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Determinants of Health Literacy-Tailored Communication Practices Adoption in French Community Pharmacies: A

Marie Rambure^1,2, Adèle Perrin¹, Noémie Rossello²

¹Research on Healthcare Performance (RESHAPE), INSERM U1290 University Claude Bernard Lyon 1 Lyon France.

Health Science Reports

|February 18, 2026

Abstract

Background:

Community pharmacy workers (CPW) have a crucial role in enhancing patients' understanding and empowerment about their disease in accordance with their health literacy (HL) level. We aimed to explore the barriers and enablers of CPWs' behaviours regarding HL in the interactions with patients with chronic conditions: 1/assessing patients' HL level and 2/tailoring communication to HL level.

Methods:

We conducted a cross-sectional sequential explanatory mixed-method study. The study was underpinned by the theoretical domain framework (TDF) that maps the key psychological and organizational factors that influence behavior of health professionals. First, an online self-completed questionnaire on TDF determinants of implementation behavior was sent to CPWs (pharmacists and pharmacy technicians in Auvergne-Rhône-Alpes, France). Findings were analysed using the confidence interval-based estimation of relevance method. Second, semi-structured interviews were conducted with a sample of survey respondents, to detail the information previously gathered.

Results:

Among the 111 respondents (91 pharmacists and 20 technicians), 84% stated that they were not aware of the concept of HL. However, after being shortly introduced to HL, most claimed to informally assess patient HL level and adapt their communication accordingly, however their assessment was described as based on subjective and unstructured approaches. Key barriers were the lack of an adapted environment (no clear indication in the pharmacy environment), resources (lack of time, staff, specific remuneration, tools dedicated to assess patients' HL level), and habitual behavior (they did not routinely assess all patients' HL and the time of the day influenced whether they adapt or not their communication to patients' HL level), and the difficulties to contact other healthcare providers (to have a multidisciplinary approach to improve patients' HL level).

Conclusions:

This study identified determinants that could be targeted to enhance adoption of HL-tailored communication techniques in community pharmacy. Our results might guide the development of effective theory-based interventions to improve communication practices among CPW.

Keywords:

behaviour behaviour determinants health literacy pharmacists theoretical domains framework

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