Stoeckel, Franziska
(2022)
Tracking and analysing transactional data to support the provision of mental healthcare in community pharmacies: an evaluation of public perspectives.
PhD thesis, University of Nottingham.
Abstract
Background
Mental health conditions, such as depression and anxiety affect a large proportion of the population in England; it has been estimated that one-in-six adults show symptoms of common mental health disorders in any given week. Additionally, the outbreak of COVID-19 in March 2019 and the measures that have been implemented to curb the spread of the disease have negatively affected some individuals’ mental health and wellbeing. Therefore, to tackle the ongoing mental health crisis, the development of support mechanisms that are easy to access and embedded in the primary care network, is required.
Community pharmacies are accessible without the need for an appointment and pharmacists are recognised as currently under-utilised, yet highly skilled primary healthcare providers. Thus, community pharmacy presents as an ideal candidate for establishing an alternative source of mental health support within the primary care network. Additionally, preliminary evidence suggests that pharmacy-recorded transactional data, as registered on loyalty cards, can be indicative of underlying health conditions, including mental health issues. Therefore, the tracking and analysing of these data could facilitate the identification of individuals at risk and, in turn, enable pharmacists to offer targeted support. However, currently there is limited evidence pertaining to public attitudes towards mental health support provided in pharmacies and the utilisation of transactional data to identify individuals at risk.
Aim
To evaluate public attitudes towards mental health support provided in community pharmacy using purchasing data as a tool to identify individuals at risk of developing mental health issues.
Methods
This study adopted an explanatory, sequential mixed methods research design, encapsulating two separate research streams. In research stream one, the views of pharmacy users towards mental health support provided in pharmacies were investigated. Research stream two evaluated the views of university students and pharmacy users towards utilising transactional data to identify individuals at risk of developing mental health conditions. Both research streams commenced with the development and subsequent distribution of surveys amongst the population of interest, in order to describe individuals’ attitudes quantitatively. The obtained data were subjected to descriptive and inferential statistical analyses performed in Stata (Release 16). The results informed the subsequent qualitative research phases. Semi-structured interviews were conducted with some pharmacy users (n=9) and university students (n=17), to provide an in-depth understanding of individuals’ stances towards both topics. The obtained narrative data were analysed thematically, utilising the software NVivo (Version 12) to aid with data management.
Results
Pharmacy users’ attitudes towards mental health support provided in pharmacies ranged from scepticism to being moderately supportive in 2019 (n=3449) and 2020 (n=1474), respectively. Individuals who reported higher levels of trust in community pharmacists exhibited more positive attitudes; self-reporting a diagnosis of depression and/or anxiety was found to be predictive of more negative attitudes. Qualitatively, the importance of trust for public acceptance of mental health support provided in pharmacies was reiterated, and factors influencing individuals’ stances were identified, such as facilitators, advantages and barriers for pharmacy provided mental health care.
In research stream two, university students as well as pharmacy users exhibited greater support for the utilisation of aggregate-level loyalty card data in health research than utilising these data to identify individuals specifically. Based on the student interviews, a preliminary framework of factors affecting individuals’ stances was developed. First, aspects pertaining to the data provider, the prospective data user and the nature of the data itself were found influence students’ attitudes. Secondly, university students performed a risk-benefit assessment, and in the instance that the expected benefits outweigh potential risks, students supported the utilisation of loyalty card data for the proposed purpose. Thirdly, greater understanding and trust in the prospective data user acted as facilitators in university students’ thought-process. Pharmacy users’ acceptance considerations appeared to be influenced by similar aspects.
Conclusions and recommendations
There is public support for establishing community pharmacy as an alternative source for mental health support within the primary care network; especially a role for pharmacists as an information hub and intermediary between pharmacy users and other healthcare professionals was endorsed. However, equipping pharmacists with the necessary toolkit to fulfil this role is crucial, e.g. by offering pharmacy-specific mental health first aid classes, or expanding existing services, such as the new medicines service and the community pharmacy consultation service. Secondly, trust between pharmacy users and pharmacists was found to be fundamental for public acceptance of new services in pharmacies. Therefore, pharmacy-practice research, which evaluates potential trust-enhancing mechanisms, is required; the results should guide future policy. Thirdly, there appears to be public support for the tracking and analysing of transactional data, especially if the benevolence of the approach is emphasised. Likewise, obtaining trust is fundamental for obtaining public acceptability. The importance of trust is widely recognised in the digital health landscape, and the implementation of trust-enhancing measures is a focal point of current policy. Pharmacy practice research and policymaking should draw lessons from these developments, if the tracking and analysing of transactional data in the realm of pharmacy-provided mental healthcare, is sought after.
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