ERIC EJ852391: Educating Pharmacy Students about Nutrition and Physical Activity Counseling

7 Pages·2003·0.07 MB·English

by  ERIC

Educating Pharmacy Students About
Nutrition and Physical Activity Counseling
Jerome E. Kotecki and Bruce D. Clayton
ABSTRACT
The current study provides measures of association between self-reported beliefs of currently practicing pharmacists
and pharmacy students’ beliefs about, willingness to provide, and preparedness to provide counseling on nutrition
and physical activity following completion of a health education unit. A 3-week health education unit focusing on
the pharmacists’ role in nutrition and physical activity counseling was developed and implemented in a required
nonprescription drug therapy pharmacy course for fifth-year doctor of pharmacy students. As expected, the
majority of pharmacy students postintervention believed that diet and physical activity health-related behaviors
were very important for the average adult. Furthermore, significantly more pharmacy students believed that it was
their professional responsibility to educate patients about diet and physical activity, felt more prepared to educate
on diet modification and physical activity, and felt more comfortable with implementing behavioral-modification
strategies to help patients achieve change than currently practicing pharmacists. The importance pharmacy
students assigned to diet and physical activity health-promoting behaviors indicates that a similar health education
program may help currently practicing pharmacists sharpen their skills in these areas.
Unhealthy eating and physical inactiv- High Blood Cholesterol in Adults [ATP III], care services (Dombrowski, 1999;
ity are major contributing factors to many Joint National Committee Report on Pre- Dombrowski & Ferro, 1999). In fact, for the
chronic medical conditions, including car- vention, Detection, Evaluation, and Treat- past three decades the pharmacy profession
diovascular disease, cancer, obesity, hyper- ment of High Blood Pressure [JNC-6]) ad- has been broadening its role to include a
tension, dyslipidemia, and diabetes melli- vise that the first-line approach (before drug range of patient-centered services beyond
tus (Centers for Disease Control and therapy) for treating these chronic diseases the traditional product-oriented functions
Prevention [CDC], 2002). Each of these dis- is making lifestyle modifications related to
eases is associated with prolonged illness nutrition and physical activity (Byers et al.,
Jerome E. Kotecki, HSD, is a professor of health
and disability that decrease the quality of 2002; CDC, 2002 Krauss et al., 2000).
science in the College of Sciences and Humani-
life for millions of Americans annually. The The need for patient counseling on
ties, Ball State University, Muncie, IN 47306;
current recommendations/guidelines from nutrition therapy and physical activity has
E-mail: [email protected]. Bruce D. Clayton,
many national organizations and expert been recently promoted by the American
PharmD, is a professor of pharmacy practice,
panels (e.g., American Heart Association, Pharmaceutical Association (APhA) as an
College of Pharmacy and Health Sciences, But-
American Cancer Society, Expert Panel on excellent opportunity for pharmacists to
ler University, Indianapolis, IN 46208
Detection, Evaluation, and Treatment of expand their provision of pharmaceutical
34 American Journal of Health Education — January/February 2003, Volume 34, No. 1
Jerome E. Kotecki and Bruce D. Clayton
of dispensing and distributing medications seling, faculty from two Indiana universi- in age from 22 to 70 years, with a mean age
(APhA, 1998). More specifically, counseling ties, the Department of Pharmacy Practice of 41.12 and a standard deviation of 10.98.
with the objective of providing patients with at Butler University and the Department of The majority of pharmacists were men
information to assist them in making Health Science at Ball State University, col- (65.6%) between 30 and 49 years of age
lifestyle changes to improve their health is laborated on developing and implementing (59.1%) who had practiced for 10 or more
viewed as a task particularly well suited to coursework related to the latest thinking years (67.8%). The descriptive characteris-
pharmacists. Because they are recognized as about healthful diet and physical activity tics of this sample are similar to those ob-
served in other research (Kotecki, 2002).
