title: Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.
abstract: BACKGROUND
  Pharmacies are key sources of medication information for patients, yet few effectively serve patients with low health literacy. The Agency for Healthcare Research and Quality (AHRQ) supported the development of four health literacy tools for pharmacists to address this problem, and to help assess and improve pharmacies' health literacy practices.
  
  
  OBJECTIVE
  This study aimed to understand the facilitators and barriers to the adoption and implementation of AHRQ's health literacy tools, particularly a tool to assess a pharmacy's health literacy practices.
  
  
  METHODS
  We conducted a comparative, multiple-case study of eight pharmacies, guided by an adaptation of Rogers's Diffusion of Innovations model. Data were collected and triangulated through interviews, site visit observations, and the review of documents, and analyzed on the factors affecting pharmacies' adoption decisions and implementation of the tools.
  
  
  RESULTS
  Factors important to pharmacies' decision to adopt the health literacy tools included awareness of health literacy; a culture of innovation; a change champion; the relative advantage and compatibility of the tools; and an invitation to utilize and receive support to use the tools. The barriers included a lack of leadership support, limited staff time, and a perception of the tools as complex with limited value. For implementation, the primary facilitators were buy-in from leadership, qualified staff, college-affiliated change champions, the adaptability and organization of the tool, and support. Barriers to implementation were limited leadership buy-in, prioritization of other activities, lack of qualified staff, and tool complexity.
  
  
  CONCLUSIONS
  If pharmacists are provided tools that could ultimately improve their health literacy practices and patient-centered services; and the tools have a clear relative advantage, are simple as well adaptable, and the pharmacists are supported in their efforts - either by colleagues or by collaborating with colleges of pharmacy-then there could be important progress toward achieving the goals of the National Action Plan for Health Literacy.
authors.affiliation: Abt Associates, Inc. Cambridge, MA 02138, USA. Electronic address: sarahjshoemaker@gmail.com.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Shoemaker
authors.forename: Leah
authors.initials: L
authors.lastname: Staub-DeLong
authors.forename: Melanie
authors.initials: M
authors.lastname: Wasserman
authors.forename: Mark
authors.initials: M
authors.lastname: Spranca
mesh_terms: D001291:Attitude of Health Personnel; D057220:Health Literacy / Q000458:organization & administration*; D006801:Humans; D015279:Organizational Culture; D010594:Pharmacies / Q000458:organization & administration*; D010595:Pharmacists; D015397:Program Evaluation
keywords: Community pharmacy; Diffusion of innovations; Health literacy; Implementation; Retail pharmacies