Trust In Professionals Research Articles

Factors associated with contact tracing compliance among communities of color in the first year of the COVID-19 pandemic

RationaleThe disproportionate impact of COVID-19 on communities of color has raised questions about the unique experiences within these communities not only in terms of becoming infected with COVID-19 but also mitigating its spread. The utility of contact tracing for managing community spread and supporting economic reopening is contingent upon, in part, compliance with contact tracer requests. ObjectiveWe investigated how trust in and knowledge of contact tracers influence intentions to comply with tracing requests and whether or not these relationships and associated antecedent factors differ between communities of color. MethodData were collected from a U.S. sample of 533 survey respondents from Fall (2020) to Spring 2021. Multi-group SEM tested quantitative study hypotheses separately for Black, AAPI, Latinx, and White sub-samples. Qualitative data were collected via open-ended questions to inform the roles of trust and knowledge in contact tracing compliance. ResultsTrust in contact tracers was associated with increased intentions to comply with tracing requests and significantly mediated the positive relationship between trust in healthcare professionals and government health officials with compliance intentions. Yet, the indirect effects of trust in government health officials on compliance intentions were significantly weaker for the Black, Latinx, and AAPI samples compared to Whites, suggesting this strategy for increasing compliance may not be as effective among communities of color. Health literacy and contact tracing knowledge played a more limited role in predicting compliance intentions directly or indirectly, and one that was inconsistent across racial groups. Qualitative results reinforce the importance of trust relative to knowledge for increasing tracing compliance intentions. ConclusionsBuilding trust in contact tracers, more so than increasing knowledge, may be key to encouraging contact tracing compliance. Differences among communities of color and between these communities and Whites inform the policy recommendations provided for improving contact tracing success.

Undermining teachers’ social capital: a question of trust, professionalism, and empowerment

The question of professional trust urgently needs closer attention in relation to teacher recruitment and retention, as this research shows it has significant bearing on the symbolic capital that may help to attract, motivate, and sustain high quality teachers. In Australian schools, teachers are frequently subject to initiatives to improve their practice, address their perceived limitations, and hold them accountable for failing students, schools, or systems. We argue that teachers, in the advent of these reforms intended to improve them, come to believe they are distrusted in their professional roles. Denying teachers the sense of themselves as capable professionals risks contributing to the problems of retention that are becoming ever more urgent in the Australian context and elsewhere in the world. This article explores the impacts of discourses and policy directions on teachers’ perceptions of professional trust. Drawing on case study data from two schools in the state of Victoria, Australia, we highlight the ways discourses of professional distrust emerge through policy directives that position teachers as ‘the problem’ in education.

The United Nations Sustainable Development Goals: Aspirational or obtainable?

The <scp>United Nations</scp> Sustainable Development Goals: Aspirational or obtainable?

Social determinant factors and access to health care for women experiencing domestic and family violence: Qualitative synthesis.

The aim of this study was to explore the social determinant factors and access to health care for women with lived experience of domestic and family violence. Qualitative synthesis. A search of CINHAL, Embase, Medline and PubMed, was conducted between December 2021 and March 2022. Primary qualitative studies published in English from 2000 to 2021 were included. Findings were thematically analysed using the Levesque et al. (2013) access to healthcare framework. Study design was assessed using the Critical Appraisal Skills Programme for qualitative research. Twenty-eight studies were included. Findings related to the Levesque domains of approachability, appropriateness and availability of health services. Social determinants included perceived stigma and fear of discrimination leading to a lack of trust in healthcare professionals and fear of disclosure, which prohibits disclosure. Women reported their limited awareness of available support services, an absence of health professional screening and insufficient response when they disclosed presence of domestic and family violence, which collectively reduced their healthcare access. Findings advance our understanding of how social determinant factors influence women's ability to access health care. The determinants related to discrimination and stigma, which prohibited the establishment of trust, were the most influential factors on access to care. Women experiencing domestic and family violence are hesitant to disclose, and violence continues in secret. Social determinant factors of stigma and trust prohibit women's disclosure and therefore their access to health care. Findings hold implications for nurses' consciousness of these social determinant factors. Raising nurses' awareness to curiously question the presence of domestic and family violence may build trust that leads to disclosure and improves access to health care. The authors intend to present the findings to people with lived experience in the next phase of this programme of research.

