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Evaluation of the use of pharmacy health education materials during national smile week 1997

Contents:	1. Introduction and background 2. Research aims and objectives 3. Research methodology 4. Research findings 5. Research conclusions Summary

4. Research findings

• This section of the report will consider the actualfindings of the research project. It is broken down into three sections asfollows:
  - Health Promotion Workers Telephone Survey
  - Pharmacists Telephone Survey
  - Pharmacists Depth Interviews

4.1 Health promotion workers telephone survey

Figure 1: Role of pharmacists as health promoters

	NUMBER
Prevalent/important role	4
Access toparents and young children	1
Information andadvice provider	4
Raising healthawareness	1
Sell productspromoting health	1
Important inrural areas	1
Good link topublic for major health promotions	1
Limited roleproviding leaflets	1
Good contactpoint for those not seeing GP	1
Credible healthinformation	1
Varies - sometake it more seriously than others	1

Base: 13

Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• The majority of the Health Promotion Workers (11 outof 13) thought that Pharmacists perceived themselves as having a healthpromotion role.

Figure 2: Perceptions of health promotion role among pharmacists

	NUMBER
Yes, definitely	6
Yes, possibly	5
No, not really	2
No, not at all	0

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• There were two respondents who thought that CommunityPharmacists did not really perceive themselves as having a health promotionrole. Both of these respondents thought that Pharmacists did not see a healthpromotion role as being part of their day to day function or position.
• All of the respondents were asked what kind ofactivity they thought Pharmacists defined as health promotion. A number ofresponses were put forward by the sample, including face to face advice onrequest, displaying leaflets and providing information. In addition there were4 respondents who thought that Pharmacists did not know how to define healthpromotion.

Figure 3: Activities pharmacists define as health promotion

	NUMBER
Face to face advice if asked	4
Leaflet display	5
Information giving	3
They don’t know	4

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• It was of interest to consider whether HealthPromotion Workers saw the role of health promotion as being relevant toCommunity Pharmacists. All but one of these respondents described the healthpromotion role as being very or quite relevant to Pharmacists.

Figure 4: Relevance of health promotion role to pharmacists

	NUMBER
Very relevant	7
Quite relevant	5
Neither/nor	0
Not very relevant	0
Not at all relevant	0
Don’t know	1

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• The twelve respondents who described the healthpromotion role as being relevant to Community Pharmacists were asked why. Themain reason which was put forward by the sample was that Pharmacists have goodpublic contact with a large number of people on a day-to-day basis. Inaddition, the health promotion workers consider the Pharmacists to be easilyaccessible, non judgemental and trustworthy in comparison with other HealthWorkers.

Figure 5: Reasons for role being relevant

RELEVANCE	NUMBER
Good public contact with large number ofpeople	6
Dealing with the publics health issues daily	1
Often first port of call	1
Immediately accessible	1
Non judgemental - no records	1
Public recognise and trust information frompharmacist	1
Modern day role of pharmacist is wider	1
See people in a "lay" context	1

Base: 12
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

4.1.2 Activity undertaken to support pharmacists

• Most of the respondents (12 out of 13) claimed thatthey had undertaken activity in their area in order to support Pharmacists intheir health promotion role. The respondents were then asked what the nature ofthat activity had been. Most frequently the respondents mentioned training (4respondents), joint project/campaigns (4 respondents) or the provision ofleaflets and materials (3 respondents).

Figure 6: Nature of activity

	NUMBER
Visits	1
Newsletter	1
Joint projects/campaigns	4
Leaflets	3
Training	4
CAPO and SCPPE tutors	1
Respond to requests for staff and displays	1
Developing at present	1
Funded window display	1

Base: 12
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

4.1.3 Perceptions of pharmacies' usage of health promotion material

• The health promotion workers were asked how oftenthey thought Pharmacists displayed health promotion material given to them byany organisation. None of the respondents thought that the Pharmacists alwaysdisplayed material. The largest single proportion of the sample (7 respondents)thought that Pharmacists usually displayed material, and a slightly smallerproportion thought that they sometimes displayed material (4 respondents).

Figure 7: Frequency of pharmacists displaying material

	NUMBER
Always	0
Usually	7
Sometimes	4
Never	0
Don’t know	2

Base: 13
Source: Market Research Scotland Ltd, June 1997.

• The respondents were asked whether they had everexperienced any difficulties getting Pharmacists to use display materials. Mostof the respondents (8 Health Promotion Workers) had not experienced anydifficulties trying to get Pharmacists to use display materials. However, anumber of problems were suggested such as lack of shelf space orinappropriately sized leaflets.

Figure 8: Difficulties with pharmacists using displays

	NUMBER
None	8
Not enough shelf space	2
Leaflets too big for dispensers	1
Leaflets too small for dispensers	1
Signs are a problem	1
Don’t know why they didn’t display	2
Only just started	1

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• Most of the Health Promotion Workers thought thatPharmacists distributed leaflets by keeping them in dispensers where peoplecould help themselves (11 respondents). A smaller proportion thought thatPharmacists handed out leaflets to relevant people or to everyone who wasmaking a purchase. Others suggested that leaflets were kept behind the counteror given to people who specifically asked for one.

