Understanding Facilitators and Barriers to Pharmacies' Adoption of an AHRQ Health Literacy Assessment Tool and the Effect on Pharmacies' Health Literacy Practices

Background: According to the 2003 National Assessment of Adult Literacy, only 12% of adults have proficient health literacy. Individuals with low health literacy are more likely to suffer from medication errors, have increased and more frequent hospital stays, and experience a higher level of illness. In response to growing awareness of health literacy as a health care quality issue, AHRQ developed a pharmacy health literacy assessment tool for pharmacies (Tool) to improve health literacy practices.

Objectives: To understand and describe what factors influenced pharmacies' decisions to use the Tool, as well as facilitators and barriers to adopting the tool, using Rogers' Diffusion of Innovations theory as a basis for understanding organizational change. To understand the effect of the assessment tool results on participating pharmacies' health literacy practices.

Methods: We employed comparative case studies of seven pharmacies (cases) that implemented the health literacy Tool for pharmacists. The cases represent diverse pharmacy types: a pharmacy in a federally-qualified health center, an independent, a retail chain, a grocery store, and an outpatient hospital pharmacy. The methods include in-depth interviews, site visits, a review of each pharmacy's assessment findings (based on a pharmacy staff survey, patient focus groups, and an auditor's assessment of the pharmacy), and review of other relevant documents (e.g., presentations).

The analysis includes a narrative of each case and case-specific information on factors (i.e., variables) that i) affected the decision to use the Tool, ii) were facilitators or barriers to adoption, or iii) impacted adoption and/or resulted in unintended consequences. The specific factors (variables) include, but are not limited to, staff availability and interest, prescription volume, pharmacy environment, perceived benefits/risks of the tool, other competing/complementary QI initiatives, resources available, patient population, presence of a change champion, and stage in the innovation-decision process. Finally, we use a cross-case analysis across the pharmacy sites to compare variables of interest.

Results: We will present a comparison of pharmacies' experiences, highlighting which variables (e.g., resources, staff) ostensibly facilitate or hinder tool adoption and implementation across sites, which factors have a varied effect depending on the pharmacy-specific context, and which unanticipated factors played a key role. Case study findings will inform the practice of pharmacy professionals providing care to patients with low health literacy, and will suggest the degree of adaptability of the assessment tool for pharmacy practices with different characteristics.