Pharmacists' counseling on oral contraceptives: A theory informed analysis

Application of behavioural theories, models, and frameworks in pharmacy practice research based on published evidence: a scoping review

BACKGROUND

Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions' mechanisms of action and are more likely to result in effective and sustained interventions.

AIM

To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research.

METHOD

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed.

RESULTS

Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework).

CONCLUSION

This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development.

Psychometric assessment of pharmacists' counseling in dementia

OBJECTIVE

This study aimed to explore pharmacists' counseling for dementia by developing a measurement tool based on the Theory of Planned Behavior.

METHODS

A survey was applied online to community pharmacists; in total, 190 community pharmacists participated in the study. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Mann-Whitney U test were performed.

RESULTS

A six-factor structure was obtained from the EFA, and the CFA confirmed the structure. These factors explained 71.294% of the total variance. The Cronbach's alpha coefficients for the factors ranged from 0.728 to 0.913. In addition, the pharmacists rated themselves as having positive attitudes and intentions toward counseling for dementia. Differences in these factors were found between the groups based on their participation in vocational training on dementia.

CONCLUSION

The developed measurement tool had a satisfactory construct and convergent and discriminant validities and reliabilities.

PRACTICE IMPLICATIONS

The developed measurement tool can be used to investigate pharmacists' self-reported counseling for dementia and can also be applied to the counseling behavior of pharmacists in various health conditions.

Applying the Theory of Planned Behavior to predict community pharmacists' intention to provide diabetes care

BACKGROUND

The role of the pharmacist has changed from dispensing medicines, to working with other healthcare professionals to assure appropriate medication therapy management. This study assessed community pharmacists' intention regarding diabetes care based on the theory of planned behavior (TPB) in Alexandria, Egypt.

METHODS

A sample of 385 community pharmacies with one index per site (one pharmacist per pharmacy) was recruited in the sample using a multistage random sampling technique. This cross-sectional survey was performed using a self-administered questionnaire that measured the constructs of TPB. A structural equation model was used to identify specific factors that most contribute to and predict pharmacists' intention to provide diabetes care.

RESULTS

The sample included 385 pharmacies, approximately half of them (51.4%) were males and the majority of them (94%) had a bachelor's degree in pharmaceutical sciences. Intention was significantly correlated with attitude, subjective norm and perceived behavioral control. "Regular screening for complications can improve quality of life for diabetic patients" (β = 1.131) was the most specific factor motivating pharmacists to perform diabetes care, while "some physicians do not appreciate pharmacists' involvement in diabetic care" was the most specific factor that negatively influenced intention of pharmacists to provide diabetes care (β = 4.283).

CONCLUSION

Community pharmacists demonstrated a positive attitude, perceived significant approval from others and felt able to intervene in diabetes care. However, lack of physician collaboration was a specific hindering factor for pharmacists' practice of diabetes care.

An objective evaluation of fundamental pharmacogenomics knowledge among pharmacists and pharmacy students

Introduction

Possessing a correct and comprehensive foundation on the science of pharmacogenomics (PGx) is an important prerequisite for pharmacists to successfully apply pharmacogenomic testing to patient care. While some work has addressed general PGx knowledge among pharmacists, little research has specifically focused on PGx foundational knowledge. This study examines the level of foundational knowledge of PGx and interest in learning about PGx among community pharmacists and first-year pharmacy students at Beirut Arab University (BAU), Beirut, Lebanon.

Methods

A cross-sectional survey was self-administered to community pharmacists within a random sample of community pharmacies in Beirut, Lebanon, and to first-year BAU pharmacy students. The knowledge component of the instrument consisted of 25 items, each worth one point, addressing fundamental PGx information. The validity and internal consistency of the designed instrument were tested among the study population. Correlation analysis was carried out between aggregate knowledge and key variables for participating pharmacists.

Results

Of 150 approached pharmacists, 137 (91 %) participated and of 132 pharmacy students, 131 (99 %) participated. The average knowledge score for community pharmacists was 15 (Standard Deviation = 4) out of a possible total of 25 with the total number of correct answers ranging from 8 to 24 out of 25 questions. The average score for pharmacy students was 17 (Standard Deviation = 5) out of a possible total of 25 with the total number of correct answers ranging from 5 to 24. Pharmacists' age and years of practice were associated with a lower aggregate knowledge score (r = -0.20; p < 0.05 and r = -0.21; p < 0.05), respectively. Pharmacists' interest in learning about PGx varied whereas 62 % were either interested or very interested in learning about PGx. Students' interest, however, was higher with 70 % being either interested or very interested. Specific PGx topics of interest to participants were highlighted.

