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Health literacy - the degree to which people can access, understand and use health information - is essential for shared decision-making and improved health outcomes. Health consumers' ability to engage with health care professionals (HCPs) is influenced by their health literacy capabilities. This research sought to understand health literacy-related barriers and enablers to engage with non-physician HCPs as experienced by consumers.A qualitative descriptive approach was undertaken. A semi-structured interview guide was used, incorporating five health literacy domains described in the Health Literacy Questionnaire that related to consumers' engagement with health professionals. Audio- or digitally-recorded interviews were conducted with Australian health consumers, and transcribed and themed using the Patient-centred Access to Care framework as a template.Interviewing 30 consumers revealed that HCPs' clinical skills often enabled consumers to seek engagement; however, during active engagement their interpersonal skills became a key enabler. Conversely, a lack of developed interpersonal skills in HCPs was frequently seen as a barrier to consumer engagement. Barriers to engagement were also created when HCPs' information did not match what consumers discovered from other sources. However, consumers self-reported that they were unable to appraise health information at least some of the time.Barriers and enablers to consumers' engagement with HCPs were identified across each of the five relevant health literacy domains. SO WHAT?: HCPs should be aware of the importance of interpersonal skills and clear health information suitable for consumers with lower health literacy. Additionally, time dedicated to educating consumers on information appraisal could act as a further enabler to effective engagement.

Mental health stigma by health care practitioners is well established with few education interventions implemented in Australia. Depth of field is a growing body of health humanities research that draws on healthcare consumers as legitimate experts (by experience) to co-design health professions education. This research aimed to explore whether a co-designed (with mental health consumers) education intervention shifts knowledge, attitudes and behavioural intentions of current and future health care practitioners towards caring for people who have experienced mental health issues. A convergent parallel mixed method design was used to collect data utilising a validated anti-stigma assessment tool at two time points pre- and post-intervention (n = 80) followed by qualitative data from semi-structured interviews (n = 10). Descriptive analysis, Wilcoxon Sign-Rank test to compare pre-post responses and interview data were thematically analysed. Collectively, data showed positive shifts in knowledge, attitudes and behavioural intentions towards people who have experienced mental health issues. Three main themes: Making connections: The power of storytelling; Knowledge and attitudes towards Borderline Personality Disorder: Shape, strengthen, challenge; and Inspiring change in health care practice. Co-designed education can positively impact health care practitioners’ knowledge, attitudes and behavioural intentions and has the potential to reframe mental health education toward recovery-oriented practice.

BACKGROUND: Use of simulated patients (SP) to assess the quality of pharmacy services and impact of interventions is increasing. The CRiSP (Checklist for Reporting research using Simulated Patient methodology) checklist was recently developed, assisting researchers to report items necessary to meet a minimum agreed standard. OBJECTIVE(S): To identify which CRiSP items were reported in SP studies for community pharmacy research, identify any gaps in reporting and describe the overall quality of reporting for the SP studies identified. METHODS: Papers published during 2018-2020 using SP methodology in community pharmacy settings were identified from MEDLINE and Embase. The 50 most recent ones were selected. Data were extracted independently and in duplicate. Each paper received a coded numerical value denoting compliance with each item of CRiSP (1 = yes, 2 = no, 3 = unclear, 4 = not applicable, 5 = partially complete). Data were analysed using Microsoft Excel and reported as frequencies and percentages of each code for the checklist items, across the 50 papers. RESULTS: No paper fulfilled all items in the CRiSP checklist. The mode(s) of delivery of SP assessments (item 17) was reported in all papers, while use of the term SP (item 1); number of SPs (4a); scenario details (9a); describing procedures12; data collection procedure (18); and ethics approval (23a) were reported in at least 80% of papers. Items not reported in over 50% of papers were: scenario development (8a), validation (8b) and flexibility (9b); materials used (10a) and copies of materials (10b); and procedures for SP identification (15). Researchers found interpretation of the checklist unclear and utilised working definitions to ensure consistency in coding. CONCLUSIONS: This review identified that pharmacy research involving SP methodology is often inadequately reported by researchers. The CRiSP checklist is a comprehensive tool to assess the quality of SP methodology reporting but may require some refinement to ensure consistency in use. ispartof: Research in Social and Administrative Pharmacy vol:18 issue:2 pages:2301-2307 ispartof: location:United States status: published

