A Qualitative Approach to Exploring Workflow and Cost Factors of Dispensing Services in Community Pharmacies in Taiwan.

Purpose: This study aimed to thoroughly document the process and cost factors involved in dispensing services within a community pharmacy. Methods: Using a cross-sectional design, this study incorporated a pragmatic and descriptive qualitative approach to outline pharmacists' viewpoints on providing dispensing services in community settings. A purposive sampling was employed to recruit pharmacists from geographically different community pharmacies, spanning from March to July 2022. Semi-structured interviews with direct content analysis were conducted through face-to-face interactions to gather firsthand insights into pharmacists' professional dispensing services. The data underwent analysis through descriptive and in vivo coding techniques to categorize, define, and label themes, thereby identifying key steps and cost components in the prescription dispensing process. The qualitative data management software, MAXQDA 2020, was utilized for data management and maintenance. Results: Ten community pharmacists participated in the study, cooperatively completing the interview process. Of these, 7 were male and 3 were female, with age ranging from 29 to 62 years. The average length of pharmacy practice experience was 11.4 years. The study revealed six integral steps in the dispensing process: (1) receiving and clarifying legality and completeness of prescriptions, (2) profiling and verifying patient prescriptions, (3) preparing prescription labels and containers, (4) dispensing right medications with right quantity, (5) inspecting dispensing accuracy, (6) handing over medications and providing counseling. Along with these processes, pharmacists emphasized that pharmacy manpower, representing a substantial portion of the associated costs, determines the success and quality of the dispensing service. Additionally, rental, utilities, consumables, and physical equipment were identified as other important cost factors associated with carrying out pharmacy dispensing services. Conclusion: The study offers a comprehensive understanding of the dispensing service workflow within community pharmacies. The findings may inform key stakeholders and policymakers about required resources for enhancing and sustaining quality dispensing services for the public in Taiwan.

Strengthening scientific credibility in the face of misinformation and disinformation: Viable solutions.

Despite numerous attempts to mitigate their spread, misinformation and disinformation are rampant on social media and other public networks, posing a substantial risk to public health and individual well-being. A concerted, multi-channel approach is required to effectively tackle this evolving problem. This paper outlines potential strategies and actionable plans to improve the response to misinformation and disinformation by stakeholders from various healthcare ecosystems.

Mapping Real-World Data to Self-Reported Information to Explore Determinants of Location Selection for Community Pharmacies in Taiwan.

Background: Easy and adequate access to community pharmacies is key to eliminating primary barriers to the utilization of medicines and healthcare services. The location of community pharmacies is important for patients and providers when choosing and opening a pharmacy, but only a handful of studies investigate factors associated with the geographical distribution of pharmacies. This study aimed to identify decisive factors for location selection when starting a pharmacy among districts/townships in Taiwan. Methods: This cross-sectional mixed mode study employed an explanatory sequential design, beginning with a quantitative analysis of national datasets, and followed by a qualitative analysis of structured interviews. The national data were extracted from the Taiwan government database of 2020, and the qualitative interviews were conducted with 10 community pharmacists through a snowball sampling in 2021. A multiple linear regression was conducted to identify salient predictors of the number of community pharmacies in each of the 368 districts/townships in Taiwan, including population density, median annual household income, number of physician offices, area, and proportion of female residents of each district/township. Ten chief pharmacists were interviewed to share viewpoints on the decision-making process of their selection of current pharmacy practice sites. Inductive thematic analysis was performed to extract factors pertinent to location selection for pharmacy operations and services. Results: Confirmed by quantitative and qualitative data, population density, numbers of physician offices, median annual household income, pharmacy operation type, and type of retail locations are key determinants for site selection in considering opening a new community pharmacy. Conclusion: The study uncovers salient factors associated with the choice of community pharmacy location in Taiwan and proposes the adequate number of physician offices that a community pharmacy can collaborate with. In addition, pharmacists should prudently consider if their preferred service features match the needs of residents.

Effects of a blended multimedia teaching approach on self-efficacy and skills in over-the-counter medication counselling versus a lecture-based approach: protocol for a prospective cohort study of undergraduate students from a pharmacy school in Taiwan.