credible sources of health information, guidelines. Despite the emphasis placed on
accessible, and in frequent contact with the educating pharmacists in diet and physical Intervention
public (Americans on average visit a phar- activity by the APhA, there is no literature A series of seven 1-hour lecture sessions
macy once every month), community on implementing and measuring the effec- focusing on national dietary and physical
pharmacists could provide an important tiveness of this type of education. The pur- activity guidelines and practical and reliable
channel for delivery of counseling on pose of this current study was twofold. First, behavior change techniques were imple-
proper diet and physical activity (Cooper, the study was designed to determine phar- mented in the nonprescription drug
1999; Dombrowski, 1999; Dombrowski & macy students’ self-reported beliefs about, therapy course. Three 2-hour laboratories
Ferro, 1999). Despite these seemingly favor- willingness to provide, and preparedness to providing experiential-learning opportuni-
able conditions, little is known about the provide counseling on nutrition and physi- ties supported the lecture and classroom
extent to which pharmacists believe in the cal activity following completion of a coor- discussions.
importance of healthy food choices and dinated and concentrated health education The lecture material was primarily based
physical activity in promoting the health unit. Second, the study was designed to on assigned readings from the APhA’s
of their patients. compare these results with the self-reported Dynamics of Pharmaceutical Care Continu-
In one of the few studies reported to beliefs of currently practicing pharmacists. ing Education monograph series The
date, Kotecki and colleagues recently sur- Pharmacist’s Role in Nutrition and Physical
veyed a random sample of 522 community METHODS Activity Counseling (APhA, 2000) and Man-
pharmacists in Indiana regarding their be- Subjects aging Obesity as a Chronic Disease (APhA,
liefs and practices related to 23 health-pro- A convenience sample of 78 doctor of 2001). In addition, recently updated diet
moting behaviors (Kotecki, Elanjian, & pharmacy students enrolled in a nonpre- and physical activity recommendations
Torabi, 2000). Their findings revealed that scription drug therapy course during the from expert panels on managing hyperten-
pharmacists were in strong agreement that 2002 spring semester at Butler University sion (Vollmer et al., 2001), hypercholester-
eliminating cigarette smoking, always wear- participated in the study. The course, titled olemia (“Executive Summary,” 2001), and
ing automobile safety belts, and practicing Self-Care and Health Promotion, is required diabetes mellitus (American Diabetes
safe sex were very important health-pro- for all fifth-year doctor of pharmacy stu- Association, 1998, 1999) were also assigned
moting behaviors. There was, however, con- dents. The overall focus of the course is readings. Finally, articles related to the
siderably less agreement among pharma- health and wellness, but it concentrates ex- transtheoretical model of behavior change
cists about the importance of diet and clusively on over-the-counter drug therapy and its stages-of-change construct (Berger
physical activity as health-promoting be- and alternative remedies such as herbal & Hudmon, 1997; Prochaska & Velicer,
haviors. Furthermore, pharmacists’ involve- products and other dietary supplements as 1997) were also assigned as readings to
ment, preparation, and confidence in deal- self-care treatment options. To meet the inform pharmacy students about the im-
ing with patients’ habits related to diet, study purposes, an immediate posttest portance of assessing a patient’s motiva-
physical activity, and weight management (IPT) and a delayed posttest (DPT) design tional readiness and the need for tailoring
was extremely low. were employed. The IPT was conducted at interventions accordingly.
Among the more notable findings from the conclusion of the intervention and the The experiential-learning laboratories
Kotecki and his colleagues was that phar- DPT was conducted 5 weeks later. provided pharmacy students the opportu-
macists did not feel it was their responsi- The currently practicing pharmacists nity to display their comprehension of the
bility to be involved in diet and physical (CPP) self-reported health promotion be- lecture material and implement strategies
activity counseling. They also felt ill liefs originated from a recent research study based on the stages-of-change approach
equipped to provide instruction on these conducted in Indiana (Kotecki et al., 2000). to assist in health-related behavior change.
health-promoting behaviors due to a lack Five hundred twenty-two randomly selected This opportunity was facilitated largely
of information and training. community pharmacists participated in a through simulated one-on-one patient
To further the role of community phar- cross-sectional mail survey of community consultations and group presentations.
