Using COM-B model in identifying facilitators, barriers and needs of community pharmacists in implementing weight management services in Malaysia: a qualitative study

Identifying the key determinants of a community pharmacy based bladder and bowel service

OBJECTIVES

Community pharmacies and their personnel present an opportunity to implement new services for bladder and bowel continence care. Underpinned by the COM-B model of capability (C), opportunity (O), motivation (M), Behaviour (B)), this study explored the opinions of healthcare staff and users of community pharmacy services, to inform the development of a new pharmacy bladder and bowel service (PBBS).

METHODS

A qualitative design was adopted by conducting in-depth semi-structured interviews with pharmacy staff, users of community pharmacy services, bladder and bowel service staff, and professionals involved with commissioning services. A thematic analysis was used, and resulting themes were mapped onto the components of the COM-B model.

RESULTS

A total of 27 participants were interviewed that represented the four groups of participants. A pro-active, protocolised PBBS was envisaged, involving targeted advice and provision of self-help materials, medication support, and referral/follow-up assessment as appropriate. Training programs for pharmacy staff, adequate funding/remuneration and information technology, awareness campaigns, policy support and guidance were identified as key behavioural targets for the success of a potential PBBS. Workforce time and capacity, service user embarrassment and stigma were potential barriers.

CONCLUSIONS

The study identified a range of elements to be considered in the design and implementation of a successful PBBS. Informed by the evidence presented by this study, a multi-faceted approach to co-design the service will be required to ensure it is fit for purpose for all healthcare public and policy stakeholders.

Pharmacists' perspectives and perceived barriers to counselling patients with kidney stones

BACKGROUND

The global increase in kidney stone incidence and its complications emphasise the need for effective management. While pharmacists can play a significant role in counselling and guiding patients, their practices in managing patients with kidney stones remain unclear.

OBJECTIVE(S)

To explore counselling practices and experiences of pharmacists when dealing with patients with kidney stones and to identify the barriers they face while providing counselling.

METHODS

A qualitative study was performed using semi-structured phone interviews with pharmacists practising in Jordan. Pharmacists were selected using quota sampling from those who took part in a previous study focused on pharmacists' knowledge of kidney stone aetiology and treatment. The COM-B Model of Behaviour Change was used to develop the interview guide and the analytical framework. Interviews were transcribed verbatim and analysed using a deductive thematic approach based on the pre-specified analytical framework.

RESULTS

Seven pharmacists (85.7% female; 57.1% working in community pharmacies) were interviewed. Counselling practices of patients with kidney stones were categorised into five themes: (1) Pharmacists' beliefs about patient counselling: perceived importance and desire to improve health through counselling; (2) Most priority patients: Types of patients mostly counselled; (3) Content of kidney stones-specific counselling: patient assessment and recommendations about kidney stones management; (4) Duration of the counselling sessions: time offered and influencing factors; (5) Barriers to patient counselling: patient-related, and pharmacist- and doctor-related challenges.

CONCLUSIONS

Pharmacists recognise the crucial role of kidney stones counselling but face gaps in their practices, including incomplete dietary education, limited knowledge of medication prescriptions, inconsistent patient-specific approaches, and potential communication challenges. These gaps can be overcome by enhancing training, standardising protocols of kidney stone treatment, promoting interprofessional communication, and improving communication strategies. Future research, including quantitative assessments, is needed to inform strategies that optimise patient counselling practices and facilitate improved outcomes.

Pharmacists' perceptions and delivery of health behaviour change recommendations: Mapping the COM-B model

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.

Application of the COM-B model to explore barriers and facilitators to participation in research by hospital pharmacists and pharmacy technicians: A cross-sectional mixed-methods survey

BACKGROUND

Combining research and clinical practice is crucial for advancing evidence-based healthcare and improving pharmacy service delivery. While hospital pharmacists report significant interest in research, this does not translate to high levels of research engagement. Furthermore, little is known regarding barriers and motivators for pharmacy technician involvement in research.

