- Marie Rambure : « PHARMA ILIADE Study : Determinants of the implementation of communication techniques adapted to patients' health literacy levels in French community pharmacies & intervention proposals, using the Theoretical Domains Framework and the Behaviour Change Wheel »
Community pharmacy professionals have a crucial role to play to enhance patients’ understanding and empowerment about their disease in accordance with their health literacy (HL) level. We aimed to explore the determinants of the implementation of patient HL level assessment and HL-tailored communication practices towards chronic patients among community pharmacy professionals.
We conducted a cross-sectional sequential explanatory mixed-method study. As a first step, an online self-completed questionnaire underpinned by the Theoretical Domain Framework (TDF) was sent to community pharmacy workers (pharmacists and pharmacy technicians of the Auvergne-Rhône-Alpes region, France). Findings were analysed using the confidence interval-based estimation of relevance (CIBER) method. As a second step, semi-structured interviews were conducted with a sample of survey respondent volunteers, to deepen the information previously gathered. The determinants explored, within these two steps, were the 12 domains of the TDF. Finally, we used the Behaviour Change Wheel (BCW), to propose, in a structured way, intervention ideas.
Among the 111 respondents (91 pharmacists and 20 technicians), count (84%) were not familiar with HL. However, after being shortly introduced to the concept, most claimed to informally assess patient HL level and adapt their communication to the understanding of patients. Key determinants that impeded these behaviours were the lack of adapted environment (no clear signage in the pharmacy environment) and resources (lack of time, staff, adapted remuneration system, tools dedicated to assess patients' HL level), the lack of automatism (they did not assess all patients’ HL and the time of the day influenced whether they adapt or not their communication to patients’ HL level), and the difficulties to contact other healthcare providers. Thanks to the BCW and based on the AHRQ universal precaution toolkit and the Effective Practice and Organisation of Care (EPOC) taxonomy, we identified implementation strategies that might be useful for these behaviours ( the creation of trainings, specific tools, checklists and practices community or the reorganisation of the pharmacy...).
Several target TDF determinants of the implementation of the HL-tailored communication techniques in community pharmacy were identified in this study. Our results might guide the design of effective theory-based interventions to improve the implementation of HL-tailored behaviours among community pharmacy workers.