Figure 9: How pharmacists distribute leaflets

	NUMBER
Keep in dispensers people help themselves	11
Hand out to everyone making a purchase	2
Hand out to relevant people	4
Keep behind counter	2
Give to people who ask for one	2
Don’t know	2
Patient information catalogue	1

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

4.1.4 Pharmacists' usage of dental health resource material

• Just over half of the Health Promotion Workers haddistributed all of the dental health resource material. One of the respondentshad distributed some of the materials. The other 5 had not distributed any ofthe materials, in this instance materials had been distributed by HEBS.

Figure 10: Distribute all or some dental health resources material

	NUMBER
All of it	7
Some of it	1
None of it	5

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• In those instances where another organisation wasthought to have distributed the material, all of the respondents perceived thatresponsibility lay with HEBS.
• The eight respondents who had distributed some or allof the dental health resource material themselves were asked which distributionchannel they had used. As can be seen in Figure 11 half of the respondents haddistributed by post and half in person.

Figure 11: Distribution channel for dental health material

	NUMBER
By post	4
In person	4

Base: 8
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• Overall, 10 of the respondents claimed that they hadforewarned the Pharmacists prior to the dental health packs being distributed.In addition, most of the respondents claimed to have given an explanation ofthe contents of the pack to Pharmacists. Most of these explanations were givenbefore the pack arrived (9 respondents), with only one giving explanations atthe time of delivery and one after the deliveries.

Figure 12: Explanation of content of pack

	NUMBER
Before it arrived	9
When it was delivered	1
After it was delivered	1
No explanation	2

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• About half of the respondents who had given anexplanation had sent a letter, and an additional four people had arranged abriefing day.

Figure 13: Type of explanation

	NUMBER
Face to face	1
By telephone	0
By letter	5
Briefing day	4
Workshop	1

Base: 10
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• The respondents were asked when they thought an idealtime was for an explanation to be given. Most respondents thought that it wouldbe preferable for an explanation to be given before a pack had arrived. Only acouple of respondents thought it would be appropriate to explain the pack atthe time of delivery or after delivery.

Figure 14: Ideal time for explanation

	NUMBER
Before it arrived	9
When it was delivered	2
After it was delivered	1
No need for explanation/self explanatory	1

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

• All of the respondents were asked to rate thedistribution technique which was used for the dental health material. It wouldappear that regardless of distribution techniques, most of the respondentsthought that the technique they used had worked quite or very well.

Figure 15: Rating of distribution technique used

	NUMBER
Worked very well	7
Worked quite well	4
Worked neither/nor	1
Did not work very well	0
Did not work at all well	0
Don’t know	1

Base: 13
Source: Health Promotion Workers, Market Research ScotlandLtd, June 1997.

4.1.5 Perceptions of dental health material pack

• Most of the respondents (11 people) said that theywere familiar with the material included in the dental health resource pack.The respondents were then asked to rate all of the aspects of the pack in termsof how useful to Pharmacists they were. In particular, Figure 16 demonstratesthat the five _ A4 size handouts were perceived as being most useful. The"Promoting Oral Health Handbook" was also perceived as beingparticularly useful by the respondents. In general, most of the pack items wereconsidered to be of some use to Pharmacists; this was true with the exceptionof the "Give Teeth a Chance Leaflet" which was perceived by thelargest proportion of respondents as being neither useful nor not useful.

Figure 16: Usefulness of pack items

	Very UsefulNo.	Quite UsefulNo.	Neither/NorNo.	Not VeryUseful No.	Not At AllUseful No.	Don’tKnow No.
Give Teeth a Chanceleaflet	1	2	6	1	1	0
5 handouts (1/3 A4 size)	5	4	1	1	0	0
Give Teeth a Chance hangingcards	2	6	1	1	0	1
Give Teeth a chance windowsticker	3	3	3	2	0	0
Give Teeth a Chance shelftalker	3	5	1	2	0	0
Give Teeth a Chancewobbler	2	7	1	1	0	0
Promoting Oral HealthHandbook (Ref for pharmacists)	4	3	2	2	0	0
Scientific Basis of Dentalhealth Education (Ref for pharmacists)	3	2	4	2	0	0

Base: 11
Source: Health Promotion Workers, Market Research Scotland Ltd, June 1997.

• The respondents were asked a similar question inrelation to the different aspects of the pack - this time they were asked torate how easy the individual items were for Pharmacists to use. Clearly thefive 1/3 A4 size handouts were perceived as being the easiest for Pharmaciststo use. The "Give Teeth a Chance Wobbler" and the "Give Teeth aChance Leaflet" were also considered to be easy to use. The aspects of thepack which were thought to be most difficult for Pharmacists to use were the"Promoting Oral Health Handbook" or the booklet entitled"Scientific Basis of Dental Health Education".

Figure 17: Ease of using pack

	Very Easy No.	QuiteEasy No.	Neither/Nor No.	Not Very Easy No.	Not At AllEasy No.	Don’tKnow No.
Give Teeth a Chance leaflet	5	2	4	0	0	0
5 handouts (1/3 A4 size)	8	3	0	0	0	0
Give Teeth a Chance hangingcards	1	4	3	1		2
Give Teeth a chance windowsticker	3	2	2	2		2
Give Teeth a Chance shelftalker	3	5	3	0	0	0
Give Teeth a Chancewobbler	4	6	1	0	0	0
Promoting Oral Health Handbook (Ref for pharmacists)	2	2	2	3	2	0
Scientific Basis of Dentalhealth Education (Ref for pharmacists)	2	1	2	4	2	0

Base: 11
Source: Market Research Scotland Ltd, June 1997.

