Using The Theory of Planned Behavior to Measure Pharmacists' Engagement in Political Advocacy ...

184 Pages·2014·1.82 MB·English

by  Tomaszewski, Daniel

Using The Theory of Planned Behavior to Measure Pharmacists’ Engagement in
Political Advocacy and Determine Factors Impacting Their Engagement

A Dissertation
SUBMITTED TO THE FACULTY OF THE
UNIVERSITY OF MINNESOTA
BY

Daniel Tomaszewski

A Dissertation
SUBMITTED TO THE FACULTY OF THE
UNIVERSITY OF MINNESOTA
BY
DOCTOR OF PHILOSOPHY

Ronald Hadsall, Marcia Worley

2014
© Daniel Tomaszewski, 2014
Dedication

A number is just a number. In my recent endeavors as a runner, I have come to
grips with the fact that I am not likely to finish first in any race, but I can still have
small victories. As a runner, that tends to come with the occasional age group
win or a new personal record. As a Ph.D. student, I graduate from this program
as its 140th graduate. Although it is not a race to the finish, there is one number I
can hang my hat on. I am and will always be the first SAPh Ph.D. graduate on
the Duluth Campus. This was in no part thanks to my speed or focus, but rather
the many who have supported me in Duluth. I dedicate this dissertation to the
program I have earned the title of first graduate from, the University of Minnesota,
College of Pharmacy, Social and Administrative Pharmacy Program, Duluth
Campus.

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Acknowledgements
The writing of a dissertation is a very unique experience that most
individuals never have the “privilege” to take part in. In order to allow as many
individuals a glimpse into what it entails, I have shared many of my trials and
tribulations throughout (both solicited and unsolicited) with many. It is these
individuals that I can thank for me maintaining my sanity (mostly), staying on
track, getting off track, and then once again getting back on track.
First, I would like to thank my family. Through the many years of late
birthday gifts, missing gatherings, and lackluster overall attention, you have
provided me with the support needed to complete not just my dissertation, but
the other many projects that have come up during my over 5 years in the
graduate program. I am grateful for this and hope that gifts start arriving early
(next year).
When I think of all of my mentors throughout my young professional life,
Randy Seifert has continuously found his way to the top of this list. Randy, your
unwavering support and friendship has made this journey well worth the work
that came with it. I do not know what you saw in me when I was finishing up
pharmacy school to encourage me to apply to the program, but it is something I
(on nearly all days) am greatly appreciative for. As I finish this chapter in my
professional career, I know that I can count on the fact that I will have you to turn
to when any challenge may arise.
Ron Hadsall and Marcia Worley, thank you for trying your best to keep a
graduate student, who got over his head early and continued to allow things to
pile on, headed down a path to completion. I am sure there were moments

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where the end may have come in question, but you were both there to provide
that necessary jolt when needed. I thank you for allowing me the freedom to
complete my journey in my way, while being available to me as I hit those speed-
bumps going too fast and in the wrong direction.
Steve Schondelmeyer, thank you for encouraging innovation in both this
project, as well as, all aspects of my professional career. It is your foresight and
straightforward feedback that has helped me come as far as I have in so many
professional aspects. I am extremely thankful for the many discussions we have
had regarding this project, the many shared teaching experiences, and the many
new endeavors to come.
Traci Toomey, it is the course I took with you that opened my eyes fully to
the topic of this research project and the continued drive to work towards
impacting the politics of healthcare. I thank you for your impact on me as a
student and a continued activist.
To my fellow graduate students, thank you for so much more than I can
fully grasp at this point in my life. It is the lively discussions about practice,
working through research problems together, and the many chances we took to
talk about anything besides pharmacy that turned this program into something
much more. There is no program like it. Tim, Holly, Victoria, Reid, and the many
others, I sincerely thank you.
And finally, to my patient, kind, wonderful, intelligent, and beautiful wife,
Alia Hussain Tomaszewski, I thank you for being the all-important, final piece of
the puzzle to put this project and my life together. It is your love and support that

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has served as the backbone of my life through this busy time and I hope I can
someday repay you for this. It was your (sometimes poorly timed) persistent
question of, “Why don’t you just finish your dissertation?” that helped get me
across the finish line. I cannot wait for the exciting times that the years ahead
will bring us and am looking forward to the ever changing question of, “Why don’t
we just…?”!

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Abstract
The level of regulation that impacts healthcare delivery in the United
States suggests the need for healthcare providers to participate in the formation
and implementation of health policies. Advancing health policies can most
effectively be accomplished through various forms of political advocacy. To date,
little research has been conducted to measure the level of involvement
pharmacists take in political advocacy.

The study’s purpose was to develop and test a survey that measured
pharmacists’ level of involvement in political advocacy and factors that impact
their involvement. To accomplish this, a survey was developed using The
Theory of Planned Behavior (TPB). The initial survey was refined through a
series of semi-structured interviews. Participants involved in the interview
process included practicing pharmacists, research experts, and political
advocacy experts.
The revised survey was used to survey a national sample of practicing
pharmacists. The overall response rate was 10.3%, which resulted in 103
usable responses for analysis. Statistical analysis included assessing the survey
items for reliability and validity and multiple regression analyses. Reliability
statistics were used to develop an ideal item list and regression analysis was
used to measure the appropriateness of The TPB. Reliability statistics suggested
the elimination of a total of 22 of the 68 items. Factor analysis was not used to
further evaluate the item list due to the low number of responses and potential
high number of factors. Results of the multiple regression analysis suggested

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the model incorporating all items related to The TPB was appropriate (adjusted
R-squared = 0.361), as well as the ideal item only model (adjusted R-squared =
0.300). In addition, each of the models’ demonstrated that the construct attitude
(p<0.001) predicted involvement in political advocacy. Using the ideal item only
model, the construct of perceived behavioral control (p=0.015) also demonstrated
a relationship.
This study provided us with an initial evaluation of pharmacists’
involvement in political advocacy. The results of the study suggested that The
TPB does appear to have utility in the topic; however, the low number of
participants limits generalizability. Additional studies are needed to further
evaluate the topic.

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Table of Contents Page
List of Tables viii – xi
List of Figures xii
Chapter 1: Introduction 1 - 24
Chapter 2: Background 25 – 64
Chapter 3: Methods 65 – 89
Chapter 4: Results 90 – 124
Chapter 5: Discussion & Conclusion 125 – 136
Bibliography 137 – 141
Appendices 142 – 170

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List of Tables Page
Table 1: Interview participants based on sex and 91
interview round

Table 2: Interview participants based on membership 92
in a professional association and sex

Table 3: Breakdown of those receiving an invitation to 92
participate in the interview process based on sex

Table 4: Breakdown of those receiving an invitation to 92
participate in the interview process based on employment type

Table 5: Breakdown of those receiving an invitation to 92
participate in the interview process based on sex and
membership in a pharmacy association

Table 6: Breakdown of those participating in the interview 93
process based on employment type and round of interview

Table 7: Breakdown of those participating in the 93
interview process based on employment type and
membership in a pharmacy association

Table 8: Summary of Sampling Frame Population, 161
Sample, and Respondents

Table 9: Sex 104

Table 10: Ethnic Origin 105
Table 11: Age (Groupings) 105
Table 12: Years in practice (Groupings) 106
Table 13: Cronbach’s Alpha Statistics for The Theory of 107
Planned Behavior Constructs (All items included)

Table 14: Cronbach’s Alpha Statistics for The Theory of 107
Planned Behavior Constructs (Items with poor correlation removed)

Table 15: Item-Total Statistics for attitude items 163

Table 16: Item-Total Statistics for subjective norm items 164

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