Exploring theory-driven strategies to improve drug-related problems documentation in community pharmacy: a qualitative interview study

Abstract Introduction Drug-related problems (DRPs) are a common issue in community pharmacies, but their documentation is inconsistent, thereby potentially decreasing continuity of care for patients, interprofessional cooperation between healthcare providers and development of pharmacists’ clinical role. Behavioural determinants as outlined in the COM-B model (capacity, opportunity, motivation, behaviour) and theoretical domains framework (TDF) influence the extent and way pharmacists record DRPs. They can also inform the implementation of changing documentation practices in community pharmacies. Recent research has increasingly applied behavioural theories to identify determinants of behaviour or facilitators and barriers to the implementation of pharmacy services but their systematic application to intervention development remains limited.[1] Aim The aim of this study was to explore the acceptability, feasibility and perceived impact of structured, theory-guided candidate interventions designed to support DRP documentation in community pharmacies across Austria. Methods This study used the Behaviour change Techniques Taxonomy v.1 and the Theory and Techniques tool to link the mechanisms of action identified in previous focus group to behaviour change techniques (BCTs).[2] These BCTs informed the modelling of three theory derived candidate interventions aimed at improving DRPs documentation in community pharmacy practice. A purposive sampling strategy was used to recruit Austrian community pharmacists previously engaged in earlier phases of the research program. Semi-structured interviews, with questions structured around the APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Spill-over effects, and Equity) explored community pharmacists’ views on the candidate interventions. Verbatim transcripts were deductively coded in MAXQDA24 using a combination of the COM-B and TDF model to generate themes. Results Thirteen community pharmacists from eight distinct Austrian states participated in the interviews. Participants’ responses suggested multiple behavioural determinants, with combinations of the candidate interventions being the most acceptable, especially when in line with existing capability and opportunity factors such as professional skills, decision processes, environmental context and social influences. Feasibility was also linked to including workflow integration, the social and professional role and clarity of responsibilities. Equity and safety concerns such as increased legal accountability, possible imbalances between different pharmacies and feasibility of nationwide implementation were recurrent themes. Conclusion A combination of the proposed interventions was considered effective and acceptable. However, to transition from theoretical efficacy to practical feasibility the capability, opportunity and motivational factors identified must be addressed. Key priorities include an enhanced education, reinforcement of professional identity and policy changes to improve interprofessional workflows. A limitation of this study is the use of pharmacists previously engaged in the research thereby introducing selection bias; however, their prior involvement facilitated more reflective and trustful discussions.