Exploring Australian community pharmacists' perspectives, practices and use of emergency hormonal contraception guidelines: a qualitative study using the Theoretical Domains Framework.

Abstract

Background: Emergency hormonal contraceptive pills (ECP), a safe and effective way to reduce the risk of unwanted pregnancy, are available without a prescription in community pharmacies in Australia, and >90 countries globally. Supply is informed by practice guidelines for pharmacists in several countries; however, use remains limited. This study aimed to explore the perspectives and practices of community pharmacists in Australia when providing ECP, to identify challenges and facilitators encountered when using ECP practice guidelines.

Methods: Semi-structured interviews were undertaken with purposively sampled Australian community pharmacists who actively supplied ECP, from across a diversity of locations and years of practice. Interview questions were informed by the Theoretical Domains Framework. The interviews were audio-recorded, transcribed verbatim, thematically analysed inductively, then deductively mapped against the Theoretical Domains Framework and double coded.

Results: Seventeen interviews were conducted. The four overarching themes - decision-making in ECP provision, geographic variation in practice, guideline use, and knowledge gaps and training needs - could be mapped against seven of the 10 relevant Theoretical Domains Framework domains. A lack of confidence and up-to-date knowledge among pharmacists was a challenge to optimal provision of ECP. Practice guidelines were acknowledged to contain valuable information, but were difficult to interpret, and use was limited.

Conclusions: Australian pharmacists' perspective of their practice in providing ECP has highlighted the challenges and facilitators to the use of the ECP practice guidelines. Guidelines were seen as inaccessible, ambiguous and impractical, indicating the need for future research to optimise their use. Findings can inform targeted interventions to enhance ECP guideline uptake and improve patient outcomes.