• The health promotion workers were then asked toconsider each aspect of the pack individually in terms of ways of improving thepack. It is important to note that most of the comments were made byindividuals, and were not the overwhelming attitude of the respondents as agroup.

Give teeth a chance leaflet

One respondents commented that this leaflet did not haveenough impact. Another person thought that it could be improved by making itmore concise, which was backed up by another health worker who thought that itcontained too much information. One individual found the text hard to read, andanother criticised the layout. One respondent thought it would benefit frommore formal wording.

5 Handouts (1/3 A4 size)

Two of the respondents thought that these handouts wouldbenefit from making the message more obvious to the reader. One respondentcriticised the childlike handwriting which they found hard to read.

Hanging card

The respondents here raised practical issues such as thefact that some companies have a policy of not using Hanging Cards, or thatceilings are not always suitable for the use of such material.

Window sticker

Size was considered to be an issue here, with 2 respondentsthinking that the Window Sticker was too big, and another respondent feelingthat it was too small. In fact, one respondent suggested that a number ofdifferent sizes would be required if the stickers were to be used as standard.In addition, 2 respondents criticised the colour, with one of the opinion thatthe yellow was a transparent background, and another commenting that yellow isnot a good colour for Window Stickers.

Shelf talker

Again the Health Workers highlighted practical issues suchas not all Pharmacists can use the Shelf Talkers, or that the adhesive padswere ineffective.

Shelf wobbler

Only two respondents made any comments in relation to theShelf Wobbler. Both suggested that it would benefit from a strong adhesive.

Promoting oral health handbook

One respondent suggested that this could be improved by ashort summary in the back of the document.

Scientific basis of dental health education

One respondent commented that this Booklet was dry andboring, whilst another would have preferred a summary to the rear of theBooklet. A clear guideline in the fluoride section was called for by oneindividual.

• The respondents were also asked how they thought thecampaign as a whole could be improved. Overall, 4 respondents suggested that itwould have benefited from more advance warning to the individual HealthPromotion Departments, and one respondent actually felt that their departmenthad not had enough briefing about the campaign. In addition, two respondentswere seeking more general publicity e.g. press and TV. A variety of othercomments were made by individuals, as shown in Figure 18 below.

Figure 18: Ways of improving campaign

	NUMBER
More general publicity (press and TV)	2
More money for hand delivery	1
Involve pharmacists and oral health care	1
More advance warning to HP Department	4
More representation from CAPOS	1
Not enough briefing of HP Department	1

Base: 10
Source: Market Research Scotland Ltd, June 1997.

• Most of the Health Promotion Workers perceived therole of distributing the dental health resource material as being very or quiterelevant to Community Pharmacists.

Figure 19: Relevance of pharmacists distributing dental resource material

	NUMBER
Very relevant	7
Quite relevant	3
Neither/nor	0
Not very relevant	0
Not at all relevant	0
Don’t know	1

Base: 11
Source: Market Research Scotland Ltd, June 1997.

• Overall, 5 respondents had had some kind of feedbackfrom the Pharmacists. On the whole, this feedback had been positive as can beseen in Figure 20.

Figure 20: Nature of feedback

	NUMBER
Good campaign - added display of toothbrushesand paste	1
Why was oral health chosen?	1
Research survey - on the whole favourable	1
Favourable - looking for more	2

Base: 5
Source: Market Research Scotland Ltd, June 1997.

4.1.6 Other links/support required

• Overall, 7 of the Health Promotion Workers had madelinks with other health professionals for National Smile Week. Over half ofthese related to contact between a Pharmacy and a Community Dental HealthService. Others had developed contact with a Dental Hygienist, Dental Nurse ora Local School.

Figure 21: Nature of links

	NUMBER
Pharmacy and dental hygienist	1
Pharmacy and community dental service	4
Pharmacy and dental nurse	1
Pharmacy and school	1

Base: 7
Source: Market Research Scotland Ltd, June 1997.

• Additional support which the Health Promotion Workersperceived as being worthwhile included a number of respondents who were lookingfor resources such as more staff, finance or training (3 respondents). Inaddition, two respondents thought there was a need for more publicity orcoordination with the media. Other responses included public competitions orbetter timetabling.
• Finally, the health workers were asked if they hadany other comments they would like to make in relation to dealing withCommunity Pharmacists and health promotion in general. Two of these respondentshighlighted the need for more resources such as material to train Pharmacists.One respondent thought that their role would be made easier if HEBS had greaterinfluence over the Pharmacies. The difficulty involved in Pharmacists attendingseminars was raised by one respondent. In addition, one individual wasinterested in finding out whether Pharmacists would accept information oncomputer.

4.2 Pharmacists telephone survey

• Due to the small sample size, it is not possible todraw statistically reliable comparisons between Health Board Areas, Depcats orstore types. This cross analysis can be found separately in tabular format.

4.2.1 Profile of the sample

• The sample was stratified in terms of Health BoardArea, store type and Carstairs Deprivation Categories (Depcat) in order toensure that it was reflective of the composition of Community Pharmaciststhroughout the Health Board Areas under consideration. Depcats range from 1 -7, with 1 representing the most affluent areas and 7 representing the mostdeprived.
• Figure 1 details the Health Board Areas where thePharmacies were located.