OBJECTIVE

To characterise the barriers and enablers to engaging in practice-based research reported by hospital pharmacy staff using the Capability, Opportunity, Motivation - Behaviour (COM-B) framework.

METHODS

An online cross-sectional survey, using the validated Research Capacity in Context tool, was sent to all employees of a statewide hospital pharmacy service. Respondent characteristics and quantitatively reported barriers and motivators were analysed using descriptive statistics. Qualitative data from open text responses were analysed through inductive thematic analysis. Results were mapped to the components of the COM-B framework at individual, team and organisation levels.

RESULTS

278 responses were received (response rate 43.3%) from pharmacists (68.0%) and pharmacy assistants/technicians (28.4%) across 19 hospitals. Research behaviour was influenced by factors linked to five of six COM-B subdomains. Reflective motivation, linked to a desire to improve practice and patient care, self-development, and recognition, indicates pharmacy staff would like to engage in research. However, barriers related to physical opportunity (lack of time for research, other work roles that take priority) and psychological capability (lack of skills and mentorship) hindered involvement. Social opportunity and automatic motivation, tied to managerial support, role perceptions and departmental research culture were also reported facilitators. Subtle differences in the factors that motivate hospital pharmacists and pharmacy technicians were identified.

CONCLUSIONS

Mapping factors associated with research participation by hospital pharmacy staff to the COM-B model is an important step towards identifying evidence-based intervention types that could form the basis of strategies to optimise hospital pharmacy staff engagement with practice-based research, using the behaviour change wheel.

Lived experiences of Turkish community pharmacists toward person-centric care: a qualitative analysis

Background

In Turkey, the SMART pharmacist program was launched to enable community pharmacists to deliver patient-centric care services. However, how far this programme has achieved success and what are the challenges faced by the programme need to be evaluated.

Objective

This study aimed to explore the experiences of community pharmacists in providing person-centric care services in pharmacies and provide recommendations for improved care effectiveness.

Methods

A phenomenological approach was adopted in this study. To conduct qualitative interviews, a semi-structured interview guide was devised to gather insights from the pharmacists. The interviews were coded verbatim. Subsequently, various themes and sub-themes were developed based on the aim and objectives of the study. A total of 14 pharmacists engaged in semi-structured interviews conducted between May and August 2023.

Results

Two main themes emerged from the data: challenges in person-centric care and recommendations to improve person-centric care. Barriers were subdivided into patient-related challenges and personal challenges. Recommendations consisted of pharmacists' professional tasks and recommendations.

Conclusion

The findings of this study, suggest that the concerned healthcare authorities should re-evaluate the 'SMART pharmacist' program in Turkey and address professional and personal challenges faced by community pharmacists in delivering effective person-centric care. Pharmacists recommend patient follow-up (follow-ups), providing a counselling environment, collaboration with physicians, expansion of pharmacy services.

Community pharmacists' acceptability of pharmacist-delivered depression screening for older adults: a qualitative study

BACKGROUND

Late-life depression often goes underdiagnosed and undertreated, affecting the quality of life of older adults. Pharmacists are well-placed to identify older adults who may be at risk of depression by using appropriate screening tools.

AIM

To explore community pharmacists' acceptability of performing late-life depression screening in Australian community pharmacies.

METHOD

Semi-structured interviews with community pharmacists were conducted to gauge their perceptions regarding delivering depression screening services for older adults. Data analysis was conducted using an iterative, inductive approach. Key themes were identified, which were further explored and divided into subthemes. Subthemes were categorised as either barriers or facilitators. Each subtheme was mapped to the Capability, Opportunity, Motivation-Behaviour model by classifying whether they impacted pharmacists' capability, opportunity, or motivation regarding depression screening.

RESULTS

Fifteen pharmacists were interviewed, 12 of whom were female and 11 of whom practised in a metropolitan area. Four key themes were identified including: training needs, environmental factors, pharmacists' roles, and organisational support, which were further divided into 13 subthemes. Three subthemes were mapped to Capability, seven to Opportunity and three to Motivation. Barriers included lack of resources and lack of remuneration, while facilitators included training, pharmacists' accessibility, and rapport with consumers.