Assessing the role of collectivism and individualism on COVID-19 beliefs and behaviors in the Southeastern United States.

America's unique response to the global COVID-19 pandemic has been both criticized and applauded across political and social spectrums. Compared to other developed nations, U.S. incidence and mortality rates were exceptionally high, due in part to inconsistent policies across local, state, and federal agencies regarding preventive behaviors like mask wearing and social distancing. Furthermore, vaccine hesitancy and conspiracy theories around COVID-19 and vaccine safety have proliferated widely, making herd immunity that much more challenging. What factors of the U.S. culture have contributed to the significant impact of the pandemic? Why have we not responded better to the challenges of COVID-19? Or would many people in the U.S. claim that we have responded perfectly well? To explore these questions, we conducted a qualitative and quantitative study of Florida State University faculty, staff, and students. This study measured their perceptions of the pandemic, their behaviors tied to safety and community, and how these practices were tied to beliefs of individualism and collectivism. We found that collectivist orientations were associated with a greater likelihood of wearing masks consistently, severe interruptions of one's social life caused by the pandemic, greater concern for infecting others, and higher levels of trust in medical professionals for behavioral guidelines surrounding the pandemic. These associations largely persist even after adjusting for political affiliation, which we find is also a strong predictor of COVID-19 beliefs and behaviors.

Medical experts and trusted confidants: parent perceptions of the clinician-parent relationship in childhood cancer

A childhood cancer diagnosis threatens the health, safety, and security of the child and whole family unit. A strong relationship between the healthcare team and family is integral to provision of holistic support during this time of crisis. Family-centered care necessitates a fluid, therapeutic relationship between parents and the child's healthcare team. This study investigated bereaved parents' perspectives on their relationship with their child's care team and the impact of these relationships on their coping across the cancer trajectory and into bereavement. Thirty-one parents whose child died from cancer between 1 and 6 years prior to study enrollment participated in semi-structured interviews about their relationships and interactions with their child's healthcare team across the illness course and into bereavement. We audio-recorded interviews, transcribed them verbatim, and utilized a codebook thematic analysis approach to analyze interview transcripts. Four themes emerged across interviews with parents describing their perceptions of the parent-clinician relationship: (1) a collaborative approach improves perceptions of care, (2) professional trust is core to the relationship, (3) parental personal preference and bias can limit relationship-building, and (4) meaningful connections form on an emotional, individualized level. These themes highlight relational patterns between parents and clinicians that can promote or erode alliance and collaboration. Bereaved parents recognize key attributes that influence the parent-clinician relationship. Educating clinicians about parent-identified positive modifiable behaviors (e.g., communication deficits) and awareness of non-modifiable care factors (e.g., individual personality preferences) may enable clinicians to strengthen relationships with parents and ultimately improve quality of care.

A qualitative evidence synthesis of patient perspectives on migraine treatment features and outcomes.

We aimed to identify migraine treatment features preferred by patients and treatment outcomes most valued by patients. The values and preferences of people living with migraine are critical for both the choice of acute therapy and management approach of migraine. We conducted a qualitative evidence synthesis. Two reviewers independently selected studies, appraised methodological quality, and undertook a framework synthesis. We developed summary of findings tables following the approach of Grading of Recommendations, Assessment, Development and Evaluations Confidence in the Evidence from Reviews of Qualitative Research to assess confidence in the findings. Of 1691 candidate references, we included 19 studies (21 publications) involving 459 patients. The studies mostly recruited White women from North America (11 studies) and Europe (8 studies). We identified eight themes encompassing features preferred by patients in a migraine treatment process. Themes described a treatment process that included shared decision-making, a tailored approach, trust in health-care professionals, sharing of knowledge and diversity of treatment options, a holistic approach that does not just address the headache, ease of communication especially for complex treatments, a non-undermining approach, and reciprocity with mutual respect between patient and provider. In terms of the treatment itself, seven themes emerged including patients' preferences for nonpharmacologic treatment, high effectiveness, rapidity of action, long-lasting effect, lower cost and more accessibility, self-management/self-delivery option that increases autonomy, and a mixed preference for abortive versus prophylactic treatments. The treatment outcomes that have high value to patients included maintaining or improving function; avoiding side effects, potential for addiction to medications, and pain reoccurrence; and avoiding non-headache symptoms such as nausea, vomiting, and sensitivity to light or sounds. Patient values and preferences were individually constructed, varied widely, and could be at odds with conventional medical perspectives and evidence of treatment effects. Considering the availability of numerous treatments for acute migraine, it is necessary that decision-making incorporates patient values and preferences identified in qualitative research. The findings of this qualitative synthesis can be used to facilitate an individually tailored approach, strengthen the patient-health-care system relationship, and guide choices and decisions in the context of a clinical encounter or a clinical practice guideline.