INTRODUCTION: Addressing communication skills in pharmacy curricula is one of the effective tactics to equip future pharmacists with better skillsets for medication counselling. To achieve this, blended teaching of PowerPoint slides and videos holds great potential for undergraduate pharmacy education majors by integrating multimedia and performance feedback into instruction. This study will develop a blended teaching programme featuring didactic lectures with video-based materials to improve students' self-efficacy and skills in medication counselling. METHODS AND ANALYSIS: This study applies critical principles and effects outlined in multimedia learning by Richard Mayer et al to develop teaching materials and perform skill evaluation for two undergraduate cohorts (class of 2025 and 2026) enrolled in Introduction to Community Pharmacy separately in 2022 and 2023. Students will receive different teaching approaches to medication counselling. In the control cohort (ie, class of 2025), students will receive a 4-week PowerPoint slides-based instruction in communication skills. We will develop six videos illustrating common scenarios of over-the-counter (OTC) medication counselling in community pharmacies. In the intervention cohort (ie, class of 2026), students will receive a 3-week PowerPoint slides-based instruction and a week-long video-based instruction in communication skills. A pre-and-post survey will be administered to evaluate students' self-efficacy in OTC counselling. In addition, each student will be evaluated through one-on-one role-playing with standardised patients in the final to demonstrate their skills in OTC counselling. A structured checklist will be used to assess students' counselling skills. T-tests will be applied to examine differences in self-efficacy of OTC counselling. Multivariate regression analyses will determine which teaching approach better facilitates the development of self-efficacy and performance in OTC counselling. ETHICS AND DISSEMINATION: The Research Ethics Committee of the National Taiwan University Hospital approved this study. The findings will be shared with pharmacy educators and contribute to existing instructional methods to facilitate the competence of pharmacy students in OTC counselling.

Pubertal progression and its relationship to psychological and behavioral outcomes among adolescent boys.

Variations in pubertal timing and tempo have relevance to psychosocial development. Accounting for pubertal timing, tempo, and psychosocial development simultaneously in a model remains challenging. This study aimed to document the typology of pubertal development in a cohort of Taiwanese adolescent boys and then to examine how the associations between psychosocial variables across time vary by the patterns of pubertal development. A group of adolescent boys (n = 1,368) reported pubertal signs and psychosocial variables for 3 years since seventh grade. The growth mixture model revealed three major classes of pubertal transition: average pubertal growth, late-onset with rapid catch-up, and late-onset with slow catch-up. In a cross-lagged panel model, the multigroup analysis found the regression coefficients mostly invariant across all three classes, except those between deviant behavior and subsequent changes in depressive symptoms that were significantly positive only in the late-onset with slow catch-up group. Adolescent boys in this group were estimated to have the highest marginal level of depressive symptoms and deviant behavior in ninth grade among the three classes. Our study highlights the heterogeneity in boys' pubertal development and the role of the pubertal development pattern in their psychosocial development.

Strengthening scientific credibility against misinformation and disinformation: Where do we stand now?

Health behaviors related to COVID-19 prevention measures, especially vaccination, are used to exemplify mechanisms whereby misinformation and disinformation can spark an "infodemic": a situation in which false information can spread more rapidly and widely than its truthful, science-based counterpart. We define key terminologies and identify potential sources that led to the pandemic infodemic, and highlight the harmful implications of such events. Issues related to scientific communication, how the public perceives information, and factors influencing individuals' decision-making are also discussed. This is the first in a series of two perspective articles on this topic.

Listening to White Noise Improved Verbal Working Memory in Children with Attention-Deficit/Hyperactivity Disorder: A Pilot Study.

Existing research demonstrates that children with attention-deficit/hyperactivity disorder (ADHD) underperform in cognitive tasks involving working memory (WM) due to hypo-arousal, which has led to the development of arousal regulation models to determine proper levels of arousal and optimal cognitive outcomes. The present study focuses on investigating the effects of external auditory stimuli on verbal WM in children with ADHD. Thirteen children with ADHD (aged 6-10 years old) and thirteen age- and gender-matched children with typical development (TD) completed the verbal WM task when listening to no sound, white noise, or pleasant music. A two-way repeated-measures analysis of variance was used to compare the verbal WM performance between groups in the three auditory conditions. Children with ADHD showed the best verbal WM performance when listening to white noise and the worst performance when listening to no sound. Yet, children with TD performed the best in the no-sound condition and the worst in the white noise condition. Our findings suggest auditory white noise is beneficial for ideal arousal regulation and cognitive performance involving verbal WM for children with ADHD and support the moderate brain arousal model. Providing external white noise is a non-invasive and cost-effective approach to improving verbal WM in children with ADHD in real-world contexts.

Exploration of changes in pharmacy students' perceptions of and attitudes towards professionalism: outcome of a community pharmacy experiential learning programme in Taiwan.

