Theoretical beliefs, specific beliefs and illustrative quotes domains presented in order of dominance
| Theoretical domain | Specific belief | N | Illustrative quotations |
| Environmental context and resources | Privacy | 28 | 'Occasionally there’s a lot of other customers around the till and having to try and sort of discreetly move the customer to a quieter place if it’s something a bit more sensitive or you feel it’s inappropriate to be discussing something within earshot of other people.' PH004 |
| Staff time/resources | 13 | 'When it’s busy staff feel pressured and, you know, if they don’t feel they’ve got enough support, they let their standards slip, which is disappointing, but, if we’re all being completely honest, it happens when you’re under pressure.' PH009 | |
| Access to patient records/information | 12 | 'That’s how sometimes that you should always recommend customers to stick to the one pharmacy because if they’re changing medication all the time, we have obviously got it on computer, that we know every medication that they’re on' MCA011 | |
| Access to other support/ facilities | 9 | 'I have doctors, receptionists, nurses on tap. If I’m suspicious that there is something more serious, than the patient thinks, then I can go away and get some advice rather rapidly, which is a great help' PH007 | |
| Practice context | 6 | ‘It’s a small community pharmacy, so we tend to know most of the patients' PH006. ‘I think there’s got to be greater utilisation, of these private spaces, because I certainly wouldn’t want to openly discuss some, you know, medical issues, when I’ve got a queue of people waiting behind to me, and to my left and right-hand side.’ MCA001 | |
| Belief about consequences | Patient safety | 27 | 'If they’re taking something else that might not be necessary or something that’s not been reviewed for a while, or is potentially harmful, you know…You can sometimes gather bits of information that you can intervene for the patient’s best interest.' PH004 |
| Professional impact | 11 | ‘The worst scenario is that you get involved in legal situations or serious illness or death. It’s negligent that point of view. So, I think members of staff have to be aware that it’s an important role that they’re playing’. PH012 | |
| Commercial impact | 6 | 'if you do your consultations right, you make the right request, the customer leaves, they feel better, they’re going to come back so your business would grow…' PH009 | |
| Impact on ability to do job | 5 | ‘The more that we get out of them, then the more that we can offer them.’ MCA001 | |
| Skills | Communication skills | 26 | 'Try our best to use kind of open questions where possible. We find just having good communication skills are obviously pretty essential' PH002. 'Skills; good listening skills, good communication skills…underpinning knowledge.' PH006 |
| Tailoring | 16 | 'You’ve got to look at their body language, you’ve got to adapt your body language, to suit them. So, it’s not just standing there, smiling, and asking a few questions because that’s not going to work.' PH007 | |
| Information gathering | 7 | ‘I would say it’s more experience that I’d picked up, you know, from years of listening to what the pharmacist would say to them and, you know, it’s basically just trying to get the information, out of every patient that you need. And that gives you the best ground to, you know, help them…’ MCA003 | |
| Social influences | Patient knowledge & perspectives | 25 | 'Some people are quite, what’s the word? They’re not really very clued up, on what medicines either they’re already taking or what medicines they can get from the pharmacy' MCA003. I think it’s perhaps the perception of the patient or customer, about why we’re asking questions. I’ve always felt that the public aren’t given enough information, about what we actually do and why we’re asking questions. You know, we need to raise the profile of pharmacists' PH010 |
| Colleague/peer influence | 10 | 'if I’d picked up something new that, all three of us have been doing for many years and I thought actually this is maybe something that’s a wee bit better, let’s try this, I would pass that information onto the rest of the staff, including my colleagues.' PH017 | |
| Advertising | 8 | 'They’ve seen it on TV, or someone else has suggested it to them, so you do sometimes ask yourself the question of, “Why are they asking for this?” You know, they’re maybe self-diagnosing.' PH006 | |
| Knowledge | Knowledge of SOPs (inc. WWHAM) | 24 | 'WWHAM questions; the who, the what, the why, the how.' MCA002 |
| Knowledge of training courses | 14 | ‘Once you complete your training, especially from a healthcare assistant point of view, I don’t think… Once you finish that structured kind of training, there’s not a lot that you’re proactively pushed to do. It’s really off your own back, to maintain your own knowledge… there’s a lot of information out there, but it’s knowing where to go looking for it or actually having the inclination, to go and do it' MCA001 | |
| Patient knowledge | 12 | 'A lot of patients don’t understand that difference between the medicines…so you obviously have to just take the time to make sure that they’re aware of what they’re actually buying.' PH001 | |
| Knowledge of guidance | 11 | 'There are the guidelines from the Royal Pharmaceutical… If we have any problems, we can get in touch with one of the support people, like the National Pharmaceutical Association or a company called Numark…’ PH007 | |
| Product knowledge | 7 | 'It’s just having a better knowledge of the product that people are asking for; make sure that you are 100% familiar with all the content indications and the licence for the products.’ PH004 | |
| Social professional role and identity | Role of MCAs | 16 | 'If the public were more aware that the staff working within the pharmacy, not just the pharmacist, are trained in their jobs rather than they’ve just come off the street and they put price tickets on things' MCA005 ' |
| Professional role | 9 | 'The way a patient might approach an assistant compared with how they might consult with a pharmacist might be different. Possibly.' PH004. 'Some people don’t want to speak to a counter assistant; they want to speak to a pharmacist.' MCA006 | |
| Job satisfaction | 7 | 'Sometimes you feel like you’re doing your job and you’ve helped someone, that’s really nice' PH018 | |
| Responsibility | 7 | ‘The pharmacist should be aware of every P medicine that’s sold in the pharmacy, so they should really be listening out for things going out' PH017 | |