Conclusion

This study identified areas where PGx foundational knowledge was acceptable and others where significant opportunities for improvement exist. These results add to the rapidly expanding field of pharmacogenomics education and practice in relation to pharmacy. In particular, these findings have significant implications for planning pharmacogenomics-related educational activities targeting current and future pharmacists.

Community Pharmacists' Knowledge, Willingness, and Readiness to Prescribe Oral Contraceptives in Saudi Arabia

Background: The role of community pharmacists (CPs) in various healthcare settings is well documented in the literature including providing safe and easy access to medications. Oral contraceptives (OCPs) are the most frequently used method of terminating unwanted pregnancies worldwide. Objective: This study aims to evaluate the Community pharmacist’s knowledge, willingness, and readiness to prescribe OCPs in Saudi communities in Saudi Arabia. Methods: This is across sectional, self-administered questionnaire-based study conducted between May and November 2021 in the central region of Saudi Arabia. The results were presented as frequencies and percentages. Chi-square tests were used to sort significant association between groups. Results: Out of 368 CPs who got the questionnaire, 347 completed (94.3%). Most of CPs were be-tween the ages of 25 and 35, with 76.9% working in chain pharmacies. Of the surveyed CPs, 45.5% had >24 months of experience in community pharmacies. 41.8% of them prescribed more than six prescriptions for OCPs/week. The patients’ safety (77.2%), physician’s resistance (54.5%), and CPs objection based on religious purposes (36.9%) and lack of time (29.7%) were the most commonly cited barriers among CPs. CPs who worked in chain pharmacies were significantly too busy (p = 0.038) to prescribe OCPs. Also, community pharmacists with experience of more than two years significantly agreed not to prescribe OCPs due to religious convictions (p = 0.009). Conclusion: The current study revealed that most of the CPs were knowledgeable about OCPs. Additionally, most of them were likely to prescribe oral contraceptives. We further suggest overcoming the barriers associated with contraceptives among CPs and providing sufficient training to improve the oral contraceptive prescriptions in CPs is needed.

Oral contraceptives: knowledge and counselling practices of Lebanese community pharmacists

OBJECTIVES

To examine the extent of Lebanese pharmacists' knowledge about oral contraceptives (OCs), the characteristics influencing their knowledge and the factors that may predict their counselling practices.

METHODS

A cross-sectional descriptive study was conducted between January and June 2020 in which a random sample of community pharmacists in Lebanon was asked to complete a self-administered questionnaire. The survey was divided into three sections including demographic information, pharmacists' knowledge and counselling practices, and their perceptions about OCs.

KEY FINDINGS

Of the 300 pharmacists invited to participate, 240 (80%) responded. The majority of the pharmacists (255; 85%) had satisfactory general knowledge about the indications, side effects, contraindications and drug interactions of OCs. However, only 173 (57.5%) participants had satisfactory knowledge about the proper use of OCs. Older pharmacists and those who have been in practice for more than 10 years achieved lower knowledge scores; however, those with postgraduate degrees had significantly higher scores. Pharmacists with a postgraduate degree and male pharmacists were less likely to counsel patients compared with their counterparts. Conversely, pharmacists with postgraduate OC training and those who had a private area for consultation presented better counselling practices.

CONCLUSIONS

More than half of the participating pharmacists appeared to have satisfactory knowledge about OCs and their proper use; however, limited counselling and key misconceptions were observed in this study.

Factors influencing patient participation in medication counseling at the community pharmacy: A systematic review

BACKGROUND

Findings document that patient participation in pharmacy encounters is associated with favorable outcomes. However, there is a need to understand factors that may enhance or hinder patient engagement and pharmacist counseling behaviors during their medication discussions. This review aims to: (1) identify barriers and facilitators for patient engagement in pharmacy consultations, (2) explore the relationship between patient factors (such as demographics and communication behavior) and subsequent pharmacist counseling behavior.

