A mixed-methods SWOT analysis of community pharmacy services in Saudi Arabia: stakeholder perspectives and strategic framework.

Background: Community pharmacies in Saudi Arabia play a significant role in healthcare access, although clinical integration remains constrained by workforce imbalance, infrastructure limitations, and regulatory fragmentation. As the healthcare system under Saudi Vision 2030 advances, emphasizing digitalization, privatization, and decentralized care, strategic evaluation of community pharmacy contributions is crucial. This study incorporates stakeholder perspectives and contemporary evidence using a mixed-methods SWOT analysis to build an evidence-based framework driving national policy and practice reform. By blending stakeholder insights with literature findings, it provides a context-specific assessment of strengths, weaknesses, opportunities, and threats impacting community pharmacy practice in the Kingdom. Methods: A convergent mixed-methods design was applied. The qualitative strand involved a structured narrative synthesis and thematic SWOT analysis of 17 peer-reviewed papers (2015-2023) following Braun and Clarke's approach. The quantitative strand contained a 25-item Likert-scale survey of 91 pharmacy stakeholders, pharmacists, academics, regulators, industry professionals, and students across all major Saudi areas. Results from both strands were merged using joint displays and systematically translated into a TOWS matrix by cross-matching internal (strengths and weaknesses) and external (opportunities and threats) factors to develop a strategic framework aligned with Saudi Vision 2030. Results: The literature-based SWOT analysis highlighted significant strengths, including a well-developed educational infrastructure and a supportive policy environment. Weaknesses comprised inadequate clinical integration and an imbalanced workforce distribution across regions. Opportunities arose from the expansion of digital health, insurance reforms, and national workforce initiatives, while threats involved growing commercial pressures within community pharmacy practice and overlapping regulatory responsibilities. The stakeholder survey reflected substantial alignment with these patterns, identifying underuse of pharmacists' clinical roles (M = 4.09, SD = 0.72) as a main weakness and the expansion of the private healthcare sector under Saudi Vision 2030 as the top opportunity (M = 4.44, SD = 0.61). Areas of divergence were also observed, particularly in the perceived urgency of digital health implementation. Conclusion: This mixed-methods SWOT-TOWS analysis moves beyond descriptive SWOT categorization by translating integrated stakeholder and literature evidence into a strategic framework for strengthening community pharmacy services in Saudi Arabia. The findings highlight both enabling conditions and persistent structural constraints, offering a system-level roadmap to support regulatory coherence, expanded clinical roles for pharmacists, and digital health integration in alignment with Saudi Vision 2030.