title: An explanatory model of community pharmacists' support in the secondary prevention of cardiovascular disease.
abstract: BACKGROUND
  Community pharmacists have faced ongoing challenges in the delivery of clinical pharmacy services. Various attitudinal and environmental factors have been found to be associated with the provision of general clinical pharmacy services or services which focus on a specific condition, including cardiovascular disease (CVD). However, the interrelationship and relative influence of explanatory factors has not been investigated.
  
  
  OBJECTIVE
  To develop a model illustrating influences on CVD support provision by community pharmacists.
  
  
  METHODS
  Mail surveys were sent to a random sample of 1350 Australian community pharmacies to investigate determinants of CVD support provision. A theoretical model modified from the Theory of Planned Behavior (TPB) was used as a framework for the survey instrument. Structural equation modeling was used to determine how pharmacists' attitudes and environmental factors influence CVD support.
  
  
  RESULTS
  A response rate of 15.8% (209/1320) was obtained. The model for CVD support provision by community pharmacists demonstrated good fit: χ(2)/df = 1.403, RMSEA = 0.047 (90% CI = 0.031-0.062), CFI = 0.962, TLI = 0.955 and WRMR = 0.838. Factors found to predict CVD support included: two attitudinal latent factors ("subjective norms of pharmacists' role in CVD support" and "pharmacists' perceived responsibilities in CVD support") and environmental factors i.e. pharmacy infrastructure (documentation and a private area), workload, location; government funded pharmacy practice programs; and pharmacists' involvement with Continuing Professional Development and attendance at CVD courses.
  
  
  CONCLUSIONS
  Pharmacists' attitudes appeared to be the strongest predictor of CVD support provision. The TPB framework was useful in identifying "subjective norms" and "pharmacists' beliefs" as key constructs of community pharmacists' attitudes. Community pharmacies would be able to provide such an advanced clinical service if they strongly believed that this was an acknowledged part of their scope of practice, had adequate infrastructure and employed sufficient numbers of pharmacists with appropriate and relevant knowledge.
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW 2006, Australia; Fakultas Farmasi, Universitas Airlangga, Jalan Dharmawangsa Dalam, Surabaya, Jawa Timur 60286, Indonesia. Electronic address: hanni.puspitasari@sydney.edu.au.
authors.forename: Hanni P
authors.initials: HP
authors.lastname: Puspitasari
authors.affiliation: School of Psychology, The University of Sydney, Lifehouse Building C39Z, Sydney, NSW 2006, Australia.
authors.forename: Daniel S J
authors.initials: DSJ
authors.lastname: Costa
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW 2006, Australia.
authors.forename: Parisa
authors.initials: P
authors.lastname: Aslani
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building A15, Sydney, NSW 2006, Australia.
authors.forename: Ines
authors.initials: I
authors.lastname: Krass
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003157:Community Pharmacy Services / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D010595:Pharmacists; D011322:Primary Prevention; D055502:Secondary Prevention / Q000379:methods*; D012931:Social Environment; D011795:Surveys and Questionnaires
keywords: Attitudes; Australia; Cardiovascular disease; Community pharmacists; Environmental factors