key: cord-0825196-2ausecw1
authors: Suppiah, Vijayaprakash; Kelly, Fiona; Watt, Oliver; Wheeler, Amanda J; Hotham, Elizabeth; McMillan, Sara
title: Mental well-being promotion by Australian community pharmacists: what’s happening and what needs to be done?
date: 2021-09-04
journal: J Pharm Health Serv Res
DOI: 10.1093/jphsr/rmab051
sha: 818f2e49e0a7f1493b399bb389eb1e82dc96f113
doc_id: 825196
cord_uid: 2ausecw1

OBJECTIVES: This study aimed to explore the range of activities provided by community pharmacists for promoting mental well-being in Australia. METHODS: An online survey was developed and piloted by 2 community pharmacists, 1 representative from the Pharmaceutical Society of Australia and 11 pharmacy students for content and face validity. Community pharmacists were recruited via direct emails to pharmacy groups and social media between November 2019 and January 2020. Descriptive statistics and chi-squared analyses were conducted. KEY FINDINGS: Data were analysed from 85 pharmacists (of 115 total pharmacy staff respondents). Although 40% reported working in a pharmacy that promoted mental well-being, most (88.2%) were not involved in such activities. However, most respondents (88.0%) identified community pharmacy as a suitable setting to promote mental well-being. Barriers to mental well-being promotion included busy pharmacy environment with competing priorities, a lack of staff training and confidence in discussing mental well-being and stigma associated with mental illness. CONCLUSIONS: Community pharmacy presents a suitable setting to promote mental well-being. However, pharmacists may not be utilizing their full range of skills and knowledge in promoting a national health priority. This study identified opportunities for increased pharmacist-led promotion of mental well-being, particularly given the emerging mental health impacts of the COVID-19 pandemic. The pandemic has highlighted the growing urgency for mental health-friendly health workers across the sector including the community pharmacy workforce to engage consumers about their mental well-being.

The role of community pharmacists in public health promotion is well established internationally and in Australia. [1, 2] Evidence is greatest for smoking cessation, cardiovascular health, diabetes management and advice on healthy lifestyles [1, 2] but is limited on how community pharmacists promote mental well-being beyond their traditional role of medication supply and advice provision. [3] High accessibility and availability without the need for an appointment place community pharmacists in a unique position as the first point of contact for individuals seeking medication and general health advice. [4] With approximately 5700 Australian community pharmacies across urban, rural and remote areas, [5] it is estimated that an average Australian will visit a community pharmacy about 14 times a year for medication or health advice. [5] Therefore, the community pharmacy could be an ideal setting to promote awareness of mental well-being and proactively encourage help-seeking behaviour.

This exploratory study aimed to investigate pharmacists' knowledge and attitudes, and facilitators and barriers, towards promoting mental well-being in Australian community pharmacies.

A survey (adapted from a previous study [6] ) was piloted with 2 community pharmacists, 1 representative from the Pharmaceutical Society of Australia (PSA) and 11 pharmacy students for content and face validity. After minor amendments for phrasing and formatting, the final survey consisted of 30 items employing Likert scales and open-ended questions (see Supplementary Material). The online survey (via SurveyMonkey) was promoted between November 2019 and January 2020 via direct emails to pharmacy groups, PSA and social media. University human ethics approval (GU HREC: 2018/916) was obtained.

All Australian community pharmacists were eligible to participate, with consent taken as survey completion. Respondents not identifying as community pharmacists were excluded from data analysis.

Descriptive statistics were reported. Content analysis of 'ideas' was conducted collating open-ended responses from participants. Missing or unclear data were excluded from analysis.

Of the 115 responses, 30 (26%) were excluded due to survey incompletion or not identifying as a community pharmacist. Table 1 presents the demographics of the participant; hereby, the majority were female (64.7%) and members of the PSA (62.4%). Forty percent had worked in community pharmacy for less than 5 years (n = 34/85), and less than half (43.5%) had completed mental health-related continuing professional development or Mental Health First Aid training in the previous 5 years.

When respondents were asked what mental well-being promotion meant to them, two main ideas emerged (Table S1) : increasing awareness of mental well-being and creating a safe environment (n = 33/85, 38.8%) and providing support and education (n = 30/85, 35.3%). Of the 30 respondents who described their mental well-being promotional role in more detail, 53.3% saw this primarily as communicating and providing consumer advice/support by signposting to mental well-being campaigns, talking with and providing consumers with coping strategies.

