Improving outpatient medication counselling in hospital pharmacy settings: a behavioral analysis using the theoretical domains framework and behavior change wheel
Background: Despite the importance of medication counselling for patients, it is common knowledge that it is often sub-optimally carried out by pharmacy staff. While some interventions have been designed to help improve counselling, no study till date has used the Capability Opportunity and Motivation behavior model (COM-B) or Theoretical Domains Framework (TDF) as a basis for identifying evidence-based intervention strategies to improve medication counselling.
Objective: To understand barriers/facilitators to optimal medication counselling by conducting a behavioral analysis using the COM-B model and TDF, and use the Behavior Change Wheel (BCW) as a basis for identifying evidence-based intervention strategies and policy categories that could be used to improve outpatient medication counselling by pharmacy staff in hospital settings located within Northwest Nigeria.
Methods: Semi-structured interviews were used to collect data from 25 purposively sampled pharmacy staff working at eight major public hospitals, from January till March 2020. Data from the interviews were then transcribed and deductively coded using the COM-B model and TDF. These findings were then used to identify areas requiring change, as well as the intervention type and policy functions required to support these changes.
Results: Findings from the behavioral analysis revealed shortfalls in pharmacy staff capability, opportunity and motivation with respect to outpatient medication counselling. To improve their counselling behaviors, change was identified as necessary in eight TDF domains namely ‘knowledge’, ‘interpersonal skills’, ‘memory’ ‘environmental context’, ‘social influences’, ‘intentions’, ‘reinforcement’ and ‘beliefs about capabilities’. Seven intervention functions including ‘education’, ‘training’, ‘modelling’, ‘enablement’ and ‘environmental restructuring’, in addition to three policy categories (‘guidelines’, ‘regulations’ and ‘environmental/social planning’) were also identified as relevant to future intervention design.
Conclusions: Various factors were identified as affecting medication counselling by the pharmacy staff, with several of them requiring changes if counselling was to be improved upon. Multi-component interventions combining several of these intervention functions are recommended for hospital authorities and other relevant stakeholders to improve outpatient medication counselling.
Wight D, Wimbush E, Jepson R, Doi L. Six steps in quality intervention development (6SQuID). J Epidemiol Community Health. 2016;70(5):520-525. https://doi.org/10.1136/jech-2015-205952
Colquhoun HL, Squires JE, Kolehmainen N, Fraser C, Grimshaw JM. Methods for designing interventions to change healthcare professionals' behaviour: a systematic review. Implement Sci. 2017;12(1):30. https://doi.org/10.1186/s13012-017-0560-5
Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. https://doi.org/10.1186/1748-5908-6-42
Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions, 1st ed. London: Silverback;2014.
Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77. https://doi.org/10.1186/s13012-017-0605-9
Seubert LJ, Whitelaw K, Boeni F, Hattingh L, Watson MC, Clifford RM. Barriers and Facilitators for Information Exchange during Over-The-Counter Consultations in Community Pharmacy: A Focus Group Study. Pharmacy (Basel). 2017;5(4):65. https://doi.org/10.3390/pharmacy5040065
Jackson C, Eliasson L, Barber N, Weinman J. Applying COM-B to medication adherence: A suggested framework for research and interventions. Eur Health Psychologist. 2014;16(1):7-17
Easthall C, Barnett N. Using Theory to Explore the Determinants of Medication Adherence; Moving Away from a One-Size-Fits-All Approach. Pharmacy (Basel). 2017;5(3):50. https://doi.org/10.3390/pharmacy5030050
Korenvain C, MacKeigan LD, Dainty KN, Guilcher SJT, McCarthy LM. Exploring deprescribing opportunities for community pharmacists using the Behaviour Change Wheel. Res Social Adm Pharm. 2020;16(12):1746-1753. https://doi.org/10.1016/j.sapharm.2020.01.019