Developing a professional guideline for the use of cyberspace by health-care professionals in Iran: a mixed methods study

&#x0D; &#x0D; &#x0D; &#x0D; The present study aimed to compile and develop a professional guideline for health-care providers in Iran regarding cyberspace usage. This was a mixed-methods study, conducted in three phases. In the first phase, the principles of ethics in cyberspace were collected through a review of the literature and available documents, and were then subjected to content analysis. In the second phase, the views of experts on medical ethics, virtual education, information technology and medical education, as well as clinical sciences experts and representatives of medical students and graduates were evaluated using the focus group method. In the third phase, the draft was evaluated by various stakeholders. Finally, after receiving the comments, the necessary modifications were applied to the guideline.&#x0D; The professional guideline for the use of cyberspace by health-care professionals comprised 30 codes in 5 domains, including the general regulations domain, care and treatment, research, education, and personal development.&#x0D; This guideline presents the various ways professionalism can be maintained in cyberspace interactions. Adherence to the principles of professionalism in cyberspace is required to protect and preserve the public trust in health-care professionals.&#x0D; &#x0D; &#x0D; &#x0D;

COVID-19 pandemic and transgender migrant women in India: Socio-economic vulnerability and vaccine hesitancy

In India, transgender women, often referred to as hijra or kinnar, remain a marginalized group and encounter interpersonal and structural barriers that subject them to social exclusion, discrimination, lack of access to education and health care, and fewer job opportunities compared with the general population. During the COVID-19 pandemic these disparities were heightened and the livelihood of transgender migrant women were severely hit and disrupted, causing further financial and physical hardship. The present study aims to explore the socio-economic vulnerability faced by these women during the pandemic and the factors that contribute to vaccine hesitancy in order to assist government officials and policy makers in the formulation of more inclusive policies for transgender people. Results indicate that the pandemic has adversely impacted their livelihood as most of them depend on sex work and begging. In order to fulfil their daily needs during the lockdown, they have borrowed loans from multiple sources with a higher interest rates and remain in debt. On vaccination status, only seven out of 43 transgender migrant women have taken one vaccine dose, and the rest are not willing to visit vaccine centres because of societal stigma and discrimination including from healthcare personnel. The study reported that these migrant women suffered intensified social stigma, verbal hostility and transphobia attitudes from healthcare professionals whihc caused panic, fear, anxiety and depression among them, and thus they evade these spaces for further consultation or to obtain any other services. Many of them have decided not to take the COVID-19 vaccine in order to stay away from hostility. Further, the lack of trust in medical professionals is also one of the principal concerns leading to vaccine hesitancy among transgender migrant women. Thus a systemic inclusive healthcare services policy is required to address the factors that may influence the vaccine acceptance among transgender women in India.

Mandatory and seasonal vaccination against COVID-19: Attitudes of the vaccinated people in Serbia.

The aim of our study was to examine the position of vaccinated people regarding the proposal for mandatory and seasonal vaccination against COVID-19 in Serbia. A cross-sectional study was conducted in a sample of people who came to receive a third dose of COVID-19 at the Institute of Public Health of Serbia in September and October 2021. Data were collected by means of a sociodemographic questionnaire. The study sample comprised 366 vaccinated adults. Factors associated with the belief that vaccination against COVID-19 should become mandatory were being married, being informed about COVID-19 from TV programmes and medical journals, trust in health professionals, and having friends affected by COVID-19. In addition to these predictors, factors associated with the belief that COVID-19 vaccination should become seasonal were being older, consistently wearing facemasks, and not being employed. The results of this study highlight that trust in information delivery, evidence-based data, and healthcare providers may be a major driver of mandatory and seasonal vaccine uptake. A careful assessment of the epidemiological situation, the capacity of the health system, and the risk-benefit ratio is needed in order to introduce seasonal and/or mandatory vaccination against COVID-19.

