Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

JOURNAL OF

INNOVATION IN HEALTH INFORMATICS

Systematic review

Cite this article MacLure K Stewart D Digital literacy knowledge and needs of pharmacy staff A systematic review J Innov Health Inform 201623(3)560ndash571

httpdxdoiorg1014236jhiv23i3840

Copyright copy 2016 The Author(s) Published by BCS The Chartered Institute for IT under Creative Commons license httpcreativecommonsorglicensesby40

Author address for correspondenceKatie MacLureSchool of Pharmacy and Life SciencesRobert Gordon University Aberdeen AB10 7GJ Scotland UKEmail kmmaclurerguacuk

Accepted July 2016

Digital literacy knowledge and needs of pharmacy staff A systematic reviewKatie MacLure

School of Pharmacy and Life SciencesRobert Gordon University UK

Derek StewartSchool of Pharmacy and Life Sciences Robert Gordon University UK

ABSTRACT

Objective To explore the digital literacy knowledge and needs of pharmacy staff including pharmacists graduate (pre-registration) pharmacists pharmacy techni-cians dispensing assistants and medicine counter assistantsMethods A systematic review was conducted following a pre-published proto-col Two reviewers systematically performed the reproducible search followed by independent screening of titlesabstracts then full papers before critical appraisal and data extraction Full articles matching the search terms were eligible for inclu-sion Exclusions were recorded with reasons Kirkpatrickrsquos 4 level model of training evaluation (reaction learning behaviour and results) was applied as an analytical framework Results Screening reduced the initial 86 papers to 5 for full review Settings included hospital and community pharmacy plus education in Australia Canada and the US No studies of pharmacy staff other than pharmacists were identified Main findings indicate that pharmacy staff lack digital literacy knowledge with mini-mal research evidenced at each level of Kirkpatrickrsquos modelConclusions As a society we acknowledge that technology is an important part of everyday life impacting on the efficiency and effectiveness of working practices but in pharmacy do we take cognisance lsquothat technology can change the nature of work faster than people can change their skillsrsquo It seems that pharmacy has embraced technology without recognised occupational standards definition of baseline skills or related personal development plans There is little evidence that digital literacy has been integrated into pharmacy staff training which remains an under-researched area

Keywords digital literacy Kirkpatrickrsquos 4 level model pharmacy education systematic review training

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Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 561

INTRODUCTION

BackgroundPharmacy staff across all practice settings are reliant on information technology (IT)1ndash4 Pharmacists graduate (pre-registration) pharmacists pharmacy technicians dispensing assistants and medicine counter assistants use widely avail-able office retail and management information systems along-side dedicated pharmacy management and electronic health (ehealth) applications in a range of community hospital and other pharmacy settings The abilities of pharmacy staff to use these applications at home and at work also known as digital literacy or digital competence or e-skills depend on personal experience and related education and training5ndash8 The British Computer Society defines digital literacy as lsquobeing able to make use of technologies to participate in and contribute to modern social cultural political and economic lifersquo9 A similar definition of digital literacy is adopted in the US lsquothe ability to use information and communication technologies to find eval-uate create and communicate information it requires both technical and cognitive skillsrsquo10 Both definitions are grounded in historical and conceptual definitions of digital literacies11

IT facilitates the provision of core pharmacy services in the UK in collaboration with other healthcare professionals with similar examples worldwide12ndash15 In the US digital literacy also forms the basis for pharmacy led health literacy as a tool for improving public health and patient outcomes16

Collaborative working in health has been viewed as both beneficial to patients and a more efficient use of health professionalsrsquo skills since long before the advent of ehealth17ndash19 Health strategists worldwide promote the adop-tion of IT and ehealth to support patient care through col-laborative working which is tracked globally by World Health Organization1ndash3121320ndash22 Both the adoption of ehealth and standards of digital literacy at home and in the workplace are key themes of interest at the international level23ndash25

United Nations Educational Scientific and Cultural Organisation identifies digital literacy as both a lsquolife skillrsquo and lsquogate skillrsquo because lsquoit targets all areas of contemporary existencersquo26 The European Commission Information Society promotes and tracks citizensrsquo and member statesrsquo digital engagement2728 Similarly the European Parliament pro-motes digital literacy for lifelong learning along with a recom-mendation for lsquobetter identification of occupational needsrsquo29

In the US a government initiative to create a lsquodigital nationrsquo recognised the role of digital literacy in promoting inclusion23 A government commissioned report into digital literacy in Australia concluded that lsquoboth citizen and worker will need to be digitally literate for the digital economy to work effectivelyrsquo while a report from New Zealand argues lsquothat technology can change the nature of work faster than people can change their skillsrsquo2425

In the UK a range of strategic principles national compe-tency frameworks for training core skills and digital literacies for the general public and recently more specific targets for the health sector have been developed by the government advisory and professional bodies30ndash36

Pharmacy students in the UK undertake the General Pharmaceutical Council accredited and regulated Master of Pharmacy course5 This undergraduate university course is followed by a pre-registration year based in practice cul-minating in an end of year written examination Training for pharmacy technicians dispensing assistants and medicines counter assistants is similarly accredited and regulated but undertaken as a combination of practical experience college and open learning6 Specific mention of the digital literacies required to facilitate pharmacy staffrsquos collaborative health-care role is not evident in the UK curricula for initial train-ing or their continuing professional development (CPD)3738 The Accreditation Council for Pharmacy Education (ACPE) in America added health informatics to its standards for phar-macist training in 2007 The focus was initially on basic com-puter skills and then on ability to find appropriate relevant evidence base for practice39 Pharmacy program accredita-tion in Canada Australia and New Zealand make explicit mention of the need to prepare students to make best lsquouse of information technology in pharmacy and more widely in health carersquo4041 While digital literacy may be covered to an extent in some initial training programmes there is limited evidence that it features in CPD for existing members of pharmacy staff

In summary despite the increasing adoption of IT and ehealth to support the role of pharmacy staff there is a pau-city of research exploring their perceptions and digital literacy knowledge and related training This review identifies evi-dence of perceived levels of digital literacy amongst phar-macy staff and their related training experiences and future needs

ObjectiveTo explore the digital literacy knowledge and needs of phar-macy staff

Review questionThis review asks lsquoWhat are the digital literacy knowledge and needs of pharmacy staffrsquo to summarise existing evidence of pharmacy staff perceptions and measures of

1 levels of digital literacy knowledge2 inclusion of digital literacy in pharmacy training3 specific digital literacy training experiences4 digital literacy training needs

