Do pharmacy practice standards effectively describe behaviour? Reviewing practice standards using a behavioural specificity framework
Open accessAbstract
BACKGROUND: Guidelines and practice standards exist to communicate the conduct and behaviour expected of health care professionals and ensure consistent quality practice. It is important that they describe behaviours explicitly so they can be interpreted, enacted and measured with ease. The AACTT framework specifies behaviour in terms of the: Action to be performed, Actor who performs the action, Context where the action occurs, Target who the action is performed with/for and Time when the action is performed (AACTT). It provides the most up to date framework for specifying behaviours and is particularly relevant to complex behavioural problems that involve sequences of behaviours performed by different people. Behavioural specificity within pharmacy practice standards has not been explored. AIM: To determine if behaviours described in the Professional Practice Standards for Australian Pharmacists specify Action, Actor, Context, Target and Time. METHODS: Two researchers independently reviewed the scope and structure of the practice standards and one extracted action statements (behaviours) verbatim. Through an iterative process, the researchers modified and developed the existing AACTT definitions to operationalise them for application to review of the action statements in the practice standards. The operational definitions, decision criteria and curated examples were combined in a codebook. The definitions were consistently applied through a directed content analysis approach to evaluate all extracted action statements by one researcher. For consistency 20% was independently checked for agreement by a second researcher. RESULTS: A novel codebook to apply AACTT criteria to evaluate practice standards was developed. Application of this codebook identified 768 independent behaviours. Of these, 300 (39%) described at least one discrete observable action, none specified an actor, 25 (3%) specified context, 131 (17%) specified target and 88 (11%) specified time. CONCLUSION(S): The behaviours detailed in practice standards for Australian pharmacists do not consistently specify behaviours in terms of Action, Actor, Context, Target and Time. Developers in the pharmacy profession, and beyond, should consider the behavioural specificity of their documents to improve interpretability, usability and adherence to the behaviours detailed. This also has implications for the development and evaluation of interventions to change such behaviours and improve quality of care.
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Cites
Three Approaches to Qualitative Content Analysis
Hsieh, H.-F., & Shannon, S. E. (2005) · Qualitative Health Research · doi:10.1177/1049732305276687 · Cited by 44,601 · see citing works
Tong, A., Sainsbury, P., & Craig, J. (2007) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzm042 · Cited by 42,509 · see citing works
Michie, S., van Stralen, M. M., & West, R. (2011) · Implementation Science · doi:10.1186/1748-5908-6-42 · Cited by 13,697 · see citing works
Document Analysis as a Qualitative Research Method
Bowen, G. A. (2009) · Qualitative Research Journal · doi:10.3316/qrj0902027 · Cited by 13,013 · see citing works
To Err is Human: Building a Safer Health System
Hendee, W. R. (2001) · Journal of Vascular and Interventional Radiology · doi:10.1016/s1051-0443(01)70072-3 · Cited by 10,122 · see citing works
Predicting and Changing Behavior
Fishbein, M., & Ajzen, I. (2011) · doi:10.4324/9780203838020 · Cited by 2,807 · see citing works
Clinical guidelines: Potential benefits, limitations, and harms of clinical guidelines
Woolf, S. H., Grol, R. P. T. M., Hutchinson, A., Eccles, M., & Grimshaw, J. (1999) · BMJ · doi:10.1136/bmj.318.7182.527 · Cited by 2,549 · see citing works
(2014) · Cited by 2,276 · see citing works
To Err is Human: Building a Safer Health System in 1999.
Stefl, M. E. (2001) · PubMed · Cited by 1,738 · see citing works
Grol, R., Dalhuijsen, J., Thomas, S., Veld, C. I. ‘., Rutten, G., & Mokkink, H. (1998) · BMJ · doi:10.1136/bmj.317.7162.858 · Cited by 877 · see citing works
The international pharmaceutical federation*
Potjewijd, T. (1932) · The Journal of the American Pharmaceutical Association (1912) · doi:10.1002/jps.3080211023 · Cited by 427 · see citing works
Action, actor, context, target, time (AACTT): a framework for specifying behaviour
Presseau, J., McCleary, N., Lorencatto, F., Patey, A. M., Grimshaw, J. M., & Francis, J. J. (2019) · Implementation Science · doi:10.1186/s13012-019-0951-x · Cited by 411 · see citing works
Changing clinical behaviour by making guidelines specific
Michie, S., & Johnston, M. (2004) · BMJ · doi:10.1136/bmj.328.7435.343 · Cited by 309 · see citing works
Kastner, M., Bhattacharyya, O. K., Hayden, L., Makarski, J., Estey, E. A., Durocher, L. D., Chatterjee, A., Perrier, L., Graham, I. D., Straus, S. E., et al. (2015) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2014.12.013 · Cited by 214 · see citing works
Shekelle, P., Kravitz, R. L., Beart, J., Marger, M., Wang, M., & Lee, M. L. (2000) · PubMed Central · Cited by 139 · see citing works
Shekelle, P. G. (2018) · JAMA · doi:10.1001/jama.2018.9660 · Cited by 134 · see citing works
Words matter: increasing the implementation of clinical guidelines
Michie, S. (2005) · BMJ Quality & Safety · doi:10.1136/qshc.2005.014100 · Cited by 133 · see citing works
Optimizing the language and format of guidelines to improve guideline uptake
Gupta, S., Rai, N., Bhattacharrya, O., Cheng, A. Y. Y., Connelly, K. A., Boulet, L.-P., Kaplan, A., Brouwers, M. C., & Kastner, M. (2016) · Canadian Medical Association Journal · doi:10.1503/cmaj.151102 · Cited by 82 · see citing works
Efficient clinical evaluation of guideline quality: development and testing of a new tool
Grimmer, K. A., Dizon, J. M. R., Milanese, S., King, E., Beaton, K., Thorpe, O., Lizarondo, L. M., Luker, J. A., Machotka, Z., & Kumar, S. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-63 · Cited by 79 · see citing works
Gould, N. J., Lorencatto, F., Stanworth, S. J., Michie, S., Prior, M. E., Glidewell, L., Grimshaw, J., & Francis, J. (2014) · Implementation Science · doi:10.1186/s13012-014-0092-1 · Cited by 70 · see citing works
on behalf of the Major outcomes with personalized dialysate TEMPerature (MyTEMP) investigators, Presseau, J., Mutsaers, B., Al‐Jaishi, A. A., Squires, J. E., McIntyre, C. W., Garg, A. X., Sood, M. M., & Grimshaw, J. (2017) · Trials · doi:10.1186/s13063-017-1965-9 · Cited by 65 · see citing works
How do patients develop trust in community pharmacists?
