Participant demographics

Out of 201 pharmacists who completed the questionnaire, 149 pharmacists responded to at least one of the three-open ended questions. Of the 149 participants that responded to question one, 75.8% identified as females, ages ranged between 21 and 66 years and 81.2% reported they were interested in further training (Table 2).

Table 2 Pharmacists’ characteristics and demographics Pharmacists’ roles in PND screening (question one)

Overall, participants felt that pharmacists have a role in PND screening, however, they also recognised potential challenges. Three overarching categories were identified from the analysis, which were: PND screening in primary care settings will support the community, community pharmacy environment, and system and policy changes. Ten subcategories resulted from these categories, which were mapped to the TFA constructs (Table 3).

Table 3 Summary of the analyses of the responses to question one (pharmacists’ roles) Category 1: PND screening in primary care settings will support the community

This category, and associated four subcategories, illustrate pharmacists’ perspectives on the advantages of community pharmacist-delivered PND screening.

Subcategory 1.A: The need for PND screening in community pharmacies

This subcategory was mapped to the TFA constructs ‘affective attitude’ and ‘perceived effectiveness’. Most pharmacists expressed that PND screening in community pharmacies would be an important service. Participants reported that perinatal women often visit community pharmacies and, hence, community pharmacy would be an appropriate setting for PND screening:

“Pharmacies are frequently visited by pregnant women and new mothers so it would make sense to provide PND screening in the pharmacy.” (ID84).

Participants also reported that given pharmacists’ accessibility, screening in community settings may allow for greater reach of screening services:

“… I think pharmacists would be able to reach a larger population and thereby identify those affected - this would be a valuable service to be able to provide to patients…” (ID199).

Participants also emphasised the benefits of offering PND screening services in community pharmacies in geographic areas which lack access to mental health services:

“Our pharmacy is located rurally, and there is very limited mental health services and baby health services. Offering a service in screening for perinatal depression would have immense benefits for the community as it would be filling a gap that currently exists...” (ID5).

Subcategory 1.B: Customer–pharmacist relationship

This subcategory was mapped to TFA constructs ‘affective attitude’ and ‘ethicality’. Participants described that they had multiple opportunities to engage with perinatal women given their existing relationships and frequent interaction with this population:

“I see pregnant women daily and have built great relationship with them.” (ID17).

This regular contact may be beneficial in allowing for opportunities for screening, with participants also highlighting that their relationships with consumers may improve comfort when disclosing mental health symptoms:

“… Pharmacists may have a longer standing and more meaningful relationship with the patent [patient] that will help with honest answers to the screen.” (ID39).

Subcategory 1.C: Accessibility

This subcategory was mapped to the TFA constructs ‘affective attitude’ and ‘perceived effectiveness’. Participants felt that community pharmacist-delivered PND screening service will provide an additional avenue for PND screening, due to high accessibility:

“Pharmacists are the most accessible primary health professionals within a mother’s healthcare team to identify potential cases of perinatal depression. Therefore this practice should be encouraged.” (ID87).

Moreover, participants felt that community pharmacies were an accessible setting for healthcare needs throughout the perinatal period:

“I think it’s so important as we are the easiest access to a health professional for the community.  Mothers often come in for all the baby essentials which provides ample opportunity to assess the mental health of the parent.” (ID 196).

Subcategory 1.D: Pharmacists are the link between detection and treatment

This subcategory was mapped to the TFA constructs ‘intervention coherence’ and ‘self-efficacy’. Participants felt that pharmacists could play important roles in detecting women at risk of PND and referring them to appropriate healthcare services, but recognised the need for further training to take on this role:

“We can definitely be trained to be able to detect anyone suffering from a mental health issue, and make the necessary referral.” (ID59).

Pharmacists also felt community pharmacy staff could encourage perinatal women to discuss and seek help for mental health symptoms:

“A pharmacy assistant or pharmacist may be able to open a conversation to encourage women to discuss their mental health and screening and referral to appropriate services, doctor or psychologist...” (ID84).

Category 2: Community pharmacy environment

The environment of the community pharmacy was an important factor thought to influence the extent of pharmacists’ potential contribution to PND screening and care.

Subcategory 2.A: Need for privacy

This subcategory was mapped to the TFA constructs ‘affective attitude’, ‘burden’ and ‘perceived effectiveness’. Pharmacists felt that PND screening could not be conducted over the counter:

“It [PND screening] would have to be done in a clinic room not at thhe [the] counter.” (ID189).

However, ensuring privacy was perceived as potentially burdensome, thereby posing a barrier to PND screening in community pharmacies:

“I think it would be very valuable but challenging in some pharmacies due to business [busyness] or lack of private areas.” (ID147).

Subcategory 2.B: PND screening requires time

This subcategory was mapped to the TFA constructs ‘burden’ and ‘opportunity cost’. Pharmacists described time constraints within pharmacies to be a major barrier to PND screening:

“Pharmacists are the most easily accessible health professional but there is very limited time in a work day.” (ID179).

Participants reflected on whether implementing PND screening services may limit pharmacists’ ability to provide care and services to other consumers:

“I don’t think pharmacists should get involved in this area, as it takes away time from other patients…” (ID29).

Category 3: System and policy changes

This category reflects the system and policy changes participants felt were necessary for delivery of PND screening in community pharmacies.

Subcategory 3.A: Pharmacists’ scope of practice

This subcategory was mapped to the TFA constructs ‘self-efficacy’, ‘ethicality’ and ‘intervention coherence’. There were mixed views regarding whether PND screening is within community pharmacists’ scope of practice. Some pharmacists believed that providing PND screening was not within their area of expertise and that PND screening was the responsibility of other healthcare professionals:

“I do not believe that pharmacists are equipped or should be involved in screening for perinatal depression. This will be stepping into GP’s/obstetricians and psychologists boundaries.” (ID56).

