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Maxwell-Smith C, Breare H, Dominguez Garcia A, Sim TF, Blackford K, Chih HJ, Jancey J, Mullan BA. Pharmacists' perceptions and delivery of health behaviour change recommendations: Mapping the COM-B model. Res Social Adm Pharm 2024; 20:115-123. [PMID: 37926620 DOI: 10.1016/j.sapharm.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Pharmacists are trusted and accessible healthcare professionals who are well-positioned to deliver brief health behaviour change technique-based interventions for chronic health conditions. However, little is known about the factors influencing pharmacists' use of behaviour change techniques and their capacity to deliver these interventions within community pharmacy. OBJECTIVES This study employed the COM-B model to explore the factors that explain pharmacists' delivery of behaviour change techniques in practice. A secondary objective was to ascertain whether capability, opportunity, and motivation are associated with and explain significant variance in the use of behaviour change techniques during patient interactions. METHODS Two-hundred and eleven Australian pharmacists (mean age = 36.1, SD = 10.7) completed a survey on their capability, opportunity, and motivation to deliver behaviour change techniques, and their delivery and frequency of use in practice. RESULTS Most pharmacists (91.3%) use behaviour change techniques during patient interactions. Results from a simple linear regression showed that a composite COM score was associated with pharmacists' behaviour change technique use F(1,195) = 47.12, β = 0.44, 95 % CI [0.09, 0.16], p < .001, and their frequency of use (F(1,198) = 44.19, β = 0.43, 95 % CI [0.02, 0.06], p < .001). While capability, opportunity, and motivation were individually associated with the range and frequency of behaviour change technique used, motivation was the only significant variable in the composite model for range (β = 0.35, 95 % CI [0.11, 0.41], p < .001) and frequency of behaviour change technique use (β = 0.22, 95 % CI [0.01, 0.09], p < .05). CONCLUSIONS Pharmacist motivation was the most important construct explaining behaviour change technique use. Interventions should seek to foster pharmacist motivation and may benefit from adopting COM-B as a behaviour change framework, to understand the factors influencing the delivery of behaviour change interventions.
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Affiliation(s)
- Chloe Maxwell-Smith
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia; EnAble Institute, Curtin University, Bentley, Western Australia, Australia.
| | - Hayley Breare
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Alejandro Dominguez Garcia
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Tin Fei Sim
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia; Pharmaceutical Society of Australia, Australia
| | - Krysten Blackford
- School of Population Health, Curtin University, Bentley, Western Australia, Australia; Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Hui Jun Chih
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Jonine Jancey
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Barbara A Mullan
- Behavioural Science and Health Research Group, Curtin University, Bentley, Western Australia, Australia; School of Population Health, Curtin University, Bentley, Western Australia, Australia; EnAble Institute, Curtin University, Bentley, Western Australia, Australia
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Liddelow C, Mullan BA, Breare H, Sim TF, Haywood D. A call for action: Educating pharmacists and pharmacy students in behaviour change techniques. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 11:100287. [PMID: 37397030 PMCID: PMC10314283 DOI: 10.1016/j.rcsop.2023.100287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/04/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023] Open
Abstract
The increasing impact of chronic disease, including cancer and heart disease on mortality signifies a need for the upskilling of health professionals in health behaviour change. Solely providing education and information to patients is generally not sufficient to change behaviour, and for any change to be sustained. The nature of pharmaceutical practice allows pharmacists to have frequent contact with patients in the community. Historically, pharmacists have often effectively engaged with patients to assist with behaviour change initiatives related to smoking cessation, weight loss or medication adherence. Unfortunately, such initiatives do not work for everyone, and more tailored and varied interventions are urgently needed to reduce the effects of chronic disease. In addition, with greater inaccessibility to hospitals and GP's (e.g., appointment wait times), it is imperative that pharmacists are upskilled in providing opportunistic health behaviour change techniques and interventions. Pharmacists need to practice to their full scope consistently and confidently, including the use of behavioural interventions. The following commentary therefore describes and provides recommendations for the upskilling of pharmacists and pharmacy students in opportunistic behaviour change. We outline nine key evidence-based behaviour change techniques, the active-ingredients of a behaviour change intervention, that are relevant to common encounters in professional practice by pharmacists, such as improving adherence to medications/treatments and health promotion initiatives. These include social support (practical and emotional), problem solving, anticipated regret, habit formation, behaviour substitution, restructuring the environment, information about others' approval, pros and cons, and monitoring and providing feedback on behaviour. Recommendations are then provided for how this upskilling can be taught to pharmacists and pharmacy students, as well as how they can use these techniques in their everyday practice.
