Back to the basics: Guidance for designing good literature searches

The number of scientific publications is growing at an unprecedented rate. Failure to properly evaluate existing literature at the start of a project may result in a researcher wasting time and resources. As pharmacy researchers and scholars look to conceptualize new studies, it is imperative to begin with a high-quality literature review that reveals what is known and unknown about a given topic. The purpose of this commentary is to provide useful guidance on conducting rigorous searches of the literature that inform the design and execution of research. Guidance for less formal literature reviews can be adapted from best practices utilized within the formalized field of evidence synthesis. Additionally, researchers can draw on guidance from PRESS (Peer Review of Electronic Search Strategies) to engage in self-evaluation of their search strategies. Finally, developing an awareness of common pitfalls when designing literature searches can provide researchers with confidence that their research is designed to fill clearly articulated gaps in knowledge.

Application of behavioural theories, models, and frameworks in pharmacy practice research based on published evidence: a scoping review

BACKGROUND

Pharmacy practice research often focuses on the design, implementation and evaluation of pharmacy services and interventions. The use of behavioural theory in intervention research allows understanding of interventions' mechanisms of action and are more likely to result in effective and sustained interventions.

AIM

To collate, summarise and categorise the reported behavioural frameworks, models and theories used in pharmacy practice research.

METHOD

PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and EBSCO (CINAHL PLUS, British Education index, ERIC) were systematically searched to capture all pharmacy practice articles that had reported the use of behavioural frameworks, theories, or models since inception of the database. Results were filtered to include articles published in English in pharmacy practice journals. Full-text screening and data extraction were independently performed by two reviewers. A narrative synthesis of the data was adopted. Studies were reviewed for alignment to the UK Medical Research Council (MRC) framework to identify in which phase(s) of the research that the theory/model/framework had been employed.

RESULTS

Fifty articles met the inclusion criteria; a trend indicating an increasing frequency of behavioural theory/frameworks/models within pharmacy practice research was identified; the most frequently reported were Theory of Planned Behaviour and Theoretical Domains Framework. Few studies provided explicit and comprehensive justification for adopting a specific theory/model/framework and description of how it underpinned the research was lacking. The majority were investigations exploring determinants of behaviours, or facilitators and barriers to implementing or delivering a wide range of pharmacy services and initiatives within a variety of clinical settings (aligned to Phase 1 UK MRC framework).

CONCLUSION

This review serves as a useful resource for future researchers to inform their investigations. Greater emphasis to adopt a systematic approach in the reporting of the use of behavioural theories/models/frameworks will benefit pharmacy practice research and will support researchers in utilizing behavioural theories/models/framework in aspects of pharmacy practice research beyond intervention development.

Back to the basics: Guidance for formulating good research questions

Good science is driven by rigorous questions. Much like the foundation of a house, a research question must be carefully constructed to prevent downstream problems in project execution. And yet, pharmacy researchers and scholars across all career stages may find themselves struggling when developing research questions. The purpose of this commentary is to provide useful guidance on composing and evaluating rigorous research questions. A variety of frameworks, such as PICO (Patient/population; Intervention; Comparison; Outcome), are available to researchers and can assist them in ensuring that their research question has covered all relevant components. Additionally, the FINER (Feasible; Interesting; Novel; Ethical; and Relevant) criteria can help researchers with evaluating their research questions for practical considerations. Finally, building awareness of common pitfalls when composing research questions can aid researchers to avoid issues that they may not otherwise discover until their manuscript undergoes peer review.

Multiple comparisons: To compare or not to compare, that is the question

Researchers attempt to minimize Type-I errors (concluding there is a relationship between variables, when there in fact, isn't one) in their experiments by exerting control over the p-value thresholds or alpha level. If a statistical test is conducted only once in a study, it is indeed possible for the researcher to maintain control, so that the likelihood of a Type-I error is equal to or less than the significance (p-value) level. When making multiple comparisons in a study, however, the likelihood of making a Type-I error can dramatically increase. When conducting multiple comparisons, researchers frequently attempt to control for the increased risk of Type-I errors by making adjustments to their alpha level or significance threshold level. The Bonferroni adjustment is the most common of these types of adjustment. However, these, often rigid adjustments, are not without risk and are often applied arbitrarily. The objective of this review is to provide a balanced commentary on the advantages and disadvantages of making adjustments when undertaking multiple comparisons. A summary discussion of familiar- and experiment-wise error is also presented. Lastly, advice on when researchers should consider making adjustments in p-value thresholds and when they should be avoided, is provided.

