Determinants of intentions to monitor antihypertensive medication adherence in Irish community pharmacy: a factorial survey

Background Community pharmacy represents an important setting to identify patients who may benefit from an adherence intervention, however it remains unclear whether it would be feasible to monitor antihypertensive adherence within the workflow of community pharmacy. The aim of this study was to identify facilitators and barriers to monitoring antihypertensive medication adherence of older adults at the point of repeat dispensing. Methods We undertook a factorial survey of Irish community pharmacists, guided by a conceptual model adapted from the Theory of Planned Behaviour (TPB). Respondents completed four sections, 1) five factorial vignettes (clinical scenario of repeat dispensing), 2) a medication monitoring attitude measure, 3) subjective norms and self-efficacy questions, and 4) demographic and workplace questions. Barriers and facilitators to adherence monitoring behaviour were identified in factorial vignette analysis using multivariate multilevel linear modelling, testing the effect of both contextual factors embedded within the vignettes (section 1), and respondent-level factors (sections 2–4) on likelihood to perform three adherence monitoring behaviours in response to the vignettes. Results Survey invites (n = 1543) were sent via email and 258 completed online survey responses were received; two-thirds of respondents were women, and one-third were qualified pharmacists for at least 15 years. In factorial vignette analysis, pharmacists were more inclined to monitor antihypertensive medication adherence by examining refill-patterns from pharmacy records than asking patients questions about their adherence or medication beliefs. Pharmacists with more positive attitudes towards medication monitoring and normative beliefs that other pharmacists monitored adherence, were more likely to monitor adherence. Contextual factors also influenced pharmacists’ likelihood to perform the three adherence monitoring behaviours, including time-pressures and the number of days late the patient collected their repeat prescription. Pharmacists’ normative beliefs and the number of days late the patient collected their repeat prescription had the largest quantitative influence on responses. Conclusions This survey identified that positive pharmacist attitudes and normative beliefs can facilitate adherence monitoring within the current workflow; however contextual time-barriers may prevent adherence monitoring. Future research should consider these findings when designing a pharmacist-led adherence intervention to be integrated within current pharmacy workflow.

Housework Division and Perceived Fairness: The Importance of Comparison Referents

A long-standing theoretical tradition underlines the importance of comparison referents for fairness evaluation, i.e., people, experiences and expectations that individuals choose to compare with their own situation. However, few studies on perceived fairness of housework division have measured and tested comparison referents, partly because of the lack of suitable data. Moreover, findings were sometimes mixed because small convenience samples were used. Previous literature also neglected the distortive effects of self-serving bias in the choice of referents. This study, conducted in an Italian context, seeks to overcome these limitations by using a probabilistic sample and two different designs: a survey data analysis and an experimental-vignette technique which avoids the distortions of self-serving bias. The survey's findings reveal that the effects of comparison referents are strong and in line with expectations, though limited to the domestic behavior of male referents. Moreover, unfavorable comparisons have a stronger effect on perceived fairness than favorable ones. The vignette analysis indicates that comparison referents affect perceived housework fairness even if the effect of self-serving bias is controlled for.