Health Beliefs, Health Practices, and Health-Seeking Behaviors among Swartzentruber Amish in Clark County, Wisconsin

Although the literature contains valuable information about Amish culture, few qualitative studies have been conducted on the health beliefs, health practices, and health-seeking behaviors of the Swartzentruber Amish, the most conservative group of Old Order Amish. The purpose of this study was to describe these dynamics for the Swartzentruber Amish of Clark County, Wisconsin. Utilizing the grounded theory approach, 25 participants were interviewed and seven themes were identified: shared decision-making is common in families; causes of illness are believed to be etiological or the will of God; home remedies are the first choice; preventive medicine is an unfamiliar concept; health information is sought from within their settlement; and professional medical care is a last resort in treatment. These Amish identified several obstacles to seeking or using professional medical care: unfamiliarity with the English medical system; communication barriers; lack of trust in medical professionals; the high cost of medical care; belief of diminished or no say in a child’s healthcare; and concern about prescription drugs. An understanding of the Swartzentruber Amish is important if healthcare professionals are to provide them with culturally congruent care. Numerous recommendations based on the findings are included for healthcare providers. [Abstract by author.]

Interprofessional Collaboration and Team Effectiveness of Pharmacists in General Practice: A Cross-National Survey.

As team-based care continues to evolve, pharmacists have been included in general practice teams in many countries, to varying extents, to improve medication use and patient safety. However, evidence on interprofessional collaboration and team effectiveness of pharmacists in general practice is sparse. This study aimed to compare the extent of interprofessional collaboration and team effectiveness of general practice pharmacists in Australia with international sites (Canada and the UK), and identify the factors associated with interprofessional collaboration and team effectiveness. General practice pharmacists from Australia, Canada, and the UK were identified through professional organisations and networks, and invited to participate in an online survey, adapted from existing validated tools. The survey explored interprofessional collaboration through four sub-domains (professional interactions, relationship initiation, trust and role clarity, and commitment to collaboration) and team effectiveness of general practice pharmacists. Of the 101 respondents (26 from Australia, 44 from Canada and 31 from the UK), 79% were female and 78% were aged below 50 years. Interprofessional collaboration and team effectiveness appeared to be high and similar between countries. Total scores for collaboration of pharmacists were 86.1 ± 7.4 in Australia, 88.5 ± 7.5 in the UK, and 89.1 ± 7.3 in Canada (mean ± SD, where higher scores represent more advanced collaboration), while the team effectiveness scores of the pharmacists were 88.6 ± 14.6 in Canada, 91.8 ± 14.6 in Australia and 97.5 ± 14.0 in the UK. Pharmacists who had worked in general practice for a longer time showed advanced interprofessional collaboration while those who worked exclusively in general practice had higher scores for team effectiveness. Overall, general practice pharmacists in the three countries were highly collaborative with general practitioners. Long-term employment and longer work hours could enhance interprofessional collaboration and team effectiveness in general practice pharmacists by improving trust and working relationships over time.

Using knowledge of, attitude toward, and daily preventive practices for COVID-19 to predict the level of post-traumatic stress and vaccine acceptance among adults in Hong Kong.

COVID-19 has been perceived as an event triggering a new type of post-traumatic stress (PTSD) that can live during and after the pandemic itself. However, it remains unclear whether such PTSD is partly related to people's knowledge of, attitude toward and daily behavioral practices (KAP) for COVID-19. Through a telephone survey, we collected responses from 3,011 adult Hong Kong residents. Then using the Catboost machine learning method, we examined whether KAP predicted the participant's PTSD level, vaccine acceptance and participation in voluntary testing. Results suggested that having good preventative practices for, poor knowledge of, and negative attitude toward COVID-19 were associated with greater susceptibility to PTSD. Having a positive attitude and good compliance with preventative practices significantly predicted willingness to get vaccinated and participate in voluntary testing. Good knowledge of COVID-19 predicted engagement in testing but showed little association with vaccine acceptance. To maintain good mental health and ongoing vaccine acceptance, it is important to foster people's sense of trust and belief in health professionals' and government's ability to control COVID-19, in addition to strengthening people's knowledge of and compliance with preventative measures.

