Is Our Pharmacy Meeting Patients' Needs? (continued)

Part III: Pharmacy Patient Focus Groups

About Pharmacy Patient Focus Groups

Focus groups are an effective way to collect detailed feedback directly from pharmacy patients about their personal experiences with and impressions of pharmacy services. The perceptions of focus group patients will help to identify physical and institutional barriers in the pharmacy that prevent those with limited literacy skills from fully understanding pharmacy instructions and accessing pharmacy services. The focus group portion of the Pharmacy Health Literacy Assessment assesses the following four elements:

• Physical Environment.
• Care Process and Workforce.
• Paperwork and Written Communication.
• Culture.

Who Should Be in the Pharmacy Patient Focus Group?

You want to include patients in the focus group who have personal experience using the pharmacy and who are responsible for managing their medications. We recommend selecting patients who:

• Are adults—age 18 and older.
• Are not new patients to the pharmacy—have filled most/all of their prescriptions at the pharmacy for at least 6 months.
• Do not have a surrogate—they pick up their own medicines.
• Do not need assistance to take their medications (for example, are not given medicines by a nurse or a home health aide).

Recruiting Pharmacy Patient Focus Group Participants

Focus group participants may be recruited using posters placed in high-visibility areas of the pharmacy. These posters should:

• Be written in large print.
• Use clear and simple language.
• Provide a contact number on tearaway tabs.
• Describe any incentive that will be offered to participants. Cash is the most effective incentive; $20 for a two-hour session should attract patients to participate, especially in a public hospital or low-income neighborhood.

Pharmacy Patient Focus Group Logistics

Focus groups will go smoothly with proper preparation. Plan for the following:

• Conduct at least two focus groups. If many pharmacy patients are not comfortable conversing in English, consider conducting a focus group in languages other than English with a bilingual moderator. This will require recruiting in other languages.
• Anticipate no-shows. Schedule approximately 15 patients for each group to ensure that 9-12 patients participate.
• Engage an experienced facilitator with extensive skills in moderating and guiding group discussions.
• Use two audio recorders and a dedicated notetaker to record the conversations.
• Conduct the focus groups in a space that is private yet accessible to the patients, such as a conference room in the same building as the pharmacy.
• Plan on each focus group lasting approximately two hours.
• Provide refreshments.
• Distribute incentive payments at the beginning of the focus group session (in order to avoid coercing participants to stay if they feel uncomfortable).

Obtaining Informed Consent

Each patient must consent to participate in the focus group after being fully informed about the purpose of the focus group and how results will be used. A short, clearly written form should be used to obtain informed consent. If the assessment is conducted as part of a research study by an academic group, this consent form will need to be approved by an Institutional Review Board. Individuals conducting the assessment should find out whether or not they need approval to conduct the assessment and involve pharmacy patients. This is likely to be necessary if the pharmacy is part of a hospital.

• Distribute a copy of the consent form to participants at the beginning of the focus group.
• Read the consent form out loud.
• Give participants ample opportunity to ask questions.

Conducting the Pharmacy Patient Focus Group

The following are guidelines for conducting focus groups:

• Audiotape the focus group. All participants must give permission to be audiotaped as part of the informed consent process.
• Administer an anonymous one-page demographic questionnaire, which is used to gather descriptive information about the participants, immediately after completing the informed consent process. Read questions out loud as participants follow along and answer each question. Participants should not put their name or identifying information on these questionnaires; the information should be completed anonymously.
• Use the Facilitator's Guide for Patient Focus Groups (Appendix 5) to lead the participants through a discussion of each topic.
• The moderator is responsible for paying attention to time and may skip certain sections of questions indicated on the topic guide if time is limited.
• Several questions in the "Paperwork and Written Communication" section assess participants' understanding of the printed materials that they receive from the pharmacy, specifically bottle labels and prescription inserts. Bring samples of each of these materials to the focus group. The moderator and notetaker should indicate whether participants have trouble pronouncing certain words or finding the correct information. Directly measuring participants' ability to find certain information on the bottle labels and inserts gives an indication of how well they are able to comprehend written medication instructions given to them by their pharmacist.

Analyzing Pharmacy Patient Focus Group Results

Transcribe the focus group recordings, and summarize notes taken by the notetaker. The moderator and at least one other person who has read the transcripts should identify themes that arise recurrently in the focus groups. Use these themes to create a coding scheme for analyzing the information. Transcripts may be coded either by hand or using qualitative software such as NVivo 7 (QSR International Pty Ltd).

Additionally, information from the demographic questionnaires should be summarized, either in a spreadsheet or statistical software such as SPSS (SPSS Inc., Chicago, IL) or SAS® software (The SAS System for Windows, SAS Institute, Cary, NC), depending on the number of questionnaires. These demographic data are essential for describing the focus group sample and indicating the perspectives represented by the qualitative data.

Interpreting and Reporting Pharmacy Patient Focus Group Results

Use the demographic information collected on the questionnaire to report the mean age and the distributions of gender, race/ethnicity, educational attainment, and duration of time (years and months) as a patient of that particular pharmacy, as well as the average number of prescriptions per patient.

Report any common themes that participants bring up during focus groups. This includes any consensus of positive or negative attitudes toward certain pharmacy services, such as satisfaction with staff friendliness or frustration with long wait times. Look specifically for common topics related to the health literacy friendliness of the pharmacy environment. For example, patients may comment that signs are easy to find and read or, conversely, that directional signs are unclear.

Pay attention to the responses to the questions related to reading and understanding bottle labels and prescription inserts. Note any suggestions that participants provide for improving pharmacy services. These may include ideas such as increasing the font size on bottle labels and inserts, adding information about side effects to the bottle label, or requiring pharmacy staff to complete customer service training.

The written report of focus group results should:

• Summarize the demographic characteristics of the group. A table will probably be the easiest method of presenting these results, as this will be quantitative data.
• Report common themes that surfaced in the focus groups. Include quotations from the transcripts to support each of these themes.
• Highlight any issues that elicited a strong positive or negative response from participants. You may include quotations from the transcripts here to illustrate participant reactions.
• Emphasize themes that indicate how well the pharmacy is currently meeting patient needs. These may include participant feelings about pharmacy layout and signage, specific print materials, or avoidance of medical jargon during counseling.
• Provide specific suggestions for improvement based on the responses of the pharmacy patients.

Go to Figure 1 in Appendix 6 for a sample outline for a report of focus group results.

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