Using the common-sense model of illness representations to explore individuals' experiences and perceptions of migraine and its management in the United Kingdom.

OBJECTIVES: Migraine is considered a chronic health condition that impacts both quality of life and psychological wellbeing. People with migraines use a range of management strategies, which include pharmacological and non-pharmacological treatments. The aim of this study was to explore individuals' experiences and perceptions of migraines and its treatment using the Common-Sense Model (CSM) of Illness Representations. METHODS: Semi-structured, one-to-one interviews were conducted with eleven individuals with a history of migraine to explore their experiences and perceptions of migraine and its treatment. Participants were recruited from across the United Kingdom via convenience sampling using social media advertisement. Interviews were recorded, transcribed verbatim, and qualitative data were analysed using theoretical framework analysis using the CSM. RESULTS: The three dimensions of the CSM were mapped on to the qualitative data. These were: (i) Cognitive representations of migraine, within five domains: (a) identity of migraine, (b) perceived causes, (c) perceived timeline, (d) perceived control/cure, and (e) perceived consequences; (ii) Emotional representations of migraine relating to (a) migraine specific emotions and (b) emotional representation of the impact of migraine; and (iii) Coping/self-management behaviours, namely (a) self-medicating behaviours and (b) care-seeking behaviours. No incongruous data were found; therefore, no further thematic analysis was required. CONCLUSION: This is the first study to apply the CSM to migraine for framework analysis of qualitative data in this way. The findings illustrate the emotional impact of migraine and the range of illness perceptions associated with appropriate self-management. The data will be used to design a questionnaire for quantitative studies to investigate the extent to which these perceptions are generalizable to the wider population of people who experience migraines.

Development of a Questionnaire to Measure Public Perceptions of the Role of Community Pharmacy in Public Health (PubPharmQ).

BACKGROUND: Community pharmacies are well placed to provide public-health interventions within primary care settings. This study aimed to establish the general public's perceptions of community pharmacy-based public-health services in the UK by designing a structured questionnaire to assess the barriers and facilitators to optimizing this role. METHODS: A standardized questionnaire was developed informed by the literature, additional semi-structured interviews, and synthesis of key findings with the authors' previous research based on data generated from eight focus groups. The original 42-item questionnaire was distributed online from May to June 2021 via social media platforms to capture the views of non-regular pharmacy users. Following exploratory factor analysis, and Cronbach's alpha analysis, total Likert scale response scores were calculated. RESULTS: Of the 306 responders, 76.8% were female with a mean age of 34.5 years (SD = 15.09). The most prevalent pharmacy use reported was 1-2 times a year (28.1%). Exploratory factor analysis revealed four scales: Expertise, Role in Public Health, Privacy, and Relationship (18 items) with acceptable internal consistency and good face and content validity. Awareness of well-established pharmacy services was high; however, responders demonstrated poor awareness of public-health-related services and low recognition of pharmacy expertise for this role. A lack of an established relationship with community pharmacies and privacy concerns were also perceived barriers. CONCLUSIONS: Based on these findings, considerable effort is needed to increase public awareness and address these concerns if strategic plans to utilize community pharmacy in the delivery of public-health policy are to be successful. The PubPharmQ provides a novel, structured questionnaire to measure the public's perceptions of community pharmacy's role in public health.

Cohort profile: The UK COVID-19 Public Experiences (COPE) prospective longitudinal mixed-methods study of health and well-being during the SARSCoV2 coronavirus pandemic.

