing on legal and regulatory awareness related to robbery and other forms of pharmacy crimes. A subset of questions was removed from the final instrument because it focused mainly on legal regulations and awareness of rules related to robbery and other pharmacy crimes, which did not align with the core aim of this study. These items are better suited to a separate study specifically designed to assess pharmacists' legal and regulatory awareness rather than their perceptions of robbery risk.

To assess internal reliability, a pilot test of the questionnaire was conducted with 20 community pharmacists. Their responses were used solely for evaluation and instrument refinement and were excluded from the final analytical sample. Internal consistency was confirmed using Cronbach's alpha, with all multi-item scales demonstrating coefficients above 0.70, indicating satisfactory reliability.

The questionnaire was divided into two primary sections. The first part focuses on demographic information such as age, gender, and other relevant variables In the second part of the questionnaire, pharmacists evaluated a series of pharmacy-level characteristics to identify which factors they perceived as increasing robbery risk. The questionnaire covered a range of pharmacy-level robbery risk factors, including location (non-crowded streets, affluent and low-income areas), pharmacist gender, number of staff on duty, pharmacy type (chain vs independent), size and expected income, presence of security cameras, and dispensing of controlled drugs. Additional items assessed beliefs that robberies are more likely in pharmacies that remain open late, are often premeditated and preceded by observation, or can be impulsive and unplanned, and that robbery risk depends primarily on offender-related criminal and personal factors. Finally, respondents were asked whether they had ever been exposed to a robbery incident in a community pharmacy, and whether they had encountered customers displaying dangerous or aggressive behavior outside any robbery incident.

Operational definitions, these operational definitions were first specified in Arabic and then refined and agreed upon by the expert panel comprising, where the low expert was the assigned expert to ensure alignment with Jordanian criminal and pharmacy regulations and community pharmacy practice, while remaining consistent with international descriptions of pharmacy robbery and related terms.

Robbery was defined as the theft or attempted theft of medicines, cash, or other valuables from an open, staffed pharmacy, involving the actual use or explicit threat of force against staff or customers.,4.6 Robbery exposure was defined as self-reported direct experience (i.e., being present/on duty) of ≥1 robbery meeting the above operational definition; respondents were coded as exposed (yes) or not exposed (no) accordingly, using an ever/never recall window for their community-pharmacy work in Jordan. Burglary was defined as unlawful entry into a closed pharmacy premises outside normal opening hours with the intention of stealing medicines, cash, or other property, without direct confrontation with staff,4,12,22.23 In line with international frameworks, workplace violence was understood as any incident in which pharmacy staff are abused, threatened, or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, well-being, or health2; physical violence as the use of physical force that has a high likelihood of causing physical, sexual, or psychological harm (e.g. hitting, slapping, pushing, or throwing objects)1; and verbal violence as threats, insults, shouting, intimidation, humiliation, or other abusive speech directed towards staff.1 Dangerous behavior was defined as actions by a customer that pose an immediate threat to the physical safety of staff, other customers, or property (e.g. explicit threats of violence, brandishing a weapon, severe physical intimidation), other than incidents meeting the operational definition of robbery, while Aggressive behavior was defined as hostile or violent verbal or physical actions by a customer that create a tense, threatening, or unsafe environment (e.g. yelling, verbal threats, aggressive gestures, refusal to follow staff instructions), again excluding incidents classified as robbery,2,5,9,24.25

Sample size calculation

2.4

The required sample size was calculated using the single-proportion formula with a finite population correction, based on an estimated population of 3700 registered community pharmacies in Jordan as of September 2023.26 Assuming a conservative prevalence estimate of 50% (p = 0.50) to maximize variability, a 99% confidence level (Z = 2.576), and a 5% margin of error (e = 0.05), the initial sample size was calculated as N = Z^2^ P (1-p) / e^2^ = 563. Where N = required sample size, Z = Z-score (standard normal value) corresponding to the chosen confidence level, which was 99%, p = assumed prevalence / proportion (here 0.50 for 50%), e = desired margin of error (absolute precision), which was 0.05.

