Virtual online focus group discussions using four domains of appreciative inquiry to explore community pharmacists' actual experiences and aspirations around antibiotic smart use in Thailand: A qualitative study

ABSTRACT

Introduction: Antimicrobial resistance (AMR) is a global threat. The Global South has illustrated gaps and challenges in contextual interventions to tackle AMR due to economic development and existing legislation on antimicrobial use. Community pharmacists are vital healthcare professionals in primary care settings to promote Antibiotic Smart Use (ASU). Objective(s) The aim of this study was to explore their experiences and aspirations around ASU to tailor sustained interventions. Method(s) Virtual online focus group discussions (FGDS) were conducted to explore the views of part- and full-time community pharmacists in Thailand who were systematically recruited to ensure their eligibility to fit with Appreciative Inquiry (AI) theory. Out of a pool of eligible participants, those who had scored above average (> 74%) and above in the attitude questionnaire - the earlier part of the project - were quota sampled and purposively invited to take part. A specific topic guide was developed using the four domains of AI (Discovery, Dream, Design and Destiny), to provide insights into their thought processes and their recommendations for the facilitation of ASU in community pharmacies. Qualitative data were analysed using Nvivo12, using thematic framework analysis with a deductive approach. Result(s) Twenty one community pharmacists participated. Seven themes around ASU emerged in the Discovery Domain of AI. There are pharmacists' practices for non-prescribed antibiotic dispensing, professional experience, work environment, commercialisation and business, commonly used non-prescribed antibiotics, visibility of the National Plan for tackling AMR, and learning points from the COVID19 pandemic. The participants dreamed about the ideals of ASU in the community pharmacy in five themes which are establishing One Health stakeholders- regulating the supply chain, following developed countries as role models, reviewing legislation, and forming witness checks and balances in healthcare professionals. Then the participants designed interventions and strategies on five themes insurance system, incentive intervention, re-classification of antibiotics, and organisational unity for supporting ASU. The Destiny domain consisted of five themes that would allow sustainable ASU in their settings the need for ASU literacy, primary care, AMR attitudes and behaviour change strategies, communication of ASU progression and resource management, and trust in pharmacists as a key to building customer loyalty. Conclusion(s) Four domains of Appreciative Inquiry provided community pharmacists with the opportunity to share their experiences and aspire to desired changes to promote ASU in the pharmacy setting and broadly across the country. This framework reflected contextual interventions and strategies with bottom-up brainstorming linked to top-down approaches. The requirement of literacy, along with strategies for changing for public and healthcare providers, could elevate ASU in community pharmacies. Integration of community pharmacy into a part of government primacy care unit and communication of the ASU progression with them might promote engagement with the remaining business aspects.