Research in Social and Administrative Pharmacy j (2015) j–j
Commentary
Making the case for change: What researchers need to consider when designing behavior change interventions aimed at improving medication dispensing Cathal A. Cadogan, Ph.D.*, Cristı´ n Ryan, Ph.D., Carmel Hughes, Ph.D. School of Pharmacy, Queen’s University Belfast, Northern Ireland, UK
Summary There is a growing emphasis on behavior change in intervention development programmes aimed at improving public health and healthcare professionals’ practice. A number of frameworks and methodological tools have been established to assist researchers in developing interventions seeking to change healthcare professionals’ behaviors. The key features of behavior change intervention design involve specifying the target group (i.e. healthcare professional or patient cohort), the target behavior and identifying mediators (i.e. barriers and facilitators) of behavior change. Once the target behavior is clearly specified and understood, specific behavior change techniques can then be used as the basis of the intervention to target identified mediators of behavior change. This commentary outlines the challenges for pharmacy practice-based researchers in targeting dispensing as a behavior when developing behavior change interventions aimed at pharmacists and proposes a definition of dispensing to consider in future research. Ó 2015 Elsevier Inc. All rights reserved. Keywords: Behavior change intervention; Dispensing; Pharmacists
Introduction There is a growing emphasis in the literature on the importance of behavior change in interventions seeking to improve public health and healthcare professionals’ clinical practice.1,2 Frameworks of behavior change have been developed to assist researchers in understanding healthcare professionals’ behaviors in any given clinical context and identifying mediators of such change.3,4 These frameworks have been linked to established taxonomies of behavior change
techniques (BCTs) which provide a method of specifying intervention content.5 With an increasing number of medications being prescribed at the population level and predicted increases in the size of the older patient cohorts wherein polypharmacy and multimorbidity are highly prevalent,6 the prescribing and dispensing of medication constitute two important target behaviors for interventions seeking to ensure that patients receive appropriate medical treatment. However, previous interventions targeting polypharmacy7 and multimorbidity8 in
* Corresponding author. Tel.: þ44 (0)2890 972348. E-mail address: [email protected] (C.A. Cadogan). 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.04.002
2
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5
older persons do not appear to have given due consideration to the importance of targeting healthcare professionals’ behaviors during intervention development. Although progress has been made in investigating physicians’ behaviors in both primary and secondary care settings using established frameworks of behavior change as the basis for intervention development,9,10 there is a deficit of related research investigating pharmacists’ dispensing behavior. In light of the significant expansion of the pharmacist’s professional role in recent years, as well as growing recognition of their potential to make a significant contribution to appropriate prescribing and use of medicines,11,12 it is likely that pharmacists will feature more prominently in healthcare interventions as both intervention recipient and deliverer. Hence, there is a need to consider how dispensing can be targeted as part of a behavior change intervention. This requires examination of the overall development process for behavior change interventions targeting healthcare professionals.
Incorporating psychological theory into the development of behavior change interventions targeting healthcare professionals The Medical Research Council’s (MRC) framework on complex interventions advocates the use of evidence and theory during intervention development.13 The use of theory in intervention development can help to target causal determinants of behavior and behavior change, thus making the intervention more likely to be effective.14 A recognized limitation of the MRC framework is that it does not provide guidance on how theory can be incorporated into the intervention development process.4 Thus, the challenge for researchers in pharmacy practice and other healthcare-related research disciplines seeking to develop behavior change interventions lies in navigating their way through the vast range of existing psychological theories and using these theories to understand target behaviors. To assist researchers across different disciplines, particularly those from a non-health psychology background, an overarching theoretical framework known as the Theoretical Domains Framework (TDF) has been developed.3 The TDF distils psychological theory relevant to behavior change in healthcare professionals into theoretical domains which are considered to be mediators (i.e. barriers and
Table 1 List of TDF domains3 Knowledge Skills Motivation and goals Memory, attention and decision processes Social/professional role and identity Environmental context and resources
Beliefs about consequences Beliefs about capabilities Social influences Emotion Behavioral regulation Nature of the behaviors
facilitators) of behavior change.3 The framework’s twelve theoretical domains are listed in Table 1. Qualitative interviews based on the TDF provide an established method to explore the target group’s perceptions of each of the domains and how they impact on the target behavior.1 This allows researchers to identify key mediators involved in changing target behaviors and to incorporate a theory-base into interventions. Quantitative methods (i.e. questionnaires) also have been used to apply the TDF during intervention development.15 Using a TDF-based approach, identified mediators of behavior change can be mapped to specific BCTs as part of a systematic approach to develop behavior change interventions (Table 2). For example, as part of a project looking at implementation of guideline recommendations for the management of acute low back pain, French et al16 conducted TDF-based focus groups with GPs and found that knowledge of guidelines was one of several barriers affecting the target behavior (i.e. implementation). This mediator of behavior change was then mapped to a BCT (i.e. information provision, thereby mapping to the ‘Knowledge’ domain) which was subsequently incorporated into the intervention.