METHODS

DesignThis systematic review followed the Centre for Review and Dissemination guidance for healthcare reviews (PROSPERO Protocol 2013CRD42013005503) in seeking to lsquoidentify evaluate and summarise the findings of all relevant individual studiesrsquo and to lsquodemonstrate where knowledge is lackinghellipto guide future researchrsquo4243 The theoretical framework adopted for analysis was Kirkpatrickrsquos 4 level model (reac-tion learning behaviour results) for evaluating training programmes4445 Kirkpatrick likens level 1 (reaction) to a

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Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 562

lsquomeasure of customer satisfactionrsquo with level 2 (learning) a lsquomeasure of knowledge acquired skills improved or attitudes changed due to trainingrsquo Level 3 (behaviour) measures lsquothe extent to which participants change their on-the-job behav-iourrsquo while level 4 (results) looks for wider impact in organisa-tional terms Although Kirkpatrickrsquos model has been criticised for over-simplification and a lack of contextual consideration its pre-eminence as a training evaluation tool has been acknowledged over several decades4647

Eligibility criteriaThis review considered English language studies that related to any aspect of digital literacy or computer skills training for any member of pharmacy staff in all pharmacy settings with no geographical or date restrictions applied

SEARCH STRATEGY

A three-step search strategy was utilised in this review An ini-tial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract and of the index terms used to describe the article A second search using all identified keywords and index terms was then undertaken across all included databases (Figure 1) Thirdly the reference list of all identified reports and articles was searched for additional studies Titles of papers were inde-pendently screened by two reviewers followed by abstracts then full papers The search string database returns and exclusions are shown in an adapted PRISMA diagram48

Assessment of methodological qualityTo reduce risk of bias papers selected for critical appraisal were assessed independently by two reviewers for method-ological quality before inclusion using a standardised critical appraisal tool adapted to suit all study types49

Data extractionData were extracted using a bespoke data extraction tool (Table 3) The data extraction was performed independently by two reviewers before cross-checking to minimise errors and reduce risk of bias

Data synthesisFindings were narratively explored through Kirkpatrickrsquos 4 level model for evaluating training programmes by focusing on evidence of reaction learning behaviour and results

RESULTS

Study selectionSystematic application of the search strategy returned 86 published papers which after independent screening of titles abstracts and full papers was reduced to 5 (Figure 1 and Table 1)

There were no studies featuring pharmacy staff other than pharmacists and no unpublished studies identified

Quality assessmentEach study was independently reviewed for quality by two of the research team Details of the clarity of the research ques-tion appropriateness of the design description of context population sampling data collection and analysis along with results limitations and conclusions are provided in Table 2 It also details reasons for the exclusion of one study on quality grounds while four were taken forward for data extraction

Study characteristics The data extraction table (Table 3) provides summarised study characteristics and contextual information In brief one of the studies was a survey conducted to establish baseline computer skills of hospital pharmacists in Canada prior to an educational intervention50 Another surveyed allied health professionals (AHPs) including pharmacists in Australia about their use of electronic evidence resources53 A further Australian study based on community pharmacists com-bined pre-intervention focus groups with a post-educational intervention evaluative survey51 The final study used mixed methods to review informatics content including computer and digital literacy skills in pharmacy education by map-ping syllabi returned by schools of pharmacy against the US ACPE Standards52

Table 1 The lsquowhen who and whatrsquo of the five papers included prior to critical appraisal

Year Authors Title

2004 Balen R and Jewesson P Pharmacist computer skills and needs assessment survey50

2005 Bearman M Bessell T Gogler J and McPhee W Educating Australian pharmacists about the use of online information in community pharmacy practice51

2008 Fox B Karcher R Flynn A amp Mitchell S Pharmacy informatics syllabi in doctor of pharmacy programs in the US52

2004 Gosling A and Westbrook J Allied health professionalsrsquo use of online evidence a survey of 790 staff working in the Australian public hospital system53

2010 Gour N and Srivastava D Knowledge of computer among healthcare professionals of India a key toward e-health54

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Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 563

Res

earc

h Q

uest

ion

Wha

t are

the

digi

tal l

itera

cy tr

aini

ng e

xper

ienc

es a

nd n

eeds

of p

harm

acy

staf

f

CIN

AH

L(n

= 8

)

Coc

hran

eLi

brar

y(n

= 0

)

Info

rma

Hea

thca

re(n

= 1

)

Rea

sons

for e

xclu

sion

s ar

e th

efo

cus

on

bull e

valu

atin

g co

urse

del

iver

y m

ode

e

g e

-lear

ning

ble

nded

lear

ning

sim

ulat

ion

stu

dent

sat

isfa

ctio

nbull

clin

ical

or d

isea

se s

peci

fic tr

aini

ng

eg

ant

ibio

tics

her

bal m

edic

ines

dia

bete

sbull

tech

nolo

gy p

latfo

rm s

peci

ic

eg

PD

As

e-p

ortfo

lio r

efer

enci

ng

sof

twar

e C

PO

Ebull

con

sulta

tion

com

mun

icat

ion

skill

sbull

vie

ws

or e

xper

ienc

es w

ith

min

imal

evi

denc

e of

pha

rmac

ybull

or o

nly

conf

eren

ce a

bstra

ct

obt

aina

ble

Med

line

(n =

30) Title

s an

dab

stra

cts

scre

ened

(n =

86)

Exc

lusi

ons

(n =

73)

Exc

lusi

ons

(n =

8)

Full

pape

rsre

view

ed(n

= 1

3)

Incl

uded

insy

stem

atic

revi

ew(n

= 5

)

Thes

esC

anad

a(n

= 0

)

ERIC

(n =

3)

IPA

(n =

42)

EThO

S(n

= 0

)Li

sta

(n =

2)

New

Yor

kA

cade

my

ofM

edic

ine

(n =

0)

SEA

RC

H N

OTE

S

A se

arch

stri

ng u

sing

Boo

lean

oper

ator

s w

as e

mpl

oyed

with

out a

date

or g

eogr

aphi

cal l

imit

Pub

licat

ions

in E

nglis

h la

ngua

ge w

ere

cons

ider

ed a

nd a

utom

atic

ale

rtscr

eate

d fo

r upd

ates

Sear

ch s

trin

g

(pha

rmac

O

R p

re-r

eg

OR

dis

pens

O

R m

edic

ines

cou

nter

)

AN

D

(exp

erie

nce

OR

vie

w O

R p

ersp

ectiv

eO

R p

erce

ptio

n O

R o

pini

on)

AN

D

(trai

ning

OR

edu

catio

n O

R le

arni

ngO

R tu

ition

)

AN

D

(dig

ital O

R te

chno

log

OR

com

put

)

