Perceptions of the Malaysian general public on community pharmacy-based weight management services

Patients' experience of accessing healthcare for obesity in Peninsular Malaysia: a qualitative descriptive study

OBJECTIVE

To explore patients' experiences accessing healthcare for obesity and their perceived behaviour changes following the care.

DESIGN

Using a descriptive qualitative research approach informed by Levesque's framework of access to healthcare, we conducted phone interviews in the Malaysian language, which were audio-recorded and transcribed verbatim. Data were analysed inductively using a reflexive thematic analysis approach.

SETTING

Primary care clinics in five states in Peninsular Malaysia.

PARTICIPANTS

Adult patients with obesity receiving face-to-face care for obesity from healthcare providers in Peninsular Malaysia.

RESULTS

We interviewed 22 participants aged 24-62, with the majority being female (77%), Malay (95%), married (73%) and with tertiary education (82%). Most participants attended obesity management services at public primary care clinics. We identified five themes: (1) moving from perceiving the need to seeking obesity care is a non-linear process for patients, (2) providers' words can inspire patients to change, (3) patients' needs and preferences are not adequately addressed in current obesity care, (4) over-focusing on weight by patients and healthcare providers can lead to self-blame and loss of hope for patients and (5) obesity healthcare can have consequences beyond weight loss.

CONCLUSION

Patients lack the self-regulatory skills to continue their lifestyle changes and struggle with self-blame and hopelessness. Over-focusing on weight by patients and obesity healthcare increase patients' self-stigmatisation. While provider-initiated weight discussions and engaging and personalised consultation provide the initial step towards weight management, obesity healthcare could be enhanced by behavioural support and patient education on the complexity of obesity. Further considerations could be given to shifting from a weight-centric to a more holistic health-centred approach in obesity healthcare.

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

Background

Previous qualitative studies exploring the experiences of community pharmacists (CP) in implementing weight management services (WMS) often lack a theoretical underpinning. This study applied the capability, opportunity, motivation, behaviour (COM-B) model to factors associated with WMS implementation among CPs to develop and recommend better intervention strategies.

Methods

A qualitative study design was used by conducting in-depth, semi-structured interviews with CPs. All the interviews were audio-recorded and duly transcribed. The thematic analysis approach was used to analyse the data, and the themes generated were mapped onto COM-B model components.

Results

The themes that emerged were (1) motivation of pharmacists and (2) knowledge and skills, which were identified as both barriers and facilitators, and (3) the barriers to implementation in aspects of social norms and resources. Factors were subsequently categorised into the subcomponents of the model: physical capability (e.g., training), psychological capability (e.g., lack of knowledge), physical opportunity (e.g., product range), social opportunity (e.g., stigma), automatic motivation (e.g., remuneration) and reflective motivation (e.g., CPs extended roles).

Conclusions

In conclusion, programs or training For Cps should develop their psychological capability to change their behaviour by being more proactive in promoting and providing weight management services, with a vital educational component. This behavioural change will improve the promotion of this service and will help many customers who were unaware of this service. Learning opportunities will leave CPs to feel more empowered and overcome barriers to implementing and maintaining WMS in primary care. The study findings provided essential insights into the factors that affect this provided service in Malaysia. The results will help to encourage the embedding of nutrition counselling in academic curricula.

Health-promoting services provided in pharmacies: A systematic review

Pharmacies are a major component of health systems and a major part of health service provision. This study aimed at identifying and introducing the potentials of pharmacies in health promotion. This was a systematic review that searched PubMed, Web of Science, Science Direct, SID, Magiran, and IranMedex from February 1990 to September 2018 for related materials. The main search keywords were (pharmacy services), (community pharmacy services), (retail pharmacy services), (pharmacy practice intervention). Inclusion was limited to those papers that discussed the health-promoting services provided in the pharmacies. The quality of included papers was assessed by the Critical Appraisal Skills Program checklists. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was followed in all stages of the study. Of the 4156 papers retrieved, 18 met the inclusion criteria and included in the analysis. Study findings were categorized into three main categories: Health and prevention services, services related to treatments, and the awareness about the pharmacies' functions. The health and prevention category consisted of education, vaccination, screening and prevention of diseases, family planning, blood pressure monitoring, quitting smoking, limiting alcohol, and weight management. The treatment-related services consisted of adherence to medication, medication consultation, minor pains, and emergency medical services. Pharmacies can provide a wide variety of services besides the medications. Purposeful development of the services provided in the pharmacies and involving them in an extended array of services may accelerate the health promotion activities of the health system and result in improved quality of life and decreased costs. To do so, the legal, educational-skill, and pricing challenges should be resolved.