Gregory, P. A. M., & Austin, Z. (2020) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2020.07.023 · Cited by 51 · see citing works
Understanding the psychology of trust between patients and their community pharmacists
Gregory, P. A. M., & Austin, Z. (2021) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/1715163521989760 · Cited by 37 · see citing works
Smith, D., Sekhon, M., Francis, J. J., & Aitken, L. M. (2019) · Journal of Clinical Nursing · doi:10.1111/jocn.15005 · Cited by 29 · see citing works
Smith, D., Cartwright, M., Dyson, J., Hartin, J., & Aitken, L. M. (2020) · Journal of Advanced Nursing · doi:10.1111/jan.14551 · Cited by 27 · see citing works
Ince, P. G., Tai, S., & Haddock, G. (2014) · Journal of Mental Health · doi:10.3109/09638237.2014.958213 · Cited by 18 · see citing works
Smith, D., Francis, J., & Aitken, L. M. (2019) · Journal of Advanced Nursing · doi:10.1111/jan.14076 · Cited by 14 · see citing works
Professional Transgressions by Australian Pharmacists
Penm, J., & Chaar, B. B. (2009) · Journal of Pharmacy Practice and Research · doi:10.1002/j.2055-2335.2009.tb00451.x · Cited by 10 · see citing works
Wallen, G. R., & Fisher, C. A. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-849905-4.00039-3 · Cited by 3 · see citing works
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Research works printed but not linked: 1
- [25]Francis JJ Presseau J Health Care Practitioner Behaviour Cambridge Handbook of Psychology, Health and Medicine [Internet] 2019 Cambridge Cambridge University Press 325 328
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Sorted by citations
Godbee, K., Guccione, L., Palmer, V. J., Gunn, J., Lautenschlager, N., & Francis, J. J. (2022) · Journal of Alzheimer's Disease · doi:10.3233/jad-220382 · Cited by 13 · see citing works
Behaviours that contribute to pharmacist professionalism: a scoping review
Mill, D. N., Page, A. T., Johnson, J. L., Lloyd, R. A., Salter, S. M., Lee, K., Seubert, L., Clifford, R. M., & D’Lima, D. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-070265 · Cited by 12 · see citing works
Self-citationMill, D. N., Seubert, L., Lee, K., Page, A. T., Johnson, J. L., Salter, S. M., Clifford, R. M., Murace, E., Fullerton, F., Halliday, M., et al. (2022) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2022.10.006 · Cited by 10 · see citing works
Self-citationKamath, S., Soo, B., Mill, D. N., Johnson, J. L., & Page, A. T. (2023) · International Journal of Pharmacy Practice · doi:10.1093/ijpp/riad012 · Cited by 7 · see citing works
Self-citationWong, L. S., Scahill, S. L., Barton, E., Lim, X. Y., Hikaka, J., Boey, J., Exeter, D. J., Hudson, M., Nu’u, A. N., & Ram, S. (. (2025) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2025.100609 · Cited by 4 · see citing works
Unveiling the drivers of sustainable housing choices among millennials in emerging markets
Sharmila Devi, R., Perumandla, S., & Bhattacharyya, S. S. (2024) · International Journal of Housing Markets and Analysis · doi:10.1108/ijhma-07-2024-0093 · Cited by 2 · see citing works
Esmalipour, R., Salari, P., Ebadi, A., Mehrdad, N., & Larijani, B. A. (2023) · DARU Journal of Pharmaceutical Sciences · doi:10.1007/s40199-023-00472-0
Mills, Z., Wright, K., & D’Lima, D. (2023) · Behavioral Sciences · doi:10.3390/bs13120991
Self-citationO’Hare, F., Paynter, C., Foran, D., Kolic, M., Ondracek, C., Saunders, T., & Ayton, L. N. (2025) · Research Methods in Medicine & Health Sciences · doi:10.1177/26320843251379255
- Authors
- Mill, D., Page, A., Johnson, J., Lee, K., Salter, S. M., Seubert, L., Clifford, R., & D’Lima, D.
- Affiliations
- The University of Western Australia (AU)
- University of South Australia (AU)
- University College London (GB)
- Corresponding author
- Mill, Deanna
- ORCID
- Venue
- BMC Health Services Research
- Published
- 2022-01-14
- Volume
- 22
- Issue
- 1
- Pages
- 71-71
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC8760715
- OpenAlex
- W4205229614
- Cited by
- 9
- References
- 29
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 4 · 2022: 2
- FWCI
- 0.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- UWA Profiles and Research Repository (University of Western Australia) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion, cc-by)
- Funders
- Australian Government
- National Health and Medical Research Council (1156892)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- pharmacy practice standards, professional practice standards, codebook generation, quality of care, professional guidelines
- MeSH terms
- Australia, Humans, Pharmaceutical Services, Pharmacies, Pharmacists, Pharmacy
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