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For each service, the factors extracted were concerned with the pharmacist's personal rationale for service provision, their perceptions of salient referents and their beliefs about positive or negative consequences of service provision.

The personal rationale factor was made up of the main variables of the TRA which are intention, attitude and subjective norm. The "perceived demand" variable also loaded on the personal rationale factor. For diagnostic testing, the pharmacist's normative belief with respect to the majority of their customers also loaded on the personal rationale factor, which suggests that this normative belief is closely related to the pharmacists decision to provide diagnostic testing. For provision of injecting equipment from the pharmacy, the normative beliefs about the majority of customers and pharmacy staff loaded on the rationale factor, suggesting that these normative beliefs may be important in determining whether the pharmacist will sell sterile injecting equipment to IDMs. The variables which loaded on the factors about pharmacists' perceptions of salient referents varied across different disease prevention services. When considering provision of anti-smoking advice, normative beliefs about health professionals and

customers were important Normative beliefs about GPs and other health professionals loaded on the perceived referents factor for provision of diagnostic testing. The normative beliefs variable about the noiajority of customers loaded on the perceived referents factor for provision of advice about safe injecting practices, but did not load significantly on this factor when provision of injecting equipment was considered. This suggests that pharmacists perceive the opinions of the majority of their customers to differ from those of the health professionals where supply of sterile injecting equipment is involved, but not where supply of information about safe injecting practices is involved.

The factors which grouped beliefs statements together were derived from sets of beliefs specific to each disease prevention service. For provision of anti-smoking advice, factors were concerned with beliefs about the consequences of service provision on the health of customers, the commercial benefits and extra resources needed for provision, e.g. time and space. PCA grouped the belief statements about provision of diagnostic testing into those concerned with the positive consequences of service provision such as improved health of customers and enhanced pharmacy image, the external requirements needed such as set-up cost, remuneration, time and space, and the negative effects of provision on the relationships between themselves and doctors.

Belief statements about provision of HTV-transmission prevention services were grouped into those concerned with negative and positive consequences of service provision. Negative effects included the effects of service provision on pharmacists' relationships with customers and pharmacy staff, and other negative consequences such as the possibility of verbal abuse and theft in the pharmacy. Positive consequences of service provision included health benefits for individual drug misusers, and enhanced public health by reduction in the spread of HTV- infection.

The TRA defines the way in which subjects' belief statements should be combined into attitude scales before analysis. PCA was carried out to assess the justification of combining belief statement scores fiom the questionnaire data in accordance with the TRA. The theory states that sets of beliefs about salient outcomes and salient referents should be scaled separately. PCA found support for scaling beliefs about outcomes and referents separately, and in addition was capable of further subdividing belief statements. For provision of diagnostic testing, PCA separated belief statements about outcomes of service provision from belief statements about resources needed for provision of diagnostic testing on the premises. For the remaining disease prevention services, factor analysis separated belief statements about positive consequences fix>m those about negative consequences of service provision.

The results of PCA also found that for each disease prevention service, intention, attitude and subjective norm were closely related to each other, in accordance with the TRA. When the current availability variable was also included in the set of variables for each disease prevention service and PCA was repeated, the current availability variables loaded significantly on the factor interpreted as the pharmacist's personal rationale for service provision. This finding supports the TRA in that current service provision was closely related to intention, attitude and subjective norm. Strong associations between these variables and the current availability variable were confirmed by Pearson correlation coefficients and regression analysis which will be discussed in the next chapter. When the intention variable was excluded from the set of variables, in addition to the current availability variable, and PCA was repeated, the interpretation of the factors was almost identical to that of the PCA already described.

PCA was applied to the data which had been collected, in order to extract findings from the data itself using an inductive approach, rather than a deductive approach. This method found support for the scaling procedures recommended by Fishbein and Ajzen (1980), and was able to improve the grouping of variables into factor scales.

5.5 SUMMARY.

The respondents to the survey of disease prevention services reported involvement in activities aimed at reducing CHD and preventing the spread of HTV-infection among IDMs. The majority of these pharmacists, were providing anti-smoking advice and sterile injecting equipment from their pharmacies. Less than 13% of respondents were providing blood pressure testing, cholesterol testing or injecting equipment via exchange schemes from their pharmacies, and these findings support previous research (Glanz et al, 1990; Walsh and Clarke, 1990; Ranscombe et al, 1991; Crede, 1993; Begley et al, 1994). At least a third of pharmacists reported making either written or verbal advice about safe injecting practices available to IDMs from their pharmacies. The strengths of pharmacists specific beliefs about provision of disease prevention services have been presented. Whilst supporting some previous work, this data provides a more detailed picture of pharmacists attitudes towards participation in health promotion activities than before. The variables, other than specific beliefs and socio­ demographic variables, which may be associated with the availability of disease prevention services from community pharmacies, include perceived customer demand, and pharmacists' intention, attitude and subjective norm specific to each service. The underlying factors associated with all variables measured for each service were extracted using PCA and an interpretation of the factors has been postulated. The relationships between current availability of disease prevention services and these variables or factors will be discussed in the following chapter.

CHAPTER 6- EXPLANATORY ANALYSIS OF QUESTIONNAIRE