Earlier this year Spoonful of Sugar in partnership with UCL entered the JoVE ‘Film Your Research competition’. This international competition invited scientists to connect with the concept of “visual science” by making a 2-minute video featuring members of the research team performing a scientific technique in the field. The SoS entry described the process of co-design using a fun example to highlight why co-design is important for all aspects of research and to improve adherence with treatment.

Co-design in research describes a process that involves designing a solution to a research problem with the end users. It helps to ensure that any research undertaken is relevant, applicable, and appropriate for the people affected by the research. Co-design can include any other stakeholders who may be influenced by the research. The first step in co-design is to identify the stakeholders, this may involve thinking ‘outside the square’ to identify the people who may have a less direct relationship with the research. Secondly, participants need to be identified and this can be done through various social and communication networks. Lastly, feedback and views about the research are gathered by using appropriately designed questions, which are then incorporated into the research.

This research technique aims to address the problem in science where solutions are developed for users without user input, resulting in solutions that don’t work or are not used. Co-design ensures that user views are listened to throughout the entire research process and avoids assumptions that isolates research from the users.

The competition received 100’s of entries from over 30 countries and SoS were among the top 15 critically-acclaimed videos from @JoVEJournal Film your research contest. Check it out!

Pharmacists and medicines go hand in hand, so it’s no surprise that assisting patients with medicines is what pharm-assist are best at.

The thing with medicines is that despite how good they are, they work most effectively only when they are taken as prescribed. The act of ‘not taking medication as prescribed’ is known as non-adherence, a straight forward term for behaviour that emanates from a complex set of beliefs. The resulting behaviours are not conducive to optimising outcomes for patients’ health.

There are many perceptual and practical factors that influence the patient’s motivation and ability to adhere to agreed treatments(1), and it’s estimated that non-adherence is somewhere between 30-50%(2). This in turn results in poor health outcomes for the patient, but also it becomes costly for the NHS in terms of the medicines wasted (an estimated £110 million worth of medicines are returned to pharmacies annually)(3) and the burden this creates for the healthcare system to keep on offering alternatives.

Non-adherence is not just a problem for developed countries, but places a burden on medicines outcomes globally; there are the same perceptual and practical concerns for developing countries(4,5). Regardless of location, once patients gain access to medicines trade-off between necessity (needing the medicines) versus the concerns (e.g. about potential long-term side-effects) come into play. This underpins a common need for healthcare systems, of all sizes and resource levels, to adopt ways to improve adherence.

What’s the solution?

The good news is, there are many ways to help patients remain adherent to their medicines and the role for pharmacists in supporting patients can be pivotal. There is an increasing call for medicines information to be embedded in the community and not just confined to a clinician’s room. Pharmacies can provide an ideal environment for patients to have an informal conversation about their medicines without the time pressures that are often associated with appointments with clinicians.

There is huge choice and flexibility for patients, with over 11,500 pharmacies in England(6) hence the potential impact of channelling adherence programmes through pharmacies can make a real difference to non-adherence rates. Internationally, organisation such as the Commonwealth Pharmacy Association are also working to increase access to pharmacy expertise in resource-scarce settings. Moreover, what’s needed by pharmacists to support behaviour changes are not complex or expensive.

Pharmacists can hold more than just the keys to the medicines cabinet, they are experts in medicines and their vital role in the community allows them to advise and support patients in making the most of their medicines.
1. Clifford S, Barber N, Horne R. Understanding different beliefs held by adherers, unintentional nonadherers, and intentional nonadherers: application of the Necessity-Concerns Framework. J Psychosom Res. 2008 Jan;64(1):41–6.

2. NICE Clinical Guidance 76: Medicines adherence: involving patients in decisions about prescribed medicines and supporting-adherence; 2009 Jan.

3. Pharmaceutical waste reduction in the NHS: A best practice compilation paper; 2015 June

4. Oqua D, Agu KA, Isah MA, Onoh OU, Iyaji PG, Wutoh AK, et al. Improving pharmacy practice through public health programs: experience from Global HIV/AIDS initiative Nigeria project. SpringerPlus. 2013;2:525.

5. Khanam MA, Lindeboom W, Koehlmoos TLP, Alam DS, Niessen L, Milton AH. Hypertension: adherence to treatment in rural Bangladesh–findings from a population-based study. Glob Health Action. 2014;7:25028.

6. General Pharmaceutical Services in England: 2006/07 to 2015/16; 2016 November