Improving outpatient medication counselling in hospital pharmacy settings: a behavioral analysis using the theoretical domains framework and behavior change wheel

Background : Despite the importance of medication counselling for patients, it is common knowledge that it is often sub - optimally carried out by pharmacy staff. While some interventions have been designed to help improve counselling, no study till date has used the Capability Opportunity and Motivation behavior model (COM - B) or Theoretical Domains Framework (TDF) as a basis for identifying evidence - based intervention strategies to improve medication counselling. Objective : To understand barrie rs/facilitators to optimal medication counselling by conducting a behavioral analysis using the COM - B model and TDF, and use the Behavior Change Wheel (BCW) as a basis for identifying evidence - based intervention strategies and policy categories that could be used to improve outpatient medication counselling by pharmacy staff in hospital settings located within Northwest Nigeria. Methods : Semi - structured interviews were used to collect data from 25 purposively sampled pharmacy staff working at eight major pu blic hospitals, from January till March 2020. Data from the interviews were then transcribed and deductively coded using the COM - B model and TDF. These findings were then used to identify areas requiring change, as well as the intervention type and policy functions required to support these changes. Results : Findings from the behavioral analysis revealed shortfalls in pharmacy staff capability, opportunity and motivation with res pect to outpatient medication counselling. To improve their counselling behavio rs, change was identified as necessary in eight TDF domains namely ‘knowledge’, ‘interpersonal skills’, ‘memory’ ‘environmental context’, ‘social influences’, ‘intentions’, ‘reinforceme nt’ and ‘beliefs about capabilities’. Seven intervention functions incl uding ‘education’, ‘training’, ‘modelling’, ‘enablement’ and ‘environmental restructuring’, in addition to three policy categories (‘guidelines’, ‘regulations’ and ‘environmental/social planning’) were also identified as relevant to future intervention des ign. Conclusions : Various factors were identified as affecting medication counselling by the pharmacy staff, with several of them requiring changes if counselling was to be improved upon. Multi - component interventions combining several of these interventi on function s are recommended for hospital authorities and other relevant stakeholders to improve outpatient medication counselling