Breastfeeding guidance in community pharmacies: The results of a mystery shopper study

Aim: To assess the nature and quality of breastfeeding‐related guidance provided by community‐based pharmacy staff.

Methods:  A covert observational ‘mystery shopper’ study of 66 randomly selected community pharmacies was employed to assess actual breastfeeding guidance practices among pharmacy staff. A female mystery shopper used a scripted scenario designed to explore guidance practices relevant to breastfeeding promotion. Pharmacy staff: mystery shopper interactions were documented immediately following the exchange by the mystery shopper and a second shadow observer. These records were qualitatively analysed against a predetermined good practice framework of guidance expected for this scenario.

Results:  Of 66 pharmacies visited, the mystery shopper consulted with 18 pharmacists and 48 pharmacy assistants. Pharmacies visited included an equal mix of chain and independent pharmacies. The mean length of each mystery shopper to pharmacy staff interaction was 2.3 minutes (range of 0.5–10 minutes). In only 9 of 66 interactions was printed educational or product information provided to complement verbal advice. Most of this material (6/9) related to infant formula product information. Analysis of the content of guidance provided indicates limited advice being given regarding breastfeeding perseverance when confronted with breastfeeding difficulties (4/66), with most interactions involving direct advice regarding brands of infant formula to use.

Conclusions:  The quality of guidance provided by pharmacy staff in the context of breastfeeding promotion suggests a need for multistrategy intervention in the pharmacy setting and identifies a potential opportunity for collaborative interventions between nutrition, nursing and pharmacy practitioners to enhance infant‐feeding guidance.