Figures 1 and 2

• The largest single proportion of the Pharmacists(48%) worked for independent stores. Almost three in ten respondents wereemployed by a chain, and 25% worked for a multiple independent.

• Figure 3 below details the Deprivation Category ofthe Pharmacies where the respondents were employed.

Figure 3

4.2.2 Attitudes towards health promoting role

• Initially, the respondents were asked a spontaneousand then a prompted question in order to determine which types of healthprofessionals or organisations had a health promotion role in their community.
• Spontaneously the vast majority of respondents (95%)thought that Pharmacies had a health promotion role. In addition, over threequarters of respondents (77%) perceived this role as being appropriate toGP’s spontaneously. Almost two thirds (63%) thought Dentists had such arole, as did 42% of the sample in relation to Health Visitors. Otherorganisations such as Schools or Family Planning Clinics were mentioned by amuch smaller proportion of the sample.
• With prompting, all of the respondents thought thatPharmacies had a health promotion role. In addition, the vast majority ofrespondents saw such a role as being of relevance to GP’s (97%), HealthVisitors (97%), Dentists (96%), Health Boards (87%) and Schools (86%). Withprompting most respondents saw a health promotion function as being appropriateto other organisation such as Family Planning Clinics (82%), Hospitals (72%)and Libraries (66%) to a slightly lesser extent.

Figures 4A and 4B

• The respondents were asked a question specificallyrelating to their own job as a Pharmacist, in order to determine whether theysaw themselves as having a health promotion role. Overall, 80% of the samplethought they definitely had such a role, and a further 17% thought that theypossibly had such a role.

• Only 4 respondents did not see themselves as having ahealth promotion role. All of these respondents felt that they had had noformal training for such a function.

Figure 5

• All of the respondents were asked whether theyperceived the health promotion role as being relevant to Community Pharmacists.Almost all of the respondents perceived the role as being either"quite" or "very" relevant. In fact, three quarters of thesample thought that a health promotion role was very relevant to CommunityPharmacists.

Figures 6A and 6B

• The 149 Community Pharmacists who perceived a healthpromotion role as being relevant to them were asked why. Most of theserespondents spontaneously highlighted their ability to give general healthadvice (71%). Just over a fifth (22%) thought that Community Pharmacists wereable to help promote a healthier lifestyle. Figure 6b details the variety ofother comments which were made by a handful of respondents.

4.2.3 Nature of health promotion activity undertaken

• There were three primary activities which theserespondents undertook in terms of health promotion activity. Almost all of therespondents claimed that they distributed leaflets (91%), put up posters (84%)or gave advice to customers (82%).

Figure 7A

• Most of the respondents thought that they receivedsupport for this health promotion activity from the Local Health PromotionDepartment (84%). A further fifth of the sample (22%) also received supportfrom the Pharmacy Health Care Scheme. Within the sample 7% stated that theyreceived no support in this role.
• A variety of other types of support were detailed bythe sample including assistance from drug companies or company head office.Three respondents mentioned HEBS.

Figures 7B and 7C

• It was important to develop an understanding as tothe nature of the support received. Most of the support which the respondentsdiscussed related to resources such as materials or leaflets (72%). A smallproportion of the sample who received support mentioned meetings with healthpromotion staff (13%) or training advice (9%).

• The respondents were asked how often they normallydisplayed health promotion material which they received. Over half of thesample claimed that they "always" used health promotion material(55%), with an additional third (36%) stating that they "usually"displayed material which they received. Only 9% of the sample thought that theydisplayed material "sometimes".

Figures 8 and 9

• Over six out of ten respondents stated that they hadnever experienced any difficulties using display materials (63%). The primarydifficulties which the Pharmacists noted spontaneously were "lack of shelfspace" (27%) and "leaflets which were too big" (9%). Otherdifficulties mentioned by respondents included "posters too big","company policy" or "lack of window space".

• It was worthwhile considering how respondentsnormally distribute leaflets. The vast majority of respondents (95%) "keepleaflets in dispensers for people to help themselves". A further third(36%) "give leaflets to relevant people", while a quarter "giveleaflets to those who ask for them" (25%). One in ten Pharmacists"hand leaflets out to everybody" (11%).

Figure 10

4.2.4 Pharmacy health care scheme

• Almost half of the sample had heard of the PharmacyHealth Care Scheme (48%).
• The 73 respondents who had heard of the PharmacyHealth Care Scheme were asked how often they received materials from thisorganisation. Most respondents thought that they received materials once ortwice a month (52%) or once every couple of months (25%). Only a very smallproportion of the sample thought that they received such materials more or lessoften.

Figures 11 and 12

4.2.5 National smile week material

• All of the respondents recalled receiving theresource material for National Smile Week.

Figures 13 and 14

• 4 out of 10 respondents thought that they hadreceived this material from their Local Health Board and 31% from HEBS. Justover a quarter of the sample (26%) couldn’t remember who they had receivedthe material from.

• The majority of respondents (84%) thought that thedental health resource material had been sent to them by post. A further 17%had had the pack delivered to them in person.

Figures 15 and 16

• Most of the respondents (64%) were advised to expectthe dental health resource material.

• Just over half of the sample had received anexplanation of the contents of the pack (55%). Most of these explanations hadbeen given either before the pack arrived (32%), or when it was delivered(21%).