Objectives Simulated patients are increasingly used to measure outcomes in health services but reporting is suboptimal. This study aims to create a checklist for the reporting of simulated patient (SP) methodology. Methods This was a Delphi study. The authors of health service research studies using SP methodology were invited to participate. Round 1 questionnaire assessed the applicability of the TIDieR (Template for Intervention Description and Replication) reporting checklist for SP methodology and asked for rewording of/additional items. Responses were thematically analysed to generate Round 2 items in which participants rated each item for importance (seven-point Likert scale) and median, mode and IQR were calculated. In Round 3, participants were invited to rescore their Round 2 responses. Consensus was defined as an IQR ≤ 1 (Extremely important) and median ≤ 2 (Very important). All consensus items were considered for inclusion in the checklist. Similarly, worded items were rationalised and items not specific to SP methodology or other existing checklists were excluded. Key findings Twenty-nine authors participated in Round 1 and a further seven for Rounds 2 and 3. Twenty-six responses were analysed for Round 1, 30 for Round 2 and 28 for Round 3. There was consensus on 29 of 54 items in Round 2 and 45 of 63 items in Round 3. The final checklist comprised 28 items. Conclusions A new reporting checklist to guide the reporting of studies, using simulated patients, complementary to CONSORT or STROBE, has been developed and will now be tested for usability.

Refereed/Peer-reviewed Background: Pharmacy practice in Australia is guided by professional practice guidelines. The guidelines communicate expected pharmacist behaviours to facilitate a consistently high standard of patient care, but are infrequently used by pharmacists and students. It is therefore essential to understand what influences pharmacists’ use of professional practice guidelines and how best to support positive behaviour change towards utilising these guidelines. Objective: To explore perceived influences on the use of professional practice guidelines by Australian pharmacists, and to map these influences to the COM-B model of behaviour.. Method: Focus group discussions were undertaken with pharmacists (including intern pharmacists) from various practice settings, locations, and with varying years of experience. Audio-recordings from each focus group were de-identified and transcribed verbatim. Transcripts were analysed using the COM-B (‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’) model. Results: Nine focus groups with 45 participants were conducted. Limited awareness of professional practice guidelines hindered pharmacists' ‘capability’ to use them. Pharmacists indicated that challenges accessing, and suboptimal content design, limited their ‘opportunity’ to use the guidelines. Pharmacists' professional role and identity (‘motivation’) appeared to inhibit use of the guidelines if they were perceived to not apply to their current role, or if pharmacists believed their experience obviated the need to use them. Motivation to use professional practice guidelines was associated with a belief that the guideline(s) would support pharmacists in their practice. Conclusion(s): Understanding what influences the use of professional practice guidelines should inform interventions to target and improve pharmacists’ use of the guidelines. The Behaviour Change Wheel offers clear next steps for this process. Awareness, access, and content could be improved in the first instance, and this may also work to improve motivation. Leveraging influences on motivation may serve to ensure that use of professional practice guidelines is embedded in future practice, albeit motivation can be more difficult to target.