AN

D

(lite

rac

OR

com

pete

nc

OR

ski

llO

R e

-ski

ll O

R e

skill

)D

iagr

am b

ased

on

PLo

S M

edic

ine

(OP

EN

AC

CE

SS

) Moh

er D

Lib

erat

i A T

etzl

aff J

Altm

an D

G

The

PR

ISM

A G

roup

(200

9) P

refe

rred

Rep

otrin

g Ite

ms

for S

yste

mat

ic R

evie

ws

and M

eta-A

naly

ses

The

PR

ISM

A S

taem

ent

PLo

S M

ed 6

(6)

e100

0097

doi

10

1371

jour

nalp

med

1000

097

Figu

re 1

Ada

pted

PR

ISM

A flo

wch

art s

how

ing

the

sear

ch s

trat

egy

and

retu

rns47

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B

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Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 564

Tabl

e 2

The

criti

cal a

ppra

isal

tool

ada

pted

from

May

s N

et a

l49

Quali

ty ch

eckli

st fo

r m

ixed m

ethod

ology

stud

iesBa

len 20

0450

Bear

man

2005

51Fo

x 200

852Go

sling

2004

53Go

ur 20

1054

Ques

tion

- clea

r ter

ms de

fined

yes

to ga

in ba

selin

e data

on

phar

macis

ts co

mpute

r skil

ls an

d tra

ining

need

s

yes

use o

f the I

ntern

et by

co

mmun

ity ph

arma

cists

in pr

actic

e an

d pote

ntial

for ed

ucati

onal

inter

venti

ons

yes

to ide

ntify

and a

nalys

e cur

rent

phar

macy

infor

matic

s edu

catio

n cu

rrent

comp

etenc

ies c

ore

reco

mmen

datio

ns fo

r tea

ching

inf

orma

tics

yes

comp

ariso

n of d

iffere

nt gr

oups

of

AHPs

use

of on

line e

viden

ce

traini

ng an

d com

puter

skills

no lsquot

o enli

ghten

the p

ersp

ectiv

e of

comp

uter u

se am

ong h

ealth

care

pr

ofess

ionals

and i

ts im

plica

tions

rsquo

Desig

n- a

ppro

priat

eye

s su

rvey o

f all p

harm

acist

s in

one h

ospit

alye

s in

two p

hase

s ne

eds a

nalys

is foc

us gr

oups

and c

ourse

evalu

ation

yes

phar

macy

sylla

bus m

appin

g of

infor

matic

s pro

gram

s aga

inst

Accre

ditati

on C

ounc

il for

Pha

rmac

y Ed

ucati

on (A

CPE)

2007

stan

dard

s

yes

surve

y of A

HPs w

ith ac

cess

to

Clini

cal In

forma

tion A

cces

s Pr

ogra

m (C

IAP)

mixe

d meth

ods i

nclud

ing cr

oss-

secti

onal

surve

y and

semi

-str

uctur

ed in

tervie

ws

Cont

ext

- well

desc

ribed

yes

post

imple

menta

tion o

f app

lied

infor

matic

s pro

gram

in a

Cana

dian

hosp

ital

yes

Austr

alian

phar

macy

educ

ation

an

d pra

ctice

yes

adop

tion o

f Ame

rican

ph

arma

cy ed

ucati

on st

anda

rds a

nd

IOM

inclus

ion of

infor

matic

s as o

ne

of fiv

e cor

e com

peten

cies

yes

intro

ducti

on of

onlin

e evid

ence

sy

stem

to ho

spita

ls in

New

South

W

ales

Austr

alia

desc

ribed

adeq

uatel

y but

with

dated

and c

ontriv

ed re

feren

cing

User

syst

em- u

ser o

f inno

vatio

nho

spita

l pha

rmac

ists

comm

unity

phar

macis

tsph

arma

cy ed

ucati

onho

spita

l-bas

ed A

HPs i

nclud

ing

phar

macis

tshe

althc

are p

rofes

siona

ls inc

luding

ph

arma

cists

Sam

plin

g- c

once

ptual

gene

ralis

ation

yes

all ho

spita

l pha

rmac

ists

(n=1

06) a

t one

hosp

ital o

ver t

wo

sites

not c

lear b

oth ph

ases

lack

detai

l of

recru

itmen

t sam

pling

timi

ngye

s fro

m all

Ame

rican

Ass

ociat

ion

of Co

llege

s of P

harm

acy w

ith

phar

macy

infor

matic

s pro

gram

s

rand

omly

selec

ted ho

spita

ls re

pres

entat

ive of

CIA

P us

e (n

= 65

) co

nven

ience

samp

le

of AH

Ps (n

= 79

0)

strati

fied s

ample

(n =

240)

of lsquoa

llrsquo he

althc

are p

rofes

siona

ls id

entifi

ed

as do

ctors

nurse

s lab

tech

nician

s ph

arma

cists

at on

e hos

pital

lsquono

know

ledge

rsquo of c

ompu

ter

Data

colle

ctio

n- s

ystem

atic

audit

able

yes

the su

rvey i

nstru

ment

deve

loped

by au

thor c

onse

nsus

aft

er re

view

of pr

eviou

sly pu

blish

ed

surve

ys (8

4 item

s ove

r 9 do

mains

)

yes

indep

ende

nt fac

ilitator

note

s tak

en at

each

focu

s grou

p by

differ

ent s

cribe

s co

urse e

valua

tion

form

(16 cl

osed

items

3 op

en)

yes

clear

ly ex

plaine

d at e

ach

stage

of th

e pro

cess

of co

llecti

on

verifi

catio

n for

relia

bility

and

valid

ation

yes

the su

rvey i

nstru

ment

deve

loped

from

prev

ious

relat

ed

rese

arch

findin

gs pl

us U

S stu

dy of

cli

nician

srsquo us

e of M

edlin

e

confu

sion b

etwee

n sur

vey a

nd

inter

view

techn

iques

use

of a

form

asse

ssing

lsquokno

wled

ge of

co

mpute

rrsquo ov

erlap

ping s

cales

lac

ks de

tail o

f dev

elopm

ent o

f su

rvey a

nd in

tervie

w too

ls

(Con

tinue

d)

on February 24 2022 by guest P

rotected by copyrighthttpinform

aticsbmjcom

B

MJ H

ealth Care Inform

first published as 1014236jhiv23i3840 on 1 July 2016 Dow

nloaded from

Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 565

Tabl

e 2

The

criti

cal a

ppra

isal

tool

ada

pted

from

May

s N

et a

l49 (C

ont)