Figures 17 and 18

• The majority of respondents had received anexplanation by letter (77%). Equal proportions of the sample thought that theyhad received a telephone call as an explanation (15%) or a face to faceintroduction to the pack (15%). A further one in ten respondents had attended abriefing day for an explanation.

• The vast majority of respondents thought that theexplanation about the contents of the pack which they had received was adequate(98%).

Figures 19 and 20

• All of the respondents were asked when they wouldprefer to be given an explanation about the pack. Most of the respondentsthought that it would be appropriate for an explanation to be given before thepack arrived (56%). An additional quarter of the sample thought that it wouldbe better if the explanation was given at the same time as the pack. Only atiny proportion of respondents would have preferred an explanation to be givenafter the pack was delivered. A fifth of the respondents felt there was no needfor an explanation (19%).

• The vast majority of respondents thought thatresponsibility for handing out the dental health resource materials wasrelevant to them (86%). In fact, overall less than one in ten respondents didnot perceive the role of handing out the pack as being relevant to them.

Figure 21

4.2.6 Usage of pack materials

• Figure 22 details items of the pack which therespondents used. Overall, most respondents used all of the items in the pack.The most heavily used items from the pack were the "Give Teeth a ChanceLeaflet" (99%), the two booklets given to Pharmacists for reference (92%and 89% respectively) and the five handouts (87%). Other items included in thepack, although used less frequently, were still used by most respondents (60 -66%).

Figure 22

• Respondents who did not use specific items from thepack were asked why they hadn’t used them, and the responses are detailedin Figure 23 below. When considering the responses within this table, it isessential to bear in mind the base number, i.e. the number of respondents,which is detailed in the far right column.
• The individual who didn’t use the "GiveTeeth a Chance Leaflet" had felt that they did not have enough copies todistribute.
• Most of the respondents who did not use the"Give Teeth a Chance Handouts" did not have enough shelf space. Lackof space was also the primary reason for respondents not using the "GiveTeeth a Chance Hanging Card", "Shelf Talker" "Wobbler"and "Promoting Oral Health Handbook". Respondents who had not usedthe "Give Teeth a Chance Window Sticker" usually found it too big ortoo small. The "Scientific Basis of Dental Health Education" had notbeen used for a variety of reasons including lack of time and interest.

Figure 23

	Not Enough Space %	Not Enough Materials %	Too Big/Long %	Too Small/Short %	Other %	BASE
Give Teeth a Chance Leaflet	-	100	-	-	-	1
Give Teeth a Chance Handouts	68	-	5	5	26	19
Give Teeth a Chance Hanging Card	54	6	23	6	13	52
Give Teeth a Chance Window Sticker	22	2	26	2	48	58
Give Teeth a Chance Shelf Talker	52	-	9	4	39	56
Give Teeth a Chance Wobbler	54	-	5	7	34	61
Promoting Oral Health Handbook	75	-	8	8	33	12
Scientific Basis of Dental HealthEducation	35	-	6	6	53	17

Source: Market Research Scotland Ltd, July 1997

• Those respondents who had used each item includedwithin the pack were asked how they had used them.
• The "Give Teeth a Chance Leaflets" werepredominantly displayed on a counter (43%), or in a stand/dispenser (32%).

Figures 24A and 24B

• The five _ A4 handouts were most often displayed onthe counter (48%), or in a stand/dispenser (25%).

• None of the respondents who had used the Hanging Cardhad used it in the way it was intended to be used i.e. hanging from theceiling. The largest proportion had used it as a window display (49%), withsmaller proportions using it on the counter (15%), or at the dispensary (12%).

Figures 24C and 24D

• As one might anticipate, the vast majority ofrespondents had used the Window Sticker within the window.

• The Shelf Talker was most frequently used as part ofa dental product display (55%). A small number of respondents had also used theShelf Talker as part of a display stand (13%), or window display (13%).

Figure 24E and 24F

• The Shelf Wobbler was predominately used as part of adental products display (34%) or window display (32%).

• Most respondents who had used the "PromotingOral Health Handbook" or the "Scientific Basis of Dental HealthEducation" had kept them for reference.

Figures 24G and 24H

4.2.7 Proposed improvement to the dental health resource pack

• The respondents were asked an individual questionrelating to each item included within the pack, and asked how it could havebeen improved. As can be seen from the following charts, the majority ofrespondents saw no need for improvement to most elements of the pack, and onlya small proportion of the sample gave constructive criticism.

Figures 25A and 25B

Figures 25C and 25D

Figures 25E and 25F

 

Figures 25G and 25H

 

• In addition, over half of the respondents thoughtthat there was no improvement needed to the pack as a whole (51%). The keyimprovement which was put forward by the sample was more advertising orpublicity (19%).

Figure 26

4.2.8 Professional links and additional support required

• 11% of the Pharmacists had made some kind of linkwith other health professionals to support National Smile Week.

Figures 27A and 27B

• Most commonly these links were made with localCommunity Dentists (41%), Oral Health Officers (18%) or the Dental Health Unitwithin local Hospitals (18%).

• Overall, one in ten respondents had undertaken otheractivity which was linked to National Smile Week (9%).

Figures 28A and 28B

• The activity undertaken most frequently related todental promotions (71%). A small minority of respondents had held competitionsabout dental care or displayed signs relating to the material.

