title: A qualitative study of English community pharmacists' experiences of providing lifestyle advice to patients with cardiovascular disease.
abstract: BACKGROUND
  Cardiovascular disease (CVD) progression is modifiable through lifestyle behaviors. Community pharmacists are ideally placed to facilitate self-management of cardiovascular health however research shows varied pharmacist engagement in providing lifestyle advice.
  
  
  OBJECTIVE
  This study explored community pharmacists' experiences and perceptions of providing lifestyle advice to patients with CVD.
  
  
  METHODS
  Semi-structured interviews were conducted with fifteen pharmacists (1 supermarket; 7 multiple; 7 independent) recruited through multiple methods from community pharmacies across the Midlands, England. A thematic analysis was conducted using a Framework approach.
  
  
  RESULTS
  Pharmacists categorized patients according to their perceptions of the patients' ability to benefit from advice. Many barriers to providing lifestyle advice were identified. Confidence to provide lifestyle advice varied, with pharmacists most comfortable providing lifestyle advice in conjunction with conversations about medicines. Some pharmacists felt lifestyle advice was an integral part of their role whilst others questioned whether pharmacists should give lifestyle advice at all, particularly when receiving no remuneration for doing so.
  
  
  CONCLUSIONS
  Pharmacists viewed providing lifestyle advice as important but identified many barriers to doing so. Lifestyle advice provision was influenced by pharmacists' perceptions of patients. Professional identity and associated role conflict appeared to underpin many of the barriers to pharmacists providing lifestyle advice. Pharmacists may benefit from enhanced training to: increase their confidence to provide lifestyle advice; integrate lifestyle advice with regular pharmaceutical practice and challenge their perceptions of some patients' receptiveness to lifestyle advice and behavior change. Changes to the way UK pharmacists are remunerated may increase the provision of lifestyle advice.
authors.affiliation: Life & Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Morton
authors.affiliation: Life & Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK. Electronic address: h.m.pattison@aston.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Pattison
authors.affiliation: Life & Health Sciences, Aston University, Aston Triangle, Birmingham B4 7ET, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Langley
authors.affiliation: School of Psychological Sciences & Manchester Centre for Health Psychology, University of Manchester, Coupland 1 Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Powell
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003469:Culture; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010595:Pharmacists; D011369:Professional-Patient Relations; D036301:Qualitative Research
keywords: Cardiovascular disease; Community pharmacists; Lifestyle advice; Professional identity; Self-management