macists in diet and physical activity coun- pharmacies in Indiana. Respondents ranged The seven lectures and three laboratories
American Journal of Health Education — January/February 2003, Volume 34, No. 1 35
Jerome E. Kotecki and Bruce D. Clayton
were implemented during the first 3 weeks 5-point Likert scales. For each of the four was found to be 0.83. The questionnaire
of the course by the visiting professor health promoting habits, students were took 10–15 minutes to finish and was
of health education. The assigned asked to indicate the extent to which they completed under conditions of anonymity.
pharmacy professor of the course assisted felt prepared to counsel patients (very The Institutional Review Boards at Ball
in the implementation of this health edu- unprepared, unprepared, equally unprepared State University and Butler University
cation material. and prepared, prepared, very prepared) approved the research methodology and
Instrument and their level of comfort with implement- survey instrument.
A survey questionnaire used to measure ing behavioral modification strategies Data Analysis
Indiana pharmacists’ health promotion in helping patients achieve changes in their The collected data were analyzed using
beliefs and practices served as the basis for behavior for each health promoting behav- SPSS 10.0. The Pearson chi-square and de-
the data collection instrument (Kotecki et ior (very uncomfortable, mildly uncomfort- scriptive statistics were used to examine re-
al., 2000). Items relating to the nutrition and able, equally uncomfortable and comfortable, lationships between self-reported beliefs of
physical activity health areas were selected somewhat comfortable, very comfortable). currently practicing pharmacists and phar-
from the questionnaire; those that did Finally, students’ attitudes toward macy students’ self-reported beliefs about,
not apply were discarded. In addition, six prevention were measured by listing six willingness to provide, and preparedness to
new items were added to measure students’ items (Table 2) using a 5-point Likert scale provide counseling on nutrition and physi-
attitudes toward prevention. The question- (strongly disagree, somewhat disagree, cal activity post intervention. The alpha
naire was subsequently provided to three equally disagree and agree, somewhat agree, level was set at p<.05.
community pharmacists and two survey strongly agree). Test-retest reliability was
researchers to assess content validity. assessed on the responses following the IPT RESULTS
Minor changes in wording were incorpo- and DPT using Pearson’s correlation Of the 78 students who participated in
rated into the final structured question- coefficient and was found to be 0.78. Inter- the course, all completed IPT questionnaires,
naire, which consisted of 34 multiple-choice nal reliability was assessed on the DPT and 68 completed DPT questionnaires. Of
items designed to yield scaled responses. responses using Cronbach alpha and the DPT participants, 52 (76%) of the
The nutrition and physical activity
beliefs were measured by listing 14 health-
related behaviors and asking respondents Table 1. Percentage of Respondents Perceiving Health-Promoting
to indicate on a 5-point Likert scale (very Behaviors as “Very Important” for the Average Adult
unimportant, somewhat unimportant,
Behavior IPTa DPTb CPPc
equally unimportant and important, some-
what important, very important) the impor- 1. Aim for a healthy weight 89 85 39d
2. Maintain normal blood pressure 89 82 70d
tance of each behavior in promoting the
3. Choose a diet low in saturated fat and cholesterol
health of an average adult. Ten items dealt
and moderate in total fat 87 82 51d
directly with the Dietary Guidelines
4. Maintain normal blood cholesterol level 86 82 58d
for Americans, three items related to main-
5. Maintain normal blood glucose level 86 83 nmf
taining normal blood pressure, cholesterol,
6. Be physically active each day 76 71 29d
and glucose levels, and one item with tak-
7. Choose a variety of fruits and vegetables daily 74 74 51d
ing a multivitamin/mineral supplement 8. Keep food safe to eat 74 68 nmf
daily (Table 1). 9. If one drinks alcoholic beverages, do so in moderation 64 59 52e
A 5-point Likert scale (very uninvolved, 10. Choose a variety of grains daily, especially whole grains 63 61 51e
somewhat uninvolved, equally uninvolved 11. Choose and prepare foods with less salt 61 52 34d
and involved, somewhat involved, very in- 12. Let the Food Pyramid guide food choices 60 56 48d
volved) was used to measure whether phar- 13. Choose beverages and foods to moderate intake
of sugars 59 55 33d
macy students believed pharmacists should
14. Take a multivitamin/mineral supplement daily 14 18 nmf
be responsible for counseling patients with
regard to four habits: diet modification,
aIPT=immediate posttest (n=78).
weight management, physical activity, and
bDPT=delayed posttest (n=68).
alcohol use. cCPP=current practicing pharmacists (n=522); published data from Kotecki et al., 2000.
