Identifying Aspects of Pharmacists' Attitudes and Barriers Toward Health Literacy: A Factor Analytic Study

BACKGROUND: Health literacy has gained prominence since the Institute of Medicine Report publicized the widespread prevalence of low health literacy. Pharmacists play an important role in enhancing health literacy as a result of their proximity to patients. Literature about pharmacists' perceptions and barriers in incorporating health literacy interventions is lacking. OBJECTIVE: To develop an instrument to measure pharmacists' attitudes and barriers toward health literacy. METHODS: A survey instrument assessing attitudes and barriers was designed based on a pharmacist focus group. The instrument was pretested among a sample of pharmacists from Illinois. The final instrument was administered to a systematic sample of 1500 pharmacists who were members of the Illinois Pharmacists Association. Dillman's 5-step total design method was followed to maximize survey responses. Exploratory principal components analysis with varimax rotation was performed on attitudes and barriers items to identify underlying components. Internal consistency of the components was determined using the Cronbach alpha and corrected item-total correlations. RESULTS: Overall, usable responses were received from 701 respondents, yielding a 48.1% response rate. Exploratory principal components analysis of the attitudes subscale produced a 5-factor solution that explained 55.87% of the variance. The 5 components included (1) low health literacy (LHL) situations, (2) LHL reasons, (3) LHL patient characteristics, (4) medication-related factors, and (5) LHL patient-interaction factors. The barriers subscale produced 3 components: (1) practice-related barriers, (2) knowledge and interaction-related barriers, and (3) process barriers, all of which explained 53.74% of the variance. Cronbach alpha values for the 5 attitudes subscales ranged from 0.33 to 0.78 and, for the 3 barriers, subscale values ranged from 0.56 to 0.71, offering evidence of internal consistency. CONCLUSIONS: Identification of components of pharmacists' attitudes and barriers toward health literacy will be useful to managers interested in incorporating health literacy interventions in their practice.