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NICE Underpinning Review
This review aims to determine which interventions are effective and cost-effective for offering advice or education to promote health and wellbeing in community pharmacy and whether providing information is acceptable to users of community pharmacy. This review focuses on the effectiveness, acceptability and cost-effectiveness of advice or education that is tailored to an individual, rather than information that is provided to a group of users of community pharmacy services. The review aims to explore whether effectiveness and cost-effectiveness varies by the characteristics of the intervention, the person delivering the intervention, or the person receiving the intervention. It will also explore how interventions could be made more acceptable to users of community pharmacy services.
The committee agreed that clinical measurements or health outcomes and actions were critical outcomes for this review. Nine effectiveness studies addressed these outcomes [ES 2.1-2.12]. Committee members agreed that intentions, attitudes, knowledge and awareness were also important outcomes, with wellbeing and quality of life being less important outcomes. One effectiveness study addressed the intention of health seeking behaviour with the use of leaflets and advice [ES 2.13], and five effectiveness studies addressed knowledge as an outcome [ES 2.15]. One effectiveness study addressed wellbeing in individuals who received diabetes, nutrition and exercise education/advice [ES 2.22-2.23], and one effectiveness study addressed quality of life in those with diabetes who received an education intervention [ES 2.24]. It was important to note that some studies addressed multiple outcomes.
No evidence was identified for the effect of advice and education interventions on attitudes and awareness [ES 2.14, 2.21], or for the influence of the characteristics of the person delivering the intervention on its effectiveness [ES 2.25]. One study addressed the influence of the characteristics of the person receiving a photo-ageing app for smoking cessation [ES 2.26-2.28]. Seven qualitative studies (4 UK) assessed the acceptability of providing education or advice interventions in community pharmacy settings [ES 2.29-2.31] and two studies investigated the cost-effectiveness of interventions within this review [ES 2.32-2.33].
The committee noted that beliefs were an additional outcome uncovered from the evidence. One study investigated the effectiveness of information plus education for decreasing negative beliefs about low back pain, decreasing physical activity related fear about low back pain, and decreasing work related fear about low back pain. [ES 2.18-2.20].
The committee acknowledged that some of the evidence indicated that education sessions and advice resulted in positive effects on clinical outcomes, action, knowledge, and well-being within certain health areas [ES 2.2, 2.4-2.6, 2.8, 2.11, 2.12, 2.15-2.17, and 2.23]. The acceptability evidence also revealed data to support the provision of advice and education on sleep disorders and the reduction of alcohol consumption [ES 2.29-2.31]. However there were concerns with the quality, applicability and generalisability of individual studies which are discussed in further detail.