Table 2 Barriers and Facilitators to Refilling Medications Using Mail Order Pharmacy: Focus Group Themes Mapped to the Capability, Motivation, Opportunity Model of Behavior Change (COM-B)
Barriers | Facilitators | |
|---|---|---|
Capability | Theme (#Focus groups; type)a | Theme (#Focus groups; type)a |
Psychological | • Lack of knowledge about how mail order process works (4; user and non-user) • Not planning ahead (3; user and non-user) • Limited technological literacy (2; user and non-user) | |
Opportunity | ||
Physical | • Mail order system (e.g., online or phone) is unreliable, inconsistent, or hard to navigate (2; user) • Longer wait times when refill requires provider authorization (1; user) • Wanting to use different forms of payment, but mail order system requires one credit card to stay on file (1; non-user) • Unpredictable delivery date (1; non-user) • Difficult to coordinate refill dates for multiple prescriptions (1; user) • Need for certain technology (e.g., computer) to use mail order system (2; user and non-user) • Concerns about mail security (e.g., possible theft) (4; user and non-user) • Possibility of receiving refill ‘too late’ (i.e., after medication has run out) because patients must time their order to match the mail order system’s allowable window to order (1; user) • Required to go to pharmacy if refill requires provider authorization (1; user) • Mail order system cannot accommodate special requests (e.g., early refill due to upcoming travel) (1; user) • Inability to get refills immediately (i.e., same day) (1; user) • Not all medications can be refilled through the mail order system (2; user) | • Mail order system is reliable, consistent, easy to navigate (2; user) • Arrives quickly in the mail (1; user) • No lines or waiting in-person at pharmacy (2; user) • No travel required to obtain refill (2; user) • Reminders to pick up refill from post office (1; user) • Notification from health system that refill is on the way (1; user) |
Social | • No availability of in-person consultation with pharmacist (1; non-user) | • Option to avoid negative interpersonal interactions (e.g., with pharmacy staff) (1; user) |
Motivation | ||
Automatic | • One-month supply of prescription refill is free when using mail order (3; user and non-user) | |
Reflective | • Belief that prescription may be negatively impacted (e.g., spoil, ‘go bad’) if left outside upon delivery (2; user and non-user) | • Confidence in ability to use mail order system (2; user) |