BACKGROUND: A powerful way to nurture and strengthen professionalism is by accruing practice-based experiences. However, few studies in Taiwan have evaluated the impacts of experiential learning programmes on pharmacy students' views on professionalism - the core of quality healthcare practices and services. This study aimed to measure changes in perceptions of and attitudes towards professionalism among third-year pharmacy students following an introductory-intermediate experiential learning course. METHODS: A single-group pre- and postcourse comparative study using a self-administered survey was conducted in 2017. Pharmacy students in their third year of a six-year programme were eligible to participate in this study. We used a 28-item questionnaire with a 10-point Likert-type scale to assess students' professionalism. Among them, 10 items were employed to assess students' perceived importance of professionalism in pharmacy practice, and another 18 items adapted from the Pharmacy Professionalism Instrument were used to evaluate students' attitudes towards pharmacy professionalism. An independent t test was performed to compare the differences in students' anonymous survey responses before and after the course, with an a priori level of statistical significance of 0.05. RESULTS: Fifty-two pharmacy students participated in the study. They showed significant improvement in three tenets of professionalism, namely, altruism (p = 0.035), accountability (p = 0.026), and duty (p = 0.002), after completing the 5-week experiential course. CONCLUSIONS: Pharmacy students' attitudes towards professionalism were modifiable by purposely designed experiential learning programme in the community setting. Such experiences may help socialize students with positive attitudes towards altruism, accountability, and duty.

Evaluation of use, comprehensibility and clarity of over-the-counter medicine labels: Consumers' perspectives and needs in Taiwan.

An estimate of one third of preventable medication errors occurred annually due to patients' misunderstanding of use instructions. To safeguard consumers' over-the-counter (OTC) medicine use and to develop future initiatives, this study evaluated the use, comprehensibility and clarity of the information labels on OTC packages from consumers' perspectives in Taiwan. This cross-sectional study was conducted at 29 community pharmacies; 50 pharmacy clerkship students helped participant enrolment from June to September 2017. Participants (n = 470) were 20 years old or above, Mandarin speaking, and with specific OTC purchases. A face-to-face survey was administered to investigate the degree to which participants read the package labels and their comprehension of correct medicine use. An 11-item survey was used to measure participants' specific OTC purchases (3 items), the use (2 items), comprehensibility (1 item) and clarity (2 items) of OTC package labels, in addition to the sociodemographic information (3 items). Participants were also solicited to provide opinions regarding package label redesign. Descriptive statistics and logistic regressions were applied for analyses. Findings show that most (84.0%) participants read instruction labels before use, with indications (79.4%), drug names (64.5%) and dosage and administration (59.8%) being the top reads. Only 30.0% of the participants fully understood how to take the medicines correctly. Younger (OR = 1.033, p < .001) and female participants (OR = 1.965, p = .014) with a higher level of education (OR = 1.940, p = .034) tended to read package label information prior to purchase or use. Younger participants (OR = 1.030, p < .001) and those who read OTC medicine labels before use (OR = 2.317, p = .004) were more likely to correctly understand medicine use. The findings indicate that older, male adults with a lower level of education should be targeted to ensure their correct understanding of OTC labels. Pharmacists should recite pertinent label information and, concomitantly, ensure consumers' understanding when providing medicine counselling.

Engaging consumers in wise use of over-the-counter medications in Taiwan: Development and evaluation of a structured medication counseling approach.

OBJECTIVE: To evaluate the impact of a tailored Symptom Allergy Indication Direction Self-care (SAIDS) counseling by pharmacists on consumers' correct understanding of over-the-counter (OTC) medication use. METHODS: This study used a time-based sampling of two independent cohorts at a single community pharmacy in Taiwan for two years beginning in December 2018. In the control cohort, participants received conventional counseling for the OTCs they selected. In the intervention cohort, participants received SAIDS counseling along with pointing out OTC package label instructions. A paper-and-pencil survey was administered face-to-face to evaluate participants' understanding for the correct use of OTCs. Descriptive statistics and chi-square tests were used to evaluate the effect of the SAIDS approach on cohorts' understanding of OTC use. RESULTS: Compared with conventional OTC counseling, participants reported better understanding regarding potential side effects of OTCs that they acquired (p < 0.001) and were more aware of strategies to cope with the associated side effects (p < 0.001). CONCLUSIONS AND PRACTICE IMPLICATIONS: Despite the time constraints that pharmacists often can offer to each customer, the SAIDS counseling approach may refine the structure and effectiveness of pharmacists' OTC counseling skills and thereby improve consumers' understanding of their ailments and self-care medications in Taiwan.

Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic.

