Enhancing community pharmacists' provision of medication adherence support to older adults: A mixed methods study using the Theoretical Domains Framework.

Abstract

Community pharmacists have an important role to play in providing medication adherence support (MAS) to older patients. However, research has shown that pharmacists rarely ask patients about adherence and offer limited solutions. The Theoretical Domains Framework (TDF) can guide the selection of behaviour change techniques (BCTs), to enhance behaviours such as MAS provision. This study aimed to: (1) explore barriers/facilitators influencing community pharmacists' provision of MAS to older patients prescribed multiple medications; (2) Identify theoretical domains to target for behaviour change; (3) Select BCTs to deliver to pharmacists to enhance MAS provision. As part of a two-phase study, semi-structured interviews and a cross-sectional survey were conducted. In Phase 1, community pharmacists in Northern Ireland (NI) were recruited using purposive/snowball sampling. TDF-based interviews were audio-recorded, transcribed and analysed by two independent researchers using the framework method/content analysis. In Phase 2, a TDF-based postal survey was mailed to all community pharmacies in NI (n=521) and analysed using descriptive statistics. Triangulated findings informed selection of target TDF domains and BCTs to deliver to enhance MAS provision. Fifteen pharmacists were interviewed for Phase 1. Barriers and facilitators included inadequate remuneration, time and knowledge of solutions and professional confidence. In Phase 2, 143 (27.4%) survey responses were received. Potential barriers included inadequate training in motivational techniques and difficulties with decision-making. Based on triangulated findings, seven domains (e.g. skills, motivation/goals) were identified as targets and mapped across to 18 BCTs (e.g. behavioural practice/rehearsal, prompts/cues). This mixed methods study provides unique perspectives on the wide range of barriers/facilitators that are perceived to influence the provision of MAS by community pharmacists. The 18 BCTs identified to target each of the seven key target domains identified in this study will be tested in a future pilot study of a patient-targeted intervention.