Statistical analysis

2.5

Statistical analyses were conducted using SPSS version 26 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were used to describe the data. Categorical variables were presented as frequencies and percentages. Chi-squared test was used to assess the association between statements and participants with significant level < 0.05. Item-level missing data were minimal; analyses were conducted on complete cases for the primary outcome and key covariates, and no data imputation was performed. To compare the strength of association between variables, Cramer's V was calculated, which would help in ranking the variables based on the strength of association. Moreover, it would provide insight into the strength of association, where value of 1 indicates complete association, “0” indicates no association, >0.25 indicates a very strong relationship, >0.15 indicates a strong relationship, >0.1 indicates a moderate relationship, and > 0.05 indicates a weak relationship.27

Binary logistic regression was conducted to examine the impact of pharmacy- and pharmacist-related factors on the likelihood of robbery exposure (coded 0 = no previous exposure, 1 = exposed robbery incident). A backward stepwise logistic regression approach was employed, starting from a full model in which all candidate predictors were entered at Step 1, including pharmacy location characteristics, pharmacist gender, number of employees, pharmacy type (chain vs independent), pharmacy size and expected income, presence of security cameras/recording systems, dispensing of controlled drugs, and perception/experience constructs related to robbery risk and customer behavior. By initially modelling all variables simultaneously and then sequentially removing non-significant predictors, this backward stepwise procedure helped to control potential confounding between correlated factors and to identify those variables with independent associations with robbery exposure. Model performance was evaluated using overall model significance, explained variance (Nagelkerke R^2^) and goodness-of-fit indices, and after nine steps the procedure yielded a final parsimonious model in which only a restricted set of predictors remained statistically significant.

Results

3

Demographics and robbery attempts

3.1

Table 1 presents the demographic characteristics of the participants and their exposure status to robbery attempts. A total of 975 participants were surveyed, among whom 42 (4.3%) were exposed to robbery attempts. Gender-stratified analysis showed that male pharmacists (7.5%) had a significantly higher prevalence of exposure to robbery attempts than female pharmacists (3.2%) (χ^2^ = 8.277, p = 0.004, Cramer's V = 0.092). Age was significantly associated with exposure to robbery attempts (χ^2^ = 36.980, p < 0.001, Cramer's V = 0.195), with participants older than 30 years reporting the highest prevalence exposure (11.7%) compared to younger groups. Regarding occupation, pharmacists showed a higher percentage of exposure (5.3%) than senior students (0.6%) and pharmacy assistant (χ^2^ = 7.445, p = 0.024, Cramer's V = 0.087). Overall, exposure to robbery attempts varied significantly by gender, age, and occupational status. However, when considering effect sizes, age emerged as the strongest and most influential demographic correlate of exposure to robbery attempts (Cramer's V = 0.195), followed by gender (0.092) and occupation (0.087).Table 1. Demographic Characteristics of Participants and Their Experience with Robbery Attempts.Table 1. VariableCategoryHave you ever been exposed to a robbery incident in a community pharmacy?TotalValueP value Chi squareCramer's VNo (n = 933)Yes (n = 42)GenderFemale697237208.280.0040.0996.8%3.2%100.0%Male2361925592.5%7.5%100.0%Age GroupLess than 255191052936.98<0.0010.1998.1%1.9%100.0%Between 25 and 30226723397.0%3.0%100.0%More than 301882521388.3%11.7%100.0%Participants occupationPharmacists626356617.450.0240.0994.7%5.3%100.0%Senior Student173117499.4%0.6%100.0%Pharmacist Assistant134614095.7%4.3%100.0%

Participants' perceptions towards factors increasing the prospects of robberies

3.2

As shown in Table 2, the highest agreement was observed for the belief that the likelihood of robberies has recently increased (92.1%). Participants also identified several pharmacy-level robbery risk factors, including late-night opening hours (81.2%), single staffing (77.3%), dispensing narcotics (77.2%), and absence of surveillance cameras (72.6%), which were perceived as particularly important contributors to robbery risk. The majority of the participants (69.5%) believe that robberies occur after observing the pharmacy for days, whereas a minority (7.3%) think that robberies occur at the moment without prior planning. While 72.1% and 68.0% of the participants dealt with customers who looked dangerous or who reacted inappropriately, respectively, 4.3% of pharmacists reported having been exposed to at least one robbery incident in their workplace.Table 2. Pharmacy staff perceptions of pharmacy-level robbery risk factors.Table 2. StatementNot sureNoYesTotal ResponsesPharmacies located in non-crowded areas are at higher risk of robbery.158 (16.2%)227 (23.3%)590 (60.5%)975Pharmacies employing mostly female staff are at higher risk of robbery.199 (20.4%)258 (26.5%)518 (53.1%)975Pharmacies with only one staff member are at higher risk of robbery138 (14.2%)83(8.5%)754 (77.3%)975Chain pharmacies are more targeted than independent ones224 (23.0%)643 (65.9%)108 (11.1%)975Pharmacies without surveillance cameras are at higher risk of robbery.117 (12.0%)150 (15.4%)708 (72.6%)975Large, high-revenue pharmacies are at higher risk of robbery.254 (26.1%)349 (35.8%)372 (38.2%)975Small, low-revenue pharmacies are at higher risk of robbery282 (28.9%)610 (62.6%)83(8.5%)975Pharmacies located in affluent areas are at higher risk of robbery366 (37.5%)361 (37.0%)248 (25.4%)975Pharmacies in low-income areas are at higher risk of robbery318 (32.6%)388 (39.8%)269 (27.6%)975Pharmacies that dispense narcotics are at higher risk of robbery150 (15.4%)72(7.4%)753 (77.2%)975Robberies are more likely in pharmacies that remain open late119 (12.2%)64 (6.6%)792 (81.2%)975Robberies are often premeditated and preceded by observation204 (20.9%)93(9.5%)678 (69.5%)975Some robberies are impulsive and occur without prior planning286 (29.3%)617 (63.3%)72(7.4%)975Robbery depends primarily on the criminal and related personal factors293 (30.1%)217 (22.3%)465 (47.7%)975Over 50% of robbery suspects are eventually apprehended519 (53.2%)152 (15.6%)304 (31.2%)975Have you ever been exposed to a robbery incident in a community pharmacy?N/A933 (95.7%)42(4.3%)975Have you ever encountered a customer you considered dangerous a? (Other than any robbery attempt.)N/A272 (27.9%)703 (72.1%)975Have you ever dealt with a customer exhibiting aggressive behavior b? (Other than any robbery attempt.)N/A312 (32.0%)663 (68.0%)975Do you think the likelihood of robberies has increased recently?N/A77(7.9%)898 (92.1%)975aDangerous behavior can be defined as actions by a customer that pose an immediate threat to the physical safety of staff, other customers, or property (e.g., threats of violence, brandishing a weapon, physical intimidation). Other than any robbery attempt.bAggressive behavior refers to hostile or violent verbal or physical actions by a customer that create a tense, threatening, or unsafe environment (e.g., yelling, threats, aggressive gestures, refusal to follow instructions). Other than any robbery attempt.

