title: Ask, advise and refer: hypothesis generation to promote a brief tobacco-cessation intervention in community pharmacies.
abstract: OBJECTIVE
  A preliminary qualitative study was conducted to identify key facilitators and barriers for pharmacists' adoption of a brief tobacco-cessation protocol, Ask-Advise-Refer (AAR).
  
  
  METHODS
  Ten community pharmacists were interviewed using semi-structured, face-to-face interviews with open-ended questions. Purposive and saturation sampling techniques were applied to identify participants and determine sample size respectively. Interviews were audio-recorded and transcribed. Using thematic analysis, two reviewers independently coded all transcripts to identify prominent themes. Appropriate measures were taken to ensure study rigor and validity.
  
  
  RESULTS
  All facilitators and barriers identified were grouped into nine distinct themes. Pharmacists' fear of negative patient reaction was the most prominent barrier to initiating tobacco-cessation discussions with patients. Other themes identified in decreasing order of prevalence were pharmacists perceiving a rationale for initiating tobacco cessation, pharmacy environment, pharmacists' perception of/prior knowledge of patients' willingness to discuss tobacco cessation/to quit, patient initiation of tobacco-cessation or worsening-health discussion, pharmacists' perceptions of AAR characteristics, length of pharmacist-patient relationship/rapport with patients, low expectations of pharmacy patrons and pharmacists' communication ability.
  
  
  CONCLUSIONS
  This study highlights the potential fear among pharmacists about negative reactions from patients in response to initiating tobacco cessation discussions. Based on the results of this study it is hypothesized that the following strategies would facilitate adoption of AAR: (1) train pharmacists to initiate cessation discussions; (2) initially target discussions with patients who have a disease or medication adversely affected by tobacco use; (3) encourage patient enquiry about pharmacy cessation services through visual cues; and (4) help pharmacists set up a workflow system compatible with the AAR protocol.
authors.affiliation: Department of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin, Madison, Wisconsin 53705, USA. patwardhan@wisc.edu
authors.forename: Pallavi D
authors.initials: PD
authors.lastname: Patwardhan
authors.forename: Betty A
authors.initials: BA
authors.lastname: Chewning
mesh_terms: D000328:Adult; D000368:Aged; D003157:Community Pharmacy Services; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D012017:Referral and Consultation; D020340:Tobacco Use Cessation