Pharmacy students’ confidence in their dChi-square tests for differences among DPT and CPP=p<.05.
ability to help future patients change eChi-square tests for differences among IPT and CPP=p<.05.
fnm=not measured.
behavior was measured in two ways using
36 American Journal of Health Education — January/February 2003, Volume 34, No. 1
Jerome E. Kotecki and Bruce D. Clayton
respondents were women and 16 (24%) were
Table 2. Percentage of Respondents Stating Pharmacists Should Be
men. Forty-two (62%) of the participants
“Very Involved” in Counseling Patients on Specific Health Behaviors
planned on working in a community phar-
macy setting, 20 (29%) in a hospital setting,
Behavior IPTa DPTb CPPc
and 6 (9%) indicated “other.”
1. Weight management 44 39 7d
Beliefs About Health Promotion
2. Alcohol use 39 30 21e
Table 1 presents the results of the rating
3. Diet modification 37 33 7d
of the 14 health-related behaviors concern- 4. Physical activity 37 30 6d
ing diet and physical activity beliefs, based
on the proportion of pharmacy students aIPT=immediate posttest (n=78).
and currently practicing pharmacists (CPP) bDPT=delayed posttest (n=68).
cCPP=current practicing pharmacists (n=522); published data from Kotecki et al., 2000.
who stated that these items were “very
dChi-square tests for differences among DPT and CPP=p<.05.
important.” Of the 14 items, 13 received a
eChi-square tests for differences among IPT and CPP=p<.05.
50% or higher student rating of “very im-
portant” at both the IPT and DPT. These
items included aim for a healthy weight Table 3. Percentage of Respondents Feeling “Very Prepared” to
(89 and 85%); maintaining normal blood Educate Patients on Specific Health Promotion Areas
pressure (89 and 82%); choosing a diet that
Behavior IPTa DPTb CPPc
is low in saturated fat and cholesterol and
moderate in total fat (87 and 82%); main- 1. Physical activity 59 52 17d
taining normal blood glucose level (86 and 2. Diet modification 54 47 11d
3. Weight management 54 42 12d
83%); maintaining normal blood choles-
4. Alcohol use 42 39 31
terol level (86 and 82%); being physically
active each day (76 and 71%); choosing
aIPT=immediate posttest (n=78).
a variety of fruits and vegetables daily
bDPT=delayed posttest (n=68).
(74 and 74%); keeping food safe to eat cCPP=current practicing pharmacists (n=522); published data from Kotecki et al., 2000.
(74 and 68%); drinking alcohol in modera- dChi-square tests for differences among DPT and CPP=p<.05.
tion (64 and 59%); choosing a variety
of grains daily, especially whole grains (63 Table 4. Percentage of Respondents Feeling “Very Comfortable”
and 61%); choosing and preparing foods Implementing Behavioral-Modification Strategies in
with less salt (61 and 52%); letting the Helping Patients Achieve Changes
Food Pyramid guide food choices (60 and
56%); and choosing beverages and foods Behavior IPTa DPTb CPPc
moderate in sugar (59 and 55%). The only 1. Physical activity 28 23 2d
item receiving less than a 50% response as 2. Weight management 26 21 2d
“very important” was taking a multivita- 3. Diet modification 23 20 4d
min/mineral supplement daily (14 and 4. Alcohol use 20 17 5d
18%). No statistically significant associa-
aIPT=immediate posttest (n=78).
tions (p>.05 by the chi-square test) were
bDPT=delayed posttest (n=68).
found between pharmacy students’ IPT
cCPP=current practicing pharmacists (n=522); published data from Kotecki et al., 2000.
and DPT items. When matching the phar-
dChi-square tests for differences among DPT and CPP=p<.05.
