Unlocking patient activation: a qualitative approach of question prompt lists in pharmacy counseling

Background: The utilization of Question Prompt Lists (QPLs) in pharmacy encounters has been demonstrated as an innovative approach in Sweden to meet individualized information needs about medication use. However, there is a gap in understanding how QPLs induce patient activation and contribute to improved medical treatment.
Methods: A qualitative inductive approach integrating some principles from conversation analysis (CA) was utilized. Audio recordings from a pilot study comprising 145 desk-encounters, featuring a QPL placed on the desk, in Swedish community pharmacies were transcribed and analyzed. The study aimed to discern the party initiating interactions and how participants allowed each other's to share their views. Fifty-six observations were included to achieve meaning saturation.
Findings: To allow the patient to take the initiative and turn the encounter according to their needs, critical elements in 1st, 2nd, and 3rd turn positions were identified. In the 1st turn, staff presentations of the QPL varied and often lacked clarity about its purpose. Nevertheless, they usually offered patients an opportunity for reflection on whether to utilize the list. Patient responses in the 2nd turn demonstrated variations in needs to relief possible concerns. Despite some customers expressing no need, pharmacists frequently initiated inquiries. When patients did indicate a need by asking questions or voluntarily sharing personal information, the pharmacist typically addressed it, albeit occasionally in a superficial manner. Hence, staff's 3rd turn positions showed whether they engaged with patient queries or adhered to the usual checklist information-approach.
Discussion: The study contributes to optimizing QPL implementation in pharmacy settings, ultimately promoting person-centered care. The findings highlighted the complexity in factors impacting QPL use and their subsequent responses in fostering patient activation. Critical elements identified in turn positions offer valuable insights into how patient activation occurs in a pharmacy setting, and how it can be enhanced through refined counseling skills.