| Referring to other healthcare professionals | 3 | ‘If it’s a recurring problem then the pharmacist might refer them to the doctor’s and say, “You’ve been given this several times. I can only give you certain things over the counter and obviously there is a lot that a qualified doctor can prescribe”.’ MCA010 | |
| Behavioural regulation | Continual training | 16 | ‘I think there’s always scope for making sure that people’s training is up to date and, you know, making sure that any new staff that come are fully trained and review what you have and then how you sell it and that sort of thing.’ PH001 |
| SOPs (inc. WWHAM) | 11 | ‘Well, we also have our standard operating procedures, which are called SOPs, and they give the general guidelines on what you should do.’ PH007 | |
| Referring to guidance/wider reading | 8 | ‘We’re, obviously, using journals and things like that, to keep abreast of updates that we share with the staff.’ PH015 | |
| Intentions | To gather information | 15 | 'You need to start at the beginning and work your way through the process, regardless what the request is' PH001 'You’ve always got to seek information. You can’t just assume. When somebody comes in and asks for co-codamol, we don’t just sell them it. That is not what we do. It’s again back to the WWHAM questions. Always the WWHAM questions; that’s where you start from and always continue' MCA009 |
| To provide best practice | 12 | 'My intention is always to get the message across so, as long as I feel that they’ve understood me, then I’m happy. You know, we’re all humans, so maybe if someone is being slightly awkward or a wee bit rude, then you are maybe not as nice to that person or maybe not spend as much time with them. As long as you get your base message across, then I feel I’ve done my job.' PH0018 | |
| To refer to other healthcare professionals | 3 | if you couldn’t sell the medicine, then you would just say, you would just refer them to go to their own doctor' MCA004 | |
| To refer to a pharmacist | 2 | ‘If you want to hold on a wee minute, I’ll get T my pharmacist, to come out and have a wee word with you.” And sometimes that does help because, he’s a pharmacist so he knows more, you know, than what the front counter staff do. You don’t want anybody going away without helping them' MCA004 | |
| Memory, attention and decision-making processes | Administrative prompts & processes | 13 | ‘I’ve basically stuck my WWHAM questions at the side of the tills because, if you do forget, the little prompt is there.' PH009. 'I’ve got it up on a board on the wall, the four questions to ask' MCA004 |
| Patient prompts | 9 | 'Any of the vulnerable patient groups, so children, people over 60, 65, anyone with any long term chronic illness, so any of the kind of red flag indicators that, all of a sudden, you maybe delve into another set of questions' MCA001. 'If it’s for a child, or if someone was on any other medication, it would be referred to the pharmacist' PH008 | |
| Automatic processes | 2 | 'You know, we’re all so aware that it’s almost second nature' PH018 | |
| Reinforcement | Job satisfaction | 10 | ‘The incentive we have is to help the person who’s standing in front of me. I’m quite happy to do that, it being part of my job anyway. But yes, I do like to feel that I helped that person in some way.’ MCA005 |
| Impact on sales | 9 | ‘If you give them advice on how to handle something, it does work and it makes them feel better, then the chances are they’re going to come back to us.’ MCA008 | |
| Patient safety | 4 | ‘The incentive is to keep the patient safe.’ PH006 | |
| Feedback | 4 | ‘Just simple phrasing I’ve learnt previously that that kind of thing sticks with people, rather than always maybe giving financial rewards or physical rewards. A simple, “Well done,” sometimes works better.’ MCA002 | |
| Belief about capabilities | Confidence due to knowledge and experience | 8 | ‘I’m very confident that I’ve got the knowledge and the appropriate skills to make sure that things are being recommended or provided safely and appropriately.’ PH004 |
| Confidence due to ability to refer | 4 | I would say I’m fairly confident, but then if I feel I’ve not asked the right questions, I would obviously refer to my pharmacist, just to make sure I wasn’t giving them something that wouldn’t be right for them.’ MCA004 | |
| Patient impact on confidence | 3 | ‘If you do get some of these customers that come in, particular for new staff, it can be a real blow to their confidence and then the worry is that they’re not going to ask the questions to another customer and they might actually miss something that is really important.’ PH012 | |
| Optimism | Pessimism | 7 | ‘There are some patients that you just can’t win with in a way.’ PH012 |
| Positivity | 5 | ‘I’m providing the best possible care; that’s what I’d want or hope that all my staff felt as well.’ PH009 | |
| Emotion | Frustration | 4 | ‘Sometimes it’s frustrating, because you know they’re not listening or they don’t believe your advice, and go anyway, and so that’s quite frustrating.’ PH018 |
| Worry | 4 | ‘Can be slightly worried for the likes of a customer if they’re continuously buying something, like, I don’t know, if we’re talking say co-codamol.’ MCA009 | |
| Uncomfortable/Nervous | 4 | ‘You see the same people buying the same things day in day out, and it can be quite hard when you want to refuse a request. It can be very difficult; it makes a lot of staff, particularly the younger staff, feel quite uncomfortable.’ PH009 | |
| Empathy | 1 | ‘You certainly kind of empathise with their feelings.’ MCA003 | |
| Under pressure | 1 | ‘People come in, and they’ve made their made up that they want codeine linctus, for a cough, we know that therapeutically it might not be the best thing for them… feel stuck a bit between a rock and a hard place, but you make the supply, and the patient takes that medication and feels they’ve got the benefit, from it.’ MCA001 | |
| Goals | Decision to cut out questions/shorten the process | 2 | ‘I always cover the areas that are vital but sometimes if it’s busy and things like that, it can take up a good part of your time having to deal with it when there’s an easier and proper way to go about it.’ MCA008 |
MCA, medicine counter assistant; N, number of interviewees who referred to each specific belief; PH, pharmacist; SOP, standard operating procedure; WWHAM, Who, What, How long, Action to date, other existing Medication being taken.