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Classifying intervention modifications in the community pharmacy context: A demonstration study.

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    Community pharmacies successfully improved medication adherence using a modified motivational interviewing intervention. Adaptability in intervention delivery and content led to significant patient adherence improvements, supporting tailored approaches in healthcare settings.

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    Area of Science:

    • Implementation science
    • Behavioral pharmacy
    • Health services research

    Background:

    • Medication nonadherence is a significant barrier to effective treatment, particularly for chronic conditions like hypertension.
    • Motivational interviewing (MI) is an evidence-based approach to address behavior change, but its implementation in community pharmacy settings requires adaptation.

    Purpose of the Study:

    • To identify modifications made to an MI intervention for medication nonadherence in community pharmacies using Stirman and colleagues' framework.
    • To determine if the adapted MI intervention improved patient medication adherence outcomes.

    Main Methods:

    • Pharmacists received MI training and delivered a brief intervention to patients with antihypertensive medication nonadherence.
    • Semistructured interviews and directed content analysis, guided by Stirman's framework, were used to document intervention modifications.
    • Paired samples t tests compared preintervention and 6-month postintervention adherence rates.

    Main Results:

    • Modifications included changes to intervention context (e.g., telephone delivery) and content (e.g., "loosening structure," "adding elements").
    • Statistically significant improvements in medication adherence were observed, increasing from 74.1% to 84.5% (P < 0.05).
    • Adherence improvements were consistent across pharmacies, irrespective of the specific modifications implemented.

    Conclusions:

    • Adaptability and tailoring of the MI intervention to the community pharmacy setting were feasible and effective.
    • The findings support the importance of intervention flexibility for successful implementation and improved patient outcomes.
    • Further research is needed to identify specific modifications that are most beneficial for patient adherence and service sustainability.