Factors Predicting the Willingness of Parents to Have Their Children Vaccinated against COVID-19 Pandemic: A Cross-sectional Survey in Jordan

Background: COVID-19 vaccination has proven to be effective in controlling the spread of the pandemic. However, many parents remain unwilling to have their children vaccinated. Purpose: This study aims to investigate the willingness on the part of Jordanian parents to have their children receive COVID-19 vaccines and to examine the predictors of this parental willingness. These predictors/variables include parents’ demographic variables, risk perception and trust in health authorities and healthcare professionals. Methods: In September 2020, an online survey was used to generate a sample made up of parents residing in every region of the country using a proportional cluster protocol. A selfreporting questionnaire was used to generate the data. Results: A total of 1,252 parents participated in this study. Analysis revealed that 25.5% of the parents were willing to have their children vaccinated and that 25%, approximately, trusted what the health authorities had to say about the pandemic. 31.4% trusted healthcare professionals for caring for COVID-19 infected people. Finally, the results of the study showed that parental risk perception, trust, gender and education were the significant predictors of the parents’ willingness to have their children vaccinated. Conclusion: Among Jordanian parents, the high prevalence of opposition to children vaccination may be explained by factors, such as risk perception of COVID-19, trust in health authorities and healthcare professionals and demographics. Implications for Nursing: Health-promotion initiatives are needed to provide parents with clear, accurate and transparent information about the possible risks of COVID-19 infection among children and the vaccine’s benefits for both children and communities. Keywords: Covid-19 pandemic, Vaccination, Parents’ willingness, Children, Jordan

Understanding Canadians' knowledge, attitudes and practices related to antimicrobial resistance and antibiotic use: Results from public opinion research.

Antimicrobial resistance is a current and pressing issue in Canada. Population-level antibiotic consumption is a key driver. The Public Health Agency of Canada undertook a comprehensive assessment of the Canadian public's knowledge, attitudes and practices in relation to antimicrobial resistance and antibiotic use, to help inform the implementation of public awareness and knowledge mobilization. Data were collected in three phases: 1) six in-person focus groups (53 participants) to help frame the survey; 2) nationwide survey administration to 1,515 Canadians 18 years and older via cell phone and landline; and 3) 12 online focus groups to analyze survey responses. Survey data is descriptive. A third (33.9%) of survey respondents reported using antibiotics at least once in the previous 12 months, 15.8% more than twice and 4.6% more than five times. Antibiotic use was reported more among 1) those with a household income below $60,000, 2) those with a medical condition, 3) those without a university education and 4) among the youngest adults (18-24 years of age) and (25-34 years of age). Misinformation about antibiotics was common: 32.5% said antibiotics "can kill viruses"; 27.9% said they are "effective against colds and flu"; and 45.8% said they are "effective in treating fungal infections". Inaccurate information was reported more often by those 1) aged 18-24 years, 2) with a high school degree or less and 3) with a household income below $60,000. In focus groups, the time/money trade-offs involved in accessing medical care were reported to contribute to pushing for a prescription or using unprescribed antibiotics, particularly in more remote contexts, while the cost of a prescription contributed to sharing and using old antibiotics. A large majority, across all demographic groups, followed the advice of medical professionals in making health decisions. High trust in medical professionals presents an important opportunity for knowledge mobilization. Delayed prescriptions may alleviate concerns about the time/money constraints of accessing future care. Consideration should be given to prioritizing access to appropriate diagnostic and other technology for northern and/or remote communities and/or medical settings serving many young children to alleviate concerns of needing a prescription or of needing to return later.

Religious Beliefs, Trust In Public Figures, And Adherence to COVID-19 Health Guidelines among American Orthodox and Non-Orthodox Jews

The COVID-19 pandemic and resultant health crisis highlighted the lack of scholarly understanding of the effects of sociocultural factors and religious beliefs on compliance with public health guidelines. Orthodox Jews in particular were suspected of mistrusting medical experts and were singled out for alleged non-compliance with COVID-19 health guidelines. We surveyed American Jews (N = 1,141) during the early stages of the pandemic about their religious beliefs connected with the pandemic, trust in relevant public figures, and compliance with health guidelines to examine whether and how these factors are related. Generally, participants expressed high levels of trust in scientists, medical professionals, and religious leaders and a high degree of adherence to health guidelines. We examined how trust varies as a function of sociodemographic features, religious affiliation, and health-related religious beliefs (i.e., spiritual health locus of control). Overall, our research underscores the relevance of religious beliefs and trust in public figures to adherence to health guidelines and public health messaging.

