*2.2. Participants*

The survey was addressed to pharmacists working in community pharmacies from Romania and Bulgaria.

To calculate an appropriate representative sample from the targeted population, convenience sampling was used [29]. Power analysis was conducted using G\*Power 3 (alpha equal to 0.05) and a sample size of 176 pharmacists was calculated to demonstrate statistically significant results for the study [30]. Ethical approval for this study was obtained from the Ethics Committee of the University of Medicine and Pharmacy of Craiova (Registration no. 54/08.07.2020) according to the Declaration of Helsinki. All pharmacists provided electronic informed consent, starting with the first question of the survey.

#### *2.3. Data Analysis*

Continuous variables were summarized as mean ± standard deviation (SD) or median with interquartile range (IQR). Statistical differences were analyzed by Student's *t-*test or Mann–Whitney test. Categorical variables were summarized as frequencies and percentages. Chi-squared test was performed to compare categorical variables as appropriate. We

further assessed the association of continuous variables with 15D scores by Spearman's correlation test. ANCOVA was used to capture association between continuous and categorical variables. We did not have missing data. Data were analyzed using GraphPad Prism 9.0 software (GraphPad Software, LLC, San Diego, CA, USA). The significance level was 0.05.

#### **3. Results**

The sample included 395 pharmacists working in community pharmacies with possible contacts with COVID-19 patients: 241 from Romania and 154 from Bulgaria. The results are shown in Table 1.


**Table 1.** Baseline characteristics of pharmacists from Romania and Bulgaria.

\*, significantly different (*p* < 0.05); ˆ, did not pass normality test.

The characteristics of the two groups of pharmacists showed that the Romanian pharmacists were older, with a higher percentage of women, married people and specialists. When considering the income working as a pharmacist, there are statistically significant differences between the two groups; Bulgarian pharmacists have a higher income, even if they are less experienced.

Different pharmacy specialties exist in Romania and Bulgaria. Of the 108 specialist pharmacists from Romania, 47 (44%) were specialists in Clinical Pharmacy, 51 (47%) were specialists in General Pharmacy, and 10 (9%) were specialists in Pharmaceutical Laboratory. In Bulgaria, most pharmacists were specialists in Clinical Pharmacy (46%).

Table 2 shows the differences between the levels of quality of life of pharmacists from Romania and Bulgaria. We observed statistically significant differences regarding sleeping, usual activities, mental function, discomfort and symptoms, depression, distress and total 15D score, with low values for distress. The smaller values for Bulgarian pharmacists were directly correlated with age (for the association between total 15D score and age: Spearman r = 0.168, *p* = 0.022). A strong correlation was also observed between mental function and discomfort and symptoms (Spearman r = −0.81, *p* = 0.028).

We assessed whether gender had a significant effect on HRQoL outcomes and no associations were found: breathing (*p*-value = 0.060), sleeping (*p*-value = 0.302), speech (*p*-value = 0.191), excretion (*p*-value = 0.582), usual activities (*p*-value = 0.887), mental function (*p*-value = 0.065), discomfort and symptoms (*p*-value = 0.322), depression (*p*-value = 0.677), distress (*p*-value = 0.622), vitality (*p*-value = 0.809), sexual activities (*p*-value = 0.077) and HRQoL score (*p*-value = 0.661).


**Table 2.** Health-related quality of lige (HRQoL) results.

\*, significantly different (*p* < 0.05); SD, Standard Deviation.

To determine whether community pharmacists used and recommended supplements with vitamin C and D, their answers were assessed and presented in Figure 2. We observed statistical differences between the two groups in the case of using supplements with vitamin C and D: the pharmacists from Bulgaria used them more. The same trend was not maintained in terms of recommending these supplements to their family/friends/patients: the percentage of pharmacists that recommend was higher than the percentage of pharmacists that used these products, without differences between Romania and Bulgaria.

**Figure 2.** Perception towards COVID-19 vaccination and vitamin recommendation. \*\*\* *p*-value < 0.001.

The community pharmacists from the two countries reported willingness to get vaccinated to prevent COVID-19 in almost the same percentage: 50% (*p =* 0.7542). A statistically significant association was found between the willingness to get vaccinated and the use of vitamin D during the COVID-19 pandemic (*p* = 0.0134). However, no association was found between the willingness to get vaccinated and the use of vitamin C during the COVID-19 pandemic (*p* = 0.4157). No other significant associations were found between the willingness to get vaccinated to prevent COVID-19 and other characteristics (age, gender, income, quality-of-life markers).