Defining dispensing as a behavior For any intervention seeking to change healthcare professionals’ behavior, it is vital to have the target behavior clearly defined at the outset. Behavior has been defined as “the product of individual or collective human actions, seen within and influenced by their structural, social and economic context”.17 The difficulty in conceptualizing dispensing as a behavior is that it has not previously been defined explicitly in behavioral terms.
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5
3
Table 2 Steps for developing a theory-based behavior change intervention (adapted from French et al16) Step 1 Step 2 Step 3 Step 4
Identify who needs need to do what differently (i.e. target group and target behavior). Use a theoretical framework to identify which mediators of behavior change (i.e. barriers and facilitators) need to be targeted. Use behavior change techniques to target identified mediators of behavior change. Select outcome measures to assess behavior change.
Instead, dispensing has been described as “a complex process which involves many activities, such as checking the appropriateness of the prescription for the patient, assembling and labeling of the prescribed product(s), coding and endorsing of the prescription, checking the accuracy of the final product(s), handing out prescription product(s) to the patient and providing appropriate advice and counseling”.18 This range of activities or “collective human actions” makes it difficult to identify which specific behaviors within the overall dispensing process need to be targeted as part of a behavior change intervention. In addition, the activities associated with the dispensing process have not been characterized consistently in the literature.19 In some instances, dispensing and patient counseling have been categorized as separate activities,20,21 whereas other sources have included patient counseling as an integral part of the dispensing process.22–24 If dispensing is to be targeted in future behavior change interventions aimed at pharmacists, it is important to consider what ‘dispensing’ means in behavioral terms to ensure that researchers have a clear understanding of the target behavior. If one considers a clinical behavior as a “behaviour enacted by a clinician (doctors, nurses, and allied health professionals) within a clinical context with respect to a patient or their care”,25 one can begin to conceptualize parts of the ‘complex dispensing process’ in terms of clinical behaviors. For example, checking the appropriateness of the prescribed medication and providing advice to patients constitute two clinical behaviors as they are typically performed by pharmacists (i.e. the clinicians) during the dispensing process in the provision of pharmaceutical care to patients (i.e. the clinical context). However, the entire range of activities within the complex dispensing process is not explicitly clinically oriented. For example, the administrative processing of the prescription is an aspect of the dispensing process that does not need to be performed exclusively by pharmacists.
To help researchers in conceptualizing dispensing as a behavior, it is proposed here that the range of activities within the complex dispensing process, as outlined by Bell et al,18 should be disaggregated and specified in behavioral terms. Thus, dispensing is defined as a complex process that involves both clinical behaviors and non-clinical behaviors. The clinical behaviors of the dispensing process are those that are intended to be performed specifically by pharmacists in the provision of pharmaceutical care to patients. These clinical behaviors involve reviewing the patient’s drug regimen, assessing the appropriateness of the prescription for the patient, engaging with other relevant healthcare professionals where necessary, and providing appropriate advice and counseling to patients or carers. The non-clinical behaviors of the dispensing process need not necessarily be performed by pharmacists and involve assembling, labeling and checking the accuracy of the medication to be dispensed before distributing the final labeled product to the patient or carer. The non-clinical behaviors also include the administrative aspects outlined above, as well as the recording of the prescribed product(s) in the patient’s medication record. The authors are using this definition of dispensing in an ongoing mixed methods study seeking to identify specific behaviors within the dispensing process that are important to the dispensing of appropriate polypharmacy to older patients. It is believed that separating the dispensing process into clinical and non-clinical behaviors and specifying the behaviors within each part of the process offers two important advantages in terms of designing a behavior change intervention. First, it makes it easier to identify which behaviors need to be targeted as part of the intervention to improve dispensing. For example, an intervention seeking to reduce dispensing errors where patients receive the wrong medication might look to target the non-clinical behaviors of the dispensing process (e.g., assembling, labeling and accuracy checking). On the other hand, an intervention to improve the appropriateness of