A heightened robbery risk was perceived in pharmacies lacking surveillance cameras (72.6%). Pharmacies located in non-crowded areas were also widely viewed as being at higher robbery risk (60.5%), and 53.1% of respondents considered pharmacies employing predominantly female staff to be more exposed to robbery. Additional factors perceived to increase robbery risk included individual criminal or offender-related factors (47.7%), operating as a large, high-revenue pharmacy (38.2%), and situations in which more than half of robbery suspects are apprehended (31.2%). In contrast, perceived robbery risk was lower for pharmacies located in low-income (27.6%) or affluent (25.4%) areas, chain pharmacies (11.1%), and small, low-revenue pharmacies (8.5%).

The findings in Table 2 indicate that pharmacists very frequently encounter customers displaying dangerous (72.1%) or aggressive (68.0%) behavior, which is particularly noteworthy and warrants further attention. Therefore, we conducted additional gender-stratified analyses to better understand differences in responses between male and female pharmacists. Among those reporting encounters with dangerous customers (72.1%, n = 703), 72.5% of male pharmacists and 71.9% of female pharmacists reported such experiences, with no statistically significant difference between genders (p = 0.89). In contrast, among those reporting encounters with aggressive customers (68.0% overall), male pharmacists reported a significantly higher prevalence than female pharmacists (78.4% vs. 64.3%, p < 0.001).

Descriptive statistics: pharmacists' perceptions of pharmacy-level robbery risk factors

3.3

See Table 2 here.

