Implementation science in community pharmacy
Analysis of barrier-cause-strategy flows to scale up a pharmacy service nationally
Generating quantitative evidence on which barriers hold back the adoption of a pharmacy service, and which strategies were associated with successful resolution
The Indica+PRO project had shown that the minor ailment service was clinically efficacious, but actual adoption across pharmacies was uneven. The challenge was no longer technical but one of implementation: understanding what determined whether adoption succeeded in each pharmacy, and building tools that would let facilitators make informed decisions in real time.
In a national programme that brought together hundreds of community pharmacies, 10 change agents (pharmacist trainers) systematically documented the implementation process in 92 of them. Each interaction generated structured triads: for every barrier or facilitator identified, its causes and the strategies applied to address it were recorded, with determinants classified according to the CFIR. The first-round dataset — 356 triads, 275 barriers and 81 facilitators, expanded into 2,393 combinations when causes and strategies were crossed — held a wealth of analytical value that had not yet been tapped.
The methodological challenge was threefold. First, to analyse the relational structure of the triads with network analysis, to identify non-obvious patterns in implementation. Second, to quantify which facilitation strategies were associated with resolving each barrier, moving beyond the qualitative approach that dominates implementation science. Third, to produce visual tools that facilitators could use during the implementation process, not just in retrospective analysis.
4,236
barrier-cause-strategy relationships documented by 10 change agents
92
pharmacies with a monitored implementation process
2
full analysis cycles (2023 and 2024) with updated data
A quantitative implementation science framework combining network analysis, hypothesis testing and visualisation of decision flows
Network analysis of implementation relationships
Graphs built on pharmacist-pharmacy-intervention relationships, with the analysis split into three complementary perspectives (combined, barriers only, facilitators only) to identify non-obvious structural patterns. As part of the internal report delivered to the research team, centrality, clustering and connectivity metrics were calculated to characterise which nodes (barriers, strategies, agents) hold the most influential positions in the implementation network, together with a summary table that consolidated the results of the EDA, the hypothesis tests and the network analysis.
Hypothesis tests on the association between strategies and barrier resolution
A full battery of statistical tests on the 356 triads, distinguishing barriers from facilitators, with specific analysis of combinations of strategies applied together. The internal report also included data mining (random forest) to explore which strategies were associated with successful resolution of each barrier, adding a replicable quantitative layer to an approach that has traditionally been qualitative in implementation science.
Sankey diagrams as a pragmatic tool for facilitators
Development of Sankey diagrams that visualise the flows from barrier or primary determinant → cause or secondary determinant → implementation strategy, allowing change agents to identify in real time which strategies have been applied successfully against each specific barrier. The diagrams, with more than 6,500 lines of code devoted to their final production for publication, are the main output of the article in Research in Social and Administrative Pharmacy and a replicable tool for future implementation programmes.
Quantitative evidence for scaling up health interventions in distributed settings
An evidence-based implementation framework that identifies critical barriers
Identification of the most frequent barriers to implementing the service (lack of planning capacity, lack of internal support, gaps in knowledge and experience) and characterisation of which facilitation strategies showed the best observed results against each specific barrier. The split analysis (combined → specific by triad type) supports diagnosis both at overall programme level and at individual pharmacy level.
Replicable visual tools to support implementation
The Sankey diagrams developed provide a tool that can be used directly in future implementation programmes in community pharmacy and other distributed healthcare settings. The approach — visualising real decision flows, not theoretical ones — lets change agents choose strategies based on what was associated with successful resolution in similar contexts, not on generic recommendations.
Publication in an international journal with a quantitative approach to implementation science
Article published in Research in Social and Administrative Pharmacy presenting the Sankey diagrams as a pragmatic tool for selecting implementation strategies. A companion article in Farmacéuticos Comunitarios documents the impact of the service in routine practice. Applying a quantitative approach to a traditionally qualitative field opens up a distinct methodological line.
What this case shows about the way we work
Quantifying implementation science in a field dominated by qualitative methods
Network analysis, data mining and statistical testing applied to an implementation dataset of a kind usually analysed with qualitative methods. A demonstration that it is possible to generate replicable quantitative evidence on which patterns of successful and unsuccessful adoption appeared in the data on health service adoption.
Visual tools designed for the end user, not just the researcher
The Sankey diagrams are designed for implementation facilitators to use during the process, not just as figures in an article. A design-for-use approach that sets this work apart from purely academic implementation science.
A full iteration of the analysis on updated data, with direct scientific output
Two full rounds of the same analytical framework (April 2023 and January 2024), the second feeding directly into the published articles. It shows the ability to maintain and improve an analytical pipeline over time as the data evolve.
Part of a longitudinal international research programme
This analysis was not a one-off engagement but one strand of a 4-year programme with the Universidad de Granada and the University of Technology Sydney. Demonstrated ability to support research teams from initial exploration to publication in indexed journals.
Queríamos contaros una muy buena noticia: nuestro abstract que enviamos al Congreso de la Federación Internacional de Farmacéuticos fue seleccionado para una presentación oral de 15 minutos y ganamos el primer premio.
Emma L. Graham
Grupo de Investigación en Atención Farmacéutica · Universidad de Granada
Project resources
Resulting scientific output
Capabilities deployed in this project
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