Post hoc evaluation of a common-sense intervention for asthma management in community pharmacy

Abstract

© 2016 Published by the BMJ Publishing Group Limited. 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 ß 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.