Comparisons of robbery risk perceptions by robbery exposure status

3.4

Table 3 presents the Chi-square test results, highlighting differences in robbery risk perceptions between pharmacists exposed and not exposed to robbery attempts.Table 3. Chi-squared test, highlighting the differences in risk perceptions between robbery exposed and robbery non-exposed pharmacy groups.Table 3. StatementAnswerHave you ever been exposed to a robbery incident in a community pharmacy?Asymptotic Significance (2-sided)No (n = 933)Yes (n = 42)Small, low-revenue pharmacies are at higher risk of robberyNot Sure27390.00129.3%21.4%No5872362.9%54.8%Yes73107.8%23.8%Robberies are more likely in pharmacies that remain open lateNot Sure11540.00412.3%9.5%No5686.0%19.0%Yes7623081.7%71.4%Large, high-revenue pharmacies are at higher risk of robberyNot Sure25130.00926.9%7.1%No3272235.0%52.4%Yes3551738.0%40.5%Have you ever dealt with a customer exhibiting aggressive behavior?No30660.01232.8%14.3%Yes6273667.2%85.7%Robberies are impulsive and occur without prior planningNot Sure274120.01229.4%28.6%No5952263.8%52.4%Yes6486.9%19.0%Chain pharmacies are more targeted than independent onesNot Sure21770.02423.3%16.7%No6182566.2%59.5%Yes981010.5%23.8%Pharmacies with only one staff member are at higher risk of robberyNot Sure13530.02614.5%7.1%No7588.0%19.0%Yes7233177.5%73.8%Pharmacies employing mostly female staff are at higher risk of robbery.Not Sure19540.02720.9%9.5%No2401825.7%42.9%Yes4982053.4%47.6%Robbery depends primarily on the criminal and related personal factorsNot Sure283100.02930.3%23.8%No213422.8%9.5%Yes4372846.8%66.7%Pharmacies located in affluent areas are at higher risk of robberyNot Sure355110.04138.0%26.2%No3382336.2%54.8%Yes240825.7%19.0%Pharmacies located in non-crowded areas are at higher risk of robbery.Not Sure15620.09316.7%4.8%No2141322.9%31.0%Yes5632760.3%64.3%Pharmacies without surveillance cameras are at higher risk of robbery.Not Sure11250.29512.0%11.9%No1401015.0%23.8%Yes6812773.0%64.3%Pharmacies in low-income areas are at higher risk of robberyNot Sure308100.14533.0%23.8%No3731540.0%35.7%Yes2521727.0%40.5%Pharmacies that dispense narcotics are at higher risk of robberyNot Sure14640.33215.6%9.5%No6757.2%11.9%Yes7203377.2%78.6%Robberies are often premeditated and preceded by observationNot Sure19590.99720.9%21.4%No8949.5%9.5%Yes6492969.6%69.0%Over 50% of robbery suspects are eventually apprehendedNot Sure501180.38753.7%42.9%No144815.4%19.0%Yes2881630.9%38.1%Have you ever encountered a customer you considered dangerous?No26660.04428.5%14.3%Yes6673671.5%85.7%Do you think the likelihood of robberies has increased recently?No7250.3257.7%11.9%Yes8613792.3%88.1%

Gaps differences in perception between the groups

3.4.1

Although a substantial proportion of participants perceived that working late at night increases robbery risk (81.7%), this belief was less prevalent among those exposed to robbery (71.4%). Conversely, while only 6% of all participants believed that late-night operation does not elevate robbery risk, a markedly higher proportion (19%) of pharmacists exposed to robbery reported that remaining open late was not a major robbery risk factor.

Similarly, perceptions regarding large, high-revenue pharmacies differed notably between the overall sample and those exposed to robbery. Nearly half of pharmacists exposed to robbery indicated that large, high-revenue pharmacies are not at increased robbery risk, compared with only 35% of participants in the overall sample who expressed this view, a difference that was statistically significant (p = 0.009).

Regarding the impulsiveness of robbery incidents, 6.9% of participants overall characterised robberies as impulsive, whereas 19% of pharmacists exposed to robbery reported that the incident they experienced was impulsive (p = 0.012). In the same context, while 66.7% of robbery-exposed pharmacists attributed the crime primarily to the personal characteristics of the offender, only 46.8% of participants overall endorsed this view, representing a statistically significant discrepancy (p = 0.029).

In relation to pharmacy type, 23.8% of pharmacists exposed to robbery perceived chain pharmacies as being at higher robbery risk, compared with 10.5% of participants in the overall sample, indicating a significant divergence between overall perceptions and the views of those with direct robbery experience (p = 0.024).

Finally, the association between staffing and robbery risk was examined. Among pharmacists exposed to robbery, 19% identified having only one staff member on duty as a robbery risk factor, whereas only 8% of participants in the overall sample shared this perception (p = 0.026), indicating a marked divergence in how single staffing is perceived in relation to robbery risk by those with and without exposure to robbery.

Similarities in perceptions between exposure groups

3.4.2

Several factors showed no statistically significant differences between the perceptions of the overall sample and the views of pharmacists exposed to robbery incidents. The belief that dispensing narcotics is a robbery risk factor was consistently endorsed across both groups (p = 0.332). Perceptions that pharmacies located in non-crowded areas are at higher robbery risk were also comparable between groups (p = 0.093). Similarly, no significant differences were observed regarding the belief that pharmacies without surveillance cameras are at higher robbery risk (p = 0.295) or that pharmacies located in low-income areas are more at risk of robbery (p = 0.145). In addition, the view that robberies are often premeditated and preceded by prior observation showed almost identical levels of agreement between participants overall and those exposed to robbery (p = 0.997). Other non-significant differences included the belief that more than 50% of robbery suspects are eventually apprehended (p = 0.387) and the perception that the likelihood of robberies has increased recently (p = 0.325). Taken together, these findings indicate that, for several key robbery risk factors, participants' perceptions were broadly aligned with the experiences of pharmacists exposed to robbery.