Quali

ty ch

eckli

st fo

r m

ixed

met

hodo

logy

stud

iesBa

len 20

0450

Bear

man

2005

51Fo

x 200

852Go

sling

2004

53Go

ur 20

1054

Data

analy

sis- s

ystem

atic

rigor

ous

confl

ict

hand

ling

appr

opria

te us

e of d

escri

ptive

sta

tistic

s and

freq

uenc

iesthe

mes n

ot cle

ar qu

alitat

ive da

ta qu

antifi

ed in

appr

opria

te inv

ersio

n of

scale

s me

an S

D ap

plied

to

non-

conti

nuou

s sca

le

cons

ensu

s rea

ched

follo

wing

ind

epen

dent

categ

orisa

tion b

y ea

ch re

sear

ch te

am m

embe

r

appr

opria

te us

e of d

escri

ptive

and

comp

arati

ve st

atisti

csina

ppro

priat

e ana

lysis

over

-an

alysis

and o

ver-i

nterp

retat

ion of

a s

mall

simple

data

set o

verla

p of

at lea

st tw

o sca

les

Resu

lts an

d lim

itatio

nscle

ar co

ncise

with

decla

red

limita

tions

arou

nd sa

mple

size

resp

onse

rate

(55

) su

rvey

instru

ment

and s

elf re

portin

g

findin

g are

grou

nded

in da

ta bu

t as

indic

ated b

y the

autho

rs w

ith

major

limita

tions

no b

aseli

ne pr

ior

to int

erve

ntion

only

two f

ocus

gr

oups

(not

audio

reco

rded

) me

thods

ques

tione

d high

drop

out

findin

gs ar

e clea

rly ex

plaine

d and

gr

ound

ed in

the d

ata li

mitat

ions

are e

xplor

ed in

term

s of r

espo

nse

rate

(36

) no

n-re

spon

dents

va

riable

detai

l of s

yllab

i and

ge

nera

lisab

ility

clear

and c

ompr

ehen

sive w

ith

decla

red l

imita

tions

of sa

mplin

g re

comm

endin

g fur

ther v

alidit

y and

re

liabil

ity te

sting

impr

ecise

term

s eg

var

ious

some

majo

rity =

100

ass

ertio

ns

not g

roun

ded i

n data

par

allels

dr

awn t

o Nige

ria an

d UK

sp

ecula

tion

major

limita

tions

but

claim

s gen

erali

sable

Conc

lusio

nsap

prop

riate

for fin

dings

appr

opria

te for

findin

gsap

prop

riate

for fin

dings

appr

opria

te for

findin

gsad

dition

al fin

dings

pres

ented

in

Conc

lusion

unju

stifie

d ass

ertio

ns

given

rese

arch

conte

xt

Ethi

csno

t cov

ered

not c

over

edye

sno

t cov

ered

yes

plus v

erba

l con

sent

Addi

tiona

l com

men

tsda

ta co

llecte

d in 2

001

clear

ly de

velop

ed an

d pre

sente

dda

ta co

llecte

d in 2

002

spec

ific to

us

ing th

e inte

rnet

data

colle

cted i

n 200

7 cle

arly

deve

loped

and p

rese

nted

data

colle

cted i

n 200

1ndash20

02

clear

ly de

velop

ed an

d pre

sente

dpo

orly

deve

loped

inco

nsist

encie

s po

orly

analy

sedr

efere

nced

Take

forw

ard

toDa

ta E

xtra

ctio

nY

YY

YN

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rotected by copyrighthttpinform

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B

MJ H

ealth Care Inform

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nloaded from

Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 566

Tabl

e 3

Dat

a ex

trac

tion

of fo

ur p

aper

s re

view

edArticle Aspect

WH

OW

HAT

WH

YW

HER

EW

HEN

HO

WSu

mm

ary

of a

utho

r con

clus

ions

Popu

latio

nIn

terv

entio

nA

imC

onte

xtSt

udy

desi

gn m

etho

dSt

oryl

ine

Out

com

eG

eogr

aphi

cal

setti

ngPr

actic

e se

tting

Tim

elin

e

Bac

kgro

und

Balen 2004

hosp

ital

phar

macis

tsPr

ior to

intro

ducti

on

of an

appli

ed

infor

matic

s pro

gram

bullTo

iden

tify

phar

macis

t ba

selin

e co

mpute

r skil

l ne

eds

Vanc

ouve

r Can

ada

one m

ultisi

te ho

spita

lDa

ta co

llecte

d in 2

001

Surve

y (84

ques

tions

9 d

omain

s)1

Comp

uter e

xper

ience

2 Co

mpute

r anx

iety

3 Co

mpute

r voc

abula

ry4

Basic

comp

uter s

kills

5 Co

mmun

icatio

ns6

Inter

net s

kills

7 Cl

inica

l data

base

inf

orma

tion r

etriev

al8

Acce

ss to

comp

uters

9 An

ticipa

ted ne

eds 5

5

respo

nse r

ate (n

= 58

)

Varie

ty of

bullAc

cess

hom

e wo

rk bull

Skill

levels

liter

ate n

ot an

xious

mor

e tra

ining

re

ques

ted bull

Use

inter

net s

earch

ing d

rug d

istrib

ution

sy

stems

ema

il pa

tient

care

syste

ms m

inima

l offi

ce pa

ckag

es (p

rese

ntatio

n sta

tistic

s an

d sp

read

shee

t)

Bearman 2005

comm

unity

ph

arma

cists

Web

skills

ed

ucati

on

prog

ramm

e int

rodu

ction

to th

e int

erne

t find

ing

onlin

e info

rmati

on

intro

ducti

on

to ev

idenc

e ba

sed p

harm

acy

and a

sses

sing

the qu

ality

of inf

orma

tion

using

inter

net

techn

ologie

s in

daily

prac

tice

Pre

to inv

estig

ate

inter

net u

se an

d ed

ucati

on ne

eds

Post

to ide

ntify

the be

nefits

we

akne

sses

of

an ed

ucati

on

prog

ramm

e

Victo

ria A

ustra

liaCo

mmun

ity

phar

macy

ed

ucati

on

Data

colle

cted i

n 200

2Pr

e bulltw

o foc

us gr

oups

(10 a

nd 11

pu

rpos

ively

selec

ted) w

ith

indep

ende

nt fac

ilitato

r 2 hr

s inc

lunc

h and

$50

scrib

e an

d whit

eboa

rds

bullInt

erne

t use

in pr

actic

e bull

Them

atic a

nalys

isEd

ucati

on in

terve

ntion

bull

147 e

nroll

ed 1

04

comp

leted

93 r

espo

nded

Post bullSu

rvey

16 qu

antita

tive

ques

tions

plus

3 lik

es

dislik

es 3

chan

ges i

n prac

tice

bull93

comp

leted

quan

titativ

e bull

107 f

ree t

ext a

nswe

rs bull

induc

tive

analy

sis of

qu

alitat

ive da

ta

Focu

s gro

up (

use o

f the I

ntern

et)

bullfrac12

have

acce

ss at

wor

k bull

Email

sea

rch en

gines

but n

ot he

alth s

pecifi

c po

rtals

web

sites

bullVa

riatio

n in

techn

ical k

nowl

edge

and s

kills

bullBa

rrier

s ne

gativ

e attit

ude

lack o

f time

cos

ts

lack o

f fami

liarity

exp

ertis

e dif

ficult

y find

ing

infor

matio

n re

sour

ce is

sues

bull

Need

to ga

in co

nfide

nce

desir

e for

furth

er

educ

ation

Surve

y bull

For m

ost c

ourse

met

expe

ctatio

n bull

Aver

age r

espo

nses

posit

ive e

ase o

f use

aim

s ob

jectiv

es m

et le

arnin

g exp

erien

ce bull

Sign

ifican

t onli

ne be

havio

ur ch

ange

s se

lf-rep

orted

(Con

tinue

d)