Background Easy access to effective over-the-counter (OTC) treatments allows self-management of some conditions, however inappropriate or incorrect supply or use of OTC medicines can cause harm. Pharmacy personnel should support consumers in their health-seeking behaviour by utilising effective communication skills underpinned by clinical knowledge. Objective To identify interventions targeted towards improving communication between consumers and pharmacy personnel during OTC consultations in the community pharmacy setting. Methods Systematic review and narrative analysis. Databases searched were MEDLINE, EMBASE, Psycinfo, Cochrane Central Register and Cochrane Database of Systematic Reviews for literature published between 2000 and 30 October 2014, as well as reference lists of included articles. The search was re-run on 18 January 2016 and 25 September 2017 to maximise the currency. Two reviewers independently screened retrieved articles for inclusion, assessed study quality and extracted data. Full publications of intervention studies were included. Participants were community pharmacy personnel and/or consumers involved in OTC consultations. Interventions which aimed to improve communication during OTC consultations in the community pharmacy setting were included if they involved a direct measurable communication outcome. Studies reporting attitudes and measures not quantifiable were excluded. The protocol was published on Prospero Database of Systematic Reviews. Results Of 4978 records identified, 11 studies met inclusion criteria. Interventions evaluated were: face-to-face training sessions (n = 10); role-plays (n = 9); a software decision making program (n = 1); and simulated patient (SP) visits followed by immediate feedback (n = 1). Outcomes were measured using: SP methodology (n = 10) and a survey (n = 1), with most (n = 10) reporting a level of improvement in some communication behaviours. Conclusion Empirical evaluation of interventions using active learning techniques such as face-to-face training with role-play can improve some communication skills. However interventions that are not fully described limit the ability for replication and/or generalisability. This review identified interventions targeting pharmacy personnel. Future interventions to improve communication should consider the consumer's role in OTC consultations.

Background: Management of minor ailments through self-care and self-medication brings both benefits and risks that can be mitigated if consumers and pharmacy personnel engage in information exchange during over-the-counter (OTC) consultations. Objective: Explore the feasibility of interventions using situational cues to promote information exchange between pharmacy personnel and consumers, during OTC consultations. Methods: Intervention tools were developed prior to conducting the study, in two community pharmacies in Perth, Western Australia. The situational cues included two posters and individual position badges. Data were collected from audio-recording OTC consultations, consumer questionnaires and interviews, and pharmacy personnel interviews. Results: Space required for posters and for researchers conducting interviews was challenging in the retail environment. Pharmacy personnel perceived that the badges positively impacted -consumers&rsquo, ability to identify the position of personnel they engaged with. Data collection methods were deemed practical and acceptable. Conclusions: The proposed interventions and evaluation methods were feasible. The use of posters and badges as situational cues to address the barriers to information exchange during OTC consultations was found to be practical, in a community pharmacy setting. There is potential to use situational cues to address other barriers identified to information exchange, to add to the effectiveness of the intervention. With growing emphasis on self-care and self-medication, effective interventions are necessary to promote information exchange to enhance appropriate management in community pharmacies.

Objectives Evidence-based pharmacy practice requires a dependable evidence base. Randomised controlled trials (RCTs) are the gold standard of high-quality primary research, and tools exist to assist researchers in conducting and reporting high-quality RCTs. This review aimed to explore whether RCTs relevant to pharmacy are conducted and reported in line with Cochrane risk of bias and CONSORT standards, respectively. Methods A MEDLINE search identified potential papers. After screening of titles, abstracts and full texts, the 50 most recent papers were reviewed and assessment of bias according to Cochrane domains and compliance with CONSORT checklist items was recorded. Each domain of the Cochrane tool and CONSORT checklist item and each article were given a percentage score, reported as median and interquartile range (IQR). Correlation between quality of conduct, quality of reporting, continent of origin, and journal impact factor was conducted using the R2 statistic. The median domain score for risk of bias by paper according to the Cochrane risk of bias tool was 53.0% (IQR 38.5–68.5), while the median compliance score by paper for the CONSORT checklist was 64.0% (IQR 36.0–94.0%). key findings The median Cochrane domain and median CONSORT item completion scores, respectively, were 50.0% (IQR 33.3–66.7%) and 59.5% (IQR 52.0–70.3%). The highest risk of bias was associated with allocation concealment and blinding, and the least well-reported items were randomisation details, sequence generation and allocation concealment. A positive relationship between conduct and reporting of RCTs was found (R2 = 0.75), while no correlation was found between quality of conduct or quality of reporting and journal impact factor, correlation coefficients (R2 = 0.06 and R2 = 0.05, respectively). Summary This review identified that issues related to randomisation and blinding are often inadequately conducted or not comprehensively reported by researchers conducting pharmacy relevant RCTs, providing useful information for education and future research.