Jones LF, Owens R, Sallis A, et al. Qualitative study using interviews and focus groups to explore the current and potential for antimicrobial stewardship in community pharmacy informed by the Theoretical Domains Framework. BMJ Open. 2018;8(12):e025101. https://doi.org/10.1136/bmjopen-2018-025101
Steed L, Sohanpal R, James WY, et al. Equipping community pharmacy workers as agents for health behaviour change: developing and testing a theory-based smoking cessation intervention. BMJ Open. 2017;7(8):e015637. https://doi.org/10.1136/bmjopen-2016-015637
Seubert LJ, Whitelaw K, Hattingh L, Watson MC, Clifford RM. Development of a Theory-Based Intervention to Enhance Information Exchange during Over-The-Counter Consultations in Community Pharmacy. Pharmacy (Basel). 2018;6(4):117. https://doi.org/10.3390/pharmacy6040117
Murphy AL, Gardner DM, Kutcher SP, Martin-Misener R. A theory-informed approach to mental health care capacity building for pharmacists. Int J Ment Health Syst. 2014;8(1):46. https://doi.org/10.1186/1752-4458-8-46
Beyene K, Aspden T, Sheridan J. Using the Behaviour Change Wheel to explore potential strategies for minimising harms from non-recreational prescription medicine sharing. Res Social Adm Pharm. 2019;15(2):130-144. https://doi.org/10.1016/j.sapharm.2018.04.001
Hussain A, Ibrahim MI. Medication counselling and dispensing practices at community pharmacies: a comparative cross sectional study from Pakistan. Int J Clin Pharm. 2011;33(5):859-867. https://doi.org/10.1007/s11096-011-9554-6
Hussain S, Hussain AA, Hussain K, et al. Pharmacist–patient counselling in Dubai: assessment and reflection on patient satisfaction. Eur J Hosp Pharm. 2013;20(4):241-247. . https://doi.org/10.1136/ejhpharm-2012-000263
Boeni F, Arnet I, Hersberger KE. Adherence counseling during patient contacts in swiss community pharmacies. Patient Prefer Adherence. 2015;9:597-605. https://doi.org/10.2147/ppa.s76027
Alfadl AA, Alrasheedy AA, Alhassun MS. Evaluation of medication counseling practice at community pharmacies in Qassim region, Saudi Arabia. Saudi Pharm J. 2018;26(2):258-262. https://doi.org/10.1016/j.jsps.2017.12.002
Yande SD, Masurkar PP, Gopinathan S, S Sansgiry S. A naturalistic observation study of medication counseling practices at retail chain pharmacies. Pharm Pract (Granada). 2020;18(1):1696. https://doi.org/10.18549/pharmpract.2020.1.1696
Al Aqeel S, Abanmy N, AlShaya H, Almeshari A. Interventions for improving pharmacist-led patient counselling in the community setting: a systematic review. Syst Rev. 2018;7(1):71. https://doi.org/10.1186/s13643-018-0727-4
Aaltonen SE, Laine NP, Volmer D, et al. Barriers to medication counselling for people with mental health disorders: a six country study. Pharm Pract (Granada). 2010;8(2):122-131. https://doi.org/10.4321/s1886-36552010000200007
Chevalier BA, Watson BM, Barras MA, Cottrell WN. Hospital pharmacists' perceptions of medication counseling: A focus group study. Res Social Adm Pharm. 2016;12(5):756-771. https://doi.org/10.1016/j.sapharm.2015.10.007
Mohammed S, Tanko N, Usman N, Biambo AA, Samaila A, Yahya AB. Assessment of patient-pharmacist communication in a tertiary health institution in North Central Nigeria. Nig J Pharm. 2019;53(2):19-26.
Yimer YS, Mohammed SA, Hailu AD. Patient-Pharmacist Interaction in Ethiopia: Systematic Review of Barriers to Communication. Patient Prefer Adherence. 2020;14:1295-1305. https://doi.org/10.2147/ppa.s258914
Okonta JM, Okonta EO, Ofoegbu TC. Barriers to Implementation of Pharmaceutical Care by Pharmacists in Nsukka and Enugu metropolis of Enugu State. J Basic Clin Pharm. 2012;3(2):295-298. https://doi.org/10.4103/0976-0105.103823
Ogbonna BO, Ezenduka CC, Soni JS, Oparah AC. Limitations to the dynamics of pharmaceutical care practice among community pharmacists in Enugu urban, southeast Nigeria. Integr Pharm Res Pract. 2015;4:49-55. https://doi.org/10.2147/iprp.s82911
Ma'aji HU, Khan F, Shuaibu A, Abdu-Aguye SN, Mohammed M. Assessment of Hospital Pharmacy Services in North-Western Nigeria. Nig J Pharm Sci. 2018;17(1):90-97
Copyright (c) 2021 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.