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Affiliation(s)
- Caitlin Liddelow
- School of Psychology, University of Wollongong, Wollongong, New South Wales, 2500, Australia
| | - Barbara A. Mullan
- enAble Institute, Curtin University, Bentley, Western Australia, 6102, Australia
- Western Australian Cancer Prevention Research Unit, Curtin University, Bentley, Western Australia, 6102, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Hayley Breare
- enAble Institute, Curtin University, Bentley, Western Australia, 6102, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Tin Fei Sim
- School of Pharmacy, Curtin Medical School, Curtin University, Bentley, Western Australia 6102, Australia
| | - Darren Haywood
- St. Vincent's Hospital Melbourne, Mental Health, Fitzroy, Victoria 3065, Australia
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia
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Heinrich CH, McHugh S, McCarthy S, Curran GM, Donovan MD. Multidisciplinary DEprescribing review for Frail oldER adults in long-term care (DEFERAL): Implementation strategy design using behaviour science tools and stakeholder engagement. Res Social Adm Pharm 2023:S1551-7411(23)00252-8. [PMID: 37230873 DOI: 10.1016/j.sapharm.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Deprescribing is a strategy for reducing the use of potentially inappropriate medications for older adults. Limited evidence exists on the development of strategies to support healthcare professionals (HCPs) deprescribing for frail older adults in long-term care (LTC). OBJECTIVE To design an implementation strategy, informed by theory, behavioural science and consensus from HCPs, which facilitates deprescribing in LTC. METHODS This study was consisted of 3 phases. First, factors influencing deprescribing in LTC were mapped to behaviour change techniques (BCTs) using the Behaviour Change Wheel and two published BCT taxonomies. Second, a Delphi survey of purposively sampled HCPs (general practitioners, pharmacists, nurses, geriatricians and psychiatrists) was conducted to select feasible BCTs to support deprescribing. The Delphi consisted of two rounds. Using Delphi results and literature on BCTs used in effective deprescribing interventions, BCTs which could form an implementation strategy were shortlisted by the research team based on acceptability, practicability and effectiveness. Finally, a roundtable discussion was held with a purposeful, convenience sample of LTC general practitioners, pharmacists and nurses to prioritise factors influencing deprescribing and tailor the proposed strategies for LTC. RESULTS Factors influencing deprescribing in LTC were mapped to 34 BCTs. The Delphi survey was completed by 16 participants. Participants reached consensus that 26 BCTs were feasible. Following the research team assessment, 21 BCTs were included in the roundtable. The roundtable discussion identified lack of resources as the primary barrier to address. The agreed implementation strategy incorporated 11 BCTs and consisted of an education-enhanced 3-monthly multidisciplinary team deprescribing review, led by a nurse, conducted at the LTC site. CONCLUSION The deprescribing strategy incorporates HCPs' experiential understanding of the nuances of LTC and thus addresses systemic barriers to deprescribing in this context. The strategy designed addresses five determinants of behaviour to best support HCPs engaging with deprescribing.
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Affiliation(s)
| | - Sheena McHugh
- School of Public Health, University College Cork, Ireland.
| | | | - Geoffrey M Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, United States; Central Arkansas Veterans Healthcare System, United States.