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B

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ealth Care Inform

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Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 567

Tabl

e 3

Dat

a ex

trac

tion

of fo

ur p

aper

s re

view

ed (C

ont)

Article Aspect

WH

OW

HAT

WH

YW

HER

EW

HEN

HO

WSu

mm

ary

of a

utho

r con

clus

ions

Popu

latio

nIn

terv

entio

nA

imC

onte

xtSt

udy

desi

gn m

etho

dSt

oryl

ine

Out

com

eG

eogr

aphi

cal

setti

ngPr

actic

e se

tting

Tim

elin

e

Bac

kgro

und

Fox 2008

Conta

cts at

Sch

ools

of Ph

arma

cyDe

fines

phar

macy

inf

orma

tics

bullTo

iden

tify

analy

se cu

rrent

state

bullto

identi

fy cu

rrent

comp

etenc

ies bull

to de

velop

core

se

t of r

ecom

m-en

datio

ns

USA

Phar

macy

ed

ucati

on bull

Data

colle

cted

2006

bullAC

PE 20

07

Guide

line 1

21 bull

one o

f five

IOM

core

comp

etenc

ies bull

AMIA

IMIA

ini

tiativ

es bull

ASHP

2015

ini

tiativ

e

bullInv

itatio

n lett

er fo

llowe

d by

Two r

emind

er em

ails

bull32

out o

f 89 s

choo

ls of

phar

macy

resp

onde

d (re

spon

se ra

te 36

) w

ith 25

pr

ovidi

ng sy

llabi

bullfou

r lsquonot

being

taug

htrsquo bull

three

integ

rated

in

curri

culum

bullSy

llabi

revie

wed a

gains

t AC

PE S

tanda

rds 2

007

bullCo

ntent

used

to de

velop

fou

ndati

onal

and c

ore

comp

etenc

ies

bullCo

nfusio

n betw

een p

harm

acy i

nform

atics

and

drug

infor

matio

n pra

ctice

bullMu

ch re

quire

d to b

e com

plian

t with

ACPE

2007

Gosling 2004

AHPs

To id

entify

aw

aren

ess

use

perce

ived b

arrie

rs to

use a

nd im

pact

of po

int of

care

on

line i

nform

ation

sy

stems

bullTo

prov

ide

base

line d

ata

for A

HPs u

se

of ele

ctron

ic ev

idenc

e re

sour

ces

Austr

alia

Publi

c hos

pital

bullDa

ta co

llecte

d 20

01ndash2

bull19

97 st

ate po

licy

bullPa

rt of

CIAP

ev

aluati

on

Surve

y of

bullQu

antita

tive s

tudy

bullCo

nven

ience

samp

le of

790

staff f

rom

65 ho

spita

ls bull

Seve

n pro

fessio

ns

(phy

siothe

rapis

ts

occu

patio

nal th

erap

ists

spee

ch pa

tholog

ists

dietic

ians

clinic

al ps

ycho

logist

s ph

arma

cists

so

cial w

orke

rs) bull

Pre-

pilote

d 25

clos

ed

ques

tions

bull

SPSS

for r

ates

frequ

ency

Ch

i-squ

are c

ompa

rison

by

profe

ssion

t-tes

ts

Conc

luded

wer

e the

follo

wing

bull

A ma

rked d

iffere

nce b

etwee

n pro

fessio

ns

(pha

rmac

ists h

ighes

t soc

ial w

orke

rs low

est)

bullA

90

agre

ed sy

stem

had p

otenti

al to

impr

ove

patie

nt ca

re bull

Facil

itator

s to u

se c

ompu

ter sk

ills an

d eas

y ac

cess

bullBa

rrier

s to u

se la

ck of

spec

ific tr

aining

and

lack o

f time

bullGe

nera

l com

puter

skills

train

ing m

ore e

ffecti

ve

in en

cour

aging

use t

han s

ystem

spec

ific

traini

ng bull

Socia

l org

anisa

tiona

l and

profe

ssion

al su

ppor

t mo

re im

porta

nt tha

n sys

tem sp

ecific

train

ing

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rotected by copyrighthttpinform

aticsbmjcom

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Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 568

Pharmacy staff digital literacy levelBalen and Jewesson50 concluded there was not yet lsquoa stan-dard definition of computer literacy and valid dimensions of computer competency for pharmacy practicersquo Based on a literature review Bearman et al51 found lsquothere was little or no information regarding community pharmacistsrsquo skills and knowledge levels or how they currently employ internet tech-nologiesrsquo Through focus groups they identified a lsquowide vari-ety of technical knowledge and skillsrsquo Where access was available participants most commonly used the internet at work for email and to search pharmacy-related topics such as medicines or patient information with a small proportion contributing to a pharmacy message forum They were lsquoless familiar with local health-specific portals or websitesrsquo Lack of familiarity or expertise and difficulty finding relevant informa-tion online were noted issues

Balen and Jewesson50 found pharmacists were likely to have both home and work access to computers Work use included information management internet searching and email drug distribution systems patient care systems but minimal use of spreadsheets statistical or presentation soft-ware They concluded hospital pharmacists were lsquocomputer literatersquo and lsquonot anxiousrsquo about using IT

Fox et al52 identified lsquoconfusion within the academypro-fession between pharmacy informatics and drug information practicersquo and low compliance with ACPE Standards 2007 on pharmacy informatics competencies Three progressive lev-els of pharmacy informatics competency were detailed under headings of terminology systematic approaches benefits and constraints Fox et al52 concluded that pharmacists lsquomust utilize information technology and automationrsquo implying but not specifying levels of digital literacy

In a convenience sample survey of AHP Gosling and Westbrook53 found pharmacists were the highest users of an online evidence system Two of 25 closed questions in the survey related to database searching and computer skills Across all AHPs nearly three quarters reported their com-puter skills as good very good or excellent with pharmacists rated most able to find online information

