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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)

From: Opportunities to encourage mail order pharmacy delivery service use for diabetes prescriptions: a qualitative study

  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)
 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)
 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)
  1. aNumber of focus groups in which the theme emerged; type of focus group (mail order pharmacy user and/or non-user)