Public perceptions of pandemic viral threats and government policies can influence adherence to containment, delay, and mitigation policies such as physical distancing, hygienic practices, use of physical barriers, uptake of testing, contact tracing, and vaccination programs. The UK COVID-19 Public Experiences (COPE) study aims to identify determinants of health behaviour using the Capability, Opportunity, Motivation (COM-B) model using a longitudinal mixed-methods approach. Here, we provide a detailed description of the demographic and self-reported health characteristics of the COPE cohort at baseline assessment, an overview of data collected, and plans for follow-up of the cohort. The COPE baseline survey was completed by 11,113 UK adult residents (18+ years of age). Baseline data collection started on the 13th of March 2020 (10-days before the introduction of the first national COVID-19 lockdown in the UK) and finished on the 13th of April 2020. Participants were recruited via the HealthWise Wales (HWW) research registry and through social media snowballing and advertising (Facebook®, Twitter®, Instagram®). Participants were predominantly female (69%), over 50 years of age (68%), identified as white (98%), and were living with their partner (68%). A large proportion (67%) had a college/university level education, and half reported a pre-existing health condition (50%). Initial follow-up plans for the cohort included in-depth surveys at 3-months and 12-months after the first UK national lockdown to assess short and medium-term effects of the pandemic on health behaviour and subjective health and well-being. Additional consent will be sought from participants at follow-up for data linkage and surveys at 18 and 24-months after the initial UK national lockdown. A large non-random sample was recruited to the COPE cohort during the early stages of the COVID-19 pandemic, which will enable longitudinal analysis of the determinants of health behaviour and changes in subjective health and well-being over the course of the pandemic.

Public Attitudes towards Medicinal Waste and Medicines Reuse in a 'Free Prescription' Healthcare System.

This study investigates public attitudes towards medicinal waste and medicines reuse within a 'free prescription' healthcare system. A quantitative online survey was employed in a sample drawn from the population of Wales, where prescription medicines have been 'free' since 2007. Qualitative interviews informed the content of the attitude statements with categorical or ordinal response options assigned. The questionnaire was hosted on the HealthWise Wales platform for 1 year from October 2017. Of the 5584 respondents, 67.2% had at least one medicine on repeat prescription. Overall, 89.1% held strong concerns about medicinal waste. High acceptance for the reuse of prescription medicines which have been returned unused by patients to pharmacies was reported for tablets (78.7%) and capsules (75.1%) if the medicine is checked by a pharmacist first (92.4% rated essential). Concerns identified related to tampering of packs (69.2%) and the need for hygienic storage (65.4%). However, those working in healthcare had less concern about the safety of reusing medicines. The level of public acceptance for the reuse of medication was higher than previously reported. This is the largest survey to capture these views to date, which has implications for the future design of medicines reuse schemes.

Deprescribing of Medicines in Care Homes-A Five-Year Evaluation of Primary Care Pharmacist Practices.

(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. The aim of this study was to present the results of this ongoing service evaluation over a five-year period. (2) Methods: Data collection and risk assessment tools developed during the feasibility study were used to measure the prevalence, nature, and impact of deprescribing interventions by primary care pharmacists over a five-year period. A random sample of approximately 5% of safety interventions were screened twice yearly by the pharmacist leads as part of standard practice. (3) Results: Over a period of five years there were 23,955 interventions (mean 2.3 per patient) reported from the 10,405 patient reviews undertaken. Deprescribing accounted for 53% of total estimated financial drug savings, equating to £431,493; and 16.1% of all interventions were related to safety. (4) Conclusions: Medication reviews in care homes, undertaken by primary care pharmacists who are linked to GP practices, generate a wide range of interventions commonly involving deprescribing, which contributes significantly to the continuous optimisation of the prescribing and monitoring of medicines.

The public's perception of the role of community pharmacists in Wales.

OBJECTIVE: To investigate the general public's perceptions of the community pharmacist's (CP) role in Wales by exploring understanding, awareness of services provided and potential interventions for promoting the role of CPs. METHODS: Qualitative methodology using focus group (FG) discussions exploring opinions, facilitated by a moderator (pharmacist) and an assistant. Topics discussed included the following: what a CP does; reasons for visiting; from whom they seek advice on medicines or lifestyle issues; use of traditional and newer services and promotion of services. The groups, totalling 32 participants, represented non-users and users of pharmacy services, that is pupils from a local secondary school (x1 group), people from the local community (x3) and patients plus carers from a Parkinson's disease group (x1). FG discussions were recorded and transcribed verbatim, and analysis was undertaken to identify themes. KEY FINDINGS: Traditional dispensing and supply of medicines roles were clearly recognised, but poor awareness of the newer services emerged, particularly in public health roles. CP's professionalism was acknowledged, but there was confusion over where they 'fit' within the National Health Service or with General Practitioners, with concerns or misconceptions raised over the impact of commercialism on professionalism. CONCLUSIONS: Based on these findings, the public is accepting of the extended role of CPs and would engage with CPs for a wider range of services. However, there is a lack of awareness of what public health services are available. Considerable work is needed to increase public awareness, during the strategic development of these services in Wales.

