A qualitative evaluation of the attitudes, barriers, and facilitators relating to the provision of vaccine information by Irish community pharmacists
Authors: Quigley D , Murphy K D 
Published: April 2022

Abstract

Introduction
Community Pharmacists (CPs) can positively impact vaccination uptake. Vaccine hesitancy is not a binary belief but consists of a range of context-specific opinions. CPs are easily-accessible, trusted healthcare professionals responsible for improving patients’ wellbeing. CPs have a positive impact on reducing vaccine hesitancy and improving vaccine uptake. The importance of pharmacists’ role as vaccination educators is clear.(1) Despite the benefits of involvement in vaccine advocacy, CPs may be reluctant to communicate with vaccine-hesitant patients or may find counselling challenging. (2)

Aim
To examine factors influencing Irish CPs’ attitudes towards vaccine information provision and propose actions to remove barriers and promote facilitators to improve vaccination counselling.

Methods
Semi-structured interviews with a purposive sample of Irish CPs took place from October-November 2020. Topics covered included personal attitudes to vaccination, attitudes to pharmacists as vaccination educators, and barriers to counselling provision. Participants also completed a survey about their work environment and history of administering vaccines and beliefs about vaccination. Interview audio recordings were transcribed verbatim and thematic analysis used to identify themes. NVivo 12 was used to analyse interview data.

Results
Twelve pharmacists were interviewed. The majority of interviewees were female (n=10), supervising pharmacists (n=7), and received flu vaccines in at least three of the previous five years (n=7/10). Survey questions were not answered by two participants. All others agreed that vaccines are safe and effective. A single participant did not agree that vaccine counselling is a valuable use of a CPs time and that CPs should try to improve public vaccine uptake.
Six themes were identified, with four relating to attitudes towards vaccine counselling; 1) vaccine value and confidence, 2) influence and duty, 3) knowledge, and 4) time and money, and two themes on actions to enhance counselling: 5) supporting resources, and 6) public awareness. Supporting materials would allow participants to be ‘very confident in going through…with them, going through risks, benefits, side-effects’ and would be ‘something tangible to show them’. In addition patients could take them home to help their deliberations. Having insufficient time was a barrier to vaccine counselling as they often were the only CP so they could not ‘start a conversation with someone about vaccine uptake if I can see that I have ten scripts waiting inside in the dispensary to be done.’

Conclusion
Participants recognised the value of vaccination for improving patient wellbeing but willingness to promote immunisation was restricted by insufficient knowledge, time, and financial supports. Limited by its low number of participants, the diversity of CPs and overlapping themes strengthen the results of this study. Provision of accessible information repositories, training resources, counselling materials, and awareness campaigns may address deficits in knowledge and confidence. Removal of time and financial barriers may require reform of the role of community pharmacy in delivery of vaccine services in Ireland.

References
(1) Isenor JE, Edwards NT, Alia TA, Slayter KL, MacDougall DM, McNeil SA, et al. Impact of pharmacists as immunizers on vaccination rates: A systematic review and meta-analysis. Vaccine. 2016 Nov 11;34(47):5708–23.
(2) Islam JY, Gruber JF, Lockhart A, Kunwar M, Wilson S, Smith SB, et al. Opportunities and Challenges of Adolescent and Adult Vaccination Administration Within Pharmacies in the United States. Biomed Inform Insights. 2017;9:1178222617692538.