Identifying critical elements in using question prompt lists at the pharmacy counter to induce patient activation—using principles of conversation analysis

Abstract

Background

The incorporation of Question Prompt Lists (QPLs) into pharmacy interactions has been tested as an innovative strategy aimed at enhancing patient engagement and addressing personal information needs. However, there is a gap in understanding regarding how QPLs induce or reduce patient activation and contribute to improved medical treatment. The specific aim of the study was therefore to qualitatively describe how pharmacy encounters in which QPL are introduced unfold, in order to identify and discuss relevant interactional mechanisms that induce or reduce patient activation.

Methods

The QPL, which includes questions about usage, interaction, side effects, and follow-up, was introduced to patients during pharmacy encounters. Employing a qualitative inductive approach based on principles from conversation analysis (CA), audio-recordings from 56 QPL encounters in community pharmacies were transcribed and thematically analysed.

Results

Most meetings began with a long initiation phase focused on determining which medications to take home. This was followed by an introduction to the QPL and a natural break where the pharmacist left to get the medicines, giving the patient an opportunity to contemplate their needs, as prompted by the QPL. While the QPL itself was not explicitly explained or discussed, the majority of patients asked questions and shared personal information. Even those who were disinterested felt compelled to justify their stance, demonstrating the influence of the norm of reciprocity. However, instances of unsolicited information provision by the pharmacist, were still identified.

Conclusion

This study demonstrates that QPLs can enhance patient activation in pharmacy encounters, even without detailed explanations, but their impact is not straightforward. The presence of the QPL encouraged patients to engage, share personal information, and ask questions. These findings suggest that QPLs can create opportunities for patient involvement, even in brief pharmacy interactions.