4
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5
medication prescribing might target the clinical behaviors of reviewing and assessing patients’ drug regimens and engaging with prescribers. Secondly, it may help to ensure that researchers identify the correct target group for the behavior change intervention. Differentiating the behaviors within the dispensing process that are pharmacist-specific (i.e. clinical behaviors) from those that are not necessarily pharmacist-specific (i.e. non-clinical behaviors), may prompt researchers to examine the potential input of additional support staff (e.g., technicians) into the dispensing process and to recognize that their behaviors may also need to be targeted as part of the intervention. Conclusion This paper proposes a definition of dispensing that can be used when developing interventions to improve dispensing within the context of pharmacy practice-based research. It is hoped that this will stimulate pharmacy practice-based researchers to give greater consideration to the role of behavior change in interventions targeting dispensing and to make full use of available frameworks and methodological tools in developing these interventions. Acknowledgments CA Cadogan is currently being supported by a project grant from the Dunhill Medical Trust [grant number: R298/0513] focusing on the development of an intervention to improve appropriate polypharmacy in older people in primary care. References 1. Francis JJ, O’Connor D, Curran J. Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework. Implement Sci 2012;7:35. 2. National Institute for Health and Care Excellence. Behaviour Change: The Principles for Effective Interventions (PH6). London: National Institute for Health and Care Excellence; 2007. 3. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005;14:26–33. 4. 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. 5. Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. Silverback Publishing; 2014.
6. The King’s Fund. Polypharmacy and Medicines Optimisation: Making it Safe and Sound. London. London, UK: The King’s Fund; 2013. 7. Patterson SM, Cadogan CA, Kerse N, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2014;10:CD008165. 8. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2012;4:CD006560. 9. McSherry LA, Dombrowski SU, Francis JJ, et al. ‘It’s a can of worms’: understanding primary care practitioners’ behaviours in relation to HPV using the Theoretical Domains Framework. Implement Sci 2012;7:73. 10. Islam R, Tinmouth AT, Francis JJ, et al. A crosscountry comparison of intensive care physicians’ beliefs about their transfusion behaviour: a qualitative study using the Theoretical Domains Framework. Implement Sci 2012;7:93. 11. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 2003;20:817–832. 12. Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother 2009;43:1096–1106. 13. Medical Research Council. Developing and Evaluating Complex Interventions: New Guidance. London: MRC; 2008. 14. Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol Int Rev 2008;57:660–680. 15. Huijg JM, Gebhardt WA, Dusseldorp E, et al. Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implement Sci 2014;9:33. 16. French SD, Green SE, O’Connor DA, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci 2012;7:38. 17. National Institute for Health and Care Excellence. How to Change Practice: Understand, Identify and Overcome Barriers to Change; 2007. London. 18. Bell HM, McElnay JC, Hughes CM. A self-reported work sampling study in community pharmacy practice. Pharm World Sci 1999;21:210–216. 19. Hassell K, Seston EM, Schafheutle EI, Wagner A, Eden M. Workload in community pharmacies in the UK and its impact on patient safety and pharmacists’ well-being: a review of the evidence. Health Soc Care Community 2011;19:561–575.
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5 20. Rutter P, Hunt A, Darracott R, Jones I. Validation of a subjective evaluation study using work sampling. J Soc Adm Pharm; 1999:16. 21. Davies JE, Barber N, Taylor D. What do community pharmacists do?: results from a work sampling study in London. Int J Pharm Pract 2014;22:309–318. 22. Pharmaceutical Services Negotiating Committee. Dispensing medicines: service specification. http:// psnc.org.uk/services-commissioning/essential-services/ essential-service-dispensing-of-medicines/; Accessed 02.02.14. 23. Pharmaceutical Society of Ireland. Pharmacy Practice Guidance Manual: A self-audit tool for pharmacists
5
and pharmacy owner. http://www.thepsi.ie/Libraries/ Publications/Pharmacy_Practice_Guidance_Manual. sflb.ashx; Accessed 02.02.14. 24. Midwest Pharmacy Workforce Research Consortium. National Pharmacist Workforce Survey: Final Report of the National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic and Practice Characteristics. http://www. pharmacy.wsu.edu/facultystaff/files/2009.pharmacist. workforce.survey.pdf; Accessed 02.02.14. 25. Eccles MP, Hrisos S, Francis J, et al. Do self-reported intentions predict clinicians’ behaviour: a systematic review. Implement Sci 2006;1.
