Examination of pharmacists’ support for implementation of syringe exchange programs in community pharmacies in North Carolina: a social ecological approach
- UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
- Heather Hinkle Roberts (Creator)
- Institution
- The University of North Carolina at Greensboro (UNCG )
- Web Site: http://library.uncg.edu/
- Advisor
- Debra Wallace
Abstract: Background: In the US, hepatitis C virus (HCV) infection is the leading bloodborne infection and injection drug use is the most common mode of transmission. North Carolina (NC) is one of the states with the highest rates of acute HCV infection. Syringe exchange programs are effective in the prevention of HCV infection in injection drug users. With only approximately 30 syringe exchange programs in North Carolina, access is limited. Implementation of syringe exchange programs in community pharmacies can increase access. Objective: This study examined NC community pharmacists’ support of implementation of syringe exchange programs in community pharmacies and the associated intrapersonal, interpersonal, and organizational factors. Factors represented constructs of the Social Ecological Model (SEM). Methods: This quantitative correlational, cross-sectional study was guided by the SEM. NC community pharmacists (N = 304) were surveyed using an online survey. Descriptive statistics, Somers’ d correlation coefficient, PLUM ordinal logistic regression modeling, and Chi-squared tests were used to answer 6 research questions. Results: Findings revealed that 68.6% of NC community pharmacists surveyed supported implementation of a syringe exchange program in their pharmacy to some extent, which included from a small extent to a great extent. Pharmacists’ support for syringe exchange programs was indicated at all three concept levels. Specifically, the major intrapersonal factors that validated support included the beliefs about the effectiveness of syringe exchange programs, practicing in an independent community pharmacy, male gender, and receiving education on syringe exchange programs. Receiving injection drug user cultural competency training was the interpersonal factor that indicated support. The major organizational factors that substantiated support were having a company/store policy that allows implementation of a syringe exchange program and receiving training on how to implement a syringe exchange programs. The belief about the effectiveness of syringe exchange programs at preventing HCV infection in injection drug users was the intrapersonal factor most strongly related to support. Concern about having increased numbers of injection drug users in the pharmacy was the interpersonal factor most strongly related to support. Receiving training on how to implement a syringe exchange program was the organizational factor most strongly related to support. Factors predicting support were type of community pharmacy, gender, and years of practice. Support and factors differed between chain and independent community pharmacists. Chain community pharmacists were 56.1% less likely to express support for implementation to a great extent compared to independent community pharmacists. Chain community pharmacists had fewer beliefs about the effectiveness of syringe exchange programs and more concerns associated with implementation. Conclusion: NC community pharmacists supported syringe exchange programs in community pharmacies to some extent. All three concept levels indicated support for syringe exchange programs among the pharmacists. A lack of knowledge of the overall potential public health impact of syringe exchange programs existed to some extent based on some responses to beliefs about syringe exchange programs. Stigmatization of injection drug users was suggested based on responses around the concern about having increased numbers of injection drug users in the pharmacy. Multilevel strategies to mitigate concerns and increase knowledge about syringe exchange programs including the public health impact and how to implement a syringe exchange program are warranted. Public health nurses are in a pivotal role to develop and implement these strategies. Implications for practice include the development and implementation of multilevel strategies through nurse-led interdisciplinary teams and consideration of chain and independent community pharmacists separately during strategy development. Implications for education include incorporation of injection drug user health information and the role of interventions such as syringe exchange programs into nursing, pharmacy, and other healthcare provider education curriculum, and provision of continuing education for current practitioners on these topics. Implications for research include conducting action or community-based participatory research with community pharmacists and other stakeholders such as pharmacy policy makers to determine best practices for implementing syringe exchange programs in community pharmacies. Implications for policy and community engagement include providing community awareness campaigns of syringe exchange program positive outcomes and contributions to decrease HCV infection and improve health of the community.
Examination of pharmacists’ support for implementation of syringe exchange programs in community pharmacies in North Carolina: a social ecological approach
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Created on 5/1/2020
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Additional Information
- Publication
- Dissertation
- Language: English
- Date: 2020
- Keywords
- HCV infection, Syringe exchange program, Community pharmacist, Injection drug user, Chain community pharmacy, Independent community pharmacy, United States, US
- Subjects
- Needle exchange programs $z North Carolina
- Hepatitis C virus $x Prevention
- Pharmacists $z North Carolina
- Pharmacy $x Social aspects
- Public health $z North Carolina