Background
Aims
Objectives
Strategic objectives
Operational objectives
Methods
Study design
Realist review
Research questions
Sample
Descriptive analysis
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‘Study design’ included primary designs (e.g. RCT, qualitative study) and secondary designs (e.g. systematic review of RCTs, systematic review of qualitative studies).
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‘Academic discipline’ referred to the broad research tradition in which the study was located (assessed by judging the academic department of the lead author, the journal in which it was published and the literature it cited). Examples of academic disciplines were public health (an interdisciplinary field of study focused on the health of communities or sub-populations), pharmacy practice (the study by pharmacists of what pharmacists do), and health economics (the study of the costs and cost-effectiveness of health interventions).
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‘Country’ referred to the country in which a primary empirical study had been undertaken; for secondary research, it was the country of the lead author.
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‘Methodological rating’ was an estimate (on a 3-point scale) of the methodological quality of the study. We gave three stars to studies that had no major flaws within their genre and were adequately powered to provide a definitive answer to the authors’ research question; two stars to studies that were too small to provide definitive answers but were otherwise methodologically robust, and one star to studies that had significant flaws (most commonly small studies in a parochial setting whose findings could not be generalised with any confidence).
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Strong direct evidence: consistent findings in two or more empirical studies of appropriate design and high scientific quality (3 stars in our rating) relating directly to the provision of smoking cessation support by community pharmacists or pharmacy workers overseen by pharmacists.
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Strong indirect evidence: consistent findings in two or more empirical studies of appropriate design and high scientific quality, relating to the provision of some other behavioural intervention by community pharmacists or pharmacy workers.
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Moderate direct (or indirect) evidence: consistent findings in two or more empirical studies of less appropriate design and/or of acceptable scientific quality (two stars in our rating) relating directly to the provision of smoking cessation support (or indirectly to the provision of some other behavioural intervention) by community pharmacists or pharmacy workers overseen by pharmacists.
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Limited evidence: only one study of appropriate design and acceptable quality (two stars) available, or inconsistent findings in several studies.
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No evidence: no relevant study of acceptable scientific quality available.
Realist analysis
Box 1: Example of how we built tentative theory from primary studies
Results
Nature of dataset
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12 systematic reviews (5 of RCTs of pharmacist-led behavioural interventions for smoking [15‐19], 1 of process elements of such interventions [20], 3 of pharmacist-led behavioural interventions other than smoking cessation [15, 19, 21], 1 of the scope of pharmacy practice [4], 1 of pharmacists’ perceptions [13], and 1 of qualitative studies of the patient experience [22]);
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1 cost-effectiveness study linked to a RCT [40];
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1 paper describing additional process detail on a RCT [46];
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1 paper describing the development of a complex intervention [73].
Descriptive findings
Question 1: What is the impact on pharmacists of training them in smoking cessation support?
Question 2: What is the perspective of patients and the public on pharmacy-based smoking cessation support and other non-dispensing roles of the pharmacist?
Question 3: What do pharmacists perceive are the barriers to delivering smoking cessation support?
Question 4: What do pharmacists believe would help them to deliver smoking cessation support?
Question 5: How do organisational and system factors influence uptake and delivery of smoking cessation counselling by pharmacists?
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Steady-state (limited flexibility, centred on the status quo, resistant to any change);
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Operational flexibility (able to react to short-term market demands but incapable of making significant structural or strategic changes);
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Structural flexibility (able to use managerial capabilities to alter a firm’s structure to respond to internal and external pressures, hence can embrace medium-term change);
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Strategic flexibility (able to engage proactively and strategically to accommodate change and embrace opportunities, hence can embrace long-term change).