Terms of engagement: Researching the delivery of public health services by community pharmacies in England

Background: Engaging community pharmacies in research providing evidence of their contribution to public health is not easy. An experienced team of researchers from a pharmacy school in England were funded by a national government agency to explore variation in clinical productivity in community pharmacies. The study involved a survey of community pharmacies, analysis of activity data, a patient survey and stakeholder interviews. Aim: To explain the public health context against which the study was undertaken, share our strategies for achieving engagement, and highlight what success looks like. Method:  Strategies for engagement included: meetings with key stakeholders prior to study design to ground the study design in the practice context; setting up an advisory group including pharmacy, service commissioner and patient representatives to provide advice throughout the study; presentations to national and local pharmacy organizations to invite endorsement of the study; individual approaches to organizational gatekeepers to clarify the purpose and benefits of the study, and secure agreement to participate. Results:  This study encountered reactions ranging from enthusiasm and encouragement to deep mistrust and negativity, stemming partly from commercial sensitivities. Early engagement was vital but not always successful. Non-participation necessitated changes in study design, and response rate to the pharmacy survey was low.  Recruitment to latter stages of the study was enhanced through established relationships and earlier lessons learned. Discussion:  Understanding the political and commercial landscape in which community pharmacy operates is key to success; early engagement and personal meetings with pharmacy stakeholders were crucial for creating rapport and trust.