Identifying health literacy interventions for everyday use in community pharmacy: a qualitative and consensus methodology study

Abstract

Background – Research has consistently shown that approximately 50% of patients do not take their prescribed medication correctly. A commonly overlooked factor in patient’s lack of understanding of health information and medicine instructions is limited health literacy. Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Medication-literacy forms an important part of health literacy whereby, the patients make good decisions about medicines. Community pharmacists need to be not only knowledgeable in the concept of health literacy, but also effective in identifying those with limited health literacy skills and supporting medication-literacy by using health literacy interventions.
Aims - This study aimed to explore community pharmacists’ awareness and knowledge of health literacy, develop and evaluate a training course then understand the usability of health literacy interventions within their everyday practice. Methods- Phase One; semi-structured, face-to-face, audio-recorded interviews explored the perspectives of a purposive sample of community pharmacists on the apparent awareness and understanding about health literacy. Data was analysed using framework analysis approach. Phase Two employed a nominal group technique to gather a consensus on which health literacy interventions could be used in community pharmacies. Phase Three developed, delivered and evaluated a training session for community pharmacists in which they learnt about the concept of health literacy and health literacy interventions generated in Phase Two. Phase Four interviewed participants on the usability of the health literacy interventions in their day-to-day practice.
Results- Phase One interviewed 19 community pharmacists and produced 5 themes; confusion seen in patients visiting the pharmacy, recognising confusion in patients, community pharmacists’ perception of patients likely to be confused, awareness and understanding of health literacy and desire to learn more about health literacy. Phase Two NGT consisted of a panel of 7 experts and generated 5 top ideas; It’s OK to ask, Teach-Back, Simple Language, Chunk-and-Check and Pictures. In Phase Three, all 21 attendees were happy with the structure of the training session, with some minor adjustments to learning materials. Phase Four conducted 11 interviews and produced four themes; appeal of intervention, limitation, adaption and continue to use.
Discussion- finding from this study showed that community pharmacists see many of the factors that cause confusion in patients. However, community pharmacists’ awareness and understanding of health literacy was inadequate.
A NGT seems to be an efficient technique to gather specific ideas about different interventions that could be used in community pharmacy. Teach-Back intervention seem to have the most impact on the participants. However, participants lack initial confidence in delivering Teach-Back. Chunk-and-Check and ‘It’s OK to ask’ did not receive as much attention, by participants, as the other health literacy interventions.
Conclusions All community pharmacists and pharmacy teams who interact with patients could benefit from being trained in the concept of health literacy and how to use health literacy interventions. The findings of this study will be used to inform and refine the pharmacy-specific health literacy education programme so community pharmacists can start to understand and help patients with limited health literacy. The health literacy interventions used in the study were all suitable for further roll out into community pharmacies.