A Pilot Australian Pharmacist Health Coaching Trial of Participants with Poorly Controlled Hypertension: A Qualitative Study of Participants’ and Coaches’ Experiences

Figures & data

Table 1 The Demographic Characteristics of the Patients and Pharmacists

Interviewee	Characteristics	Number
Participant	Male	8
	Female	12
	Age	64±13.7
	Number of anti-hypertensives	1.4±0.7
Pharmacist	Female	2
	Years of practice	3; 5

Table 2 Themes and Categories from Interviews

Main Theme	Time At Which Quote Recorded and Subcategory (Bold)	Participant Quotes
Beliefs about and management of hypertension
	Study commencement
	Erroneous causes	“You getting excited or angry or something”.. [11] “High blood pressure can regulate your mood as well”. [12] “Stress can put it up?” [17]
	Clinical target uncertainty	“The doctor mentioned what it should be”. [6] “130/95 would be acceptable”. [12] “He (the GP (physician)) didn’t say”. [20]
	Medications	“Take tablets, maybe have a rest”. [03] “Just through tablets. I try to remember to take it every day”. [04] “Taking medications regularly”. [17]
	Simple goals	“Maybe try to eat less chocolate and drink Coca-Cola, but it’s winter”. [11] “The only thing that I do have that feel like I shouldn’t do it eat is potato chips”. [18] “I want to focus on my diet first and organize light and easy packages. With exercise I get tired and my back hurts because I carry a lot of extra weight”. [19]
	Brief reflections	“Makes me feel that I’ve got to go further”. [01] “I don’t know. I wasn’t far off last time. Just right. Maybe deep down I’m worried”. [05] “Makes me feel nice, better”. [08]
	Study conclusion
	Recognized causes	“Hypertension is because it comes from being overweight or high diet because your parents have it”. [15] “The stress in your blood vessels......a bit like heart disease where you get a build-up in your arteries”. [09] “It’s long term, food habits and genetically also”. [08]
	Definitive targets	“At my age, I’d say 140 and below and the other one would be about 80-90”. [02] “Normal blood pressure is 130/80”. [04] “About 135-120 around that way”. [10]
	Multifactorial approach	“Taking my tablets on time and exercising actually and my food has less salt”. [03] “Same, I’m taking blood pressure tablets every day and I’ve been to regular checks with the doctor and he says it’s good. No changes to my medications, still the same”. [06] “I have been doing regular exercises and in the morning walk and stuff and being physically active around the house as well as diet control”. [12]
Reflection on health goals
	Study commencement
	Simple goals	“Maybe try to eat less chocolate and drink Coca-Cola, but it’s winter”. [11] “The only thing that I do have that feel like I shouldn’t do it eat is potato chips”. [18] “I want to focus on my diet first and organize light and easy packages. With exercise I get tired and my back hurts because I carry a lot of extra weight”. [19]
	Brief reflections	“Makes me feel that I’ve got to go further”. [01] “I don’t know. I wasn’t far off last time. Just right. Maybe deep down I’m worried”. [05] “Makes me feel nice, better”. [08]
	Study conclusion
	Sophisticated goals	“Keep my blood pressure the same but cut down on chocolate a little bit. Still keeping up my steps and medication”. [11] “Cut out coffee and don’t take too much salt and continue with my gardening and chair exercises”. [18] “I can set my goals higher with the weight loss ....So I think I can set my goals higher .... Walk more often and get a prescription for cholesterol medicine and take it every day with my blood pressure medicine”. [19]
	Integrative reflections	“I feel okay, but I’m trying to lose a bit of weight that would help me to reduce my blood pressure. I’m trying, but of course, sometimes you just can’t do that. I’m avoiding fatty foods, but to be honest with you with exercise, I’m not doing what I should be doing. But as the weather starts warming up I will start again.... Without fail, I’ll take my medications” .[02] “I just trying not to be weak and eat the wrong foods. Time was the only challenge I want to get to work quickly, but I also want to do the exercise. And when I’m coming home I want to rush because there’s something I want to come home for”. [04] “The biggest challenge was increasing exercising and modifying the diet. I’ve given up a few things like habits and sugars and things and reduced them right down. I’ve joined the gym. And the tablets have worked as well, there has a big improvement in my blood pressure”. [06]
Understanding of and experiences from health coaching
	Study commencement
	Health expert	“From the name, you’ll talk about improving your health”. [07] “I don’t know much about it. But getting advice from experts, how to look after yourself in relation to the blood pressure and medication management”. [08] “People with expertise and training, giving information to people”.[10]
	Study conclusion
	Accountability	“It has helped keep me aware of my blood pressure. And it prompted me to make changes. I faced some challenges”. [19] ”This has been good, it keeps me focused they have been informative and keep you focused. I appreciate the time”. [06] “It kept me accountable because I know I’m seeing you the next month and you’re going to check and you’re going to see if I haven’t done anything”. [09]
	Positive feelings	“I think it’s very good that the pharmacy does that, especially for older people like me”. [02] “I think it would be helpful because before doctors just usually don’t have enough time to just sit down and talk. They just say, okay you’ve got high blood pressure I’m going to put you on some pills and send you on your way”.[04] “Yes most definitely, if someone has questions, or even to check yourselves, are you following your routine or not. If you have questions you can ask, yeah I recommended it”. [05] “Yes, definitely. Because sometimes you don’t have a doctor and the pharmacist is there to help if you don’t need to go to the doctor to check your blood pressure”. [11]
Logistics of health coaching in pharmacy
	Study commencement
	Planning	“I found it (the paperwork) very useful. I don’t think anything needs to be added in my opinion, nothing else. Everything is in the papers already”. [01] “I thought, it was a little bit challenging for loss of better words because it was my first one, so I didn’t know what to do at what time. I had a proforma to help guide me in the session”. [02]
	Time management	“At a pharmacy where they don’t have multiple pharmacists, it could take out time from your daily activities. And that could be problematic, especially if it’s a busy pharmacy and a busy time of day”. [01] “When I first started (health coaching), I was trying to fit the session after my work hours or during my lunch break.” [02]
	Study conclusion
	Teamwork	“We often have multiple pharmacists on it any one time, and we do have a designated health hub where a pharmacist is rostered on to work at certain times during the day.... So, it doesn’t really take out of your daily activities because that is your job for basically that amount of time during the day or for the day”. [01] “If I was the only pharmacist that was dispensing of course it would be difficult. When there were more pharmacists ....I would tell the patient to wait 5-10 minutes to clear the mess and after that do the blood pressure session”. [02]
	Planning	“It worked well. The documents helped”. [01] “I tried to stick to the proforma a lot more strictly I know that I need to ask those specific questions to get all my data” .[02]
	Strengthened health outcomes	“I think they all experienced positive feedback, reducing the blood pressure because they knew how important it is to take the medicines. Previously before the blood pressure sessions, they were thinking if I run out a couple of days without my medicines it’s not a big deal, but after explaining to them how to it’s important to take the medicine regularly and not to miss a dose. I think they all had an improvement in blood pressure. Also, I have advised them for the lifestyle, diet, and exercising and because of that a little bit dropped their blood pressure, almost every one of my participants improved”. [01] “It was positive. Participants who started with quite a high blood pressure and mostly managed to sort of reduce that. And they were happy at the end with themselves as well as with the health coaching sessions that we had run. They were really happy with me, and when they were asked if they’d be willing to take part in another health coaching study, all of the participants said that they would be willing to do that as well”. [02]