METHODS

A systematic review of literature using PRISMA guidelines examined studies published in English addressing influences on patient participation and the relationship between patient factors and pharmacist counseling behavior. Four databases were used - PubMed, CINAHL, PsycINFO, and Scopus. Findings were framed thematically within the constructs of Street's Linguistic Model of Patient Participation in Care (LM).

FINDINGS

Fifty studies from 1983 to 2019, including 37 using self-reported data, were identified. Patient involvement in patient-pharmacist communication was influenced by enabling factors such as patient knowledge, communication skills, and pharmacy environment. Predisposing factors for participation ranged from patients' beliefs and past experiences to demographic characteristics such as gender and age. Pharmacists' participative behavior with patients was positively associated with patients' engagement and perceived patient cues in the conversation.

CONCLUSION

This systematic review identified predictors of patients' engagement in pharmacy encounters drawing on LM framework. Various predisposing factors, enabling factors, and pharmacist' responses impacted patients' willingness to actively participate in medication counseling at community pharmacies. Equally important, studies documented considerable impact by patients on pharmacists' counseling behavior. Pharmacy encounters should no longer be viewed as controlled simply by pharmacists' expertise and agendas. Patient characteristics and factors such as patient question-asking and expectations also appear to be associated with and influence patient-pharmacist interpersonal communication. Additional research needs to address the identified facilitators and barriers to enhance patient participation and pharmacist counseling behavior.

The availability of contraceptive methods in Turkish pharmacies and the status of pharmacies and pharmacists as providers of contraception

OBJECTIVES

We aimed to assess pharmacists' contraceptive knowledge and evaluate the contraceptives requested and sold in pharmacies.

METHODS

A descriptive study was carried out in October 2016 in cooperation with the Chamber of Pharmacists of Istanbul Province, Turkey. Data were collected by questionnaire, and pharmacists' total knowledge scores were calculated.

RESULTS

The study comprised 101 participants, 86.1% of whom were women. Combined oral contraceptives were the most requested (97.0%) and supplied (94.1%) contraceptive method. The mean total knowledge score of pharmacists was 51.6 ± 12.9 (median 54.0, range 14.0-72.0). Among pharmacists, 51.5% said they had never received any training about contraception.

CONCLUSION

The results showed that pharmacists providing contraceptive counselling services need continuing in-service training. The current regulations on the duties and responsibilities of pharmacists in Turkey involve the provision of counselling about medication use. Effective training is suggested to provide better quality services in family planning/reproductive health care.

Development and validation of a theory-based instrument to predict community pharmacists' intention to provide pharmaceutical care services

BACKGROUND

Predicting pharmacists' intention to provide Pharmaceutical Care (PC) and identifying modifiable factors associated with their intention can aid in the design and tailoring of behavior-based interventions to promote the adoption of PC as a standard of pharmacy practice. There is a need for valid and reliable instruments that are theoretically grounded to measure these factors.

OBJECTIVE

To develop and test the psychometric properties of the "Pharmaceutical Care Intention (PCI) scale" to identify socio-cognitive factors associated with community pharmacists' intention to provide PC services to patients with chronic conditions.

METHODS

A self-administered questionnaire was developed in English and translated into Arabic, guided by constructs derived from a modified Theory of Planned Behavior (TPB) framework and a thorough review of the PC literature. The questionnaire was reviewed for face and content validity, pilot tested, and then administered to a sample of community pharmacists in Alexandria, Egypt. Exploratory factor analysis (EFA) was employed to identify and refine the underlying dimensional structure of the PCI scale and test for its convergent and discriminant validity. Reliability was assessed by computing Cronbach's α.

RESULTS

Out of the 109 approached pharmacists, 97 usable responses were analyzed (response rate = 89%). EFA resulted in a 23-item, 6-factor solution explaining 52.14% of the variance in responses and providing evidence for convergent and discriminant validity. The resulting factors aligned with the modified TPB constructs: intention (α = 0.74), attitude (α = 0.89), subjective norm (α = 0.58), perceived behavioral control to identify (α = 0.66) and intervene (α = 0.82) to address drug-related problems, and perceived moral obligation (α = 0.72). Cronbach's α of the pooled items of the PCI scale was 0.77.

CONCLUSION

The PCI scale is a parsimonious, theory-driven instrument with acceptable construct validity and reliability to examine factors associated with community pharmacists' intention to provide PC.