Responsible autonomy: The interplay of autonomy, control and trust for knowledge professionals working remotely during COVID-19

This article revisits the concept of responsible autonomy, analysing the interplay of employee autonomy, management control and trust experienced by knowledge professionals in the UK compelled to work remotely during the coronavirus pandemic. The authors theorise about the tensions and paradoxes of responsible autonomy in the contemporary context of the COVID-19 crisis, drawing on empirical findings gathered in May 2020 and May 2021. Many participants experienced increased autonomy and discretion, but also work intensification and blurred work–life boundaries. Interestingly, many accepted this paradox as a palatable trade-off for the autonomy of being able to work from home, particularly where there was reciprocal trust between employee and manager. Trust is the glue in responsible autonomy, yet exists in tension with intrusive managerial control.

COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda.

Despite being a priority population for COVID-19 vaccination, limited data are available regarding acceptability of COVID-19 vaccines among people living with HIV (PLWH) in Sub-Saharan Africa. We described COVID-19 vaccine acceptability and factors associated with vaccine acceptability among PLWH in Uganda. This was a cross-sectional study conducted among PLWH, aged ≥18 years, enrolled participants who were seeking HIV care from six purposely selected accredited ART clinics in Kampala. We obtained data on vaccine acceptability defined as willingness to accept any of the available COVID-19 vaccines using interviewer-administered questionnaires. In addition, we assessed vaccination status, complacency regarding COVID-19 disease, vaccine confidence, and vaccine convenience. Factors associated with COVID-19 vaccine acceptability were evaluated using modified Poisson regression with robust standard errors. We enrolled 767 participants of whom 485 (63%) were women. The median age was 33 years [interquartile range (IQR) 28-40] for women and 40 years [IQR], (34-47) for men. Of the respondents 534 (69.6%,95% confidence interval [CI]: 66.3%-72.8%) reported receiving at least one vaccine dose, with women significantly more likely than men to have been vaccinated (73% vs. 63%; p = 0.003). Among the unvaccinated 169 (72.7%, 95% CI: 66.6%-78.0%) were willing to accept vaccination, had greater vaccine confidence (85.9% had strong belief that the vaccines were effective; 81.9% that they were beneficial and 71% safe for PLWH; 90.5% had trust in health care professionals or 77.4% top government officials), and believed that it would be easy to obtain a vaccine if one decided to be vaccinated (83.6%). Vaccine acceptability was positively associated with greater vaccine confidence (adjusted prevalence ratio [aPR] 1.44; 95% CI: 1.08-1.90), and positive perception that it would be easy to obtain a vaccine (aPR 1.57; 95% CI: 1.26-1.96). vaccine acceptance was high among this cohort of PLWH, and was positively associated with greater vaccine confidence, and perceived easiness (convince) to obtained the vaccine. Building vaccine confidence and making vaccines easily accessible should be a priority for vaccination programs targeting PLWH.

Using the theoretical domains framework to explore stakeholder perspectives of a “prescriber-ready pharmacist” to help develop the future workforce