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Jamil N, Zainal ZA, Alias SH, Chong LY, Hashim R. A systematic review of behaviour change techniques in pharmacist-delivered self-management interventions towards patients with chronic obstructive pulmonary disease. Res Social Adm Pharm 2023:S1551-7411(23)00256-5. [PMID: 37202279 DOI: 10.1016/j.sapharm.2023.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Self-management interventions often employ behaviour change techniques in order to produce desired target behaviours that are necessary for day-to-day living with a chronic disease. Despite the large number of self-management interventions for patients with chronic obstructive pulmonary disease (COPD), previously reported interventions have been typically delivered by healthcare providers other than the pharmacist. OBJECTIVE This systematic review examined the components of pharmacists-delivered COPD self-management interventions according to an established taxonomy of behaviour change techniques (BCTs). METHODS A systematic search was conducted on PubMed, ScienceDirect, OVID, and Google Scholar from January 2011 to December 2021 for studies of pharmacist-delivered self-management interventions in COPD patients. RESULTS A total of seventeen studies of intervention were eligible for inclusion in the narrative review. Interventions were educational and were delivered individually and face-to-face for the first session. Across studies, pharmacists spent an average of 35 min on the first meeting and had an average of 6 follow-up sessions. Recurrent BCTs in pharmacist interventions were "Information on the health consequence", "Feedback on behaviour", "Instruction on how to perform a behaviour", "Demonstration of the behaviour" and "Behavioural practice/rehearsal". CONCLUSIONS Pharmacists have provided interventions towards improving health behaviours, especially on adherence and usage of inhaler devices for patients with COPD. Future self-management interventions should be designed using the identified BCTs for the improvement of COPD self-management and disease outcomes.
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Affiliation(s)
- Nurdiana Jamil
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Zainol Akbar Zainal
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Siti Hazlina Alias
- Faculty of Psychology and Social Sciences, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
| | - Li Yin Chong
- Serdang Hospital, Ministry of Health Malaysia, Jalan Puchong, 43000, Kajang, Selangor, Malaysia.
| | - Rosnani Hashim
- Faculty of Pharmacy, University of Cyberjaya, Persiaran Bestari, 63000, Cyberjaya, Selangor, Malaysia.
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Hølmkjær P, Vermehren C, Holm A, Rozing MP, Høj K, Overbeck G. Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia. BMC Health Serv Res 2022; 22:1582. [PMID: 36572903 PMCID: PMC9791154 DOI: 10.1186/s12913-022-08961-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION First-line treatment for behavioral and psychiatric symptoms of dementia is non-pharmacological. Still, psychotropic medication is widely used, despite its limited effect and harmful side-effects. More than half of all nursing home residents with dementia receive antidepressants, even though deprescribing is safe and feasible. Interventions to promote deprescribing of antidepressants in nursing homes are few and complex. To optimize the deprescribing process through an intervention, transparency for the development of the intervention is needed. We aim to describe the steps in the development and tailoring of an intervention targeting GPs, nursing home staff, and relatives to enhance collaboration on reducing the use of antidepressants in institutionalized older persons with dementia in Denmark. METHOD A step-wise process guided by the core elements in the Medical Research Council constituted the tailoring process. Five steps were included; 1) a literature search, 2) interviews with stakeholders, 3) drafting the intervention prototype, 4) professionals' assessment of the intervention, and 5) refinement of the intervention. The steps were conducted from June 2020 to June 2022. RESULTS Based on the literature search, interviews with stakeholders, and professionals' assessment of the intervention, four main themes were identified; 1) focusing on antidepressants, 2) importance of professional qualifications, 3) collaboration and communication, and 4) patient and relative involvement. They guided intervention development and refinement of the final intervention, which included 1) a case-based training course and 2) a dialog tool including a symptom assessment scale to be used in a structured consultation at the nursing home. CONCLUSION This study presents a detailed account of the tailoring process for a complex intervention to optimize deprescribing of antidepressants for older persons with dementia at nursing homes. By presenting a thorough development process, we expect to achieve increased adherence to the intervention which is currently being tested in an ongoing cluster randomized controlled trial. The transparency of the process will also increase the future development of other similar complex interventions.
