Results of Bivariate Analysis on Current Availability of Services.

The variables which differentiated between providers and non-providers of disease prevention services are described below and the percentile scores used to help interpret findings are tabulated in Appendix 14.

6.3.1.1 Current Availability of Anti-smoking Leaflets. A. Belief Statements.

Providers were significantly more likely (p<0.05) to believe that by providing anti­ smoking leaflets, customers would think about stopping smoking and non-providers were significantly more likely (p<0.001) to believe that the leaflets would take up too much space. Providers were significantly more likely (p<0.05) to evaluate carrying the authority of a health professional, and requests for anti-smoking advice, more positively than non-providers. The product scores of belief strength and belief evaluation were not able to provide any more insights, than belief strength scores, into the differences in pharmacists’ provision of anti-smoking leaflets.

Providers were significantly more likely than non-providers (p<0.05) to believe that the majority of their customers, the pharmaceutical profession and other health

no significant differences between providers and non-providers in motivation-to-comply with the relevant salient referents.

B. Socio-demographic Variables.

There were no statistically significant associations which met the Chi-square test criteria, between the current availability of anti-smoking leaflets and any of the socio­ demographic variables.

C. Other Variables.

Providers were significantly more likely (p=0.011) to receive more verbal requests for anti-smoking leaflets than non-providers and providers were significantly more likely (p=0.0000) to intend to provide these leaflets. There were no statistically significant associations between the current availability of anti-smoking leaflets and the single item measures of the pharmacist's attitude or subjective norm towards providing anti­ smoking leaflets.

6.3.1.2 Current Availability of Verbal Anti-smoking Advice. A. Belief Statements.

Providers of verbal anti-smoking advice were significantly more likely than non­ providers (p<0.001) to believe in positive outcomes of provision, such as getting customers to think about giving up smoking, and ultimately, inçroving the health of customers. Those respondents who provided anti-smoking advice believed that they were more likely to carry the authority of a health professional than those who did not provide the advice (p<0.05). Providers were significantly less likely than non-providers (p<0.001) to believe in negative outcomes such as loss of custom or loss of too much space in the pharmacy. The product scores of belief strength and belief evaluation were not able to provide any more insights than belief strength scores, into the differences in pharmacists' provision of verbal anti-smoking advice.

Providers were significantly more likely than non-providers (p<0.05) to believe that the majority of their customers, the pharmaceutical profession and other health professionals would like them to provide verbal advice about smoking cessation. There were no significant differences between providers and non-providers in motivation-to- comply with the relevant salient referents. The product normative belief scores reflected the belief strength scores and the product normative belief scale scores for providers were significantly higher (p<0.05) than for non-providers.

B. Socio-Demographic Variables.

Providers were significantly more likely (p=0.012) to have registered as members of the RPSGB before 1980 and non-providers were significantly more likely to have registered

after 1980. Providers were more likely (p=0.011) to have a moderate prescription workload, whereas non-providers were more likely to have a heavy or slight prescription workload.

C. Other Variables.

The Mann-Whitney U test found significant differences (p=0.0000) between providers and non-providers of verbal anti-smoking advice for the variables perceived customer demand, attitude in the current situation, subjective norm and intention.

6.3.1.3 Current Availability of Blood Pressure Testing. A. Belief statements.

Those pharmacists who provided blood pressure testing on the premises were significantly more likely (p<0.001) than non-providers to believe that blood pressures tests gave very accurate results and non-providers were significantly more likely (p<0.001) to believe that service provision would depend on having more space in their pharmacy. The product scores of belief strength and belief evaluation were not able to provide any more insights into the differences in pharmacists' attitudes towards provision of blood pressure testing, than the belief strength scores alone.

Providers were significantly more likely than non-providers (p<0.05) to believe that the majority of their customers, health professionals (other than local GPs) and the pharmaceutical profession would like them to make blood pressure testing available on the pharmacy premises. The motivation-to-comply scores did not significantly differentiate between providers and non-providers of blood pressure testing. Hence trends in the product normative belief scores reflected the belief strength scores.

B. Socio-demographic Variables.

Compared with non-providers the providers were significantly more likely to:- have autonomy in decision-making (p=0.0000)

have been working in the present pharmacy for more than 10 years (p=0.0001) be owners than managers or locums (p=0.0001)

be working in independent pharmacies rather than multiples (p=0.0008) have a counselling area in the pharmacy (p=0.0000)

have sold blood pressure testing kits in the past (p=0.0078). C. Other Variables.