BACKGROUND: Type 2 diabetes (T2D) incurs tremendous health costs associated with various complications due to poor diabetes control. Medication adherence, which is correlated with patients' health literacy, should be consistently practiced achieving optimal diabetes control. A deeper understanding of the specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. OBJECTIVES: This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy. METHODS: A questionnaire was administered via a face-to-face approach with 205 participants at a family medicine clinic. Study participants were all above 20 years of age with T2D, were prescribed at least one oral diabetes medication, and understood English. The questionnaire assessed participants' health literacy, self-efficacy for medication use, beliefs in medicines, patient-provider communication, perceived barriers to medication adherence, and self-reported medication adherence. Separate analysis of covariance was used to compare the mean scores of patient factors related to medication adherence across people with different health literacy levels. RESULTS: The mean age of participants was 61 years old, and the majority of the participants were female (57%), White (75%), and college educated (62%). Thirty-three percent of the participants had adequate health literacy, but only 43% of them reported high adherence to their diabetes medications. Analysis of covariance showed that having stronger self-efficacy (P < 0.001), lower concern beliefs about medication (P = 0.047), and fewer perceived barriers to medication-taking (P < 0.001), are necessary for better medication adherence. CONCLUSION: Findings suggest that practitioners should address concern beliefs among low-adherent patients with low health literacy, help improve self-efficacy, and address perceived barriers to medication adherence among all low-adherent patients to optimally support patients' diabetes care.

A path model linking health literacy, medication self-efficacy, medication adherence, and glycemic control.

OBJECTIVE: To investigate whether medication self-efficacy moderates or mediates the relationship between health literacy and medication adherence. To propose a path model that illustrates the interrelated relationship between health literacy, medication self-efficacy, medication adherence, and hemoglobin A1c (HbA1c). METHODS: This cross-sectional study was performed via a face-to-face survey. Factors that may influence medication adherence and HbA1c were identified from the literature review. One hundred and seventy-four participants included were ≥20 years old with diagnosed type 2 diabetes, understood English, and were prescribed at least one oral diabetes medicine. During clinic visits, a questionnaire was administered to evaluate health literacy, medication self-efficacy, and medication adherence. HbA1c values were obtained from electronic medical records. Path analyses were conducted for data analysis. RESULTS: Medication self-efficacy mediated but did not moderate the relationship between numeracy and diabetes medication adherence. Participants with higher numeracy skills may develop a greater level of medication self-efficacy, which in turn may result in a higher level of diabetes medication adherence and a lower level of HbA1c. CONCLUSION: Enhancing patients' medication self-efficacy and numeracy skills may be imperative in intervention programs to improve diabetes medication adherence. PRACTICE IMPLICATIONS: An improvement in numeracy skills and medication self-efficacy is recommended to enhance diabetes medication adherence.

Quick screen of patients' numeracy and document literacy skills: the factor structure of the Newest Vital Sign.

INTRODUCTION: The Newest Vital Sign (NVS) is a survey designed to measure general health literacy whereby an interviewer asks six questions related to information printed on a nutritional label from an ice cream container. It enables researchers to evaluate several health literacy dimensions in a short period of time, including document literacy, comprehension, quantitative literacy (numeracy), application, and evaluation. No study has empirically examined which items belong to which latent dimensions of health literacy in the NVS using factor analysis. Identifying the factor structure of the NVS would enable health care providers to choose appropriate intervention strategies to address patients' health literacy as well as improve their health outcomes accordingly. This study aimed to explore the factor structure of the NVS that is used to assess multiple dimensions of health literacy. METHODS: A cross-sectional study administering the NVS in a face-to-face manner was conducted at two family medicine clinics in the USA. One hundred and seventy four individuals who participated were at least 20 years old, diagnosed with type 2 diabetes, prescribed at least one oral diabetes medicine, and used English as their primary language. Exploratory factor analysis and confirmatory factor analysis were conducted to investigate the factor structure of the NVS. RESULTS: Numeracy and document literacy are two dimensions of health literacy that were identified and accounted for 63.05% of the variance in the NVS. Internal consistency (Cronbach's alpha) of the NVS were 0.78 and 0.91 for numeracy and document literacy, respectively. CONCLUSION: Numeracy and document literacy appropriately represent the factor structure of the NVS and may be used for assessing health literacy in greater detail for patients with type 2 diabetes.

Transitions of Developmental Trajectories of Depressive Symptoms Between Junior and Senior High School Among Youths in Taiwan: Linkages to Symptoms in Young Adulthood.