Digital literacy in pharmacy trainingThe study by Fox et al52 focused on searching pharmacy syllabi for elements of informatics training They cite Flynn55 in asserting lsquofew pharmacy programs provide formal phar-macy informaticsrsquo However they elaborated the role of the Institute of Medicine (IOM) who recognise lsquoutilizing the tools and techniques of informaticsrsquo as a core competency for all clinical healthcare professionals This is further evidenced by the initiatives around educational provision by the American Medical Informatics Association (AMIA) and International Medical Informatics Association (IMIA) whose recommen-dations were adopted by the American Society of Health-Systems Pharmacists (ASHP)

Balen and Jewesson50 noted that lsquoinformatics is not a for-mal component of the core undergraduate or graduate pro-gramsrsquo at their local university and lsquoremains an uncommon component of most pharmacy and medical school curricularsquo

in North America Findings from Bearman et alrsquos51 literature review showed that lsquomany [community pharmacists] have not been educated in internet use for professional practicersquo Although Gosling and Westbrook53 found a lsquomarked differ-ence between professions usersquo of an online evidence system there is no clear way to relate this back to pharmacy or other allied health professional training

Digital literacy training experiencesBalen and Jewesson50 found that 79 of pharmacists (n =106) who responded to their survey lsquohad received no formal computer trainingrsquo Following their educational inter-vention Bearman et al51 received positive feedback from par-ticipants about improved searching skills and more effective searching while lsquoalmost half of the 93 respondents reported a change in practicersquo While declaring informatics a new dis-cipline for pharmacy Fox et al52 emphasised the intricate link between IT and pharmacy informatics explaining lsquoIT tools pro-vide the infrastructure for information management to support pharmacy informaticsrsquo In findings across all AHPs Gosling and Westbrook53 identified social organisational and profes-sional support along with general computer skills training as important facilitators influencing the use of technologies in pharmacy practice

Digital literacy training needsEach of the included studies indicated participants want or need more digital literacy related training Balen and Jewesson50 found that 77 (n =106) in need of lsquogeneral com-puter skills upgradingrsquo ranking medical database and Internet search as priority areas Access to Internet related educa-tion was viewed as a priority for community pharmacists by Bearman et al51 while Gosling and Westbrook53 found lsquogen-eral training aimed at improving computer skills more impor-tanthellipthan specific system-based trainingrsquo Finally Fox et al52 recommended a set of foundational core competencies lsquobased on themes extracted from course syllabi and from per-sonal experiencersquo and encouraged pharmacy educators to lsquolook to informatics in other disciplines such as medicine and nursing for guidancersquo

Applying the analytical frameworkIn terms of Kirkpatrickrsquos 4 level model the pre-training survey of computer skills conducted by Kirkpatrick and Kirkpatrick45 and Balen and Jewesson50 evidenced baseline evaluation recognised as a preliminary activity for level 2 (learning) Similarly Gosling and Westbrook53 conducted a survey which included measures of baseline skills (level 2 learning) Although good computer skills were shown to be associated with the use of technology by pharmacists (level 3 behav-iour) it is not clear from the findings presented whether phar-macists were included in the AHPs who received training Bearman et al51 reported pharmacists lsquowere highly positive about the learning experiencersquo (level 1 reaction) in particular the lsquoflexible delivery of the coursersquo while online resource iden-tification attracted most comments Findings also reported lsquospecific changes in practicersquo (level 3 behaviour) around lsquouse

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MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 569

of new websites more effective searching a change to reg-ular use of specific resourcesrsquo The emphasis in the article by Fox et al52 was on syllabus content which informatics skills (level 2 learning) are taught in pharmacy education

Their conclusions and recommendations aspired to levels 3 (behaviour) and 4 (results) in urging pharmacy programs lsquoto prepare future pharmacists to approach their professional practice as drug safety experts and medication knowledge workers who must utilize information technology and automa-tion in order to create a safer more effective medication-use systemrsquo

DISCUSSION

The evolving role of pharmacy within the collaborative healthcare team is increasingly reliant on a range of ehealth technologies and digital literacy This review set out to sum-marise the best available existing evidence of pharmacy staff perceptions and measures of their levels of digital literacy knowledge the inclusion of digital literacy in their pharmacy training specific digital literacy training experiences and their digital literacy training needs Very limited research was identified about pharmacists while no studies were found in relation to other pharmacy staff

The need for better identification of citizen and work-force skills for the digital age is a matter of increasing focus worldwide but there is little evidence of its impact on phar-macy education or pharmacy practice While pharmacy programmes in America demonstrated a lack of compliance with the ACPE standards 2007 there was even less evi-dence of digital literacies in pharmacy programmes outside the US So while digital literacy is acknowledged as an important lifelong and work-based skill this is not readily evidenced in initial pharmacy staff training nor CPD Further research might also explain whether higher digital literacy levels amongst hospital pharmacists compared with their community-based colleagues is due to their realm of daily practice postgraduate training or multidisciplinary team working

The limited evidence found of digital literacy training expe-rience was however positive Improved search and basic computer skills with social organisational and professional support were shown to facilitate the use of technologies in pharmacy Yet the majority of pharmacy staff had received no digital literacy training The US leads in viewing digital lit-eracy in pharmacy as a pathway to engaging the community in health literacy with the potential to improve social welfare inclusion and individual health and well being

All studies indicated that pharmacists want or need more digital literacy training but their recommendations lack baseline data and are not current quantifiable measurable or specific A key finding of this review is the lack of digital literacy research amongst not only pharmacists but all phar-macy staff as pharmacy assistants technicians and medi-cine counter assistants all use technology in daily pharmacy practice The core competencies recommended for phar-macy informatics are founded on digital literacy and so may

offer a starting point for further research which should be broadened to include all pharmacy staff As the role of phar-macists and therefore all pharmacy staff continues to grow in the UK the digital literacy levels for current and future phar-macists and staff must keep pace with technological change

In launching the US 2012 Digital Government Strategy President Obama said lsquoI want us to ask ourselves every day how are we using technology to make a real difference in peoplersquos livesrsquo56 As the role of pharmacy in healthcare con-tinues to expand there are calls for enhanced workforce skills most recently from the UK Academy of Medical Royal Colleges who emphasise the need for lsquoenhanced informatics skills in healthcare professionals so that the significant ben-efits that technology can enable are realisedrsquo57