Comparing ranks for variables based on the experience of being robbed

3.5

Table 4 presents the comparative ranking of pharmacy-level robbery risk factors among pharmacists exposed and not exposed to robbery attempts, based on the proportion in each group who agreed that each statement represented a robbery risk factor. In both groups, the highest-ranked item was the perception that the likelihood of robberies has increased recently (88.1% among pharmacists exposed to robbery vs 92.3% among those not exposed; no rank difference). Among pharmacists exposed to robbery, the next most prominent items were having dealt with an aggressive customer and having encountered a customer considered dangerous (both 85.7%), followed by the belief that pharmacies dispensing narcotics are at higher risk of robbery (78.6%) and that pharmacies with only one staff member are at higher risk (73.8%). In contrast, among pharmacists not exposed to robbery, late opening ranked second (81.7%), followed by single staffing (77.5%) and dispensing narcotics (77.2%), indicating that extended opening hours and single staffing are particularly salient perceived risk factors in the non-exposed group.Table 4. The comparative ranking analysis among pharmacists exposed and not exposed to robbery attempts.Table 4. Rank – exposed to robberyRobbery risk factor statement% “Yes” exposed to robbery% “Yes” not exposed to robberyRank – not exposed to robberyRank differenceaStatistically significantb1Do you think the likelihood of robberies has increased recently?88.192.310No2Have you ever encountered a customer you considered dangerous?85.771.56+4Yes2Have you ever dealt with a customer exhibiting aggressive behavior?85.767.28+6Yes3Pharmacies that dispense narcotics are at higher risk of robbery78.677.24+1No4Pharmacies with only one staff member are at higher risk of robbery73.877.53−1Yes5Robberies are more likely in pharmacies that remain open late71.481.72−3Yes6Robberies are often premeditated and preceded by observation6969.57+1No7Robbery depends primarily on the criminal and related personal factors66.746.811+4Yes8Pharmacies without surveillance cameras are at higher risk of robbery.64.3735−3No8Pharmacies located in non-crowded areas are at higher risk of robbery.64.360.39+1No9Pharmacies employing mostly female staff are at higher risk of robbery.47.653.410+1Yes10Large, high-revenue pharmacies are at higher risk of robbery40.53812+2Yes10Pharmacies in low-income areas are at higher risk of robbery40.52714+4No11Over 50% of robbery suspects are eventually apprehended38.130.813+2Yes12Chain pharmacies are more targeted than independent ones23.810.516+4Yes12Small, low-revenue pharmacies are at higher risk of robbery23.87.817+5Yes13Pharmacies located in affluent areas are at higher risk of robbery1925.715+2Yes13Robberies are impulsive and occur without prior planning196.818+5YesaRank difference, Positive rank difference = factor ranked as more important among pharmacists exposed to robbery. Negative rank difference = factor ranked as less important among pharmacists exposed to robbery.bBased on chi-square tests reported in Table 3.

The rank-difference analysis in Table 5 shows which robbery risk factors became more or less salient following robbery exposure. Positive rank differences (higher importance among pharmacists exposed to robbery) were observed for several items, including having encountered a dangerous customer (+4 ranks), having dealt with an aggressive customer (+6), the belief that robbery risk depends primarily on the offender and related personal factors (+4), chain pharmacies being more targeted than independent ones (+4), pharmacies in low-income areas (+4), small low-revenue pharmacies (+5), and the view that some robberies are impulsive and occur without prior planning (+5). Conversely, negative rank differences indicated reduced perceived importance among robbery-exposed pharmacists for remaining open late (−3 ranks) and the absence of surveillance cameras (−3). Several other robbery risk factors showed little or no shift in rank between groups—such as increased likelihood of robberies overall (0), dispensing narcotics (+1), premeditation and prior observation (+1), non-crowded locations (+1), predominantly female staff (+1), and pharmacies in affluent areas (+1)—suggesting a broadly shared baseline recognition of these risks regardless of direct robbery exposure.Table 5. Multivariable logistic regression of exposure to robbery.Table 5. Risk factors for exposure to robbery versus no exposureOdds Ratio (OR)95% C.I.for ORSignificanceLowerUpperChain pharmacies are more targeted than independent ones0.037No0.3390.1160.9920.048Yes0.3180.1280.7870.013Large, high-revenue pharmacies are at higher risk of robbery0.033No0.1880.0520.6850.011Yes0.9420.4541.9530.873Small, low-revenue pharmacies are at higher risk of robbery0.001No0.2900.1130.7430.010Yes0.2180.1000.4760.000Pharmacies located in affluent areas are at higher risk of robbery0.028No1.2700.5033.2070.613Yes0.2500.1000.6270.003Robberies are more likely in pharmacies that remain open late0.060No0.7140.3221.5840.408Yes0.2670.0880.8060.019Robberies are impulsive and occur without prior planning0.051No0.4370.1651.1590.096Yes0.3280.1340.8040.015Robbery depends primarily on the criminal and related personal factors0.001No1.2660.4033.9730.687Yes6.2822.48215.9040.000Have you ever dealt with a customer exhibiting aggressive behavior? (Yes)3.1081.2467.7550.015