• The respondents were asked whether there were anyother forms of support which would have been helpful in relation to the dentalhealth resource material. The majority of respondents (72%) did not think thatany other support was necessary. One in ten respondents thought that moreadvertising or publicity would have been helpful, and 7% thought that freesamples would have been useful.

Figures 29 and 30

• The respondents were also asked if there was anyadditional support which would be helpful in relation to health promotion ingeneral. Most of the respondents could not think of any other helpful support(61%). A small proportion of the sample were looking for more advertising andpublicity on an ongoing basis (7%). In addition, 6% were looking for moreup-to-date information, and 5% thought that more liaison with Pharmacists wouldbe beneficial. Figure 30 details a variety of other comments which were made bya small number of respondents.

4.3 Pharmacists depth interviews

4.3.2 Attitudes towards the health promoting role

• Within the local community, the respondentshighlighted a range of organisations who they perceived as being responsiblefor promoting good health behaviour. These included:-
  - GP’s
  - Health Nurses/Visitors
  - Dentists
  - Pharmacists
• Only one of these respondents (a non material user)did not see a health promotion role as being relevant to Pharmacists. Thisrespondent thought that they were not paid to act as a health promoter, and didnot have the time within their job for giving more than occasional advice.
• A couple of respondents did not see health promotionas being part of their job (non material users). However, despite this mostrespondents thought that the role was relevant to them as they usually have agreat deal of customer contact. This was found to be particularly true withinsmall Pharmacies where the Pharmacist had a more "hands on" role.
• The respondents highlighted a number of barriers tothe role of a health promoter for Pharmacists. Most of the respondents found itdifficult to give time over to giving advice. A number of these respondentsfind that a large proportion of their time is spent acting as shop assistantsrather than Pharmacists, and it was therefore difficult for them to find thetime to give advice whilst serving. Those who had not used the materialappeared to suffer to a greater extent in terms of lack of time.

"I often don’t have the time very often, but I dohave the training and skills to do it."

• Availability of relevant material was also seen as aproblem by some respondents. More specifically, respondents were concerned thatthey did not always have leaflets on key issues all year round. Privacy wasperceived as being important in order to give meaningful advice in an open andcomfortable environment. For some of these Pharmacists it was often difficultto find a private area were they could discuss people’s problems orqueries in depth. This was particularly a problem in the smaller Pharmacieswhere all available space was given over to stock.
• Lack of training was perceived to be an issueparticularly amongst independents, older Pharmacists and those who had not usedthe material. A number of them felt that while they had a certain level ofknowledge, this knowledge was not always up to date with the current advicebeing giving on health promotion issues.
• Most of the respondents found that they had competingpriorities when trying to find space to display materials. If health promotionmaterials are competing with stock for space, it is unlikely that they would bedisplayed regardless of their nature or source.

4.3.3 Nature of activity undertaken

• All of the respondents to this aspect of the surveydisplay leaflets. Leaflets are usually displayed in a dispenser near thePharmacy counter. A small number of the respondents also give leaflets out inbags when people make relevant purchases e.g. leaflets about sun protectionbeing provided to those purchasing sun cream.
• The majority of respondents also gave verbal adviceon request from a customer. The type of advice most often requested bycustomers is usually found to relate to personal problems rather than generalhealth issues or health promotion. In many cases health promotion advice isgiven indirectly, or in addition to product advice.
• Responsibility as to what type of material, or whichmaterials will be displayed, usually lies with the Pharmacist or the StoreManager. The decision about which material will be displayed is particularlyrelated to available space. For example, if new health promotion materialarrives soon after another pack has been displayed within the Pharmacy, it isunlikely that the second pack will ever be displayed.

"If we’ve just taken down and put up a new setof posters etc on a Monday and another arrives on a Tuesday, you can guess what happens toit."

• Another key factor is the time available to staff tophysically change the display. If a Pharmacy has a particularly busy period, oris short staffed then these displays will be changed less frequently. A smallerproportion of the sample are also concerned with ensuring that any materialdisplayed is of particular relevance to their customers or is particularlytopical, e.g. sun cream during the summer time. In some chains, such as Mossthe Chemist and Boots, the Head Office has input into the decision as to whichmaterial will be displayed. In certain cases, the local Pharmacy appear to haveno control over what will ultimately be displayed in their shops.
• Lack of time and other health promotion packs werethe key reasons why some Pharmacists had not used the material.
• Most of the respondents felt that they usually havetoo much material to display.

"We get a huge amount of information but therenever enough time or space to use it."

• Despite this, many respondents felt that non seasonalissues, for example vitamins, are not well covered on an all year round basis.There was a demand amongst respondents for materials relating to such nonseasonal issues to be provided all year round, in order to ensure that they hadleaflets available for their customers.

"The usual scenario is you get the same amount eachyear on vitamins or sun care.
But sun care is really only an issue for a few months ayear."

• Health promotion materials are received from a rangeof sources on an ongoing basis. Most of the respondents received between 2 and6 packs or batches of leaflets each month. The primary sources for suchmaterials included drug companies, HEBS and local Health Boards.
• The majority of respondents had no awareness of thePharmacy Health Care Scheme. Those who were aware of the Pharmacy Health CareScheme had little knowledge about how the scheme worked, or how frequently theyreceived and displayed Pharmacy Health Care materials.

"I assume they’re one of the bodies who sendme leaflets."