Objective: The objective of this study was to assess the acceptability, content validity and usability of the My Medicines and Me (M3Q) self-report side effect questionnaire. Methods: Eight focus groups consisting of mental health patients, carers, general practitioners, psychiatrists, mental health nurses and pharmacists were conducted, involving 78 participants. Two researchers independently examined the transcriptions and analysed the data thematically using an inductive method. Results: The findings supported changes to the formatting, length and phrasing of questions in the original version of the questionnaire. Although the groups provided differing views on the usability of the M3Q in clinical practice, the patient and carer groups were unconditionally in favour of such a tool to be used systematically to describe patients’ subjective experiences with side effects. Conclusion: The differing contribution made by all groups involved in the administration and completion of the M3Q assisted with content validity of the questionnaire. The acceptability and usability of this novel side effect questionnaire was also explored, with many participants agreeing it was a necessary tool for a patient centred approach to treatment. Following implementation of the changes to the current format of the questionnaire, investigation into the uptake and use in clinical practice should be carried out.

Consumers are confident managing minor ailments through self-care, often self-medicating from a range of over-the-counter (OTC) medicines available from community pharmacies. To minimise risks, pharmacy personnel endeavour to engage in a consultation when consumers present with OTC enquiries however they find consumers resistant. The aim was to determine stakeholder perspectives regarding barriers and facilitators for information exchange during OTC consultations in community pharmacies and to understand the elicited themes in behavioural terms. Focus groups were undertaken with community pharmacist, pharmacy assistant and consumer participants. Independent duplicate analysis of transcription data was conducted using inductive and framework methods. Eight focus groups involving 60 participants were conducted. Themes that emerged indicated consumers did not understand pharmacists’ professional role, they were less likely to exchange information if asking for a specific product than if asking about symptom treatment, and they wanted privacy. Consumers were confident to self-diagnose and did not understand OTC medicine risks. Pharmacy personnel felt a duty of care to ensure consumer safety, and that with experience communication skills developed to better engage consumers in consultations. They also identified the need for privacy. Consumers need education about community pharmacists’ role and responsibilities to motivate them to engage in OTC consultations. They also require privacy when doing so.

Background: Some Australian pharmacists use continuing education to maintain knowledge and acquire new information. There has been a progression from continuing education to continuing professional development (CPD) - a mandatory requirement for pharmacists in all jurisdictions of Australia. Aim: To identify post-registration learning trends of community pharmacists in Western Australia. Method: A questionnaire was developed and administered by face-to-face interviews with community pharmacists in metropolitan Perth. Pharmacists registered for less than 12 months and pharmacists working in hospitals were excluded. Results: 103 pharmacists were approached with a response rate of 95%. Journals (41%), reference books (23%) and the Internet (18%) were the most commonly used educational resources cited by pharmacists. Keeping scientific information up-to-date (39%) and gathering practical knowledge (22%) were the leading motivators for pharmacists to participate in continuing education. Factors that hindered participation in continuing education included lack of time (34%), family commitments (21%) and business commitments (21%). 79% of pharmacists agreed with the concept of mandatory CPD. 47% of pharmacists suggested that the primary sanction for not complying with mandatory CPD should be counselling to determine reasons for non-compliance. Conclusion: Community pharmacists preferred educational resources that were easily accessible at convenient times. Most pharmacists were able to fulfil the requirements of CPD, however, further educational support and promotion would ensure the successful uptake of CPD by community pharmacists in Western Australia.

(1) Background: Community pharmacy personnel help mitigate risks of self-care by consumers who seek over-the-counter (OTC) medicines or treatment of symptoms and/or conditions. Exchange of information facilitates the OTC consultation, but pharmacy personnel often report difficulties in engaging consumers in a dialogue. The aim of this study was to describe the development of a behaviour change intervention to enhance information exchange between pharmacy personnel and consumers during OTC consultations in community pharmacies. (2) Methods: The Behaviour Change Wheel methodological framework was used to link factors that influence consumer engagement with information exchange during OTC consultations with intervention functions to change behaviour. Options generated were rationalized and the final intervention strategy was derived. (3) Results: Education, persuasion, environmental restructuring, and modelling were determined to be potential intervention functions. The intervention incorporated placing situational cues in the form of posters in the community pharmacy modelling information exchange behaviour, persuading through highlighting the benefits of exchanging information and educating about its importance. (4) Conclusions: A systematic, theoretically underpinned approach was applied to develop candidate interventions to promote information exchange in OTC consultations. The feasibility and efficacy of the intervention strategy has since been tested and will be reported elsewhere.