Regression, multivariable model

3.6

Table 5 presents the multivariable binary logistic regression analysis used to identify statistically significant risk factors for exposure to robbery versus no exposure, adjusting for all other variables in the model and applying a backward stepwise selection approach to reduce potential confounding. In the final Step-9 model, the retained correlates of robbery exposure were restricted to a focused set of constructs: pharmacy type (chain vs independent), pharmacy size and economic profile (large high-revenue and small low-revenue outlets), pharmacy location in affluent areas, opening-hours profile (late-opening pharmacies), attributions about offender behavior (impulsivity and offender-related personal factors), and prior exposure to aggressive customers. For most of these constructs the overall Wald test indicated a statistically significant association with robbery exposure; for two perception items—“Robberies are more likely in pharmacies that remain open late” (overall p = 0.060) and “Robberies are impulsive and occur without prior planning” (overall p = 0.051) the overall effects were attenuated to borderline non-significance, but they were retained in the model because at least one response category within each remained significantly associated with robbery exposure (p < 0.05). In contrast, other factors entered at Step 1—pharmacy location characteristics (crowded vs non-crowded and more vs less affluent areas), staff gender composition, number of staff on duty, security technology (presence of surveillance cameras/recording systems), dispensing of controlled drugs, beliefs about premeditated/observed robberies, and prior encounters with “dangerous” customers—did not remain statistically significant after adjustment and were therefore not independently associated with robbery exposure in the final model.

The final multivariable logistic regression model showed excellent performance, with a very high Nagelkerke R^2^ of 0.860, indicating that the predictors explained a large proportion of the variance in robbery exposure and provided strong discrimination between exposed and non-exposed pharmacists. Although the Hosmer–Lemeshow test suggested some deviation from perfect calibration (χ^2^ = 17.61, df = 8, p = 0.024), the overall model fit remained statistically robust (Omnibus χ^2^ = 1008.94, df = 14, p < 0.001).

In the final multivariable model, the strongest risk gradient was observed for the belief that robbery risk depends primarily on the offender and related personal factors: pharmacists who agreed with this statement had markedly higher odds of exposure to robbery (OR = 6.28, 95% CI 2.48–15.90; p < 0.001), whereas disagreement was not significantly associated with exposure (OR = 1.27, 95% CI 0.40–3.97; p = 0.687). The next strongest risk marker was prior exposure to aggressive customers, with pharmacists who had ever dealt with an aggressive customer showing significantly higher odds of robbery exposure (OR = 3.11, 95% CI 1.25–7.76; p = 0.015). Several perceptions were instead associated with lower odds of exposure. For chain versus independent pharmacies, both agreement and disagreement that chain pharmacies are more targeted were linked to similarly reduced odds of robbery exposure (Yes: OR = 0.32, 95% CI 0.13–0.79; p = 0.013; No: OR = 0.34, 95% CI 0.12–0.99; p = 0.048). For small, low-revenue pharmacies, both agreement and disagreement that these pharmacies are at higher risk were also protective, with slightly lower odds among those who agreed (Yes: OR = 0.22, 95% CI 0.10–0.48; p < 0.001; No: OR = 0.29, 95% CI 0.11–0.74; p = 0.010). Disagreement that large, high-revenue pharmacies are at higher risk was associated with substantially reduced odds (OR = 0.19, 95% CI 0.05–0.69; p = 0.011), whereas agreement was not significant (OR = 0.94, 95% CI 0.45–1.95; p = 0.873). Agreement that pharmacies in affluent areas are at higher risk (OR = 0.25, 95% CI 0.10–0.63; p = 0.003), that robberies are more likely in pharmacies that remain open late (OR = 0.27, 95% CI 0.09–0.81; p = 0.019), and that some robberies are impulsive and occur without prior planning (OR = 0.33, 95% CI 0.13–0.80; p = 0.015) was likewise associated with lower odds of robbery exposure, while the corresponding “No” categories for these items did not reach statistical significance.

Discussion

4

This cross-sectional study provides the first large, nationwide sample evidence on pharmacy robberies in Jordanian community pharmacies and directly addresses our stated objectives. Robbery emerged as an infrequent but tangible risk (4.3% reported at least one robbery attempt), occurring against a background of widespread exposure to dangerous (72.1%) and aggressive (68.0%) customer behavior. Pharmacy staff most frequently identified late-night opening, single staffing, dispensing of narcotics, and absence of surveillance cameras as pharmacy-level characteristics that increase robbery risk, and these perceptions, together with systematic differences in rankings between robbery-exposed and non-exposed staff, were further clarified through multivariable modelling of independent correlates of robbery exposure.

