Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Ethics Approval
PRECEDE Planning Model Component
2.3. Intervention Context and Setting
2.4. Procedure and Participants
2.5. Data Collection
2.6. Data Analysis
3. Results
3.1. PRECEDE
3.1.1. PRECEDE—Phase 1—Social Assessment
3.1.2. PRECEDE—Phase 2—Epidemiological Assessment
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- To improve rural consumer access to ear health care; and
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- To determine pharmacist level of preparedness and confidence to examine an ear and make appropriate recommendations or referrals following a protocol.
3.1.3. PRECEDE—Phase 3—Behavioural and Environmental Assessment
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- To identify untreated ear conditions in rural communities, which may lead to reduced complications, developmental delay and functional impairment;
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- To improve collaboration between community pharmacy and general practitioner (GP) services;
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- To provide targeted patient ear health referrals to GP practice; and
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- To support engagement of telehealth through the use of video-otoscopy and timely transfer of care.
3.1.4. PRECEDE—Phase 4—Educational and Ecological Assessment
3.1.5. PRECEDE—Phase 5—Administrative and Policy Assessment
3.2. PROCEED
3.2.1. Phase 5A—Pilot Study
3.2.2. Phase 6—Implementation
3.2.3. Phase 7—Process Evaluation
4. Discussion
4.1. Phase 8—Impact Evaluation
4.2. Phase 9—Outcome Evaluation
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Clinical Trials Registration
References
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Construct | Definition as Applied to This Study | Data Source |
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Phase 1—Social Assessment | Determine desired outcomes and goals of LISTEN UP for rural consumers, pharmacists and health professionals. | Questionnaire and interviews [16,17,18]. |
Phase 2—Epidemiological Assessment | Determine measurable, time-limited, health-related objectives of LISTEN UP. | Systematic review [15], scoping review [8] and interviews [19,20]. |
Phase 3—Behavioural and Environmental Assessment | Identify key environmental and behavioural factors that may impact or influence LISTEN UP. Develop sub-objectives of LISTEN UP. | Systematic review [15], scoping review [8] and interviews [19,20]. |
Phase 4—Educational and Ecological Assessment | Determine modifiable factors (predisposing, enabling and reinforcing) that would result in behaviour change and a sustainable change process. | Systematic review [15], scoping review [8] and community consultation. |
Phase 5—Administrative and Policy Assessment | Investigation and application of policy, regulation and law surrounding community pharmacy practice. | Consultation with policy makers, regulatory and governing bodies. |
Phase 5A—Pilot Study | Pilot the intervention for six months. | Pilot study data and consultation with pharmacists. |
Phase 6—Implementation | Implementation of the intervention for six to twelve months. | |
Phase 7—Process evaluation | Assessment of the intervention exposure, the extent to which the program is implemented as designed and participant appraisal of the intervention. | Participant demographic data. Participant satisfaction survey. Pharmacist interviews on feasibility, barriers and enablers to intervention implementation. |
Phase 8—Impact evaluation | Assessment of the behavioural and environmental sub-objectives by identifying untreated ear conditions in the community, improving collaboration with GPs through targeted referrals and utilisation of telehealth technologies. | LISTEN UP complete data set. Pre- and post- interviews with GPs and pharmacists. |
Phase 9—Outcome evaluation | Assessment of public health impact through exploration of patient experience of accessing ear care. | LISTEN UP complete data set. Pre- and post- interviews with GPs and pharmacists. |
Data Source | Related Phase | Results Relevant to Model |
---|---|---|
Systematic review [15] | Behavioural and environmental assessment | Limited expanded service models in rural pharmacy practice. No ear services identified. Barriers and enablers explored and considered for LISTEN UP model. |
Scoping review [8] | Behavioural and environmental assessment | Limited pharmacy ear health services in community pharmacy. Barriers and enablers explored and considered for LISTEN UP model. |
Consumer questionnaires [16] | Social assessment | Hearing health ranked seventh of 26 expanded pharmacy services. |
Health professional questionnaires and interviews [17,19,21] | Social assessment | Hearing health ranked seventh of 26 expanded pharmacy services. Varying levels of support for pharmacists to provide expanded services depending on profession and location. |
Pharmacist questionnaires and interviews [18,19] | Social assessment Educational and ecological assessment | Expected improved health outcomes and increased access from pharmacists providing expanded services. Consensus that the management of ear health in pharmacy could be improved. |
Stakeholder interviews [19] including: Pharmaceutical Society of Australia, Pharmacy Guild of Australia, Aboriginal Medical Service, and Australian Primary Health Network | Educational and ecological assessment | Consensus for rural pharmacists to increase service delivery for ear care. |
Policy and regulatory meetings | Administrative and policy assessment | Administrative requirements, indemnity insurance, scope of practice and training incorporated into model. |
Specialist health professional interviews | Educational and ecological assessment | Training and education recommendations and best practice suggestions to be incorporated into model. |
Advisory panel | Educational and ecological assessment Administrative and policy assessment Continuing through PROCEED segment. | Positive response to the model with minor suggestions incorporated. |
Age (Years) | Gender | ||
19–24 | 3 (17%) | Female | 12 (67%) |
25–34 | 5 (28%) | Male | 6 (33%) |
35–44 | 1 (5%) | Ethnicity | |
45–54 | 3 (17%) | Caucasian | 11 (61%) |
55–64 | 4 (22%) | Indigenous | 5 (28%) |
65 and above | 2 (11%) | Unknown | 2 (11%) |
Presenting Complaint (n = number of patients) | Pharmacist’s Clinical Impression (number of patients) | ||
Pain/Pressure | 11 | Ear wax impaction | 6 |
Blocked (wax/water) | 10 | Ruptured ear drum | 3 |
Hearing Impairment | 3 | Unsure | 3 |
Itch | 2 | Normal ear | 2 |
Other | 2 | Inflammation | 2 |
Calcification | 2 | ||
Otitis media | 2 |
Questions with Yes/No Answer Option | Yes |
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Before coming to the pharmacy today, I tried to see a GP about my ear | 6 (33%) |
If the service was not available today I would have gone to my GP | 13(72%) |
If the service was not available today I would have gone to the hospital | 10 (50%) |
Next time I have an ear problem I will come to the pharmacy instead of a GP | 18 (100%) |
Free Text Comments | |
“Very good reassurance about my ears.” “Service exceeded my expectation.” “I am satisfied with how the pharmacist checked my ears. Great service.” “Excellent support, information was great, feel reassured. Thank you.” |
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Share and Cite
Taylor, S.; Cairns, A.; Glass, B. Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model. Int. J. Environ. Res. Public Health 2021, 18, 6456. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126456
Taylor S, Cairns A, Glass B. Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model. International Journal of Environmental Research and Public Health. 2021; 18(12):6456. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126456
Chicago/Turabian StyleTaylor, Selina, Alice Cairns, and Beverley Glass. 2021. "Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model" International Journal of Environmental Research and Public Health 18, no. 12: 6456. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126456