Community Pharmacists' Awareness toward Their Roles in Healthcare and Interaction with General Practitioners: A Cross-Sectional Study

Introduction:

There is a paucity of data on the extended role of community pharmacists (CP) in Malaysia. This study is aimed to evaluate CPs awareness toward their roles in healthcare and interaction with general practitioners (GPs).

Materials and Methods:

A cross-sectional design using a validated questionnaire was conducted nationwide among randomly selected Malaysian CPs. The questionnaire consisted of consisted of 32 questions with three sections. The Cronbach's alpha measure for the scale on awareness was 0.494 and 0.724 for the interaction between CPs and GPs. Descriptive statistics were reported. The Chi-square test, Mann–Whitney test, Kruskal–Wallis test, and post hoc analyses were applied at the alpha level of 0.05.

Results:

Of the 127 CPs who filled out the responses, 57.5% (n = 73) mentioned that they rarely or never interacted with GPs. Many CPs (n = 106, 83.5%) were aware of their role in providing patient education, and 109 (85.8%) indicated that they could suggest nonprescription medicines to patients, whereas 88 respondents (69.3%) were aware that they could suggest alternative medicines. A total of 117 respondents (92.1%) indicated their willingness to perform selected screening tests and identify and prevent prescription errors. A considerable number of CPs (n = 76, 59.8%) were aware of their ability to design and regulate prescribed regimens, and 89 (70.1%) showed their willingness to monitor these regimens. The total average score of the CPs’ awareness toward their roles in providing healthcare for the 16 activities/items and the value of the interaction mean score was 12.00 (±2.92), with a median score of 12.00 (interquartile range: 9.5–14.5).

Conclusions:

Malaysian CPs are fully aware of their role in providing healthcare and pharmaceutical care. Though the majority of them were willing to provide extended services, they are often unable to perform these roles due to the lack of interprofessional collaboration, lack of time, and absence of remuneration for their extended services. Training programs, practice guidelines, and professional service fee may encourage CPs to perform more extended services.

Attitudes, Practices, and Barriers of Malaysian Community Pharmacists Toward Provision of Weight Management Services

In Malaysia, sharp increment in the prevalence of obesity over the last four decades has been documented. Community pharmacists (CPs) are strategically placed to tackle obesity by providing weight managements services (WMS) to general public. This study assessed the attitudes, practices and perceived barriers of Malaysian CPs to the provision of WMS. A cross-sectional, descriptive survey was conducted, and responses related to attitudes, practices and perceived barriers of CPs were collected using five-point Likert scale. A total of 550 pharmacists who worked across six states of Malaysia (Selangor, Federal Territory of Kuala Lumpur, Pulau Pinang, Johor, Sabah, and Melaka) participated in this study. Most of the CPs strongly agreed that over eating (n = 312, 56.7%) and sedentary lifestyles (n = 297, 54.0%) contribute to obesity and overweight. Most of them also strongly agreed that exercise training is an effective weight reduction strategy (n = 285, 51.9%), but they were generally not in favor of surgery (n = 231, 42% disagreed/strongly disagreed). CPs generally perceived barriers related to a lack of staff to provide WMS (n = 308, 56.0% agreed/strongly agreed) and ethical and legal issues associated with sales of products/drugs for obesity management (n = 285, 51.9% agreed/strongly agreed). Sociodemographic and practice characteristics such as age group, type of pharmacy, highest education qualification, and employment status of CPs influenced the attitudes, practices and perceived barriers associated with WMS. In terms of age, CPs who were aged less then 30 years expressed significantly stronger agreement that medication adherence is beneficial for weight loss compared to those CPs between 41-50 years. Additionally, CPs who were pharmacy owners provided significantly more frequent BMI measurement and patient information materials as part of their weight management practices compared to CPs who worked as a part timer/locum. This study could be taken as a baseline study on Malaysian CPs' perceptions on WMS.