In total, 975 responses were analyzed, with each respondent representing a different community pharmacy. This pharmacy-level sample exceeds those of recent studies on workplace violence among pharmacists in Saudi Arabia (n = 319)2 and Southeast Europe (n = 732),1 which examined violence more broadly rather than robbery specifically, and is also larger than the US study of pharmacy students on curricular addition of robbery education (n = 285), which focused on educational needs rather than robbery risk in practice settings.6

In our survey, 4.3% of respondents reported that their community pharmacy had experienced robbery incident, indicating that robbery is an infrequent but tangible event in Jordanian community pharmacies. This prevalence is lower than the lifetime robbery exposure reported among community pharmacy staff in Southeast Europe (26%).1 Nevertheless, robbery is clearly recognized as a significant risk in community pharmacy practice and as a very traumatic event for those who experience it.1 This is further evidenced by recent calls for dedicated robbery-related content in pharmacy curricula in the United States.6

Beyond exposure to robbery incidents, our data indicates that 72.1% of respondents had encountered customers displaying dangerous behavior and 68.0% had encountered aggressive behavior. These proportions are consistent with the broader literature on workplace violence against pharmacists, including a recent meta-analysis estimating that around 45% of pharmacists have experienced workplace violence, with 50% reporting verbal abuse, 42% threats and 27% physical assaults3 and with cross-sectional studies from Southeast Europe, where more than 80% of community pharmacy staff reported verbal violence at work,1 in Saudi Arabia approximately half of pharmacists reported at least one form of workplace violence, predominantly verbal.2 In our study, 92.1% of participants believed that the likelihood of robbery had increased, underscoring a pervasive sense of vulnerability among pharmacy staff and the reported perceived potential for everyday aggression escalation into more serious violent events,2.15

In the present study, male staff reported higher robbery exposure than females (7.5% vs. 3.2%), and those aged > 30 years were more likely to have experienced a robbery than those <25 years (11.7% vs. 1.9%). These gradients indicate that robbery risk is concentrated among more experienced staff and are consistent with previous reports from Shelley and the Pharmacists Mutual Insurance Company that male gender, longer tenure, increase vulnerability to pharmacy crime,22.25 Moreover, in both robbery-exposed and non-exposed groups, dispensing narcotics, late-night opening and single staffing were consistently ranked as key robbery risk factors. This perception is consistent with external evidence that solo workers, particularly in retail and late-night settings, face elevated risks of robbery and violence, and that offenders frequently prefer targets with few or lone employees,1,22.25

In the present study, the final backward stepwise logistic regression, the model showed high explanatory power (Nagelkerke R^2^ = 0.860). The strongest independent correlate of robbery exposure was the belief that robbery risk depends primarily on offender-related personal factors (OR = 6.28, 95% CI 2.48–15.90; p < 0.001), followed by prior experience of aggressive customers (OR = 3.11, 95% CI 1.25–7.76; p = 0.015). These findings are consistent with offender-focused accounts of pharmacy crime and wider workplace-violence evidence that emphasise offender motivation, drug-seeking and escalating aggression as key drivers of serious incidents,3,22.25

In contrast, factors often treated as “classic” environmental risk markers, such as pharmacy type, economic profile, affluent location, late opening hours, and single-staffing,322 showed – in our multivariable regression model- weaker associations with reported exposure after adjustment of other variables. Moreover, hardware-focused features (e.g., lack of cameras) were not independently associated with exposure.

Although the broader literature on surveillance in public and occupational settings remains mixed and continues to argue that cameras serve both deterrent and investigative functions,28, 29, 30 our findings—across both the risk-ranking results and the regression model—support that surveillance cameras at pharmacies may operate for investigative (detective) measure, rather than as an independently protective or deterrent factor against robbery exposure,31.32 This interpretation is aligned with offender-interview evidence indicating that internal cameras were commonly viewed as unimportant for target selection, largely because offenders assumed cameras are ubiquitous, can be mitigated through disguises, or are poorly positioned or nonfunctional.22

The results support the view that offender- and behavior centered cues—particularly repeated aggressive customer encounters—may be more informative for understanding robbery risk than structural premises characteristics alone. This aligns with evidence from the broader criminological concept of repeat victimization, where some offenders return to the same target when conditions remain unchanged (Weisel 2005), suggesting that prior incidents and recurrent offender–pharmacy interactions can be more indicative of subsequent risk than static premises features,22,33.34

