Design of the Interview Schedule.

The design of the initial interview schedule was based on the literature review, discussion with colleagues and the experience of preliminary, pre-pilot and pilot interviews. The questions were ordered so that there was a natural flow ûom one question to another and from one topic to another. Each new section or topic was introduced to enable the interviewee to focus their thoughts on the new topic. Unfavourable reactions to questions about IDMs were anticipated from some pharmacists and therefore these questions were asked during the later stages of the interview, and were not referred to in the general introductory information. Questions about socio-demographic variables were left to the end of the interview, to avoid asking a series of personal questions during the opening minutes, and to let the respondent concentrate on the more difticult questions first

2.2.2.1 Preliminary, Pre-pilot and Pilot Interviews.

Preliminary interviews conducted with 18 practising community pharmacists, revealed that it was feasible to conduct in-depth interviews with community pharmacists in order to explore their perceived role in health promotion and the findings were used as a basis for the pre-pilot interview schedule. Pre-pilot and pilot studies were carried out in order to highlight any problems in the design of the semi-structured schedule. Pre-pilot interviews with 10 pharmacists highlighted the need to reduce the length of the interview

schedule and to increase the specificity of questions e.g. by asking separate questions about literature and verbal advice, blood pressure and cholesterol testing.

The main objectives of the pilot study were: a) to indicate probable participation rates; b) to assess the adequacy of question order,

c) to detect any ambiguous or poorly-worded questions; d) to determine items of possible irrelevance;

e) to receive verbal feedback about clarity of instructions, wording of questions and general comments regarding how the pharmacist felt about participating in the interview;

f) to determine the time necessary to complete the interview.

Pilot interviews were conducted with pharmacy managers in the South Thames (East) Region, to ensure that in the main study a random stratified sangle could be taken fix>m the total number of pharmacies in North Thames (East) Region and because there is no reason to suppose that the socio-demographic characteristics of these two adjacent Regions are different A quota sample of 20 pharmacies was drawn from the RPSGB Register of Premises (RPSGB, 1991) and 11 pharmacists agreed to be interviewed. The reasons for non-participation were studied so that where possible, participation rates could be maximised in the main study. Reasons for non-participation given by community pharmacists included lack of time, lack of space, illness and absence from the pharmacy due to holidays. Two blanks were drawn in the sample, one premises being solely a photographic department and the other being a pharmacy which had closed down.

During the pilot studies, a few minor alterations were made to the wording of questions and the instmctions for the interviewer were clarified. The aim was to collect as much information as possible, even if interviewees refused to answer questions on sensitive issues and none of the interviewees refused to answer any of the questions at this stage. The mean time taken to conduct the pilot interviews, including interruption time was 78 minutes (range 60 to 135 minutes). Despite the length of time needed to con^lete the interviews, a decision was made to proceed to the main study without omitting large sections of the interview schedule, due to the quality of the data obtained and the positive feedback from interviewees about participation in the study.

2.2.2.2 Content of the Semi-structured Interview Schedule.

The content and emphasis of questions were identified during preliminary work and specific wording was refined during pre-pilot and pilot studies. The semi-structured interview schedule is shown in Appendix 2.

The first two questions were included for two reasons:-

1) the question should have been relatively easy for the pharmacists to answer and would thus encourage them to start talking confidently and to relax if they were feeling apprehensive;

2) to find out the priority respondents attached to health promotion, in relation to other aspects of their daily work.

The remainder of the interview schedule was divided into 3 roughly equal sections:- Section A:- general questions about health, health education and health

promotion and the role of community pharmacists and their staff, in relation to these concepts;

Section B:- questions about the role of pharmacists in the prevention of CHD; Section C:- questions about the role of pharmacists in preventing HTV-

transmission, particularly among IDMs.

General questions about health were designed to explore the pharmacists' beliefs about causes of ill-health, restoration of health, and responsibility for preservation of health. In addition questions were included to explore the pharmacists' understanding of the term "health" itself. The general questions about health education and health promotion were designed to explore the pharmacists' understanding of these terms, and the current levels of involvement of pharmacists and their staff in specific health promotion activities. Questions were included to ensure that responses were gathered about perceived incentives for and barriers against providing health promotion. Respondents were given ample opportunity to raise any relevant comments at the end of each section.

The parts of the schedule about specific health promotion activities followed the same format as the latter half of Section A and were designed to achieve similar objectives, only to be specific to each particular activity e.g. providing anti-smoking literature. For each activity the following were addressed:

a) the pharmacists' beliefs about provision fix)m pharmacies in general, and then fix)m their own pharmacy;

b) previous and current levels of involvement of the pharmacist and/or the pharmacy staff in each activity;

c) perceived advantages, disadvantages, approval, disapproval, incentives for and barriers against involvement in the health promotion activity;

d) the proactive or reactive approach of the pharmacist;

e) the pharmacists' beliefs about effectiveness of health promotion activities; f) intentions to be involved in health promotion activities in the future; g) any comments the respondent wished to make.

Before embarking on these blocks of questions of a repetitive nature, a few more general questions were asked at the beginning of Sections B and C, in order to make the interview more interesting, to check the content validity of the schedule and to improve the flow between sections.