Design and participants
In this study, self-administered questionnaire survey was conducted anonymously. The questionnaires were sent to the 74 registered dietitians and 195 supervising pharmacists working at 195 community pharmacies operated by I&H Co., Ltd. The included community pharmacies, widely distributed throughout Japan, mainly in the Kanto and Kansai areas. A questionnaire and a document explaining the study were sent to each pharmacy from the Faculty of Pharmacy, Keio University. The document stated that the survey was conducted confidentially and anonymously. Subjects who read the document and agreed to cooperate in this study were asked to complete the questionnaire survey on paper. The completed questionnaires were returned directly from the individuals to the Faculty of Pharmacy, Keio University. It was clearly stated in the document that no one from I&H Co., Ltd. would have access to the contents of individual responses. Questionnaires returned between July 8, 2019 and July 31, 2019 were used in the analysis.
Questionnaire survey
The questionnaire used multiple-choice and descriptive questions in Japanese. The questions and options in the questionnaire were developed based on observation of registered dietitians’ work in community pharmacies and advice from registered dietitians working in pharmacies. In the present survey, we ensured the relevance to practice of the questionnaires by reflecting opinions of several registered dietitians working at community pharmacies in the questionnaire before the questionnaire survey. Three types of questionnaires were prepared: one for registered dietitians, one for pharmacists in community pharmacies where registered dietitians or dietitians work, and one for pharmacists in community pharmacies where neither registered dietitians nor dietitians work (translations of the questionnaires are given as an Additional file 1).
Registered dietitians and pharmacists were asked in common about the frequency of dietetic consultation with patients with various diseases or symptoms using a 5-point scale, with “1; Never”, “2; Rarely”, “3; Neither”, “4; Sometimes”, and “5; Often”, and also on how much they could explain about nutrition and diet that needed attention using a 5-point scale, with “1; Never”, “2; Not very well”, “3; Neither”, “4; Somewhat”, and “5; Very well” for each disease.
Only pharmacists were asked about their perceptions of nutritional management in community pharmacies using a 5-point scale, with “1; Strongly disagree”, “2; Disagree a little”, “3; Neither”, “4; Agree a little”, and “5; Strongly agree”. Pharmacists working in community pharmacies with registered dietitians/dietitians were asked in descriptive questions if they were satisfied with the presence of registered dietitians/dietitians in their pharmacies and what challenges pharmacies face to fully utilize the profession of registered dietitians/dietitians.
Only registered dietitians were asked in multiple-choice questions about the timing and/or situation that led to dietetic consultation, and whether they were able to utilize their occupational abilities. They were also asked about difficulties or challenges of dietetic consultation using a 5-point scale, with “1; Strongly disagree”, “2; Disagree a little”, “3; Neither”, “4; Agree a little”, and “5; Strongly agree”, and about the frequency of cooperation between registered dietitians and pharmacists using a 5-point scale, with “1; Never”, “2; Rarely”, “3; Neither”, “4; Sometimes”, and “5; Often”. In addition, they were asked about challenges and solutions regarding dietetic consultation in community pharmacies in descriptive questions.
Statistical analysis
Registered dietitians were classified into two groups according to the extent to which they were able to utilize their occupational abilities as registered dietitians: the “Not able to fully utilize occupational abilities” group and the “Able to utilize occupational abilities” group. Those who answered “never” or “not very well” were classified as the former, and those who answered “somewhat” or “very well” were classified as the latter, in the question asking whether they were able to utilize their abilities as registered dietitians. For these two groups, “difficulties or challenges in dietetic consultation” and “the frequency of cooperation between registered dietitians and pharmacists” were cross-tabulated. The χ-square test was used to evaluate the difference between the two groups.
For questions common to registered dietitians and pharmacists, the responses (five options) were scored, and the scores were compared among three groups: registered dietitians (D), pharmacists working in a community pharmacy with a registered dietitian/dietitian (P with D), and pharmacists working in a community pharmacy without registered dietitian/dietitian (P without D). The Kruskal-Wallis test was performed at the 5% level of significance, and where differences were found, the Dunn-Bonferroni method was used to compare those groups. The statistical analysis software IBM®SPSS®Statistics version 27 and Microsoft Office Excel were used for these analyses.
Moreover, the contents of the free text responses were subjected to quantitative text analysis using the free software KH Coder [9]. For each question, words with high frequencies of occurrence were extracted as characteristic words. A co-occurrence network was also created to show the strength of association between featured words.