title: Psychosocial and behavioural determinants of the implementation of Pharmaceutical Care in Spain.
abstract: OBJECTIVE
  We aimed to gain greater understanding of the implementation of the Pharmaceutical Care (PhC) initiative in Spain. Our investigation was underpinned by Prochaska and Di Clemente's stages of change model. We also used the A.S.E. (Attitude, Social influence and self-Efficacy) Model to identify the psychosocial determinants of this professional behaviour.
  
  
  METHODS
  Spanish community pharmacists.
  
  
  METHODS
  A validated questionnaire was sent to all community pharmacists registered on a national database and 1,977 (10.3%) responded. The questionnaire assessed stage of change regarding the implementation of PhC and the psychosocial determinants of this professional behaviour. Data were analyzed using descriptive statistics. Kruskal-Wallis and Mann-Whitney U tests were used to compare psychosocial determinants according to stage of change. The profile of community pharmacists who had implemented PhC was identified through logistic regression analysis.
  
  
  METHODS
  attitude, social influence, self-efficacy, motivations, needs and stages of change to perform PhC.
  
  
  RESULTS
  Some respondents (n = 228; 11.8%) had adopted PhC, and were, thus, in the action or maintenance stage. The mean A.S.E. determinants scores increased significantly by stage i.e. from "precontemplation" to "action": attitude (0.28 vs. 0.99), social influence of people (2.61 vs. 3.07), and self-efficacy (2.74 vs. 3.61). Conversely, most needs were highlighted by precontemplators (3.66 vs. 347.). Variables significantly associated with the probability of implementing PhC were: having undertaken appropriate training (OR: 13.92; CI 95%: 5.37-36.08); self-efficacy (OR: 3.19; CI 95%: 2.38-4.28), having assistant pharmacists (OR: 1.70; CI 95%: 1.02-2.80) and positive attitude (OR: 1.03; CI 95%: 1.01-1.04). The A.S.E. determinants were the best predictors of PhC implementation according to the regression model.
  
  
  CONCLUSIONS
  The implementation of PhC among Spanish community pharmacists appears to be relatively low. Strategies to move pharmacists should be adapted to stage: focussed on emphasizing advantages at initial stages and facilitating training courses, guidelines and communication to professionals at intermediate and advanced stages.
authors.affiliation: University of Oviedo, Oviedo, Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Zardaín
authors.forename: María Olivo
authors.initials: MO
authors.lastname: del Valle
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Loza
authors.forename: Eduardo
authors.initials: E
authors.lastname: García
authors.forename: Alberto
authors.initials: A
authors.lastname: Lana
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Markham
authors.forename: María Luisa
authors.initials: ML
authors.lastname: López
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003157:Community Pharmacy Services; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D024382:Professional Role / Q000523:psychology*; D013030:Spain