Classifying Intervention Modifications in the Community Pharmacy Context: A Demonstration Study

ABSTRACT Objectives The objectives of this study were to apply Stirman and colleagues' framework to identify the modifications made to a Motivational Interviewing-based intervention to address medication nonadherence and to determine whether the locally modified intervention impacted expected patient medication adherence outcomes in community pharmacies. Methods Pharmacists at 4 pharmacies were trained to provide a brief Motivational Interviewing (MI) intervention to 50 patients per pharmacy who were non-adherent to antihypertensive medications. Training included a three-hour online course in MI and in-pharmacy training on patient identification and documentation. Semi-structured interviews were conducted to determine modifications to the process of identifying eligible patients, MI interventions, and documenting the intervention. Directed content analysis was guided by the Stirman and colleagues' framework. Pre-intervention and 6 month post-intervention adherence rates for the patients who received the intervention were calculated. Paired samples t-tests were used to assess the impact of the intervention on adherence rates. Results Modifications were made to the context of the intervention (e.g., telephone instead of in-pharmacy). Additionally, content modifications included ‘loosening the structure' (e.g., reordering intervention steps), ‘drifting or departing' (e.g., too busy to attempt), ‘adding elements' (e.g., reminder cards), and ‘repeating elements' (e.g., patient identification). There were statistically significant improvements in adherence from pre-intervention to 6 months post-intervention (74.1% to 84.5%; p Conclusion Modifications made during intervention implementation were classified using the Wiltsey Stirman and colleagues' framework. Despite modifications, adherence rates improved and were consistent with expectations based on prior studies of similar interventions. These findings support previous implementation research on adaptability and suggest that the ability to tailor, modify, or refine an intervention to meet the needs of the provider/setting may allow for success of the intervention. Future research on the impact of specific modifications will help determine which modifications are detrimental and beneficial to patient outcomes and sustainability of services.