While most of the respondents (n = 73/83, 88.0%) believed that community pharmacies were suitable venues for mental well-being promotion, less than half reported actively promoting mental well-being (n = 34/85, 40.0%) in their workplace. Promotional activities they described focussed on their traditional roles in psychotropic medication management (n = 59/69, 85.5%), encouraging help-seeking (n = 53/69, 76.8%) and referring consumers to mental well-being campaigns (n = 47/69, 68.1%) and other support services (n = 57/69, 82.6%). Chi-squared analyses did not yield any significant relationships between type of pharmacy or previous training for mental well-being promotion.

Almost 90% of the respondents (n = 60/68) felt that pharmacists were not actively promoting mental well-being at the level they could in their role. The top three barriers they described for effective mental well-being promotion included: (1) busy pharmacy environment and competing priorities (57.6%), (2) lack of confidence in discussing mental well-being with consumers (27.1%) and equally (3) lack of staff training and the stigma attached to mental illness (17.9%) ( Table 2 ). Facilitators included: (1) pharmacies' accessibility to their communities (44.0%), (2) pharmacists viewed as trustworthy and knowledgeable health professionals (27.4%) and (3) pharmacists' ability to build consumer rapport (19.0%) ( Table 2) . 

This study provides the first snapshot of Australian community pharmacists' perspectives about their role in mental well-being promotion. Even though most community pharmacists and consumers [6] noted the potential role of pharmacists in mental well-being promotion, less than half of the respondents were active in mental well-being promotion at the time of participating which aligns with consumer reports of limited experiences of pharmacy-led mental well-being promotion. [6] Interestingly, both pharmacists and consumers reported similar barriers and facilitators for mental well-being promotion in community pharmacy. Common facilitators were pharmacists being accessible and trustworthy, and common barriers included lack of staff training and confidence, and stigma surrounding mental illnesses. [6] Similar to other research, [7] the busy environment, limited time and competing priorities were major barriers identified -important considerations when determining capacity to deliver additional health services in community pharmacies. [7] Given the mental health impacts of the COVID-19 pandemic, the call for mental well-being promotion is more important than ever. [8] Yet, this needs to be considered within the context of any associated issues with pharmacist burnout and capacity. [9] It should be noted that this survey was undertaken before the pandemic and, therefore, responses may not reflect the current situation.

There are limitations to acknowledge: (1) survey relies on selfreported information and the possibility that responses were subjected to social desirability and recall bias and (2) the survey was promoted during the holiday season possibly explaining the low participation rate. [5] While response rate is not the sole measurement of study quality, a larger response rate would strengthen statistical power and reduce any sampling error. [10] 

Although there is an abundance of resources and community campaigns available for community pharmacy to access, the relatively low uptake of these reflects potentially unmet needs and missed opportunities. Future work should investigate the development of mental well-being-related training programmes that focus on a more holistic approach to promoting mental well-being, rather than focussing on treating an illness and medication provision. Such programmes should be considered a part of contemporary pharmacy practice due to the increasing mental health issues of distress and access needs related to the COVID-19 pandemic.

Supplementary data are available at Journal of Pharmaceutical Health Services Research online.

The role of community pharmacists in public health: a scoping review of the literature

The effects of community pharmacy-delivered public health interventions on population health and health inequalities: a review of reviews

Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature

Pharmaceutical care, health promotion, and disease prevention

Community pharmacy in Australia

Consumer perceptions of community pharmacy-based promotion of mental health and well-being

Influences on the frequency and type of community pharmacy services

Impact of COVID-19 pandemic on mental health in the general population: a systematic review

The burden of COVID-19 on pharmacists

Response rates and nonresponse errors in surveys

The authors thank the pharmacists who completed the survey and those who helped with piloting and survey promotion.

The data generated and/or analysed during this study are available from the corresponding author on reasonable request.

All authors designed the study. OW collected and analysed the data and drafted the manuscript. All authors participated in discussing the analyses and findings, critically revised the manuscript, and read and approved the final version to be submitted.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The authors declare no conflicts of interest.