Commentary
Making the case for change: What researchers need to consider when designing behavior change interventions aimed at improving medication dispensing Cathal A. Cadogan, Ph.D.*, Cristı´ n Ryan, Ph.D., Carmel Hughes, Ph.D. School of Pharmacy, Queen’s University Belfast, Northern Ireland, UK
Summary There is a growing emphasis on behavior change in intervention development programmes aimed at improving public health and healthcare professionals’ practice. A number of frameworks and methodological tools have been established to assist researchers in developing interventions seeking to change healthcare professionals’ behaviors. The key features of behavior change intervention design involve specifying the target group (i.e. healthcare professional or patient cohort), the target behavior and identifying mediators (i.e. barriers and facilitators) of behavior change. Once the target behavior is clearly specified and understood, specific behavior change techniques can then be used as the basis of the intervention to target identified mediators of behavior change. This commentary outlines the challenges for pharmacy practice-based researchers in targeting dispensing as a behavior when developing behavior change interventions aimed at pharmacists and proposes a definition of dispensing to consider in future research. Ó 2015 Elsevier Inc. All rights reserved. Keywords: Behavior change intervention; Dispensing; Pharmacists
Introduction There is a growing emphasis in the literature on the importance of behavior change in interventions seeking to improve public health and healthcare professionals’ clinical practice.1,2 Frameworks of behavior change have been developed to assist researchers in understanding healthcare professionals’ behaviors in any given clinical context and identifying mediators of such change.3,4 These frameworks have been linked to established taxonomies of behavior change
techniques (BCTs) which provide a method of specifying intervention content.5 With an increasing number of medications being prescribed at the population level and predicted increases in the size of the older patient cohorts wherein polypharmacy and multimorbidity are highly prevalent,6 the prescribing and dispensing of medication constitute two important target behaviors for interventions seeking to ensure that patients receive appropriate medical treatment. However, previous interventions targeting polypharmacy7 and multimorbidity8 in
* Corresponding author. Tel.: þ44 (0)2890 972348. E-mail address: [email protected] (C.A. Cadogan). 1551-7411/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.sapharm.2015.04.002
2
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5
older persons do not appear to have given due consideration to the importance of targeting healthcare professionals’ behaviors during intervention development. Although progress has been made in investigating physicians’ behaviors in both primary and secondary care settings using established frameworks of behavior change as the basis for intervention development,9,10 there is a deficit of related research investigating pharmacists’ dispensing behavior. In light of the significant expansion of the pharmacist’s professional role in recent years, as well as growing recognition of their potential to make a significant contribution to appropriate prescribing and use of medicines,11,12 it is likely that pharmacists will feature more prominently in healthcare interventions as both intervention recipient and deliverer. Hence, there is a need to consider how dispensing can be targeted as part of a behavior change intervention. This requires examination of the overall development process for behavior change interventions targeting healthcare professionals.
Incorporating psychological theory into the development of behavior change interventions targeting healthcare professionals The Medical Research Council’s (MRC) framework on complex interventions advocates the use of evidence and theory during intervention development.13 The use of theory in intervention development can help to target causal determinants of behavior and behavior change, thus making the intervention more likely to be effective.14 A recognized limitation of the MRC framework is that it does not provide guidance on how theory can be incorporated into the intervention development process.4 Thus, the challenge for researchers in pharmacy practice and other healthcare-related research disciplines seeking to develop behavior change interventions lies in navigating their way through the vast range of existing psychological theories and using these theories to understand target behaviors. To assist researchers across different disciplines, particularly those from a non-health psychology background, an overarching theoretical framework known as the Theoretical Domains Framework (TDF) has been developed.3 The TDF distils psychological theory relevant to behavior change in healthcare professionals into theoretical domains which are considered to be mediators (i.e. barriers and
Table 1 List of TDF domains3 Knowledge Skills Motivation and goals Memory, attention and decision processes Social/professional role and identity Environmental context and resources
Beliefs about consequences Beliefs about capabilities Social influences Emotion Behavioral regulation Nature of the behaviors
facilitators) of behavior change.3 The framework’s twelve theoretical domains are listed in Table 1. Qualitative interviews based on the TDF provide an established method to explore the target group’s perceptions of each of the domains and how they impact on the target behavior.1 This allows researchers to identify key mediators involved in changing target behaviors and to incorporate a theory-base into interventions. Quantitative methods (i.e. questionnaires) also have been used to apply the TDF during intervention development.15 Using a TDF-based approach, identified mediators of behavior change can be mapped to specific BCTs as part of a systematic approach to develop behavior change interventions (Table 2). For example, as part of a project looking at implementation of guideline recommendations for the management of acute low back pain, French et al16 conducted TDF-based focus groups with GPs and found that knowledge of guidelines was one of several barriers affecting the target behavior (i.e. implementation). This mediator of behavior change was then mapped to a BCT (i.e. information provision, thereby mapping to the ‘Knowledge’ domain) which was subsequently incorporated into the intervention.