macy students DPT and CPP beliefs, it was
found that statistically significant differ-
ences existed for 9 of the 11 comparable importance of each of the health-promot- (44 and 39%), alcohol use (39 and 30%),
behaviors (p<.05 by the chi-square test) ing behaviors than were the current prac- diet modification (37 and 33%),and physi-
(Table 1). Significant statistical differences ticing pharmacists. cal activity (37 and 30%) (Table 3). The
(p<.05) existed on each of the 11 compa- Beliefs About Pharmacist Involvement figures reflect significant increases for the
rable behaviors tested with IPT and At least 3 of every 10 pharmacy students DPT over the CPP group in the proportions
CPP. In other words, immediately follow- at both IPT and DPT believed that phar- of respondents who thought pharmacists
ing the intervention the pharmacy students macists should be “very involved” in should be very involved on three (weight
were more likely to believe in the counseling patients on weight management management, diet modification, and physi-
American Journal of Health Education — January/February 2003, Volume 34, No. 1 37
Jerome E. Kotecki and Bruce D. Clayton
cal activity) of the behaviors (p<.05). dorse the pharmacists’ role in the prevention Factor Surveillance System in the decade of
Confidence in Dealing of disease (Table 2). More than four-fifths the 1990s reveals that Indiana adults ex-
with Behavioral Change of the pharmacy students agreed that phar- ceeded the rest of the United States in dis-
macists should devote more time to provid- ease-promoting behaviors, including not
As shown in Table 4, more than half of
ing preventive services to their patients and consuming enough fruits and vegetables, no
the pharmacy students perceived themselves
that keeping patients healthy by influencing leisure time physical activity, overweight
as “very prepared” to educate patients on
the adoption of healthy lifestyles is very im- and obesity, chronic drinking of alcohol,
physical activity (59%), diet modification
portant. However, less than half (35%) binge drinking, and not being checked for
(54%), and weight management (54%) at the
agreed that they would find the preventive hypertension and hypercholesterolemia
IPT. However, statistically significant (p<.05)
aspects of medicine more interesting or grati- (CDC, 2001). These conditions have con-
differences did exist among the pharmacy
fying than treating ill patients. Nonetheless, tributed to Indiana’s higher rates of cardio-
students’ DPT and the CPP when it came to
the majority of pharmacy students agreed vascular disease, cancers, and diabetes mel-
feeling very prepared to counsel patients on
that preventive medicine should be a re- litus compared with the rest of the United
physical activity, diet modification, and
quired part of the pharmacy school curricu- States (CDC, 1999).
weight management. Further, pharmacy stu-
lum. Finally, more than four-fifths of the The Healthy People 2010 goals for Indi-
dents reported statistically significant higher
pharmacy students thought they would find ana acknowledge the need for actively in-
levels of confidence at both the IPT and DPT
compared with the CPP for helping patients educating patients a challenging and pleas- volving health care professionals in coun-
achieve behavior changes regarding physical ing part of pharmacy practice. Attitudes to- seling and patient education when it comes
activity, weight management, diet, and alco- ward prevention were not measured on cur- to improving lifestyles among the populace
hol habits (Table 5). rently practicing pharmacists; thus, no (ISDH, 2001). Therefore, health education
comparisons could be made. must be practiced in a variety of settings
Attitudes Toward Prevention
and by various health care professionals.