Background Peer assisted learning (PAL) has been described as “the development of knowledge and skill through active help and support among status equals or matched companions”. To enhance the learning experience of health professions students and improve collaborative and collegial learning, six pilot Peer Assisted Learning (PAL) projects were conducted across a health science faculty. Methods A responsive mixed method evaluation design was applied to explore the adequacy of the preparation for PAL, the impact PAL had on student attainment of examination, consultation, communication and feedback skills and to explore students’ learning experiences through PAL. Results The 149 participants agreed the training programme was well organised, offered a safe learning environment and prepared the participant for the PAL activity. The impact of PAL included improvements in students’ confidence and ability to give feedback and developed students’ teaching, clinical and communication skills. Qualitative analysis revealed participants experienced deeper learning through teaching and learning from their peers, became more open to giving and receiving feedback and valued the comfortable/safe learning environment offered through PAL. Conclusion Providing appropriate training in peer teaching and feedback and the schools engagement and openness to peer learning in the classroom and clinical setting enhances students’ peer assisted learning experience.

ObjectivesThe Medication Appropriateness Tool for Comorbid Health conditions in Dementia (MATCH-D) criteria provide expert consensus guidance about medication use for people with dementia. This study aimed to identify enablers and barriers to implementing the criteria in practice.SettingParticipants came from both rural and metropolitan communities in two Australian states.ParticipantsFocus groups were held with consumers, general practitioners, nurses and pharmacists. Outcomes: data were analysed thematically.ResultsNine focus groups were conducted. Fifty-five participants validated the content of MATCH-D, appraising them as providing patient-centred principles of care. Participants identified potential applications (including the use of MATCH-D as a discussion aid or educational tool for consumers about medicines) and suggested supporting resources.ConclusionParticipants provided insights into applying MATCH-D in practice and suggested resources to be included in an accompanying toolkit. These data provide external validation of MATCH-D and an empiric basis for their translation to practice. Following resource development, we plan to evaluate the feasibility and efficacy of implementation in practice.

Objectives The aim was to evaluate a common-sense, behavioural change intervention to implement clinical guidelines for asthma management in the community pharmacy setting. Design The components of the common-sense intervention were described in terms of categories and dimensions using the Intervention Taxonomy (ITAX) and Behaviour Change Techniques (BCTs) using the Behaviour Change Wheel (BCW), Capability, Opportunity and Motivation-Behaviour (COM-B) System and Behaviour Change Techniques Taxonomy (BCTTv1). The retrospective application of these existing tools facilitated evaluation of the mechanism, fidelity, logistics and rationale of the common-sense intervention. Intervention The initial intervention study was conducted in 336 community pharmacies in the metropolitan area of Perth, Western Australia. Small-group workshops were conducted in 25 pharmacies; 162 received academic detailing and 149 acted as controls. The intervention was designed to improve pharmacy compliance with guidelines for a non-prescription supply of asthma reliever medications. Results Retrospective application of ITAX identified mechanisms for the short-acting β agonists intervention including improving knowledge, behavioural skills, problem-solving skills, motivation and self-efficacy. All the logistical elements were considered in the intervention design but the duration and intensity of the intervention was minimal. The intervention was delivered as intended (as a workshop) to 13.4% of participants indicating compromised fidelity and significant adaptation. Retrospective application of the BCW, COM-B system and BCTTv1 identified 9 different behaviour change techniques as the rationale for promoting guideline-based practice change. Conclusions There was a sound rationale and clear mechanism for all the components of the intervention but issues related to logistics, adaptability and fidelity might have affected outcomes. Small group workshops could be a useful implementation strategy in community pharmacy, if logistical issues can be overcome and less adaptation occurs. Duration, intensity and reinforcement need consideration for successful wider implementation. Further qualitative evaluations, triangulation of research and evaluations across interventions should be used to provide a greater understanding of unresolved issues.