However, others reflected on the evolution of pharmacists’ roles in primary care, and the potential for pharmacists’ roles in screening:

“I think screening for perinatal depression could form part of Pharmacist’s scope of practice and our expanding role in primary health care.” (ID78).

Subcategory 3.B: Training

This subcategory was mapped to TFA constructs ‘self-efficacy’, ‘burden’ and ‘intervention coherence’. Pharmacists indicated that further training around PND was required:

“I believe with the right training, pharmacist can provide benefit in perinatal depression screening.” (ID17).

However, pharmacists felt that they would need to commit effort and time to upskilling in this area:

“It may be hard to implement as it requires extensive training and confidence.” (ID58).

Subcategory 3.C: Financial implications

This subcategory was mapped to the TFA constructs ‘opportunity cost’ and ‘burden’. Participants felt that remuneration was a prerequisite to delivering PND screening:

“… remuneration would be essential to providing this service adequately.” (ID136).

However, they also reflected on whether the financial investment would be worthwhile:

“In terms of application to community pharmacy I am unsure if the condition of PND is common enough to warrant the cost of training/implementing a service.” (ID124).

Subcategory 3.D: Human resources

This subcategory was mapped to the TFA constructs ‘opportunity cost’ and ‘burden’. To perform screening effectively, participants indicated that an adequate number of staff were needed and the lack of sufficient workforce in community pharmacy was seen as a potential barrier:

“… I don’t believe it is possible to give it the time and attention it deserves if there is only 1 pharmacist on duty. You would need at least 2 pharmacists…” (ID39).

Pharmacists also considered how the implementation of screening services would impact their workload and performance:

“[G]reat in theory but in reality, its [sic] another increase in pharmacist work loads. [S]o either pharmacists work harder and put themselves at risk or they sacrifice some other part of their work.” (ID125).

Training requirements (question two)

This question investigated participants’ (n = 148) thoughts on pharmacists’ training needs - three categories emerged: Training content, Training delivery and Training length.

Category 1: Training content

Pharmacists acknowledged the importance of existing general mental health training, as well as the need for more specialised training in PND screening:

“Mental Health First Aid is a good start but also guidelines of the correct questions to ask and the services available to help in referral and treatment.” (ID84).

Pharmacists offered suggestions for the content of the training:

“CPD [continuing professional development] -style courses on perinatal depression screening, covering issues such as the screening process, the factors taken into consideration and score interpretation. Also the pharmacy environment and other business issues.” (ID119).

Pharmacists also recognised the need for extensive training on interpreting scores:

“Workshop where we get a template and run through the scores and what to do with the scores.” (ID73).

Another commonly identified element of training was communication:

“Training on how to approach patients with sensitivity (eg types of questions and how to ask them)…” (ID131).

Participants also stressed the importance of establishing appropriate referral pathways:

“Referral options would also need to be discussed, as for community pharmacists I would imagine the appropriate referral would be either to the patient’s GP, midwife, private doctor or, if q10 is answered as yes (suicide risk) how we as pharmacists would arrange for the patient to be taken to the local ED [emergency department] for mental health assessment.” (ID172).

Category 2: Training length

There were opposing views on the length of training, whereby some responses highlighted the need for in-depth, longer training:

“An extensive training course would need to be provided.” (ID78).

While others disagreed:

“Training should be brief, if anything, enough just to identify perinatal depression in women so we can refer to a doctor or other health professional.” (ID57).

Category 3: Training delivery

There were mixed views on how training should be delivered, with some preferring online delivery:

“Online course should suffice.” (ID100).

And, others reporting a preference for in-person training:

“So [I] believe pharmacist should be given the opportunity to do face to face training…” (ID52).

However, some participants recommended a mix of both modalities:

“[O]nline and f2f [face to face] training such as vaccine administration training.” (ID201).

PND resources (question three)

Data analysis of responses (n = 147) resulted in three categories: Adapting community pharmacy operating structures, Pharmacist-specific resources and Consumer-specific resources.

Category 1: Adapting community pharmacy operating structures

This category referred to resources that needed to change or be available to deliver PND screening:

“A consultation room, training, remuneration for their time and easy to contact professionals where help is required” (ID7).

Furthermore, there was a reported need for greater staff numbers:

“… staffing requirements (at least 2 pharmacist present) so that 1 pharmacist could conduct screening” (ID50).

Participants also highlighted the importance of being paid:

“Remuneration!! As pharmacists we are … willing to provide primary care to ur [your] communities but we cannot work for free!” (ID146).

Category 2: Pharmacist-specific resources

Pharmacists felt that there was a lack of information for them in this area and wanted readily-available pharmacist-specific resources:

“Just any information, I haven’t really come across it unless I specifically look for as cpd [continuing professional development] activities to complete.” (ID185).

Participants also provided suggestions on their preferences for resource content:

“How to use the Edinburgh scale. How to interpret and what to do with women who test positive.” (ID 42).

They also wanted resources that could direct them to other points of care:

“… places to seek help eg. Mother’s groups, PANDA [Perinatal Anxiety & Depression Australia].” (ID36).

Category 3: Consumer-specific resources

This category reflects pharmacists’ preferences for resources that they provide to consumers:

“Informative leaflets - to give to patients regarding PND Resources - hotlines, websites, referral screening kit - including the questionnaire itself .” (ID103).

Pharmacists highlighted the importance of developing user-friendly resources:

“And [An] infographic that you could share with patients to help them understand their results. A booklet that explains screening process from beginning to end that pharmacists can refer to.” (ID147).