Pharmacy students’ attitudes toward pre-
DISCUSSION One prominent health care provider in In-
vention, as measured by a series of six closed-
Trends data from the Behavioral Risk diana is the community pharmacist. In fact,
ended items, show that they thoroughly en-
Table 5. Percentage of Responses by Pharmacy Students to Attitudes About Prevention (N=68)
Strongly Somewhat Equally Somewhat Strongly
Item agree agree disagree/agree disagree disagree
1. Pharmacists should devote more time to providing
preventive services to their patients. 64 27 8 2 0
2. The most important thing a pharmacist can do
to keep patients healthy is to influence them
to adopt healthy lifestyles. 39 44 14 3 0
3. In general, I think I would get a greater sense of
gratification from diagnosing and treating
ill patients than I do from preventive care. 12 23 20 33 12
4. In general, the preventive aspects of medicine—
educating and counseling patients on
healthy lifestyles—are not very interesting
to me as a pharmacist. 8 12 15 32 33
5. More formal instruction on preventive medicine
should be a required part of the curriculum
in pharmacy school. 21 35 27 14 3
6. In general, I think I would find educating patients to be a
challenging and enjoyable part of pharmacy practice. 33 52 11 3 2
38 American Journal of Health Education — January/February 2003, Volume 34, No. 1
Jerome E. Kotecki and Bruce D. Clayton
pharmacists are the third most prevalent for pharmacists can contribute to creating Clinical Pharmacy, 2000). This ambition is
licensed health care professionals in Indi- an established norm for pharmacists prac- comparable to a similar drive for the health
ana, for a statewide pharmacist-to-popula- ticing nutrition and physical activity coun- education profession, in which the profes-
tion ratio of 1:1,085 or 95 per 100,000 seling, as well as teach pharmacists the skills sion has been encouraged to collaborate
(ISDH, 1999). they need to have a reasonable possibility with a broad range of individuals and or-
Pharmacists, like most health care pro- of success in assisting patients in achieving ganizations outside their close-knit aca-
fessionals, are more willing to devote time these behavior changes. This study demon- demic society (Seffrin, 1997). In fact, health
and energy to counseling patients in areas strates that a well-designed and well-sup- education professionals can lend support in
in which they feel they have a reasonable ported health education program taught by convincing pharmacists of the effectiveness
possibility of success. One area in which a health educator can significantly impact of well-designed state-of-the-art behavioral
pharmacists feel very successful in helping the depth of professional commitment and interventions when it comes to diet and
patients change behavior is with the proper skill that is necessary for pharmacists. Find- physical activity counseling. Moreover,
use of medication (Kotecki et al., 2000), ings of this study indicate that pharmacy health educators, by the nature of their skills
which is consistent with their academic cur- students were more likely to believe in the and required professional competencies
riculum. However, in many chronic medi- importance of diet and physical activity in (National Commission for Health Educa-
cal conditions nutrition therapy and in- promoting the health of adults following the tion Credentialing, 1996) are ideally suited
creased physical activity serve as the educational intervention than current prac- to assist in the education of pharmacists for
foundation of treatment (Byers et al., 2002; ticing pharmacists (Kotecki et al., 2000). health promotion counseling. To accom-
CDC, 2002; Krauss, et al., 2000;). Drug The pharmacy students were also more plish this, health educators will need to be-
therapy is intended as an adjunct to, not a likely to believe that it was their professional come familiar with pharmacy practice is-
substitute for, proper diet and physical ac- responsibility to educate patients on these sues and to provide pharmacists with
tivity. Additionally, changing fundamental matters, and felt more prepared and com- perspectives on how to counsel on health
and ingrained behaviors, such as behaviors fortable in counseling patients about diet education and assist them to shape the
related to diet and physical activity, are ex- and physical activity than did current prac- broadening health promotion agenda.
tremely difficult and time-consuming and ticing pharmacists. Not only is there a need for educating
require different counseling techniques. Of particular interest was the retention preservice pharmacists, but there also ap-
Therefore, it is not surprising that pharma- for each of these important beliefs 5 weeks pears to be a need to educate practicing
cists do not feel successful or believe they after the educational program (no statisti- pharmacists if this role is to be expanded.
should be involved in these areas (Kotecki cally significant changes occurred between Although the samples are not equivalent in
et al, 2000). IPT and DPT). Consequently, these phar- all characteristics, and self-reported data
Still, when it comes to counseling on diet macy students, on entering their clinical must be viewed cautiously, the considerable
and physical activity, pharmacists should be rotations and subsequent professional prac- importance pharmacy students assigned to
involved. This conclusion is consistent with tices, might be more able or more likely to the diet and physical activity health-pro-
the emerging trend that recognizes the im- provide patient counseling on such issues moting behaviors indicates that a similar
portance of an interdisciplinary team effort as a routine component of pharmaceutical educational program may help currently
by all health care providers in helping Ameri- care. In fact, instilling patient counseling practicing Indiana pharmacists sharpen
cans follow national diet and physical activ- skills related to health promotion and dis- their skills in these areas. Most of the cur-
ity guidelines (Byers et al., 2002; CDC, 2002; ease prevention are key elements of a new rently practicing pharmacists surveyed in
Krauss et al., 2000). Pharmacists, as mem- mission and curriculum for doctor of phar- 2000 were eager to participate in continu-
bers of this team, can be a readily accessible macy students (American College of Clini- ing education to improve their health pro-
source of information on the importance of cal Pharmacy, 2000). Success in this area is motion expertise (Kotecki et al., 2000). Of
nutrition and physical activity in chronic critical if the pharmacy profession is going course, like anything else health education
disease management (Cooper, 1999; to play an active role in patient counseling is more valuable when done correctly. At a
Dombrowski, 1999; Dombrowski & Ferro, related to health promotion. minimum, it is important that future health
1999). However, pharmacists who fail to To enhance the adoption of this phar- education efforts for pharmacists are com-
adopt this unifying philosophy of practice macist counseling role related to healthy prehensive, coordinated, and concentrated.
