Abstract

Background
The concept of a Healthy Living Pharmacy (HLP) was piloted in Portsmouth in 20091. This saw the development of pharmacy staff into Healthy Living Pharmacy Champions (HLPCs) to promote health and well being from community pharmacies1. For participants in this study to become a HLPC, pharmacy staff undertook the Royal Society for Public Health (RSPH) Level 2 Award in Understanding Health Improvement. This was also the training used in the HLP pilot1. Pharmacy support staff also already undertake qualifications and training to perform their various pharmacy roles2. It was not known to what extent any previous training along with the RSPH training, met the needs of support staff to implement the HLP initiative and delivery public health interventions. As part of a wider study of the views of pharmacy support staff on delivering the HLP initiative in Northumberland, insights were gained into the perceived training needs of support staff to deliver the HLP initiative from community pharmacy.

Aims and Objectives
To explore the views and attitudes of pharmacy support staff on the HLP initiative, including identification of barriers and facilitators to delivery of public health interventions such as training.

Methods
Face to face semi-structured interviews were conducted with 21 participants from 12 HLPs in Northumberland in August-October 2013. Participants had only undergone the RSPH training as part of becoming a HLP at the point of interview. HLP Champions (n=16) and non-champion (n=5) staff were included in the sample. Participants also covered a range of pharmacy roles including medicines counter assistants (n=9), dispensing assistants (n=6) and pharmacy technicians (n=6). National multiple (n=8), small chain (n=2) and independently owned (n=2) pharmacies were represented. Participants were recruited by contacting pharmacists in HLPs who nominated support staff for potential participation. Informed consent was obtained prior to conducting interviews. A topic guide was developed and underwent face validity testing and piloting with one participant. Data from the pilot was subsequently incorporated into the results. Interviews were audio recorded, transcribed verbatim and analysed using Framework approach. The study was approved by RGU ethics committee. NHS ethics approval was not required.

Results and Discussion
Two of the seven parent themes identified from the data analysis indicated the perceived training needs of support staff to deliver the HLP initiative. These were ‘Factors which could be barriers or facilitators to public health activity’ and ‘concerns about becoming a HLP prior to accreditation’.

Training from various sources was generally seen by participants as a facilitator to public health activity, with the most useful training that which concentrated on delivery of clinical knowledge for health promotion. However, a need for more of this type of knowledge on specific topics, such as cancer awareness was also expressed by some participants. A couple of participants also described using health promotion materials such as leaflets to gain further knowledge in preparation for public health campaigns.

Participants did not agree about whether there was an additional training need around developing skills for initiating lifestyle conversations. Some felt the RSPH training had been adequate for this, whilst others still did not feel confident in initiating lifestyle conversations despite receiving the training. Participants also perceived some lifestyle topics as ‘difficult’ to have with clients, which also influenced their ability to initiate lifestyle conversations. Not all participants agreed on which topics were ‘difficult’, but smoking cessation was generally described as being easier, and interventions around alcohol consumption were generally cited as more difficult. Some staff may therefore benefit from supplementary training to develop skills and confidence around starting conversations, specifically in areas which are perceived as ‘difficult’.
Participants’ perceived demand for some public health interventions from pharmacy clients was another sub-theme which indicated an additional training need. Demand was interpreted by participants through quantity of requests for advice, over-the-counter products or access to pharmacy services in relation to public health. Without any perceived demand for a type of intervention, some participants seemed to struggle to place them in the context of their community pharmacy setting. This suggested a wider training need around the role of community pharmacy in public health.

Client point in change cycle, although not recognised in the context of formal theories, was widely acknowledged by participants as another factor which could be barrier to provision of health promotion interventions. Incorporating training in stage of change for smoking cessation for pharmacy staff has previously been indicated as a successful strategy for supporting pharmacy staff to deliver smoking cessation interventions3.

A couple of participants felt that they lacked knowledge about the HLP concept itself, which was included in ‘Concerns prior to becoming accredited a HLP’ and this seemed to lead to lack of confidence in delivery of the initiative. Training on the HLP initiative concept needs to be delivered before accreditation to ensure delivery of outcomes from the pharmacies soon after accreditation.

Conclusion
Existing training for current pharmacy support staff roles provides a good foundation from which to deliver public health interventions. Despite completion of the RSPH Award in Understanding Health Improvement, additional training needs were identified in this study. These included development of skills around initiating lifestyle conversations, especially for topics perceived as ‘difficult’, preparation for the delivery of public health campaigns, and to provide context to the delivery of public health from community pharmacy.