The development of the Self-Medicating Scale (SMS): a scale to measure people's beliefs about self-medication.

OBJECTIVE: We describe the development of a reliable and valid measure of people's beliefs about self-medication. To achieve this, student self-medication beliefs and behaviours in response to acute pain were investigated. Specific objectives were to establish the internal reliability plus content and construct validity of this scale. METHOD: The nine item 'Self-Medicating Scale (SMS)' was developed following one to one interviews conducted with a purposive sample of 10 lay people in 2001 to explore their self-medicating beliefs and behaviour. The SMS was completed by 304 undergraduate pharmacy students in March 2006, along with measures of self-reported over the counter (OTC) analgesic use, pain severity and other non-pharmacological methods of pain relief, using a cross-sectional design. Exploratory factor analysis was conducted on SMS items using Maximum Likelihood extraction and Varimax rotation. MAIN OUTCOME MEASURE: Factor structure of the SMS and relationships between SMS scales and medication-taking behaviour. RESULTS: Factor analysis of the SMS revealed three factor structures which were named 'Reluctance', 'Don't think twice' and 'Run its course' (each three item scales with good Cronbach's alpha 0.82, 0.77 and 0.75 respectively). Of the 304 respondents, 93% reported having experienced pain over the past month and nearly three quarters of these indicated that they had self-medicated with OTC analgesics (mean 10.8 doses). Statistically significant differences or associations were found in all three SMS scores and each of the main outcome variables i.e. whether or not analgesics were taken, number of doses of OTC analgesics taken and number of non-pharmacological remedies tried. CONCLUSIONS: These results show that the SMS possesses good internal reliability, plus good content and construct validity indicating that it is a useful measure of self-medication beliefs. More work is needed to extend these findings to the wider general public and with other OTC medications.

Reasons for the use of mild analgesics among English students.

OBJECTIVE: Mild analgesics such as paracetamol and ibuprofen are amongst the most commonly used over-the-counter (OTC) drugs. However, little is known about what beliefs people hold about them. The present paper examines: (a) the patterns of mild analgesic usage in a sample of university students, (b) their beliefs about the associated risks and the necessity of taking mild analgesics, and (c) the association between beliefs about analgesics and self-reports of their use. SETTING: A convenience sample of 333 students studying at a large English University were approached on the University campus. Of these, 291 agreed to participate, yielding an 87% response rate. METHOD: This study employed a cross-sectional design, with all participants completing the same questionnaire concerning their use of mild painkillers, such as paracetamol and ibuprofen, and beliefs about their use. MAIN OUTCOME MEASURE: Four questions asked about their patterns of mild analgesic use in the past month, specifically (a) have they taken analgesics, (b) how often did they take analgesics when they had symptoms, (c) did they take more than a single dose of 1-2 tablets at one time, and (d) did they exceed the maximum dose. RESULTS: Almost all of the 291 participants reported symptoms in the past month, with over two thirds treating with mild analgesics, and one sixth exceeding the maximum dose. Only 17% indicated that there were short-term risks of using mild analgesics, although half indicated that there were long-term risks. The risks that were identified generally did not conform with current medical thinking. Perceptions of risks were not generally associated with self-reports of analgesic usage. Rather, respondents who thought analgesics were more necessary were more likely to report taking analgesics, report taking more analgesics, and report exceeding the maximum dose. CONCLUSION: These results indicate the need for caution in current moves to encourage self-medication. If people are unaware of the risks of drugs such as paracetamol or ibuprofen, then they may only contact health professionals after they experience adverse effects.