Crilly, Philip (2022) The use of eHealth tools by community pharmacists to improve public health – An exploratory study to determine the feasibility of a community pharmacy weight management service with private Facebook support group. (PhD thesis), Kingston University, .
Abstract
Background The role of community pharmacists (CPs) in public health has expanded in recent decades. However, the public seem unaware of what is available, and often access health services from other providers, such as their General Practitioner (GP). In addition, advances in technology have meant that the public are choosing to access health advice online themselves instead of visiting a healthcare professional (HCP). The term ‘eHealth’ has been coined to describe the use of technology in healthcare. The aim of this research was to develop a community pharmacy public health service that incorporated an eHealth tool, and to determine the feasibility of delivering such a service in community pharmacies in England. Method A literature review was carried out looking at CP use of eHealth tools to improve public health globally. Following this, the perceptions of CPs and the public, in Greater London, on the role of the CP in public health and the use of eHealth tools for public health purposes was examined, in one survey study and in one mixed method study. To investigate the digital literacy skills of the community pharmacy workforce, a further survey study was carried out. Finally, a feasibility study was conducted using weight loss as the health topic and a private Facebook group (PFG) as the eHealth intervention tool. The service used the NHS 12-week weight loss plan as its basic structure. In addition to the support from the PFG, participants attended once monthly (in-person or online) meetings with a researcher, who recorded their anthropometric measurements. Outside of the monthly meetings, participants accessed support from a CP moderator (thesis author), and group members, on the PFG, where posts were shared that addressed weight loss topics. All studies were granted ethical approval from the university ethics committee. Data were analysed in SPSS and Microsoft Excel. Results The literature review highlighted that whilst CPs have used some eHealth tools for public health purposes, these are limited, with the most popular tool being the telephone. The public view CPs as third choice for health advice, behind their GP and searching for information online. They do, however, trust CPs and would use an eHealth tool if it was created and maintained by them. CPs themselves believed that they had an important role in public health, however, barriers such as lack of remuneration, lack of interest from the public, and disjointed commissioning decisions limited this role. CPs would, however, be prepared to deliver a health service with an eHealth element if they received the appropriate training to do so. While most staff deemed themselves to have high digital literacy, this did not translate in practice, therefore, training is needed. The findings indicated that weight management was a topic for which an eHealth support tool may prove useful. Thus, the community pharmacy weight management service (CPWMS) with PFG was created. A significant proportion (70.7%, N=29/41, p=0.0004) of participants lost more than 5% of their body weight by the end of the study indicating its success. This proportion is higher than what is documented in the literature for similar services delivered face-to-face. Not only did participants lose weight, but they also increased their knowledge of nutrition and physical activity (PA) guidelines. This new knowledge translated into new behaviours with participants increasing their PA habits and choosing healthier food and drink options. The role of the CP in the CPWMS with PFG was highly valued by participants, Conclusion The results indicate that the profession has a unique opportunity to improve public health using eHealth for service delivery, however, the digital literacy skills of the community pharmacy workforce need to be enhanced.
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