Pharmacists' barriers and enablers to delivering health behaviour recommendations for patients with behavioural determinants of disease: Application of the COM-B model.

Background: Pharmacists are among the most trusted and accessible health professionals in Australia. Community pharmacists are well positioned to deliver brief health recommendations to reduce risk factors of communicable and non-communicable disease during patient interactions. However, effective facilitation of these interactions in pharmacy practice should be considered. The Capability, Opportunity, Motivation and Behaviour (COM-B) model provides a framework to map understanding of the factors affecting pharmacists' delivery of health behaviour recommendations to patients, with the aim of reducing disease risk factors.

Methods: Thirteen semi-structured interviews were conducted with Australian community pharmacists (M = 38.7 years, SD = 15.6). Participants described their barriers and enablers to delivering brief health behaviour change recommendations during patient counselling. Transcripts were analysed using reflexive thematic analysis, with the COM-B model as a guiding framework.

Results: Three themes were identified: 'Perceptions of patient willingness', 'Professional Role and Identity', and 'Structural constraints in pharmacy practice.' Pharmacists reported being motivated to engage with patients about behaviour change but felt inhibited by retail-models of pharmacy, time constraints, and lack of experiential learning. A patient-centred pharmacy model, theoretical knowledge of behaviour change, proprietor support, and patient interest appeared to be instrumental in the effective facilitation of behaviour change advice.

Discussion: Pharmacists are reportedly motivated to engage with patients about health risk factors and disease management. However, external barriers to recommendations and lack of time may only be reduced with management support. Findings necessitate pharmacy model-level initiatives to effectively overcome barriers, such as educating pharmacists about the benefits of behavioural medicine, and training in brief behaviour change techniques through professional development opportunities. Behavioural medicine can enhance pharmacists' capacity to support individuals in managing chronic and communicable disease, but this may need to be incorporated and prioritised early in pharmacy training, including throughout tertiary pharmacy curricula.