related to the recommendations for health- lifestyles, pharmacy academia and profes- Although the suggestions provided in
ful food choices and physical activity are sional organizations are developing collabo- this article are informative and useful, they
missing an opportunity to respond to a pro- rative relationships with other health pro- should be viewed in light of a number of
found public health need. fessionals to help shape this new model of study constraints that might influence the
The modification of program curricula pharmacy practice (American College of generalizability of the results. The design of
American Journal of Health Education — January/February 2003, Volume 34, No. 1 39
Jerome E. Kotecki and Bruce D. Clayton
the study was driven by (1) needing to limit trieved December 15, 2001 from www. and Treatment of High Blood Cholesterol in
the evaluation to an intact group; (2) need- aphanet.org/education/dpcm/dpcmmain.asp. Adults (Adult Treatment Panel III) (2001). Jour-
ing to minimize the response burden to American Pharmaceutical Association. nal of the American Medical Association, 285,
participants who were finishing their final (1998). Pharmacist Practice Activity Classifica- 2486–2497.
semester of full-time pharmacy course tion 1.0. Retrieved December 15, 2000 from Indiana State Department of Health (ISDH).
work, while at the same time scheduling www.aphanet.org /AphA/practiceclass.html. (2001). Epidemiology Resource Center/Data
their 10 required experiential rotations for Berger, B. A., & Hudmon, K. S. (1997). Readi- Analysis Team. Indiana health behavior risk fac-
the upcoming year; and (3) needing to uti- ness to change: Implications for patient care. tors—1999 State Data. Retrieved January 15,
lize similar items that measured currently Journal of the American Pharmaceutical Associa- 2002 from www.state.in.us/isdh/dataandstats/
practicing pharmacists self-reported beliefs tion, 37, 321–329. brfss/htm.
from the 2000 study. Finally, various factors Byers, T., Nestle, M., McTiernan, A., Dolye, Indiana State Department of Health (ISDH).
influence the environments in which com- C., Currie-Williams, A., Gansler, T., & Thun, M. (1999). Indiana Health Care Professional Devel-
munity pharmacists are educated and em- (2002). American Cancer Society guidelines on opment Commission 1999 Annual Report. Re-
ployed; therefore, the generalizability of the nutrition and physical activity for cancer pre- trieved march 20, 2002 from www.IN.gov/isdh/
results outside of Indiana might be limited vention: Reducing the risk of cancer with publications/1999report/toc.htm.
by differences in education, laws, and prac- healthy food choices and physical activity. CA: Kotecki, J. E. (2002). Factors related to phar-
tices in other states or countries. A Cancer Journal for Clinicians, 52, 92–119. macists’ over-the-counter recommendations.
Centers for Disease Control and Prevention. Journal of Community Health, 27, 291–306.
ACKNOWLEDGMENTS (2002). Physical activity and good nutrition: Es- Kotecki, J. E., Elanjian, S. I., & Torabi, M. R.