Strengths and weaknessesIt is a strength of this review that it demonstrates the lack of research conducted around digital literacy of pharmacy staff but it is also its main weakness With so few studies on which to base the review findings must be treated with cau-tion Although not a weakness of this review the survey-or evaluation-based studies used self-reporting which is recog-nised for its inherent bias The use of standardised tools in this review applied independently by more than one reviewer reduced the risk of bias for both inclusion and reporting

CONCLUSION

In conclusion although all pharmacy staff are reliant on tech-nology in their daily practice there is a lack of evidence of their specific and measurable digital literacy knowledge levels training experience and needs As a society we acknowledge that technology is an important part of everyday life impacting on the efficiency and effectiveness of working practices but in pharmacy do we take cognisance lsquothat technology can change the nature of work faster than people can change their skillsrsquo23 It seems pharmacy has embraced technol-ogy without recognised occupational standards definition of baseline skills or related personal development plans This review recommends future research should be focused on establishing what digital literacy knowledge is needed and how training should be designed delivered and evaluated for all pharmacy staff at all levels and career stages

Competing interestsThe authors have no competing interests to declare

AcknowledgementsThe lead author gratefully acknowledges the expert input of the late Yash Kumarasamy and Professor Alison Strath to the study design and review protocol

FundingNo dedicated funding was received for this review but it is part of a larger research programme funded by NHS Education for Scotland The authors gratefully acknowledge their support

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Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 570

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2 Scottish Government eHealth Strategy 2011ndash2017 Edinburgh Scottish Government 2011

3 Department of Health A Report from the NHS Future Forum Education and Training London Department of Health 2011

4 Crown J Review of Prescribing Supply and Administration of Medicines Final report NHS Executive Department of Health 1999

5 General Pharmaceutical Council Future Pharmacists Standards for Initial Education and Training of Pharmacists London GPHC 2011 Available from wwwpharmacyregula-tionorg Accessed 01 August 2016

6 General Pharmaceutical Council Accreditation and Recognition of Pharmacy Technician Level 3 Knowledge-Based and Competence-Based Qualifications Scottish Qualifications Authority GPhCLondon 2011 Available from wwwpharmacy-regulationorg Accessed 01 August 2016

7 Beetham H McGill L and Littlejohn A Thriving in the 21st Century the Report of the LLiDA Project (Learning Literacies for the Digital Age) Provision in the UK 2009 Available from httpwwwwebarchiveorgukwaybackarchive20140614091049httpwwwjiscacukwhatwedoprojectselearningllidaaspx Accessed 01 August 2016

8 MacLure K and Stewart D Self-Reported Digital Literacy of the Pharmacy Workforce in North East Scotland Available from httpwwwmdpicom2226-478734182 Pharmacy 2015 3 (4)182ndash196 httpdxdoiorg103390pharmacy3040182

9 British Computer Society Digital Literacy for Life programme Available from httpdlflbcsorg Accessed 01 August 2016

10 American Library Association 2013 Digital Literacy Libraries and Public Policy Report of the Office for Information Technology Policyrsquos Digital Literacy Task Force Available from httpwwwdistrictdispatchorgwp-contentuploads2013012012_OITP_digilitreport_1_22_13pdf Accessed 01 August 2016

11 Lankshear C and Knobel M (Ed) Digital literacies Concepts Policies and Practices Vol 30 Peter LangNew York 2008

12 CMS Advisory Group Establishing Effective Therapeutic Partnerships A Generic Framework to Underpin the Chronic Medication Service Element of the Community Pharmacy Contract Edinburgh The Scottish Government 2009

13 McElenay JC Connected health and the pharmacist IJPP 201119(1)3ndash4 Available from httponlinelibrarywileycomdoi101111j2042-7174201000088xpdf httpdxdoiorg101111j2042-7174201000088x

14 Australian Government Department of Health eHealth and pharmacists 2013 Accessed 18 October 2013

15 Ministry of Health British Columbia eHealth ndash Faster safer better healthcare Benefits for Health Professionals Available from httpwwwhealthgovbccaehealthprofessionalshtml Accessed 01 August 2016

16 Agency for Healthcare Research and Quality Is Our Pharmacy Meeting Patientsrsquo Needs Pharmacy Health Literacy Assessment Tool Userrsquos Guide RockvilleAgency for Healthcare Research and Quality 2007 Available from httpwwwahrqgovprofessionalsquality-patient-safetypharmhealthlitpharm-litindexhtml Accessed 01 August 2016

17 Department of Health Working for PatientsLondon HMSO 2007

18 Nolan M Towards an ethos of interdisciplinary practice BMJ 1995311(7000)305 Available from httpwwwbmjcomcon-tent3117000305 Accessed 01 August 2016 httpdxdoiorg101136bmj3117000305

19 Hepler CD and Strand LM Opportunities and responsibilities in pharmaceutical care American Journal of Hospital Pharmacy 1990 47(3)533ndash543

20 Scottish Government NHS Scotland eHealth Citizen eHealth Survey Available online from httpwwwehealthscotnhsukpage_id=143 Accessed 12 January 2012

21 European Commission eHealth Action Plan 2012-2020 public consultation 2011 Available from httpsjoinupeceuropaeucommunityepracticenewsuk-ehealth-survey-enhance-health-care-scotland Accessed 01 August 2016

22 World Health Organisation eHealth Country Profiles Geneva WHO 2011

23 NTIA United States Department of Commerce Exploring the Digital Nation Americarsquos Emerging Online Experience 2013Available from httpwwwntiadocgovreport2013exploring-digital-nation-americas-emerging-online-experience Accessed 01 August 2016

24 Innovation amp Business Skills Australia Scoping Study ndash identify-ing digital literacy skills cybercitizen and e-employee in the 21st century 2010Available from httpswwwibsaorgausitesdefaultfilesmediaInvestigating20Digital20Literacy20Skillspdf Accessed 01 August 2016

25 New Zealand Ministry of Education Digital Information Literacy Supported Development of Capability in Tertiary Environments 2010 Available from httpswwweducation-countsgovtnzpublicationse-Learning80624 Accessed 10 October 2013

26 UNESCO Institute for Technologies in Education Policy Brief Digital Literacy in Education 2011 Available from httpiiteunescoorgpublications3214688 Accessed 01 August 2016

27 European Commission ndash Information Society Available from httpeceuropaeuinformation_societyindex_enhtm Accessed 01 August 2016

28 European Commission ndash Digital Agenda for Europe (website) Available from httpsdigital-agenda-dataeu Accessed 01 August 2016

29 European Parliament Recommendation 2006962EC of the European Parliament and of the Council of 18 December 2006 on key competences for lifelong learning [Official Journal L 394 of 30122006] Available from httpeuropaeulegisla-tion_summarieseducation_training_youthlifelong_learningc11090_enhtm Accessed 01 August 2016