CONCLUSION

The findings of this study demonstrate that while community pharmacists found depression screening for older adults in community pharmacies to be an acceptable service, there remains a need for the development of funding schemes and standardised guidelines for pharmacist-delivered depression screening for older adults.

Implementation of behaviour change training in practice amongst pharmacy professionals in primary care settings: Analysis using the COM-B model

BACKGROUND

The Pharmacy Integration Fund (PhIF) was established in England in 2016, with funded learning programmes or 'pathways' designed to support the development of clinical pharmacy practice in a range of settings. Despite pharmacy staff being well positioned to provide more clinical work, limited research has investigated behaviour change training targeted at widespread practice transformation.

OBJECTIVE(S)

To investigate implementation of PhIF learning in practice, using the COM-B model of behaviour change.

METHODS

An online survey distributed in February and October 2020 included questions on motivations for learning, confidence in target behaviours and impact of PhIF training on behaviour. The October 2020 survey also included questions exploring the effect of the COVID-19 pandemic. Quantitative data were analysed in SPSS. v.27 (IBM). Inferential statistics were used to compare between the pathways (Primary care pathways [PCP], Post-registration pathway [PRP] and Accuracy Checking Pharmacy Technician [ACPT] pathway). Free text comments were categorised and themed.

RESULTS

Three-hundred and eighty-three responses were received (49% PRP learners, 39% PCP learners and 12% ACPT learners). Learners generally had the capacity and opportunities to apply learning, and were strongly motivated to implement behaviours in practice, although learners based in community pharmacy (those on the PRP) were less likely to report receiving employer support. Enhanced knowledge/skills (capacity) were more commonly reported than change to patient-facing activities, leading clinical services and conducting medication reviews with patients with complex needs (clinical practice behaviours targeted by the pathways). The COVID-19 pandemic heightened barriers to implementing practice change.

CONCLUSIONS

Implementation of a range of clinical practice behaviours following at scale training appears to have been largely successful. Despite this, the community pharmacy context, where funded service opportunities may be lacking, continues to present challenges to workforce transformation plans. More work is needed to understand how training can be implemented to promote practice change for pharmacy professionals in all settings.

Examining the influences on the use of behavioural science within UK local authority public health: Qualitative thematic analysis and deductive mapping to the COM-B model and Theoretical Domains Framework

Background

Behavioural science and its contribution towards improving public health is receiving increased recognition. Yet, the translation of these insights into public health practice is under-researched. This study explored the factors influencing the use of behavioural science within public health at a local authority level.

Methods

Fourteen local authority staff (n = 13 female) in the south of England participated in semi-structured interviews, which were analysed inductively to identify key themes. These were later mapped deductively to the COM-B model and Theoretical Domains Framework.

Findings

Nine themes were identified as factors that influence the use of behavioural science in local authority public health: (1) "Limited past experience," (2) "Narrow understanding," (3) "Perceived value of behavioural science," (4) "Translational gap from theory-to-practice," (5) "No protected time," (6) "Old ways of working," (7) "Political influence and organisational culture," (8) "Relationships with key stakeholders," (9) "Access to behavioural science resources". Deductive mapping of these themes revealed that five of the COM constructs (excluding Physical Capability) and eleven of the TDF domains influenced behavioural science use, with "Social influences" and "Knowledge" being the most prominent.

Discussion

Use of behavioural science within local authority public health practice is limited and inconsistent. For it to be successfully implemented, there must be an understanding of its role and value, alongside strategies to overcome a translational gap from theory to practice. Public health teams would benefit from protected time to enable application and strategies to break old habits of using a common-sense approach. System-wide buy-in, particularly related to senior leadership and system partners is needed, which would benefit from organisational and political culture change. Training opportunities, practical resources and expert in-house support should be considered a priority across public health teams.