title: Development of a medication monitoring attitude measure using a mixed methods item development process.
abstract: OBJECTIVE
  Medication monitoring is important for safe and effective medication use; however, no attitudinal measure exists for a health care provider's medication monitoring attitude. The objectives of this study were to (1) create a measure of a community pharmacist medication monitoring attitude; (2) test concurrent validity using a validated measure of medication monitoring behaviours; and (3) report community pharmacist attitudes towards medication monitoring.
  
  
  METHODS
  A mixed methods item development process was employed to generate Likert-type items from qualitative interviews. Following item review and piloting, a four-contact survey, including 20 6-point Likert-type items and the four-item Behavioral Pharmaceutical Care Scale monitoring domain, was mailed to 599 randomly sampled US community pharmacists from the state of Iowa. Exploratory factor analysis, Pearson's correlation and descriptive statistics were used to address study objectives.
  
  
  RESULTS
  There were 254 (42.4%) returned and usable surveys. Factor analysis yielded two domains, a seven-item, positively worded internal (α = 0.819) and an eight-item, negatively worded external domain (α = 0.811). Both domains were positively correlated with the monitoring domain of the Behavioral Pharmaceutical Care Scale supporting convergent validity. Overall, respondents had a positive internal monitoring attitude with a mean of 4.62 (0.68), although many practiced in an environment less conducive to monitoring, as evident by a mean of 3.13 (0.88). Pharmacists were more oriented towards medication side effect and effectiveness monitoring than nonadherence monitoring.
  
  
  CONCLUSIONS
  The mixed methods item development process created a reliable and valid measure of a pharmacist's medication monitoring attitude. While pharmacists had an overall positive medication monitoring attitude, improvements are needed to bolster adherence monitoring and make pharmacy environments more conducive to monitoring.
authors.affiliation: Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Witry
authors.affiliation: Department of Teaching and Learning, University of Iowa College of Education, Iowa City, IA, USA.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Wesely
authors.affiliation: Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA, USA.
authors.forename: Amber M
authors.initials: AM
authors.lastname: Goedken
authors.affiliation: Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA, USA.
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Ernst
authors.affiliation: Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA, USA.
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Sorofman
authors.affiliation: Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Doucette
mesh_terms: D001291:Attitude of Health Personnel; D003157:Community Pharmacy Services / Q000458:organization & administration*; D016903:Drug Monitoring / Q000379:methods*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007484:Iowa; D008297:Male; D055118:Medication Adherence; D010595:Pharmacists / Q000458:organization & administration*; D010865:Pilot Projects; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
keywords: attitude; counselling; measure; mixed methods; pharmacist