The authors wish to acknowledge Dean sential Elements to prevent Chronic Diseases and (2000). Health promotion beliefs and practices
Patricia Chase PhD, Paula Ceh, PharmD Obesity 2002. Retrieved March 15, 2001 from among pharmacists. Journal of the American
and Barbara Howes, MLS, at Butler Univer- www.cdc.gov/nccdphp/dnpa/dnpaaag.htm. Pharmaceutical Association, 40, 773–779.
sity and the College of Sciences and Hu- Centers for Disease Control and Prevention. Krauss, R. M., Eckel, R. H., Howard, B.,
manities at Ball State University for their (2001). National Center for Chronic Disease Pre- Apple, L. J., Daniels, S.R., Deckelbaum, R.J.,
support of this study. vention & Health Promotion, Behavioral Risk Erdman, J.W., Kris-Etherton, P., Goldberg, I.J.,
Factor Surveillance System. 2001. Trends Data. Kotchen, T.A., Lichtenstein, A.H., Mitch, W.E.,
REFERENCES Retrieved January 15, 2001 from http:// Mullis, R., Robinson, K., Wylie-Rosett, J., St. Jeor,
American College of Clinical Pharmacy. apps.nccd.cdc.gov/brfss/Trends/TrendData.asp. S., Suttie, J., Tribble, D.L., & Bazzarree, T. (2000).
(2000). A vision of pharmacy’s future roles, re- Centers for Disease Control and Prevention. AHA dietary guidelines, Revision 2000: A state-
sponsibilities, and manpower needs in the (1999). National Center for Chronic Disease Pre- ment for healthcare professionals from the nu-
United States. Journal of Human Pharmacology vention & Health Promotion, Chronic Diseases trition committee of the American Heart Asso-
and Drug Therapy, 20, 991–1022. and Their Risk Factors: The Nation’s Leading ciation. Circulation, 102, 2284–2299.
American Diabetes Association. (1999). Po- Causes of Death, 1999. Retrieved January 15, National Commission for Health Education
sition statement: Nutrition recommendations 2001 from www.cdc.gov/nccdphp/statbook/ Credentialing, Inc. (1996). A competency-based
and principles for people with diabetes melli- statbook.htm. framework for professional development of certi-
tus. Diabetes Care, 22(suppl 1), S42–45. Cooper, C. (1999). Wellness, nutrition and fied health education specialists. Allentown, PA:
American Diabetes Association. (1998). Po- exercise: Role of the pharmacist. Pharmacy Author.
sition Statement: Diabetes mellitus and exercise. Times, 65, 67–72. Prochaska, J. O., & Velicer, W. F. (1997). The
Diabetes Care, 21(suppl 1), S49–53. Dombrowski, S. R. (1999). Pharmacist coun- transtheoretical model of health behavior
American Pharmaceutical Association. seling on nutrition and physical activity-part 1 change. American Journal of Health Promotion,
(2001). Concepts in comprehensive weight man- of 2: Understanding current guidelines. Journal 12, 38–48.
agement: Managing obesity as a chronic disease of the American Pharmaceutical Association, 39, Seffrin, J. R. (1997). Premises, promises, and
(The Dynamics of Pharmaceutical Care Continu- 479–491. potential payoffs of health education, Journal of
ing Education Monograph Series). Retrieved Dombrowski, S. R., & Ferro, L. A. (1999). Health Education, 28, 298–307.
December 15, 2001 from www.aphanet.org/edu- Pharmacist counseling on nutrition and physi- Vollmer, W. M., Sacks, F. M, Ard, J., Appel,
cation/dpcm/dpcmmain .asp. cal activity-part 2 of 2: Helping patients make L.J., Bray, G.A., Simons-Morton, D.G., Conlin,
American Pharmaceutical Association. (2000). changes. Journal of the American Pharmaceuti- P.R., Svetkey, L.P., Erlinger, T.P., Moore, T.J., &
The pharmacists’s role in nutrition and physical ac- cal Association, 39, 613–627. Karanja. (2001). Effects of diet and sodium in-
tivity counseling (The Dynamics of Pharmaceuti- Executive Summary of the Third Report of take on blood pressure: Subgroup analysis of the
cal Care Continuing Education Monograph Se- the National Cholesterol Education Program DASH-Sodium Trial. Annals of Internal Medi-
ries; ACPE number 202-000-99-157-H01). Re- (NCEP) Expert Panel on Detection, Evaluation, cine, 135,1019–1028.
40 American Journal of Health Education — January/February 2003, Volume 34, No. 1