We investigated the heterogeneous developmental trajectories of depressive symptoms in junior and senior high school, the transitions to different trajectories after entering senior high school, and the linkages to the development of depressive symptoms in early adulthood among Taiwanese adolescents. An eight-wave longitudinal data set was analyzed, including 2687 Taiwanese adolescents (51.2% boys, M age = 14.3 at first wave). Using a manual three-step latent transition growth mixture model, we found that a three-class solution fit the data for both junior high school (termed high-improving, cumulative, and JS-low-stable) and senior high school period (termed heightening, moderate-stable, and HS-low-stable). The depressive symptoms of most individuals maintained at a low level (i.e., low-stable) from adolescence to early adulthood; however, nearly a quarter of the adolescents reported depressive symptoms that were moderately or highly severe in senior high school and beyond. More than 30% of the participants experienced transitioning into a different developmental trajectory between junior and senior high school. When perceiving a higher level of paternal behavioral control, adolescents categorized in the high-improving class in junior high school would have a higher chance to transition to the moderate-stable class than to HS-low-stable class in senior high school. Adolescent boys and girls did not differ in the probability of transitioning between trajectories across junior and senior high school. However, a clear and consistent pattern of symptoms between late adolescence and early adulthood was not observed. These results help elucidate the heterogeneity and fluidity associated with the development of depressive symptoms between early adolescence and early adulthood in light of school transition among youths in Taiwan.

A Nuanced Look at Women in STEM Fields at Two-Year Colleges: Factors That Shape Female Students' Transfer Intent.

In this study, we explored the relationship between the intent to transfer upward and a set of motivational, contextual, and socio-demographic background factors among 696 female students beginning in science, technology, engineering, and mathematics (STEM) programs or courses at two-year colleges in a Midwestern state. Drawing upon survey data and administrative records, our multinomial logistic regression analysis revealed that students' math and science self-efficacy beliefs, as well as transfer-oriented interaction, were significant and positive predictors for their intent to transfer into STEM fields as opposed to having no intent to transfer. In addition, the association between transfer intent and these key motivational and contextual factors was moderated by students' racial/ethnic backgrounds, marital status, and childcare obligations. For example, despite the positive relationship between transfer-oriented interaction and the intention to transfer into STEM fields, Black women were less likely to have intent to transfer into STEM fields than White students until Black students reported a moderate level of transfer-oriented interaction. Conversely, Hispanic students were more likely to report intent to transfer into STEM fields than their White peers, even when Hispanic students reported a relatively low level of engagement in transfer-oriented interaction. These and other reported findings bear important and nuanced implications as policymakers, educators, and researchers continue to discover ways to better support women's educational pathways and success in STEM fields at and through two-year colleges.

Association of parental warmth and harsh discipline with developmental trajectories of depressive symptoms among adolescents in Chinese society.

This article examines the relationship between parenting styles and the development of depressive symptoms among adolescents. We analyzed a nationally representative longitudinal data set of adolescents aged 12 to 14 in Taiwan. Results from growth mixture modeling revealed a nonlinear increase in the intensity of depressive symptoms between early and middle adolescence. More pronounced depressive symptoms in earlier years were also shown to be associated with more rapid development of similar symptoms later in adolescence. Perceived parenting styles, as manifest in parental warmth and harsh discipline, were categorized into 4 latent heterogeneous classes: attentive, reserved, austere, and conflicting. Adolescents living under austere parenting tend to report the most pronounced depressive symptoms from early to middle adolescence; however, the development of symptoms in this group was the slowest. We also discuss the role of harsh parenting in Chinese culture, as it pertains to the roles traditionally assumed by the father and mother.

Adolescent disclosure of information about peers: the mediating role of perceptions of parents' right to know.

Following the important insight that what parents know about their adolescent offspring depends primarily on what the child tells them, this study examines how attitudes about what parents have a right to know mediate the associations between several factors (quality of parent-child relationships, time spent with family and peers, levels of antisocial and prosocial behaviors, and gender and age) and adolescents' disclosures about peer relations. In two studies of early and middle adolescents (Ns = 231, 249; M ages = 14.5, 13.0; 62.3, 51.8 % female; 53.7, 67.5 % European American), a new measure of right-to-know attitudes is derived and then applied to four facets of adolescents' experiences with peers: details of activities with peers, issues in specific relationships, and positive and negative peer characteristics. The findings indicate that adolescents are more inclined to disclose certain aspects of their peer relations than others, but these inclinations are related to several factors-especially the quality of mother-child relationships and involvement in antisocial behavior-and mediated by adolescents' attitudes regarding what parents have a right to know about peers. The results are related to autonomy development and parental oversight of adolescent peer interactions.