Using the behaviour change wheel to understand and address barriers to pharmacy naloxone supply in Australia |
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| Affiliation: | 1. Monash Addiction Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston 3199, VIC, Australia;2. National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King St, Randwick 2031 New South Wales, Australia;3. Medical School, The Australian National University, Florey Building 54 Mills Road, Acton 2601, Canberra, Australia;1. The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia;2. Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia;3. National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia;4. School of Psychology, University of Tasmania, Hobart, Tasmania, Australia;5. Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia;6. NSW Users and AIDS Association, NSW, Australia;7. Kirketon Road Centre, Sydney, NSW, Australia;8. Next Step Drug and Alcohol Services, Mental Health Commission, WA, Australia;9. National Drug Research Institute, Curtin University, WA, Australia;10. Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Newcastle, NSW, Australia;11. Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia;12. Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, NSW, Australia;13. University of Sydney, Sydney, NSW, Australia;14. Drug Health Service, South West Sydney LHD, NSW, Australia;15. Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia;p. Drug Health, Western Sydney Local Health District, Sydney, NSW, Australia;1. Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, One University Parkway, High Point, NC 27268, United States;2. High Point University Fred Wilson School of Pharmacy, One University Parkway, High Point, NC 27268, United States |
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| Abstract: | BackgroundThere has been low community pharmacy-based naloxone supply in Australia despite its over-the-counter status. The Behaviour Change Wheel (BCW) is a method used to understand individual and system-level barriers and facilitators to a particular behaviour to inform program implementation. The BCW is focused on three essential conditions of behaviour change (capability, opportunity, and motivation (termed the COM-B)) which we use to assess pharmacists perceptions and experiences of naloxone provision with the aim of using informing targets for interventions to improve naloxone distribution.MethodQualitative interviews with community pharmacists (n = 37) from four Australian jurisdictions explored naloxone knowledge, expectations and experiences dispensing the medicine. Audio-recorded interviews were transcribed verbatim and coded against the a priori domains in the COM-B (capability, opportunity, and motivation). Results were analysed to identify key barriers and facilitators to naloxone provision within each domain. Finally, we mapped our analysis against the intervention functions and policy-level strategies provided in the BCW to identify example intervention strategies.ResultsUnderlying all pharmacists’ descriptions of naloxone were structural impediments to dispensing including poor communication regarding pharmacists’ role and disrupted supply chains. Mapped across the three COM-B domains, we find two divergent groups of pharmacists. Pharmacists’ capability and motivation to supply naloxone was higher amongst those who did not problematize people who inject drugs and who worked in pharmacies already supplying harm reduction services. Pharmacists were less likely to discuss capabilities and opportunities for naloxone dispensing when harm reduction was not normalised in their workplace and/or they described people who inject drugs using negative and stigmatising language.ConclusionsAnalysis using the COM-B framework reveals key areas where implementation and policy strategies are needed to increase naloxone supply. Individual- and structural-level supports are needed to improve pharmacists’ knowledge of naloxone and address other logistical and cultural barriers that limit naloxone provision in pharmacy settings. |
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