title: Intervention fidelity for a complex behaviour change intervention in community pharmacy addressing cardiovascular disease risk.
abstract: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.
authors.affiliation: Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Deakin University campus, Princes Hwy, Warrnambool, VIC 3280, Australia, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia, kevin.mcnamara@greaterhealth.org.
authors.forename: K P
authors.initials: KP
authors.lastname: McNamara
authors.affiliation: Centre for Physical Activity and Nutrition Research, Faculty of Health, Deakin University, Victoria, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: O'Reilly
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia.
authors.forename: J
authors.initials: J
authors.lastname: George
authors.affiliation: Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Australia.
authors.forename: G M
authors.initials: GM
authors.lastname: Peterson
authors.affiliation: Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Australia.
authors.forename: S L
authors.initials: SL
authors.lastname: Jackson
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, and.
authors.forename: G
authors.initials: G
authors.lastname: Duncan
authors.affiliation: Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Howarth
authors.affiliation: Deakin University Population Health Strategic Research Centre, Melbourne, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: Dunbar
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003157:Community Pharmacy Services / Q000458:organization & administration; D003376:Counseling / Q000379:methods*; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010595:Pharmacists; D024382:Professional Role; D015397:Program Evaluation; D012307:Risk Factors; D012959:Socioeconomic Factors; D012982:Sodium, Dietary; D055105:Waist Circumference; D015431:Weight Loss
chemical_list: D008055:Lipids; D012982:Sodium, Dietary