Defining dispensing as a behavior For any intervention seeking to change healthcare professionals’ behavior, it is vital to have the target behavior clearly defined at the outset. Behavior has been defined as “the product of individual or collective human actions, seen within and influenced by their structural, social and economic context”.17 The difficulty in conceptualizing dispensing as a behavior is that it has not previously been defined explicitly in behavioral terms.
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5
3
Table 2 Steps for developing a theory-based behavior change intervention (adapted from French et al16) Step 1 Step 2 Step 3 Step 4
Identify who needs need to do what differently (i.e. target group and target behavior). Use a theoretical framework to identify which mediators of behavior change (i.e. barriers and facilitators) need to be targeted. Use behavior change techniques to target identified mediators of behavior change. Select outcome measures to assess behavior change.
Instead, dispensing has been described as “a complex process which involves many activities, such as checking the appropriateness of the prescription for the patient, assembling and labeling of the prescribed product(s), coding and endorsing of the prescription, checking the accuracy of the final product(s), handing out prescription product(s) to the patient and providing appropriate advice and counseling”.18 This range of activities or “collective human actions” makes it difficult to identify which specific behaviors within the overall dispensing process need to be targeted as part of a behavior change intervention. In addition, the activities associated with the dispensing process have not been characterized consistently in the literature.19 In some instances, dispensing and patient counseling have been categorized as separate activities,20,21 whereas other sources have included patient counseling as an integral part of the dispensing process.22–24 If dispensing is to be targeted in future behavior change interventions aimed at pharmacists, it is important to consider what ‘dispensing’ means in behavioral terms to ensure that researchers have a clear understanding of the target behavior. If one considers a clinical behavior as a “behaviour enacted by a clinician (doctors, nurses, and allied health professionals) within a clinical context with respect to a patient or their care”,25 one can begin to conceptualize parts of the ‘complex dispensing process’ in terms of clinical behaviors. For example, checking the appropriateness of the prescribed medication and providing advice to patients constitute two clinical behaviors as they are typically performed by pharmacists (i.e. the clinicians) during the dispensing process in the provision of pharmaceutical care to patients (i.e. the clinical context). However, the entire range of activities within the complex dispensing process is not explicitly clinically oriented. For example, the administrative processing of the prescription is an aspect of the dispensing process that does not need to be performed exclusively by pharmacists.
To help researchers in conceptualizing dispensing as a behavior, it is proposed here that the range of activities within the complex dispensing process, as outlined by Bell et al,18 should be disaggregated and specified in behavioral terms. Thus, dispensing is defined as a complex process that involves both clinical behaviors and non-clinical behaviors. The clinical behaviors of the dispensing process are those that are intended to be performed specifically by pharmacists in the provision of pharmaceutical care to patients. These clinical behaviors involve reviewing the patient’s drug regimen, assessing the appropriateness of the prescription for the patient, engaging with other relevant healthcare professionals where necessary, and providing appropriate advice and counseling to patients or carers. The non-clinical behaviors of the dispensing process need not necessarily be performed by pharmacists and involve assembling, labeling and checking the accuracy of the medication to be dispensed before distributing the final labeled product to the patient or carer. The non-clinical behaviors also include the administrative aspects outlined above, as well as the recording of the prescribed product(s) in the patient’s medication record. The authors are using this definition of dispensing in an ongoing mixed methods study seeking to identify specific behaviors within the dispensing process that are important to the dispensing of appropriate polypharmacy to older patients. It is believed that separating the dispensing process into clinical and non-clinical behaviors and specifying the behaviors within each part of the process offers two important advantages in terms of designing a behavior change intervention. First, it makes it easier to identify which behaviors need to be targeted as part of the intervention to improve dispensing. For example, an intervention seeking to reduce dispensing errors where patients receive the wrong medication might look to target the non-clinical behaviors of the dispensing process (e.g., assembling, labeling and accuracy checking). On the other hand, an intervention to improve the appropriateness of
4
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5
medication prescribing might target the clinical behaviors of reviewing and assessing patients’ drug regimens and engaging with prescribers. Secondly, it may help to ensure that researchers identify the correct target group for the behavior change intervention. Differentiating the behaviors within the dispensing process that are pharmacist-specific (i.e. clinical behaviors) from those that are not necessarily pharmacist-specific (i.e. non-clinical behaviors), may prompt researchers to examine the potential input of additional support staff (e.g., technicians) into the dispensing process and to recognize that their behaviors may also need to be targeted as part of the intervention. Conclusion This paper proposes a definition of dispensing that can be used when developing interventions to improve dispensing within the context of pharmacy practice-based research. It is hoped that this will stimulate pharmacy practice-based researchers to give greater consideration to the role of behavior change in interventions targeting dispensing and to make full use of available frameworks and methodological tools in developing these interventions. Acknowledgments CA Cadogan is currently being supported by a project grant from the Dunhill Medical Trust [grant number: R298/0513] focusing on the development of an intervention to improve appropriate polypharmacy in older people in primary care. References 1. Francis JJ, O’Connor D, Curran J. Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework. Implement Sci 2012;7:35. 2. National Institute for Health and Care Excellence. Behaviour Change: The Principles for Effective Interventions (PH6). London: National Institute for Health and Care Excellence; 2007. 3. Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005;14:26–33. 4. 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. 5. Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. Silverback Publishing; 2014.