Abstract Introduction The General Pharmaceutical Council’s (GPhC’s) revised standards for the Initial Education and Training of Pharmacists, enable pharmacists to prescribe on registration”.1 This major reform is transforming the education and training of ‘day-one pharmacist prescribers’ allowing them to play a greater role in patient care. Aim To explore stakeholder perspectives on a “prescriber-ready pharmacist” to help inform the initial education and training of the future pharmacy workforce. Methods Structured interviews with a diverse group of stakeholders, and an interview and focus groups with pharmacy students, took place in Autumn 2021. The schedule was developed using the Theoretical Domains Framework (TDF).2. Participants were identified and recruited via email by the investigators, who had legitimate access to their contact details. All were held and recorded on Microsoft Teams, then transcribed and analysed using Framework Method.3 Ethical approval from LJMU, School of Pharmacy, REC (PBS/2021-22/01). Results The study included 50 participants; interviews with six patients, eight community pharmacists (two independent prescribers (IPs)), 10 hospital pharmacists (six IPs), 12 primary care pharmacists (eight IPs), two nurses (one IP), five GPs, and one second year pharmacy student; and two focus groups, with three, final-year pharmacy students. Participants felt person-centred care, communication and consultation skills were very important for ‘day-one pharmacist prescribers’. Professional knowledge and clinical skills e.g., “interpretation of diagnostic tests” [Hospital Pharmacist_04], were cited by hospital and primary care pharmacists. Conversely, professionalism were more likely to be mentioned by community pharmacists, “General knowledge about legalities of prescribing” [Community Pharmacist_07] and understanding their limitations. Many felt the pharmacy degree needed to become more clinical with additional placement opportunities, which would be challenging in terms of time constraints and staff capacity “… have to provide training for a large number of students that [they] haven't had to train in that way before” [Primary Care Pharmacist_05]. Barriers to ‘day one’ pharmacists prescribing included a lack of experience and confidence and pharmacist respondents felt it was important for them to gain the trust of other health care professionals. Barriers specifically for community pharmacy were: a perceived lack of support and commercial pressures, along with logistical barriers including lack of space, equipment, IT issues and pharmacists sitting outside of the ‘parent team’ in hospitals. Discussion/Conclusion Hospital and primary care pharmacists in the study were more likely to mention professional knowledge and skills, for example clinical and diagnostic skills. This may be explained because many were qualified independent prescribers and so have a better understanding of the knowledge and skills to perform the role. The additional challenges faced by community pharmacy presented may be because of a lack of defined roles for independent prescribers working within this setting. A limitation of the study is a lack of stakeholder representation from medics and other health care professionals in secondary care. ‘Prescriber-ready pharmacists’ require appropriate professional knowledge and skills, and provide a person-centred service within their sphere of competence. Stakeholders need assurance that these pharmacists are competent as independent prescribers at the point of registration before, through changes to the undergraduate programme, in particular placement opportunities.

“Nobody wants to rock the boat”: a grounded theory study of taking medication to prevent a further heart attack

Abstract Introduction Following an acute myocardial infarction (AMI), patients are prescribed a daily regime of five medications to prevent secondary cardiovascular events, however medication adherence in this patient group has been measured at only 66%.1 Sub-optimal adherence leads to increased mortality, morbidity and healthcare system costs. Current interventions such as monitored dosage systems, phone message reminders and pharmacist consultations have made some improvements but are largely based on presumptions about adherence than formal evidence. Studying the experience of medication-taking following an AMI, and the personal requirement and adjustment that is required to enable adherence could arguably generate the evidence needed to support future interventions in this field. Aim The aim of this study was to use grounded theory methodology to create a model explaining the process of medication-taking in patients prescribed medication following an AMI. Methods Following ethical approval (UREC 18/36), semi-structured interviews were conducted with thirteen people (based in South-East England) taking medication following at least one AMI episode in the past. The interviews were conducted in person, online or via the telephone and audio-recorded. These recordings were transcribed verbatim and analysed according to constructed grounded theory.2 NVivo software was used to organise and display the coded data and produce a model of the medication-taking process. Results Patients took medication because they wanted to continue living their lives. They saw medication as offering them protection, alongside diet and exercise. Following hospital discharge, patients incorporated medication into their daily routines at home. They used mealtimes and bedtime as a prompt, and kept medication located close to these activities. Patients described rarely missing doses but recognised being away from routines was a cause of medication omission. In this stable stage, patients considered medication-taking unproblematic; they ‘just got on with it’. The professional trust established with the medical team was the basis for following medication directions, and patients conferred the authority to make decisions about their treatment, not wanting to initiate changes themselves; to not ‘rock the boat’. The main cause of change to medication-taking was experiencing adverse bodily effects, ascribed by patients to medication and described as side effects. Patients used small noticeable bodily changes as a prompt for further investigation and information- seeking, after which they presented evidence to the medical team, who instigated medication changes. There was a background dislike of taking medication, which was eased by knowledge of medication action and personal biomedical results. These patients were intentionally adherent to medication but were drawn to question their treatment when ‘side effects’ or misunderstanding arose. Discussion/Conclusion Medication-taking in this group is driven by a desire to live, so they accommodate medication routine to fit their lives, but ‘side effects’ can disturb their intention to continue the routine. This action is reinforced by trust relationships with medical professionals. Resistance to taking medication is alleviated by knowledge of medication action and biomedical results. Practitioners can use patient education, test results and shared decision-making as points to further the patient relationship and strengthen adherence behaviours.