• The respondents were able to make clear distinctionsin the materials which they received. There were two types of materials whichthe respondents differentiated between. The first was material from drugcompanies, which was trying to sell particular products by promoting goodhealth behaviour. The second was materials from HEBS or local Health Boards,which were trying to educate about good behaviour without selling particularproducts.
• Despite this differentiation in the type of materialswhich respondents receive, there was little difference in the perceived qualityof the materials, and the Pharmacists thought that uptake from the customerswas the same regardless of the material’s source.

4.3.4 Support of activity undertaken

• It was clear that the chains received more support onan ongoing basis for health promotion activity. Pharmacists who work for thechains are often able to access ongoing training, which should help to keeptheir level of knowledge and understanding of health promotion issues up todate. In addition, many of these organisations produce their own healthpromotion material on an ongoing basis. The Head Offices of chains oftenorganise product promotion which are arranged specifically to tie in withhealth promotions, eg. leaflets about the benefits of different types ofvitamins displayed beside a three for two supplement offer.
• In addition, the chain Pharmacies are usually largershops. This results in more space being available for display material andgreater availability of staff for support, e.g. if a Pharmacist is givingadvice there is another member of staff who can operate the till.

"We are under pressure all the time, if someoneneed to be served I have to do it - so I make a point of not getting into lengthy health promotiondiscussions."

• Apart from the provision of materials, there was noevidence of any external support. Most of the respondents saw little need forany external support, with the exception of training about health promotion.The respondents saw value from training in terms of increasing their knowledge,and ensuring that the advice they were giving was always up to date.
• However, there are obvious problems associated withsmall independents actually being able to access training in relation togetting time off work, in order to attend training events. One respondentsuggested an alternative to a training course or programme of training would bean easy to read handbook about all aspects of health promotion. The suggestionwas that the handbook would relate to all aspects of health promotion, butcould be built upon with monthly and bi-monthly updates slotting into a boundfolder.

"Training is a nice idea but for small companieslike this it’s just not feasible. I’d have to get a locum."

4.3.5 Usage of materials

• Most respondents do not display everything which theyreceive in terms of health promotion materials, due to lack of time to displaymaterials or inappropriateness of the content of materials. This was the reasonfor some Pharmacists not using the material. There are also a number oflogistical difficulties which prevent or restrict the usage of some types ofmaterial.
• A number of respondents perceived children picking up"irrelevant" leaflets eg stop smoking stickers as being wastage. Thishad led several respondents to place shelves or displays out of children’sreach.
• Many of the respondents have very little availablewall or shelf space. Any available space is usually given over to stock. Thisis coupled with respondents finding they had too much material to display.

"If it’s a question of stock or display, stockwill win every time"

• Shelf Talkers and Shelf Wobblers were criticised froma logistical viewpoint, as they often fall off or get knocked off shelves whenpeople are picking up goods.
• A couple of respondents are keen to source largerdisplay racks which would allow them to show more leaflets.
• As most respondents felt that they had no time orcapacity to increase the amount of health promotion work which they do at themoment, ie displaying leaflets and giving advice, very few perceived a need forany additional support. However, a couple of respondents would welcome theopportunity to develop relationships with other Local Health Professionals. Alack of knowledge about how other health professionals work, or how to meetother health professionals, has prevented this from happening in the past.

4.3.6 National smile week material

• Half of the Pharmacies interviewed were stilldisplaying all of the National Smile Week leaflets at the time of the interviewwhich was five weeks after National Smile Week. In addition, two respondentswere using the Shelf Talkers, and one was using a Window Sticker. One ShelfWobbler was in use at a counter, and one Pharmacist was using Hanging Cardspropped up against a shelf rather than hung up.
• All but one respondent had spontaneous recall of thepack and its contents. Three of the respondents had particularly good recalland remembered receiving the pack from HEBS as part of National Smile Week.However, most of the respondents received the pack through the post withoutadvance warning or explanation. The majority of respondents perceived this asbeing satisfactory, as they thought that the pack was fairly self explanatoryand did not require an introduction.

"There is rarely a need for explanation, either youput it up or you don’t."

• A small number of respondents, most often independentstores, would have preferred a written warning and a face-to-face delivery andexplanation of the pack. Usage of the National Smile Week material varied fromPharmacy to Pharmacy.

Five 1/3rd A4 leaflets

• The majority of respondents had used the _ A4handouts. Those who had not used them, said they thought the message containedin them was obvious and well documented among parents, and they already had anumber of other displays which were in use at the time of distribution.

"There are ‘bog standard’ issues in termsof size so they’re easy to use and I genuinely like them as well."

• All of the respondents have appropriate sized leafletdispensers which meant that there were no logistical difficulties in displayingthe leaflets. The leaflets were considered to be eye-catching, and appealed tothe Pharmacists themselves as they were bright and colourful. In addition, the_ A4 leaflets were simple and easy to understand as they were short andconcise.
• It was thought particularly appropriate that theseleaflets were appealing to children.
• A small number of respondents criticised the leafletswhich were in darker colours, as they were not thought to be as eye-catching asthe brighter, lighter shades.

Give teeth a chance booklet

• Overall, three of the respondents did not rememberreceiving the Booklet. All of those who remembered receiving the Bookletswithin the pack either handed them out (in bags to parents) or left them on thecounter for customers to pick up themselves.
• About a third of the respondents did not have anappropriate dispenser. This usually led to respondents leaving the Booklets ona counter rather than not using the material at all.