Providers of blood pressure tests on the pharmacy premises differed fix)m non-providers in that they were significantly more likely (p=0.0000) to intend to provide this service in future, and to experience a greater demand for the service from customers. Providers

their current situation (p=0.0000), than non-providers. The providers were significantly more likely (p=0.0000) to believe that "important others" wanted them to make the service available in their pharmacy.

6.3.1.4 Current Availability of Cholesterol Testing. A. Belief Statements.

Those respondents who offered cholesterol testing on the premises were significantly more likely (p<0.001) than non-providers to believe that the test gave very accurate results. For 2 items, the product of belief strength and belief evaluation differentiated between providers and non-providers where belief strength alone was unable to differentiate: providers were significantly less negative (p<0.05) about the damaging effect pharmacy cholesterol testing would have on their relationship with local GPs and providers were more likely (p<0.05) to evaluate customer interest in cholesterol testing more positively.

Providers were significantly more likely (p<0.05) than non-providers to believe that the majority of their customers and the pharmaceutical profession would like them to make cholesterol testing available on the pharmacy premises. The motivation-to-comply scores did not significantly differentiate between providers and non-providers of cholesterol testing. The product normative belief scores indicated that providers were significantly more likely (p>0.05) to believe that the majority of their customers and local GPs wanted them to provide cholesterol testing than non-providers.

B. Socio-demographic Variables.

Compared with non-providers those respondents who provided blood cholesterol testing on the pharmacy premises were significantly more likely to:-

have autonomy in decision making (p=0.0047)

have a heavy prescription workload compared to a moderate or slight prescription workload (p=0.0152)

have a counselling area in the pharmacy (p=0.0001)

have sold blood pressure testing kits in the past (p=0.0036)

currently supply controlled drugs to registered drug misusers (p=0.0139). C. Other Variables.

The scores of providers were significantly different (p=0.0000) from those of non­ providers on the perceived customer demand, intention, attitude in the current situation and subjective norm variables.

6.3.1.5 Current Availability of Leaflets about Safe Injecting. A. Belief Statements.

The respondents who supplied leaflets about safe injecting practices to IDMs firom their pharmacy were significantly more likely (p<0.001) to believe that in doing so, they were helping to increase levels of safe injecting practices, and that it would give them job satisfaction. The respondents who did not provide this type of literature were significantly more likely (p<0.001) to report that provision would depend on whether they had IDMs visiting the pharmacy or not. Despite significant differences in belief evaluation scores for providers and non-providers on seven statements, product scores were unable to enhance interpretation of reasons for differences in service provision, other than those implied by belief strength scores alone.

Those pharmacists who provided leaflets about safe injecting practices to IDMs were significantly more likely (p<0.001) to believe that the majority of customers, and the pharmacy staff did not want them to make the leaflets available. Providers were significantly more likely (p<0.05) than non-providers to want to comply with the wishes of IDMs and drug dependence centres. The product normative belief scores reflected both the belief strength and motivation-to-comply scores.

B. Socio-demographic Variables.

Compared with non-providers, those respondents who were providing leaflets about safe injecting practices were significantly more likely to:-

have autonomy in decision making (p=0.0000)

have a heavy or moderate prescription workload (p=0.0110)

have been working in their present pharmacy for over 5 years (p=0.0068) have registered in the 1950s or 1970s (p=0.0019)

be owners rather than managers or locums (p=0.0000)

work in independent pharmacies rather than multiples (p=0.0000) work in pharmacies in deprived areas (p=0.0083)

have a counselling area in the pharmacy (p=0.0020)

currently supply controlled drugs to registered drug misusers (p=0.0082).

The Chi-square analysis showed that there were significantly more providers than one would expect in Essex FHSA (p=0.0209) and more non-providers in the FHSAs of Camden and Islington, Enfield and Haringey.

C. Other Variables.

The providers were significantly different (p=0.0000) fix)m non-providers on the variables perceived customer demand, intention, attitude in the current situation and subjective norm.

6.3.1.6 Current Availability of Verbal Advice about Safe Injecting. A. Belief Statements.

Providers were significantly more likely (p<0.001) than non-providers to believe that they would achieve job satisfaction by advising IDMs about safe injecting practices. The providers were significantly less likely (p<0.001) to believe in negative outcomes of service provision such as upsetting other customers, upsetting the pharmacy staff, taking up too much time, IDMs being abusive to them and their staff, and increasing the number of IDMs visiting their pharmacy. The product scores were unable to provide any more insights into the differences between providers and non-providers of verbal advice about safe injecting practices, than the belief strength scores alone.