6. The King’s Fund. Polypharmacy and Medicines Optimisation: Making it Safe and Sound. London. London, UK: The King’s Fund; 2013. 7. Patterson SM, Cadogan CA, Kerse N, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2014;10:CD008165. 8. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2012;4:CD006560. 9. McSherry LA, Dombrowski SU, Francis JJ, et al. ‘It’s a can of worms’: understanding primary care practitioners’ behaviours in relation to HPV using the Theoretical Domains Framework. Implement Sci 2012;7:73. 10. Islam R, Tinmouth AT, Francis JJ, et al. A crosscountry comparison of intensive care physicians’ beliefs about their transfusion behaviour: a qualitative study using the Theoretical Domains Framework. Implement Sci 2012;7:93. 11. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 2003;20:817–832. 12. Castelino RL, Bajorek BV, Chen TF. Targeting suboptimal prescribing in the elderly: a review of the impact of pharmacy services. Ann Pharmacother 2009;43:1096–1106. 13. Medical Research Council. Developing and Evaluating Complex Interventions: New Guidance. London: MRC; 2008. 14. Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol Int Rev 2008;57:660–680. 15. Huijg JM, Gebhardt WA, Dusseldorp E, et al. Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implement Sci 2014;9:33. 16. French SD, Green SE, O’Connor DA, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci 2012;7:38. 17. National Institute for Health and Care Excellence. How to Change Practice: Understand, Identify and Overcome Barriers to Change; 2007. London. 18. Bell HM, McElnay JC, Hughes CM. A self-reported work sampling study in community pharmacy practice. Pharm World Sci 1999;21:210–216. 19. Hassell K, Seston EM, Schafheutle EI, Wagner A, Eden M. Workload in community pharmacies in the UK and its impact on patient safety and pharmacists’ well-being: a review of the evidence. Health Soc Care Community 2011;19:561–575.
Cadogan et al. / Research in Social and Administrative Pharmacy j (2015) 1–5 20. Rutter P, Hunt A, Darracott R, Jones I. Validation of a subjective evaluation study using work sampling. J Soc Adm Pharm; 1999:16. 21. Davies JE, Barber N, Taylor D. What do community pharmacists do?: results from a work sampling study in London. Int J Pharm Pract 2014;22:309–318. 22. Pharmaceutical Services Negotiating Committee. Dispensing medicines: service specification. http:// psnc.org.uk/services-commissioning/essential-services/ essential-service-dispensing-of-medicines/; Accessed 02.02.14. 23. Pharmaceutical Society of Ireland. Pharmacy Practice Guidance Manual: A self-audit tool for pharmacists
5
and pharmacy owner. http://www.thepsi.ie/Libraries/ Publications/Pharmacy_Practice_Guidance_Manual. sflb.ashx; Accessed 02.02.14. 24. Midwest Pharmacy Workforce Research Consortium. National Pharmacist Workforce Survey: Final Report of the National Sample Survey of the Pharmacist Workforce to Determine Contemporary Demographic and Practice Characteristics. http://www. pharmacy.wsu.edu/facultystaff/files/2009.pharmacist. workforce.survey.pdf; Accessed 02.02.14. 25. Eccles MP, Hrisos S, Francis J, et al. Do self-reported intentions predict clinicians’ behaviour: a systematic review. Implement Sci 2006;1.