"I’d still leave them lying around somewherebut they don’t fit into my dispenser so they’re likely to get binned if people don’t pickthem up."

• Again, these Booklets were described as colourful andappealing to children. The booklets were perceived as being more informativethan the short leaflets, but despite this were still thought to be easy to readand understand.
• One respondent in particular had opened up the pagesin the Booklet and used it as a notice board display.

Shelf wobbler

• Several of the respondents did not recall receiving aShelf Wobbler. Only two respondents actually used the Shelf Wobbler. One hadbeen displayed behind a counter which was no longer there, and one was still inuse on a shelf.
• Despite the low usage of the Shelf Wobbler, most ofthe respondents found them colourful and attractive, although a couple ofrespondents did criticise it because they thought they looked like a productpromotion.
• Despite the appeal of the Shelf Wobbler, the ShelfWobblers were described as being impractical and cluttered. A particularproblem associated with any display materials being used on shelves is thatthey often block the view of products on the shelf below. In addition,respondents find it irritating that the Shelf Wobblers frequently fell off theshelves due to poor adhesive, or were pulled off by children.

"Just a big pain - can’t be bothered withthem."

Shelf talker

• A small number of respondents had no recollection ofreceiving a Shelf Talker. About half of the respondents had used the ShelfTalker, largely because it is perceived as being more practical than the ShelfWobbler. The Shelf Talker was thought to take up less space and to have betteradhesive than the Shelf Wobbler. Despite this, a small number of respondentsstill found the Shelf Talkers irritating and impractical.
• Those respondents who liked the Shelf Talker praisedthem because they were simple and concise, with a strong clear message whichwas easy to read and understand.

Window sticker

• None of the respondents at this stage of the researchhad used a Window Sticker. About half of the respondents had a logisticaldifficulty in that they had no clear space, because windows were dedicated topromotional displays at all times. Other respondents preferred to keep windowsclear so as not to restrict light into the shop, or reduce the customers viewof the inside of a shop.
• It is also worth noting that multiples, inparticular, often have an "no window stickers" policy.
• The window sticker was criticised for being too paleby a small number of respondents, who thought that it blended into thebackground within the shop.

Hanging cards

• Several of the respondents did not remember receivingthe Hanging Cards. The Cards tended to be preferred by larger stores andmultiples. Many of the multiples use their own Hanging Cards on a regular basisso these are easy to use and well received.
• Others praised the style and design of the hangingcards. It is worth noting that a number of respondents had not understood howthe Hanging Cards worked.

"You don’t get any instructions."

• However, most of the respondents found the HangingCards difficult to use because of a lack of space. They were particularlyimpractical in small shops, most often the independents.

Promoting oral health handbook

• About half of the respondents had no recollection ofreceiving the Handbook. Whilst it was seen as useful for a reference book, mostrespondents were unlikely to read it properly. The size and weight of the bookwas particularly off-putting to respondents.

"You put things like this to the side, and sayI’ll read that later, but you very rarely do - it’s just too heavy."

• Once respondents had had time to examine the contentsof the Handbook, a number suggestions were made in order to make the Handbookmore appropriate to Community Pharmacists. In particular, the directory ofresources was not of any interest to the respondents, and it was proposed thatthis was an additional resource which you could access in another way.
• In addition, respondents suggested that the researchelement should be simplified and reduced for their purposes.

Scientific basis of oral health

• About half of the respondents had no recollection ofreceiving this Booklet. At first glance, respondents thought they would be morelikely to read this than the Handbook, as it looked more lightweight and easierto read. However, once respondents had opened the Booklet and furtherconsidered the content, the style of writing and the information containedwithin it was considered to be "complex", "heavy" and"difficult to digest".
• Despite this, most of the respondents thought thatthey would or had kept it for reference. The respondents proposed that theHandbook and the Booklet were combined into one concise and more user friendlyBooklet, which signposted respondents to other organisations for support andinformation if required.
• Respondents were then asked whether they hadundertaken any other activities during National Smile Week. It is first worthnoting that several of the respondents did not realise it was National SmileWeek. Most respondents complained that they had had no advance warning ofNational Smile Week and, therefore, it was difficult for them to organise anyother activity. One respondent had run a stand at the entrance of the Pharmacywith their Local Health Centre, and had handed out leaflets and given advice topassers by and customers.
• It is encouraging that overall the respondents feltthat the role of promoting oral health was as relevant to Community Pharmacistsas any other aspect of oral health.

4.1.1 The role of pharmacists as health promoters

• The Health Promotion Workers were asked what rolethey saw Pharmacists in their area having in relation to health promotion. Arange of responses were put forward by the 13 respondents to this aspect of theproject, as can be seen in the following Figure 1. All of the respondentsperceived Pharmacists as having some kind of role in relation to healthpromotion. However, this role was seen as varying widely from "a limitedrole providing leaflets" to an "important role" as an"information provider" within local communities.

4.3.1 Profile of sample

• 12 face to face depth interviews were conducted withPharmacists. The following table shows a breakdown of the respondents in thisaspect of the survey.

STORE TYPE	NUMBER OF INTERVIEWS ACHIEVED
Chain	4
Multiple Independent	4
Independent	4
AREA
West	4
East	4
North	4
DEPCAT
4 and above	6
5 and below	6
USED DENTAL HEALTH MATERIAL
Used	8
Did not use	4
TOTAL	12