Providers were significantly more likely (p<0.001) than non-providers to think that the majority of their customers, and the pharmacy staff wanted them to make the advice available to IDMs. Providers were significantly more likely (p<0.05) than non-providers to want to comply with the wishes of IDMs. Overall, the product normative belief scores associated with the provision of verbal advice to IDMs, reflected the belief strength scores.

B. Socio-demographic Variables.

Compared with non-providers those respondents who currently provided verbal advice about safe injecting practices were significantly more likely to:-

have autonomy in decision making (p=0.0001)

have a heavy prescription workload rather than a moderate or slight prescription workload (p=0.0302)

be owners rather than managers (p=0.0423)

work in suburban pharmacies rather than urban or rural pharmacies(p=0.0462)

have a counselling area in the pharmacy (p=0.0031)

supply controlled drugs to registered drug misusers (p=0.0000) have sold blood pressure testing kits in the past (p=0.0119) C. Other Variables.

Those respondents who made verbal advice available about safe injecting practices were significantly different fi*om non-providers in terms of the perceived customer demand, intention, single-item attitude measures and subjective norm.

6.3.1.7 Current Availability of Sterile Injecting Equipment for Sale to IDMs. A. Belief Statements.

Respondents who sold injecting equipment to IDMs were significantly less likely (p<0.001) than non-providers, to believe in the negative outcomes, such as loss of customers, upsetting the pharmacy staff, and unsafe disposal of used needles. The product scores highlighted that non-providers were significantly more likely (p<0.001) than providers to believe that sale of injecting equipment would encourage injecting drug misuse per se.

Providers were significantly more likely (p<0.001) than non-providers to think that the majority of their customers, pharmacy staff, local GPs, and other health professionals, would like them to sell sterile injecting equipment to IDMs. Providers were significantly more likely (p<0.05) than non-providers to want to comply with the wishes of IDMs and drug dependence centres. The normative belief scale values reflected both belief strengths and motivadon-to-comply scores.

B. Socio-demographic Variables.

Compared with non-providers, those respondents who sold sterile injecting equipment to drug misusers were significantly more likely to:-

have autonomy in decision making (p=0.0000)

dispense controlled drugs to registered drug misusers (p=0.0000) be situated in "deprived" areas rather than affluent areas (p=0.0155). C. Other Variables.

Respondents who sold sterile injecting equipment to IDMs differed significantly (p=0.0000) from those who did not on the perceived customer demand, intention, single item attitude measures and subjective norm variables.

6.3.1.8 Current Availability of a "Needle Exchange" Scheme. A. Belief Statements.

Respondents who did not operate an injecting equipment exchange scheme were significantly more likely (p<0.001) than providers, to believe in negative outcomes such as loss of customers, IDMs stealing goods fijom the pharmacy, encouragement of injecting drug misuse per se, abuse to themselves and their staff, and upset pharmacy staff. Non-providers were significantly more likely (pcO.OOl) than providers to believe that an injecting equipment exchange scheme would not be made use of in their area. The product scores were no more able to aid interpretation of differences between providers and non-providers than belief strength scores alone. The product scale scores were significantly higher (p<0.001) for providers than for non-providers.

Those pharmacists who did not operate a "needle exchange" scheme were significantly more likely (p<0.001) to believe that the majority of their customers and their pharmacy staff did not want them to operate such a scheme in the pharmacy. The providers were significantly more likely (p<0.05) to want to comply with the wishes of pharmacy staff, IDMs, HTV-prevention organisations and the pharmaceutical profession. The product normative belief scores were able to differentiate between providers of injecting equipment exchange schemes and non-providers on more belief statements than belief strengths alone.

Compared to those respondents who did not operate a "needle exchange" scheme at the time of the survey, those respondents who did provide such a scheme were significantly more likely to:-

have autonomy in decision making (p=0.0037)

have a heavy prescription workload rather than a moderate or slight prescription workload (p=0.0082)

be owners rather than managers or locums (p=0.0107)

work in independent pharmacies rather than multiples (p=0.0091) work in suburban rather than urban pharmacies (p=0.0400)

dispense controlled drugs for registered drug misusers (p=0.0001)

have worked in their present pharmacy for more than 10 years (p=0.0044) have a counselling area in the pharmacy (p=0.0298).