The role of Design Science Research Methodology in developing pharmacy eHealth services

The increasing focus on efficiency of care has prompted health systems to look for innovative solutions that yield maximum value for care. Integration of care and eHealth are seen as the most promising solutions in the high technological environment of the coming decades. Pharmacy services have been developed to a point where the face of community pharmacy has changed dramatically. Thus, service design and implementation has become an area of increased attention by Pharmacy practice researchers, and the arrival of eHealth concepts to Pharmacy is driving the need to find alternative ways to design new services. Moreover, known barriers and challenges remain when securing integration of pharmacy services with the health systems. In this paper, Design Science Research Methodology (DSRM), a user-centered alternative methodology to the design, development and implementation of health services, especially eHealth services, is presented. This alternative, originally from the Information Sciences field, has been adopted as a service design methodology in diverse settings, including health care. Here, case studies are used to explain how a DSRM process should be conducted in a health care setting, illustrating what methods to choose in each step of the process. Finally, the advantages of DSRM compared to other user-centered methodologies for service design are presented, hopefully prompting the discussion on the use of DSRM for the study of the implementation and sustainability of pharmacy services.

Meta-research in pharmacy: Time for a look in the mirror

The volume of the biomedical literature continues to expand at a substantial rate. The research literature surrounding pharmaceutical services is no different. Due in part to events in the recent past, researchers, consumers, funders, and policymakers have raised concerns about the credibility, transparency, and potential waste in the global research enterprise. Meta-research, or research on research, provides a way to examine the efficiency, quality, and potential bias in the overall research ecosystem. The field of meta-research is a relatively new but rapidly growing field that has seen many applications in biomedical research. Applications in pharmacy research, however, are still developing. The goals of this commentary are to introduce pharmacy researchers to the concept of meta-research, discuss several examples of meta-research in pharmacy, and motivate the importance of sustained meta-research efforts in pharmacy.

Q methodology: An underutilised tool in pharmacy practice research

Pharmacy practice research is often concerned with opinions, perspectives, values, or a variety of other subjective domains, whether that be in regard to the experiences of patients, views of stakeholders about innovative pharmacy services, or culture in pharmacy practice. This article offers a brief introduction to Q methodology, which is a philosophical, conceptual, and technical framework well-suited to shed light on such subjective views. Q methodology combines qualitative and quantitative processes to uncover distinct viewpoints present about any given topic. While other textual analyses focus on identifying the constituent themes about a topic, Q methodology instead detects and interprets holistic and shared perspectives. The introduction covers key theoretical principles, as well as the logistics and procedures involved in completing a Q-methodological study. Example data from a study investigating views on pharmacist integration into general practice in New Zealand are presented to highlight the potential of Q methodology for pharmacy practice research.

Pharmacists' background, interests, barriers, self-perceived competence and confidence to design and undertake pharmacy practice-based research in the GCC geographic area

BACKGROUND

The absence of ability and certainty to design and undertake pharmacy practice-based research (PPBR) was a major issue among pharmacists worldwide as reported in previous literature, despite them having an interest in conducting PPBR. Therefore, this study aimed at highlighting the research background of the Gulf Cooperation Council (GCC) pharmacists which are the six Arab states of the Arabian Gulf, and examining barriers to conducting PPBR. In addition, to determine the self-perceived level of competence and confidence when planning and conducting PPBR.

METHODS

This is a descriptive, cross-sectional questionnaire-based study, performed among pharmacists working in the GCC countries (i.e. Saudi Arabia, United Arab Emirates, Kuwait, Bahrain, Oman and Qatar). A pre-validated questionnaire was distributed to a convenience sample, via distribution of 500 research participation cards to conference attendees. These cards a quick response (QR) code, which should be scanned via mobile phone, to direct all readers to the online survey. All pharmacist delegates attending the conference (i.e. the Saudi International Pharmaceutical Sciences Annual National Conference (SIPHA) and Dubai International Pharmaceuticals and Technologies Conference and Exhibition (DUPHAT) in 2020 and who are working in one of the GCC co. untries as pharmacists were considered. The data were analysed using the Statistical Package for the Social Sciences (SPSS) and Excel software.

RESULTS

Two hundred and fourteen pharmacists were included. Seventy percent of the pharmacists had past PPBR background. Confidence and competence of pharmacists for research skills in regard to employing appropriate inferential statistical test, choosing software for statistical analysis, drafting a comprehensive plan for data analyses and determining appropriate sample size were weak. Highest competence and confidence were seen in preparing a presentation and searching the literature. Pharmacists with previous research experience (K-W: p = 0.001) and training (K-W: p = 0.003) had an overall ability to conduct PPBR. In addition, they had more interest in conducting PPBR (MWU = 3061.500, z = - 4.126, p = 0.000) and in learning about how to do so (MWU = 8698, z = - 1.898, p = 0.050).