Limitations

4.1

This study has a few key limitations that should be acknowledged. First, the cross-sectional survey design captures perceptions and experiences at a single point in time and therefore cannot account for temporal changes in crime patterns or pharmacy operations. Second, reliance on self-reported data introduces the potential for recall and social desirability bias, which may affect the accuracy of reported robbery exposure and robbery risk perceptions. Third, the use of an online questionnaire disseminated via social media platforms may have introduced selection bias, as participants with stronger opinions or prior exposure to crime might have been more inclined to respond. In addition, only one response per pharmacy was collected to avoid clustering and over-representing individual workplaces; as a result, within-pharmacy variation in staff perceptions could not be systematically examined. Nonetheless, dissemination via nationwide professional WhatsApp groups and Facebook pages, combined with a relatively large and heterogeneous sample of pharmacists, likely enhanced respondent diversity and statistical precision, partially mitigating concerns about selection bias—particularly for perceptions of pharmacy-level robbery risk factors. Although the regression model exhibited high explanatory power (Nagelkerke R^2^ = 0.860), the limited number of robbery events means that overfitting cannot be excluded, and the estimates should be interpreted with caution. Robbery exposure was assessed as a binary self-report (ever vs never); the questionnaire did not capture the number of incidents (single vs multiple exposures) nor the timing, recency of the exposure. Finally, because the study was conducted exclusively in Jordan, the findings may not be directly generalizable to settings with different regulatory, social, or economic contexts, and the absence of longitudinal data or qualitative follow-up limits the ability to explore how robbery risk perceptions and responses evolve over time or are shaped by local context.

Strengths

4.2

Despite these limitations, the study has several important strengths. It represents, to our knowledge, the first academic investigation of pharmacy robberies in Jordan, addressing a previously unexplored area of pharmacy safety research. The survey instrument underwent structured content validation by a multidisciplinary panel, ensuring that the included robbery risk factors and exposure items were both contextually relevant and evidence-informed. The large and diverse sample of 975 participants provides broad coverage of the community pharmacy workforce and enhances the stability and internal validity of the estimated associations. The explicit comparison between pharmacists exposed and not exposed to robbery, in terms of both reported experiences and perceived pharmacy-level robbery risk factors, offers novel insights into perception–experience gaps that are directly relevant to risk assessment and management in practice. Furthermore, by situating the Jordanian findings alongside emerging international evidence on pharmacy violence and robbery1–,3,6 this study contributes context-specific data to the wider global discourse on community pharmacy safety and security.

Conclusion

5

This study provides the first systematic evidence on pharmacy robbery in Jordanian community pharmacies, showing that robbery occurs within a broader context of highly prevalent dangerous and aggressive customer behavior. Pharmacists consistently identified late opening, single staffing, dispensing narcotics and lack of surveillance cameras as key pharmacy-level robbery risk factors, and several of these factors were appraised differently by pharmacists exposed and not exposed to robbery, suggesting that direct exposure to robbery shapes how risk is perceived.

Offender- and behavior-focused factors—particularly beliefs about offender motivation and prior aggressive customer encounters—were more strongly associated with robbery exposure than traditional environmental markers such as pharmacy type, location or security hardware. These findings support the need for evidence-informed security policies in community pharmacies, including minimum staffing during high-risk periods, appropriate surveillance and alarm systems, and targeted training to recognize and manage high-risk customer behavior, alongside improved crime reporting and further longitudinal and qualitative research.

Future recommendations

6

From a practical perspective, pharmacy owners and policymakers should prioritise comprehensive security protocols in community pharmacies, and regulations requiring a minimum of two staff members during identified high-risk periods (such as late opening hours). These measures should be complemented by structured training in risk recognition and conflict de-escalation, with a particular focus on managing dangerous and aggressive customer behavior. Regulatory bodies could also mandate standardised reporting systems for pharmacy crime to improve data accuracy and enable monitoring of robbery trends over time.

For future research, longitudinal studies are needed to frameworks influence robbery risk over time in community pharmacies. In addition, qualitative or mixed-methods studies exploring offender motivations and decision-making, alongside the perspectives of pharmacists exposed and not exposed to robbery, would complement the present findings and help to inform more targeted, behavior-centred prevention strategies.

Declaration of generative AI and AI-assisted technologies in the manuscript preparation process

During the preparation of this work, the authors used ChatGPT (OpenAI) as a language-support tool to assist with translating (Arabic – English), editing, clarifying wording, and improving the coherence and academic style of the manuscript. No AI tools were used for data collection, data analysis, or the generation or interpretation of study results. After using this tool, the authors thoroughly reviewed, revised, and edited all content and took full responsibility for the integrity and accuracy of the final manuscript.

CRediT authorship contribution statement

Mohanad Odeh: Writing – review & editing, Validation, Supervision, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Dana M. Odeh: Writing – review & editing, Methodology, Formal analysis, Conceptualization. Enas Alkhader: Writing – review & editing, Software, Resources, Formal analysis, Data curation. Duaa Alzyoud: Writing – original draft, Visualization, Software.

Declaration of competing interest

The authors received no financial support for this research and declare no conflicts of interest.