C. Other Variables.

The pharmacists who operated a "needle exchange" scheme differed significantly (p=0.0000) fixjm those who did not on the perceived customer demand, intention, attitude and subjective norm variables.

The results presented in this section show that the survey instrument was successful in measuring differences between pharmacists who provided disease prevention services and those who did not. The results of the bivariate analysis have to be interpreted with caution due to the large number of tests that were carried out: when a significance level of p=0.05 is taken, and 100 bivariate tests are computed, there is a chance that 5 of those tests will be statistically significant by chance alone. This is a disadvantage of carrying out a large number of bivariate tests. Another problem of bivariate statistics is that associations between variables may change when confounders and modifiers are included in the analysis. The solution to these problems is to analyse all the data simultaneously using multivariate techniques.

6.3.2 Results of Logistic Regression, following PC A.

The technique of logistic regression was useful in determining which variables were important in differentiating between providers and non-providers of disease prevention services. A summary of the results of logistic regression, following PCA is given in Table 6.1. More detailed results of the logistic regression analysis are given in Appendix 12. On the basis of the classification tables, the logistic regression models appeared to fit the data well, particularly the models for the provision of all 4 CHD prevention services and the provision of an injecting equipment exchange scheme. The goodness of fit statistics suggested that the models about the provision of anti-smoking advice, cholesterol testing and sale of injecting equipment were the best models.

6.3.2.1 Current Availability of Anti-smoking Leaflets.

There were only 9 respondents who did not currently provide anti-smoking leaflets at the time of the survey. Provision of anti-smoking leaflets was strongly associated with pharmacies having regular customers rather than passing trade or an even mix of regular and passing trade. The odds of leaflet provision decreased if respondents believed that availability depended solely upon delivery of leaflets to the pharmacy.

6.3.2.2 Current Availability of Verbal Anti-smoking Advice.

Provision of verbal anti-smoking advice was strongly associated with scores on the personal rationale factor and was also associated with pharmacy ownership. The odds of provision were increased in independent pharmacies, increased slightly in large multiples and were decreased in small multiples.

6.3.2.S Current Availability of Blood Pressure Testing.

The respondents with low scores on the personal rationale factor were more likely to provide blood pressure testing on the premises. For all services, low scores on the personal rationale factor correlated with a positive predisposition towards service provision. Both the logistic regression analysis and Pearson correlation coefficient suggest that provision of blood pressure testing on the premises is hindered by pharmacists believing that the service will cost too much to set up initially. Provision of blood pressure testing was not hindered by the belief that more space would be required, but the partial correlation coefficient was close to 0 for this variable in the final model.

Table 6.1: Variables in the logistic regression models, following PCA.

Service Variables

Anti-smoking leaflets

1. The type of custom.

(Regular customers or passing trade.)

2. Belief about delivery of leaflets to the pharmacy. Verbal anti­

smoking advice

1. Personal rationale for provision (factor 2.) 2. Ownership of the pharmacy

(Independent/small multiple/large multiple.) Blood pressure

testing

1. Personal rationale for provision (factor 2.) 2. Belief that it will cost too much to set up initially.

3. Belief that it will depend on having more space in their pharmacy.

Cholesterol testing

1. Personal rationale for provision (factor 2.) 2. Pharmacy location (urban/subuiban/rural.) 3. Autonomy of the pharmacist

Leaflets about safe injecting practices

1. Personal rationale for provision (factor 4.) 2. Autonomy of the pharmacist

3. Length of time working in the present pharmacy.

4. Beliefs about negative consequences of provision (factor 1.) 5. Beliefs about their own contribution to public health

particularly reducing the spread of HTV (factor 2.) Verbal advice

about safe injecting

practices

1. Personal rationale for provision (factor 4.)

2. Beliefs about negative consequences of provision (factor 3.) 3. Date of registration with the Royal Pharmaceutical Society of Great Britain.

4. Type of custom. Sale of sterile

injecting equipment

1. Personal rationale for provision (factor 3.)

2. Beliefs about negative consequences of provision (factor 1.) 3. Normative beliefs about professional reference groups and injecting drug misusers (factor 2.)

4. Beliefs about positive consequences of the pharmacist's contribution to public health and for the business (factor 4.) 5. Date of registration with the Royal Pharmaceutical Society of Great Britain.

6. Length of time working in the present pharmacy.

In document The provision of disease prevention services from community pharmacies (Page 170-186)