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Affiliation(s)
- Pernille Hølmkjær
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Vermehren
- grid.4973.90000 0004 0646 7373Department of Clinical Pharmacology, University Hospital Copenhagen, Capital Region, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Anne Holm
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Pieter Rozing
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Høj
- grid.7048.b0000 0001 1956 2722Research Unit for General Practice, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark ,grid.27530.330000 0004 0646 7349Unit of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Gritt Overbeck
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
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Patton DE, Pearce CJ, Cartwright M, Smith F, Cadogan CA, Ryan C, Clark E, Francis JJ, Hughes CM. A non-randomised pilot study of the Solutions for Medication Adherence Problems (S-MAP) intervention in community pharmacies to support older adults adhere to multiple medications. Pilot Feasibility Stud 2021; 7:18. [PMID: 33413650 PMCID: PMC7788279 DOI: 10.1186/s40814-020-00762-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Older patients prescribed multiple medications commonly experience difficulties with adherence. High-quality evidence on interventions targeting older patients is lacking. Theory is rarely used to tailor adherence solutions. This study aimed to pilot test a novel intervention, developed using the Theoretical Domains Framework, which guides community pharmacists in identifying adherence barriers and delivering tailored solutions (behaviour change techniques). Key study procedures (e.g. recruitment, data collection) for a future randomised controlled trial (cRCT) were also assessed. METHODS Using purposive sampling, this non-randomised pilot study aimed to recruit 12 community pharmacies (six in Northern Ireland; six in London, England). Pharmacists were trained to deliver the intervention to non-adherent older patients (maximum 10 per pharmacy; target n = 60-120) aged ≥ 65 years (reduced to 50 years due to recruitment challenges) and prescribed ≥ 4 regular medicines. The intervention, guided by an iPad web-application, was delivered over 3-4 face-to-face or telephone sessions, tailored to specific barriers to adherence. We assessed the feasibility of collecting adherence data (primary outcome: self-report and dispensing records), health-related quality of life (HRQOL) and unplanned hospitalisations (secondary outcomes) at baseline and 6-months. The final decision on progressing to a cRCT, using pre-defined 'stop-amend-go' criteria, is presented. RESULTS Fifteen pharmacists from 12 pharmacies were recruited and trained. One pharmacy subsequently dropped out. Sixty patients were recruited (meeting the 'Amend' progression criteria), with 56 receiving the intervention. Adherence barriers were identified for 55 patients (98%) and a wide range of behaviour change solutions delivered (median: 5 per patient). Self-report and dispensing adherence data were available for 37 (61.7%) and 44 (73.3%) patients, respectively. HRQOL data were available for 35 (58.3%) patients. GP-reported and self-reported hospitalisations data were available for 47 (78.3%) and 23 (38.3%) patients, respectively. All progression concepts were met (nine 'Go' and three 'Amend' criteria). CONCLUSION This study demonstrates the feasibility of key study procedures (e.g. pharmacy recruitment) and delivery of a tailored adherence intervention in community pharmacies. However, modifications are required to enhance issues identified with patient recruitment, retention and missing data. A future definitive cRCT will explore the effectiveness of the intervention. TRIAL REGISTRATION ISRCTN, ISRCTN73831533 , Registered 12 January 2018.
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Affiliation(s)
- D. E. Patton
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - C. J. Pearce
- School of Health Sciences, City University of London, London, UK
| | - M. Cartwright
- School of Health Sciences, City University of London, London, UK
| | - F. Smith
- School of Pharmacy, University College London, London, UK
| | - C. A. Cadogan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C. Ryan
- School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - E. Clark
- School of Health Sciences, City University of London, London, UK
| | - J. J. Francis
- School of Health Sciences, City University of London, London, UK
| | - C. M. Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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