CONCLUSIONS

Pharmacists practicing in the GCC geographic area realized the importance of planning and conducting PPBR and were more confident and competent to undertake and contribute to PPBR, except for skills related to statistical analysis. Therefore, training programmes especially for biostatistics and data analysis are mandatory to enhance pharmacists' research capabilities.

Balancing traditional activities and cognitive pharmaceutical services by community pharmacists: a work sampling study

Background Community pharmacy is undergoing a transition, shifting focus from traditional roles to the provision of cognitive pharmaceutical services. However, traditional activities performed by community pharmacists reduce the amount of available time for implementing and providing such services. Therefore, hampering the community pharmacist in the transition. Objective The aim of this study was to identify characteristics of community pharmacists that spend a higher proportion of their time on cognitive pharmacy services and to identify activities that compete with time spent on such activities by community pharmacists. Setting Daily community pharmacy practice. Method Self-reporting work sampling using smartphone technology was used to register the activities of community pharmacists. Participating pharmacists recorded their current activity five times per working day for 6 weeks and also completed an online survey about baseline characteristics. Main outcome measure Time utilization. Results Ninety-one Dutch community pharmacists provided work-sampling data. The results showed that Dutch community pharmacists are predominantly spending less time on managerial activities when spending more time on cognitive services (from 25.7% to 14.5%, p = 0.016). Pharmacists who are spending more time on such services, want to spend even more time on direct patient contact compared to pharmacists who spend less time on it (p = 0.030). Conclusion This study shows that community pharmacists that spend more time on cognitive pharmacy services are devoting less time on managerial activities, logistics and other activities. Pharmacists spending more time on cognitive pharmaceutical services are mostly locum pharmacists or work at a pharmacy located in a residential area with largely older inhabitants.

Student pharmacists' experiences of teamwork in a quality improvement course

INTRODUCTION

Student pharmacists need to work in teams in the educational and practice settings, but there is limited information on their teamwork experiences in the published literature. The study objective was to assess second-year (P2) student pharmacists' teamwork experiences in an experiential quality improvement (QI) course.

METHODS

A retrospective pre-post survey was conducted with P2 students to assess teamwork experience attitudes. Students reported their agreement with 17 statements about teamwork, first after the project was planned and again after the project was complete. A Kuder-Richardson 20 score was calculated to assess internal consistency. Differences between pre- and post- groups for each teamwork item were assessed using McNemar's test. An alpha level of 0.05 was used, and a Bonferroni correction was applied for multiple comparisons.

RESULTS

Sixty P2 students (50%) responded to the survey. After the project was complete, the majority indicated agreement with good teamwork qualities and disagreement with poor teamwork qualities for most items. More than 60% of respondents indicated they would like to do collaborative work again while 20% of respondents indicated imbalances in member contributions caused conflict within the team.

CONCLUSIONS

The majority of student pharmacists in this investigation had positive experiences working in teams, but new important findings from this study indicate that further work is needed to prevent imbalances in team-member contributions and to encourage students to work on future collaborative projects in some cases.

Pharmacy in transition: A work sampling study of community pharmacists using smartphone technology

INTRODUCTION

The nature of community pharmacy is changing, shifting from the preparation and distribution of medicines to the provision of cognitive pharmaceutical services (CPS); however, often the provision of traditional services leaves little time for innovative services. This study investigated the time community pharmacists spend on the tasks and activities of daily practice and to what extent they are able to implement CPS-related services in daily practice.

METHODS

Self-reporting work sampling was used to register the activities of community pharmacists. A smartphone application, designed specifically for this purpose, alerted participants to register their current activity five times per working day for 6 weeks. Participants also completed an online survey about baseline characteristics.

RESULTS

Ninety-one Dutch community pharmacists provided work-sampling data (7848 registered activities). Overall, 51.5% of their time was spent on professional activities, 35.4% on semi-professional activities, and 13.1% on non-professional activities. The proportion of time devoted to CPS decreased during the workweek, whereas the time spent on traditional task increased.

DISCUSSION AND CONCLUSION

This study shows it is feasible to collect work-sampling data using smartphone technology. Community pharmacists spent almost half of their time on semi-professional and non-professional activities, activities that could be delegated to other staff members. In practice, the transition to CPS is hampered by competing traditional tasks, which prevents community pharmacists from profiling themselves as pharmaceutical experts in daily practice.