30 Royal Pharmaceutical Society amp Royal College of General Practitioners Joint Statement Breaking Down the Barriers ndash How Community Pharmacists and GPs can Work Together to Improve Patient Care London RPS amp RCGP 2011

31 British Computer Society ndash The Chartered Institute for IT Adult Education and Further Education Available from httpwwwbcsorgcategory15758 Accessed 01 August 2016

32 Royal Pharmaceutical Society Empowering Pharmacists to Improve Pharmaceutical Care and Medicines Safety Through Information Technology Information Technology Strategic Principles RPSEdinburgh 2011

33 Academy of Medical Royal Colleges amp the Scottish Government E Health Competency Framework Defining the role of the expert clinician Available from httpwwwaomrcorgukpublicationsreports-guidanceehealth-competency-frame-work-0611 Accessed 01 August 2016

34 e-Skills UK National Occupational Standards for IT Users Available from httpswwwe-skillscomstandards-and-qual-ificationsnational-occupational-standards-nos Accessed 01 August 2016

35 Skills for Health First ever UK-wide core skills and training framework for health Available online at httpwwwskills-forhealthorgukservicesitem146-core-skills-training-frame-work 01 August 2016

on February 24 2022 by guest P

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aticsbmjcom

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MJ H

ealth Care Inform

first published as 1014236jhiv23i3840 on 1 July 2016 Dow

nloaded from

Journal of Innovation in Health Informatics Vol 23 No 3 (2016)

MacLure and Stewart Digital literacy knowledge and needs of pharmacy staff A systematic review 571

36 Department of Health The NHS Knowledge and Skills Framework and the Development Review Process Final Draft Crown Copyright 2004

37 Royal Pharmaceutical Society Continuing Professional Development section (website) Available from httpwwwrpharmscomdevelopmentcontinuing-professional-develop-mentasp Accessed 01 August 2016

38 NHS Education for Scotland Pharmacy National UK Centre for Continuing Pharmaceutical Education in Scotland (website) Available from httpwwwnesscotnhsukeducation-and-train-ingby-disciplinepharmacyaspx Accessed 01 August 2016

39 Accreditation Council for Pharmacy Education (website) Available from httpswwwacpe-accreditorgdefaultasp Accessed 01 August 2016

40 Canadian Council for Accreditation of Pharmacy Programs (website) Available from httpccapp-accreditcafind-an-accredited-program Accessed 01 August 2016

41 Accreditation Standards for Pharmacy Degree Programmes in Australia and New Zealand (website) httppharmacycouncilorgau Accessed 01 August 2016

42 MacLure K Stewart D Strath A and Kumarasamy Y Pharmacy staffrsquos digital literacy training experiences and needs a sys-tematic review protocol PROSPERO 2013CRD42013005503 Available from wwwcrdyorkacukPROSPEROdisplay_recordaspID=CRD42013005503

43 Ackers J Aguiar-Ibaacutentildeez R Baba-Akbari Sari A Beynon S Booth A and Burch J Systematic Reviews CRDrsquos Guidance for Undertaking Reviews in Health Care Centre for Reviews and Dissemination University of York 2009

44 Kirkpatrick D Great Ideas Revisited Techniques for Evaluating Training Programs Revisiting Kirkpatrickrsquos Four-Level Model Training and Development Journal1996 50(1)54ndash59

45 Kirkpatrick DL and Kirkpatrick JD Implementing the Four Levels A Practical Guide for Effective Evaluation of Training Programs San Francisco Berrett-Koehler Store 2007

46 Bates R A critical analysis of evaluation practice the Kirkpatrick model and the principle of beneficence Evaluation and Program Planning 2004 27341ndash347 Available from httpsaetcnecucsfedusitesaetcnecucsfedufilesA20critical20analysis20of20evaluation20practice_0pdf httpdxdoiorg101016jevalprogplan200404011

47 Employment Security Department Washington State Evaluating Training Programs Kirkpatrickrsquos 4 Levels Available from wwwwagovesdtrainingtoolboxtg_kirkpatrickhtm Accessed 01 August 2016

48 Moher D Liberati A Tetzlaff J and Altman DG Preferred reporting items for systematic reviews and meta-analyses the PRISMA statement Annals of Internal Medicine 2009151(4)264ndash269 httpdxdoiorg1073260003-4819-151-4-200908180-00135 PMid19622511

49 Mays N Roberts E and Popay J Synthesising research evi-dence In N Fulop P Allen A Clarke and N Black (Ed) Methods for Studying the Delivery and Organisation of Health Services LondonRoutledge 2001

50 Balen RM and Jewesson PJ Pharmacist computer skills and needs assessment survey JMIR 20046(1)e11 Available from httpwwwjmirorg20041e11 httpdxdoiorg102196jmir61e11 PMid15111277 PMCidPMC1550586

51 Bearman M Bessell T Gogler J and McPhee W Educating Australian pharmacists about the use of online information in com-munity pharmacy practice IJPP 200513(2)109ndash115 Accessed 01 August 2016 httpdxdoiorg1012110022357055876

52 Fox BI Karcher RB Flynn A and Mitchell S Pharmacy infor-matics syllabi in doctor of pharmacy programs in the US AJPE 200872(4)89 Accessed 01 August 2016 httpdxdoiorg105688aj720489 PMid19002287

53 Gosling AS and Westbrook JI) Allied health profession-alsrsquo use of online evidence a survey of 790 staff working in the Australian public hospital system International Journal of Medical Informatics 200473(4)391ndash401 Accessed 01 August 2016 httpdxdoiorg101016jijmedinf200312017

54 Gour N and Srivastava D Knowledge of computer among healthcare professionals of India a key toward e-health Telemed J E Health 201016(9)957ndash962 Available from httpwwwncbinlmnihgovpubmed21091287 Accessed 01 August 2016

55 Flynn AJ The current state of pharmacy informatics education in professional programs at US colleges of pharmacy American Journal of Pharmaceutical Education 200569(4) Article 66 Available from httpwwwajpeorgdoiabs105688aj690466 Accessed 01 August 2016 httpdxdoiorg105688aj690466

56 US Government Digital Government Building a 21st Century Platform to Better Serve the American People 2012 Available from httpwwwwhitehousegovsitesdefaultfilesombegovdigital-governmentdigital-governmenthtml Accessed 01 August 2016

57 Academy of Royal Medical Colleges i-care Information Communication and Technology in the NHS 2013 Available from httpwwwaomrcorgukpublicationsreports-guidanceicare-ict-in-the-nhs-1013 Accessed 01 August 2016

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aticsbmjcom

B

MJ H

ealth Care Inform

first published as 1014236jhiv23i3840 on 1 July 2016 Dow

nloaded from