Pharmacists' counseling on oral contraceptives: A theory informed analysis

Abstract

Background: Providing correct and complete counseling on the use of oral contraceptives (OCs) is central to securing the autonomy of women in child-bearing age and is a powerful, proven tool of social change. Pharmacists in many developing countries such as Egypt are involved in dispensing and at times prescribing pharmaceuticals, including oral contraceptives that are readily available without a prescription.

Objectives: To predict Egyptian community pharmacists' counseling on oral contraceptives while utilizing a theoretical framework guided by the Theory of Planned Behavior (TPB).

Methods: A cross-sectional, self-administered survey was completed by a random sample of community pharmacists in Alexandria, Egypt to determine their attitudes and behaviors regarding counseling on OCs. Multiple regression was used to predict self-reported counseling on oral contraceptives as a function of the TPB-related constructs and six other factors - "perceived importance of profit from dispensing OCs on pharmacy revenue," "number of hours worked," "age," "gender," "pharmacy practice degree" and "marital status" of the pharmacist.

Results: Of the 181 pharmacists invited to complete the survey, 168 (93%) participated. Pharmacists indicated they talked to a slightly higher proportion of women about the importance of taking OCs at the same time daily than about topics such as which day to start taking OCs, side effects and what to do when a dose of OCs was missed. Pharmacists' reported counseling on oral contraceptives was positively associated with their perception that women welcomed pharmacist initiated OC counseling (β = 0.315, P < 0.001), perceived adequacy of time available to counsel women on OCs (β = 0.290, P = 0.003) and the perceived number of women who asked for their help in selecting an OC without providing a prescription in the past week (β = 0.160, P = 0.018). Pharmacists reported that women's welcoming pharmacists initiating OC counseling was associated with the pharmacists' reported percent who asked pharmacists for OC advice out of the last 5 women seeking OC (r = 0.45; P < 0.0001). Male pharmacists were less likely than female pharmacists to report that women welcomed pharmacist initiated OC counseling (r = -0.27; P = 0.0005).

Conclusions: The TPB appears to help predict pharmacists' OC counseling. There is a need to prepare pharmacists who are frequently requested to assist women with the selection of an oral contraceptive. Interventions that would facilitate women's requests for information may be valuable to increase pharmacists' counseling on oral contraceptives. Future qualitative and observational studies are needed to assess complexities in counseling on oral contraceptives in developing countries.

Keywords: Contraception; Egypt; Family planning; Oral contraceptives; Pharmacist; Theory of planned behavior.