Objective
To evaluate a health promotion scheme offered through community pharmacies in one health authority area

Background
Community pharmacists participating in the scheme provided health promotion advice in the form of brief (Level 1) and extended (Level 2, lasting 20 minutes) interventions based on the 'Stages of Change' model. Four topics were run sequentially, each for three months - oral health, physical activity, smoking cessation and medicines for secondary prevention following a MI.

Methods
The evaluation included stakeholder perspectives from clients, participating and non-participating pharmacists, and members of the board which oversaw the scheme. Questionnaires completed by clients were analysed and a sub-sample of clients were interviewed. All 'pharmacists in charge' in the 80 community pharmacies in the health authority area were invited to participate in a telephone interview. The interview used a structured questionnaire based on our previous research (1,2), with a mix of open and closed questions. The ten pharmacists participating in the health promotion scheme were asked additional questions about it. All the pharmacists were asked first to cite three critical incidents from their own practice relating to internal or external change. Following the interview the pharmacists were sent the Kirton Adaptor Innovator (KAI) inventory and the Myers Briggs Type Inventory (MBTI) for completion and return. Members of the board were interviewed by telephone using a structured schedule.

Results
57 of the 80 pharmacists agreed to take part (71%). Numbers of interventions (in particular, of Level 2) were lower than participating pharmacists and project board members had expected or hoped. The exception was smoking cessation, which was generally viewed as a successful campaign. For the other topics the intention had been for pharmacists to use their PMRs to target advice but this was said to have occurred rarely. The Stages of Change model was generally perceived by pharmacists and board members to be useful for the community pharmacy setting but not all of the campaign topics were felt to lend themselves to this approach. Furthermore, it was suggested that while helping a client to move from one stage to the next was a valuable achievement, pharmacists themselves viewed success only in terms of clients reaching the 'maintenance' stage. The feasibility of routinely offering Level 2 interventions in the current community pharmacy setting was questioned by respondents.

Conclusions
This was the first community pharmacy health promotion scheme to use the Stages of Change model for topics other than smoking cessation. Client uptake was variable and lower than expected. The findings of this evaluation can be used to inform future service developments in health promotion.

References

1. Tann J, Blenkinsopp A, Allen J, Platts A. (1996) Leading edge practitioners in communiy pharmacy: Approaches to innovation. Int J Pharm Pract; 4: 235-45
2. Blenkinsopp A, Tann J, Platts A. (In press) A method for distinguishing leading edge practitioners - a case study in community pharmacy. J Soc Admin Pharm